Webinar - COVID-19 vaccination for pharmacist immunisers - August 2021
A pharmacist immuniser in NSW may administer the COVID-19 Vaccine Astra Zeneca (ChAdOx1-S) to eligible patient groups under the Commonwealth vaccination program in the following settings:
This includes vaccinating people who may have mobility issues in their car if they are monitored continuously post vaccination.
In all settings the environment must comply with the standards including outdoor waiting areas.
Pharmacist immunisers in public health facilities (hospitals and vaccination hub locations) are able to vaccinate under separate authority and conditions subject to NSW Health policy directives. The NSW Pharmacist Vaccination Standards do not apply to pharmacist immunisers in public health services.
While pharmacists are strongly encouraged to receive 2 doses of a COVID-19 vaccine, Pharmacist immunisers are not required to be vaccinated prior to administering the COVID-19 vaccine. Guidelines for the appropriate use of COVID-19 personal protective equipment (PPE) and associated work practices should continue to be followed to minimise the risk of transmission of COVID-19 in the vaccination setting. COVID-19 vaccination will offer an additional layer of protection from developing a symptomatic infection with the SARS-CoV-2 virus that causes COVID-19, and therefore pharmacists are strongly encouraged to have the vaccination unless there is a medical contraindication
Priority vaccination may be available to pharmacists and pharmacy support staff in outbreak areas. Please visit the Australian Government eligibility checker to see if you are eligible.
Due to the limited supply of the BNT162b2 [mRNA] COVID-19 Pfizer (Comirnaty) vaccine at this time, this vaccine is currently only available through selected General Practice and vaccination clinics run by NSW Health. Availability of the vaccine will change as supplies increase.
Co-administration of the COVID-19 vaccine with other vaccines is not routinely recommended. The Australian Technical Advisory Group on Immunisation (ATAGI) recommends a minimum 7-day interval between administration of a COVID-19 vaccine and any other vaccine, including influenza vaccine. This interval can be shortened (including same day administration) in special circumstances.
The community pharmacy does not need to have a separate entrance and exit for people receiving vaccines. The pharmacist immuniser must conduct the vaccination in an immunisation service room, consulting room or immunisation area; this may be a dedicated space or an existing consulting room for the purpose of providing vaccination services. Please refer to section 2.3 of the NSW Pharmacist Vaccination Standards for requirements. The pharmacist must also ensure that all requirements specified by the Australian Government in relation to the COVID-19 vaccination program are also complied with.
Pharmacies must have a COVID-19 Safety plan which should include maintaining physical distancing for all customers and patients, including during and following vaccination.
Intern pharmacists (pharmacists with provisional registration) in NSW are not authorized to administer the COVID-19 Vaccine AstraZeneca (ChAdOx1-S) vaccine. They are only able to administer other specified vaccines (influenza, MMR and dTPa) under the supervision of a pharmacist immuniser who holds certification to vaccinate for the relevant vaccine.
The patient should be directed to contact the Australian Immunisation Register (AIR) to have their record amended. They can be contacted on 1800 653 809 or by emailing AIR@servicesaustralia.gov.au.
You may proceed with vaccination provided that you are confident that the patient did not receive the previously recorded vaccine.
From 1 March 2021 all vaccination providers are required to report all COVID-19 vaccinations administered to the Australian Immunisation Register (AIR). The patient should be advised to contact their previous vaccination provider to arrange for the vaccination record to be uploaded to the AIR as soon as possible. You will need to verify the date of previous vaccination prior to administering another dose.
Pharmacist immunisers must not supply or administer the COVID-19 vaccine and must refer persons to a medical practitioner if:
A serious adverse event includes:
For more infromation refer to COVID-19 vaccine: Enhanced surveillance and adverse event reporting guidelines.
