By Betty Abera, Project Director, Pharmacy-Based Immunization
As the world continues to analyze the aftermath of the COVID-19 pandemic, one lesson has become abundantly clear: health systems must be decentralized, accessible, and resilient to withstand future public health emergencies. For governments across Africa, this presents a unique opportunity to reimagine immunization delivery by integrating pharmacy-based immunization into national pandemic preparedness strategies.
A Missed Opportunity During COVID-19
During the COVID-19 vaccine rollout, many African countries faced challenges that hindered swift and widespread coverage: limited vaccination sites, workforce shortages, and supply chain bottlenecks. Yet in countries where pharmacists were authorized to vaccinate, such as the United States, United Kingdom, and parts of Canada and Australia, pharmacies became vital access points, particularly for hard-to-reach communities.
In the United States, pharmacies administered more than 314 million COVID-19 vaccine doses between December 2020-Spetmeber 2023, accounting for nearly half of all vaccines delivered nationwide. In England, community pharmacies delivered nearly half of COVID-19 vaccinations in 2023. Canadian pharmacists administered over 17 million doses by March 2022, highlighting their critical role in immunization efforts.
These numbers reflect more than convenience; they demonstrate the scalability and resilience of pharmacy-based immunization during public health emergencies.
During the COVID-19 vaccine rollout, many African countries faced challenges that hindered swift and widespread coverage: limited vaccination sites, workforce shortages, and supply chain bottlenecks.
The Case for Pharmacy-Based Immunization in Africa
Africa has the world’s lowest health workforce available per population, yet it also has one of the fastest growing pharmacy sectors. With over 300,000 community pharmacies across the continent, often operating long hours and serving diverse populations, these facilities represent a largely untapped public health asset.
- Expanding Reach Quickly: Pharmacies are embedded within communities: urban, peri-urban, and even rural. In a crisis, this proximity allows for rapid scaling of vaccination campaigns, reducing delays caused by centralized bottlenecks.
- Relieving the Health Workforce Burden: Empowering trained pharmacists to administer vaccines creates an additional tier of frontline immunizers. This reduces pressure on already overstretched hospitals and clinics, as seen in other global regions.
- Strengthening Routine and Emergency Immunization: During the COVID-19 pandemic, many African countries experienced significant drops in routine immunization rates. Pharmacy integration could help maintain immunization continuity even in times of crisis.
- Combatting Vaccine Hesitancy: Pharmacies are often trusted points of contact. Studies from various African countries show that the public views pharmacists as credible health advisors, which makes them ideal for vaccine education and reassurance.
Lessons from Pilot Programs in Africa
Several African nations have already begun exploring pharmacy-based immunization pilots:
- In South Africa, private-sector chains like Clicks and Dis-Chem were part of the national COVID-19 vaccine rollout, improving access in several provinces.
- In Nigeria, a collaboration involving Breakthrough ACTION-Nigeria, the Association of Community Pharmacy in Nigeria (ACPN), and the Primary Health Care Board (PHCB) trained pharmacists to deliver COVID-19 vaccines through community pharmacies in four states. Oyo State recorded the highest number of vaccinations among them.
- In Rwanda, pharmacies are being explored as partners in managing non-communicable diseases and future immunization services.
Evidence of Increased Vaccination Rates
Substantial evidence from global studies confirms that integrating pharmacists into immunization programs significantly increases overall vaccine uptake.
A comprehensive meta-analysis of 14 randomized controlled trails and 79 observational studies found that pharmacist-led immunization efforts had a measurable impact in immunization uptake.
In the United States, initiatives such as Project IMPACT Immunizations demonstrated how pharmacists could identify additional immunization needs. Out of 1,080 patients seeking influenza vaccines, pharmacists identified and administered additional needed vaccines to 447 patients, 95.3% of which were given at the point of care.
These findings highlight the potential of pharmacy-based immunization to amplify existing public health infrastructures, expanding reach, improving convenience, and ensuring more people get vaccinated.
Acknowledging the Vital Role of Nurses
It is essential to recognize the central contribution of nurses to Africa’s pandemic response. Nurses have been the backbone of immunization programs, delivering millions of life-saving vaccines, often in the most difficult conditions. Pharmacy-based immunization is not intended to replace or compete with the work of nurses, but to complement it. By expanding the cadre of trained vaccinators to include pharmacists, health systems can improve reach, reduce bottlenecks, and foster more resilient, collaborative healthcare ecosystems.
A multidisciplinary approach, where nurses, pharmacists, and other health professionals work in synergy, is critical to managing both routine and emergency vaccination efforts. Rather than diluting the role of any one profession, this model amplifies the impact of each, ensuring that no community is left behind during future outbreaks or public health crises. Empowering all qualified providers, including nurses and pharmacists, will be essential for building an immunization infrastructure capable of withstanding future pandemics.
Policy Recommendations for African Governments
- Regulatory Reform: Update national laws to authorize pharmacists to administer vaccines safely and legally.
- Capacity Building: Develop national training and certification programs for pharmacists in immunization delivery.
- Integration into National Immunization Programs: Include pharmacies in national vaccine logistics, reporting, and outreach systems.
- Public-Private Partnerships: Strengthen collaboration between ministries of health and private pharmacies for coordinated service delivery.
Conclusion: A Strategic Imperative
The next pandemic is inevitable; the only unknown is its timing. Pharmacy-based immunization is cost-effective, scalable, and accessible. It is a critical component of pandemic preparedness that African countries can no longer afford to overlook. By investing in pharmacy-based immunization today, African governments can protect more lives tomorrow.
Join us in building a resilient, community-driven future for health in Africa
If you are a policymaker, health leader, donor, or implementer passionate about expanding access to life-saving vaccines, we invite you to partner with us. Together, we can make pharmacy-based immunization a pillar of pandemic preparedness across the continent. Contact Susan Reuther, Manager of Strategic Partnerships, PSI at [email protected] or Betty Abera, Project Director, Pharmacy-Based Immunization, PSI at [email protected].