This is to ensure that the patient has been thoroughly assessed for their suitability to receive the COVID-19 AstraZeneca (ChAdOx1-S) vaccine and to ensure the patient is fully informed of benefits and potential harms of the vaccine prior to vaccination. Patients must be advised to monitor for signs of an adverse event following vaccination and should be advised to seek immediate medical attention if they develop any of the following symptoms after vaccination:
The most common time period for onset of TTS symptoms is 4–30 days after vaccination.
The COVID-19 AstraZeneca (ChAdOx1-S) vaccine is provisionally registered by the Therapeutic Goods Administration (TGA) and new evidence on benefits and potential harms is rapidly emerging.
The detailed consenting procedure before administering the COVID-19 AstraZeneca (ChAdOx1-S) vaccine includes:
Informed consent must be documented either:
Information on contraindications and precautions for COVID-19 vaccines are provided by:
All pharmacist immunisers must have access to these resources at all times when conducting vaccination clinics.
Pharmacists working in other practice settings are not permitted to administer the BNT162b2 [mRNA] COVID-19 Pfizer (Comirnaty) vaccine.
Pharmacist immunisers in NSW Health operated clinics are able to administer the Pfizer COVID-19 vaccine under a separate authority and conditions subject to NSW Health policy directives. The pharmacist must ensure that they familiarise themselves with the relevant authority.
Where a patient experiences an adverse event following the administration of the COVID-19 vaccine, these must be reported. All uncommon, unexpected or serious adverse events following immunisation (AEFI) or any event considered by the clinician to be significant following immunisation must be notified by medical practitioners, pharmacists or other health professionals to the local Public Health Unit (PHU) on 1300 066 055 or by email to MOH-covidaefi@health.nsw.gov.au using the NSW Health AEFI case notification form or by using the National Adverse Events Following Immunisation (AEFI) reporting form, Additional advice is available on the NSW Health webpage.
Pharmacist immunisers who are having trouble obtaining consumables, should contact the Australian Government Vaccine Operations Centre (VOC) on 1800 318 208 or email COVID19VaccineOperationsCentre@health.gov.au, as there may be available stock that can be ordered. Please note some consumables (e.g. 38mm needles recommended for patients with obesity) will not be provided by the Australian Government.
It is mandatory under the Australian Immunisation Register Act 2015 to report all COVID-19 vaccination encounters to the Australian Immunisation Register (AIR). It is mandatory for pharmacist immunisers in NSW to check a patient's immunisation history in AIR prior to administering any vaccine.
COVID-19 vaccine encounters should be uploaded into AIR within 24 hours from vaccine administration (including the patient's individual Medicare reference number, if the person is Medicare eligible), or as soon as possible, to ensure the consumer's immunisation information is up to date.
Vaccinations can be reported to AIR:
Pharmacist immunisers should confirm with their software provider that their existing professional services software will report COVID-19 vaccinations to the AIR.
Information to promote COVID-19 vaccination are provided in the On-boarding pack for approved Commonwealth providers. Also see additional resources for community pharmacy.
COVID-19 information is available on the Department of Health website
A translating and interpreting service (TIS National) is available for people who do not speak English and for agencies and businesses that need to communicate with their non-English speaking clients. Phone: 131 450
See the COVID-19 vaccine consent form.
The observation area should be in an area on the pharmacy premises and must have adequate seating available. The pharmacist immuniser must either observe, (or direct an appropriately trained pharmacy staff member to observe when the service is conducted in a community pharmacy), the person for 15 minutes post vaccination to monitor for acute adverse events or anaphylaxis. A pharmacy may use a suitable area outside the pharmacy premises only if that area is under the control of the pharmacist immuniser to ensure physical distancing and observation, and the pharmacist immuniser, or an appropriately trained pharmacy staff member, continuously observes patients following vaccination. The patient remains in the care of the pharmacist immuniser until completion of the observation period. The observation area must be suitable for the emergency management of any adverse event.
Vaccination is one of the accepted reasons under the current public health order to leave home.
As with any other vaccines, vaccination should be deferred if the recipient is acutely unwell. This is a general precaution for all vaccines and will avoid potential misattribution of symptoms from the acute illness as being due to the vaccine or vice-versa. Persons who are symptomatic should not be vaccinated and directed to go to a COVID-19 testing clinic and self-isolate until they receive a negative result.
If your pharmacy must close due to a positive COVID-19 case, you will need to advise persons with a booking for vaccination and reschedule the booking as soon as possible
ATAGI has recommended a shorter interval between the first and second doses of COVID-19 AstraZeneca (ChAdOx1-S) vaccine of 4-8 weeks in an outbreak (versus the routine 12-week interval) so that maximal protection against COVID-19 can be achieved earlier. Refer to ATAGI statement on use of COVID-19 vaccines in an outbreak setting for details.
The current advice from the Australian Technical Advisory Group on Immunisation (ATAGI) is that the BNT162b2 [mRNA] COVID-19 Pfizer (Comirnaty) vaccine and COVID-19 AstraZeneca (ChAdOx1-S) vaccine are not considered interchangeable. The two-dose course should be completed with the same vaccine. This is because the evidence from clinical trials shows this is effective. This advice may change over time.
If the patient requires a different vaccine due to an adverse event after their first dose or they have a medical condition that may be a contraindication for receiving dose 2 of the Pfizer vaccine, they should be referred to a medical practitioner to discuss their individual situation.
The shelf life of an opened COVID-19 AstraZeneca (ChAdOx1-S) multi-dose vial (MDV) is 6 hours cumulative total time when at room temperature up to 30oC or 48 hours from vial penetration when stored in cold chain conditions of +2oC to +8oC. The advice in the COVID-19 AstraZeneca (ChAdOx1-S) Product Information must be reviewed regularly to monitor for any changes.
COVID-19 AstraZeneca (ChAdOx1-S) vaccine doses in a syringe that has been drawn in advance, must be used within 1 hr if kept at room temperature, or 6 hours if stored at 2-8oC. More information is available in the COVID-19 AstraZeneca (ChAdOx1-S) Product Information, this advice must be reviewed regularly to monitor for any changes.
If the second dose of COVID-19 AstraZeneca (ChAdOx1-S) vaccine is overdue (i.e. past the recommended interval), The Australian Technical Advisory Group on Immunisation (ATAGI) have advised that it should be given as soon as possible and no further doses are required. The second dose will be effective regardless of how late it is given.
As with any other vaccines, vaccination should be deferred if the recipient is acutely unwell. This is a general precaution for all vaccines and will avoid potential misattribution of symptoms from the acute illness as being due to the vaccine or vice-versa.
NSW Health have issued a special License to supply by wholesale certain restricted substances in relation to the COVID-19 vaccine. This allows an authorized person who has been supplied the COVID-19 vaccine (under the Commonwealth Department of Health COVID-19 Vaccine program) to supply that vaccine to another authorized person operating at another COVID-19 provider (under the Commonwealth Department of Health COVID-19 vaccine program). You must alert the Commonwealth, keep records as required in the license, maintain cold chain and it must be supplied only to a site approved by the Commonwealth.
Pharmacist immunisers must refer pregnant women seeking vaccination to their medical practitioner.
Pregnant women should be routinely offered BNT162b2 [mRNA] COVID-19 Pfizer (Comirnaty) vaccine at any stage of pregnancy. Pregnant women with COVID-19 have an increased risk of severe illness and adverse pregnancy outcomes. COVID-19 Pfizer (Comirnaty) vaccine is preferred for women who are pregnant due to the amount of safety data available.
Due to the current outbreak in NSW, the COVID-19 AstraZeneca (ChAdOx1-S) vaccine is now available for all adults (18+). If the Pfizer COVID-19 vaccine is not available, pregnant women considering receiving the AstraZeneca COVID-19 vaccine must speak to their GP or relevant health professional to discuss their individual circumstances.
Pharmacist immunisers must refer pregnant women to their general practitioner or specialist to discuss the best choice for them. BNT162b2 [mRNA] COVID-19 Pfizer (Comirnaty) should be routinely offered to pregnant women at any stage of pregnancy, and to women who are breastfeeding or planning pregnancy. Pregnant women with COVID-19 have an increased risk of severe illness and adverse pregnancy outcomes.
Women who received their first dose of the AstraZeneca vaccine and are pregnant can receive dose two of either the AstraZeneca vaccine or the Pfizer vaccine, although the Pfizer vaccine is preferred.
There is a growing body of evidence supporting the safety of mRNA COVID-19 vaccines in pregnancy, there are still very limited data on the safety of viral vector vaccines (such as the AstraZeneca vaccine) in pregnancy and there is comparatively less data on the safety and efficacy of mixed vaccine schedules than completing the series with the same vaccine. Refer to COVID-19 vaccination – Shared decision making guide for women who are pregnant, breastfeeding or planning pregnancy
Pharmacists can administer the second dose of AstraZeneca COVID-19 vaccine if the person received their first dose elsewhere in accordance with the vaccination standards and practice setting. You will need to verify the date of previous vaccination in the AIR prior to administering another dose.
Certain viruses, including the novel coronavirus, SARS-CoV-2, naturally mutate over time. Often these mutations don't impact how viruses affect us. However, some recent variants of SARS-CoV-2 are more easily spread and appear to be associated with increased numbers of cases in some countries.
Current evidence from clinical trials indicates that the antibodies induced from COVID-19 vaccines are likely to provide protection to a variety of mutations and minor changes. However, in some cases there may be an impact on how antibody developed from vaccines based on the original strain can 'neutralise' the virus.
There have been four variants of concern (VoC) since the start of the global COVID-19 pandemic. The WHO has classified the variants as Alpha, Beta, Gamma and Delta. They also monitor Variants of Interest (VoI) and Alerts for Further Monitoring.
Currently approved vaccines have been shown to be effective to provide at least some protection against new variants as these vaccines work to create a broad immune response. The mutations causing these variants should not make the vaccines ineffective. A study from the UK found the Pfizer vaccine is 96% effective against hospitalisation for the Delta strain after the second dose. This same study found AstraZeneca vaccine to be 92% effective against hospitalisation after two doses.
Persons previously been diagnosed with COVID-19 should be referred to their general practitioner to determine the best time to have a COVID-19 vaccination. Persons may be advised to wait for up to 6 months after they have recovered from COVID-19 to have their vaccine.
Prophylactic use of paracetamol or ibuprofen is not recommended before receiving a COVID-19 vaccine. Antipyretics and analgesics can be taken after vaccination for management of vaccine-related side effects such as fever and myalgia, if required.
Pharmacists should refer any patients with a previous history of severe allergic reaction to a previous dose of COVID-19 vaccine or one of its ingredients to their general practitioner for assessment to determine whether it will be safe to receive subsequent COVID-19 vaccination.
People should be advised to monitor for signs of an adverse event following vaccination. They should be provided written information and should be advised to seek immediate medical attention if they develop any of the following symptoms after vaccination:
Patients should not receive the COVID-19 AstraZeneca (ChAdOx1-S) vaccine if they have a history of any of the following:
Patients with a history of clotting should be referred to their medical practitioner for an assessment and review of most appropriate options.
People will develop an immune response within 2–3 weeks after the first dose of COVID-19 vaccine and will be partially protected. However, all people need a second dose to achieve maximum and longer lasting protection.
Patients who are infected and have only had one dose of vaccine, will still be able to have the second dose of COVID-19 vaccine, but may be advised to delay the second dose for up to 6 months after they have recovered from COVID-19.They must be referred to their General Practitioner for consideration of their individual circumstances.
COVID-19 vaccinations must be provided free of charge. The Australian Government is committed to offering every person in Australia access to safe and effective COVID-19 vaccines at no cost. Vaccination providers cannot charge to administer the COVID-19 vaccine. The vaccine is free and the consult appointment for patients to receive the vaccination is also free. Charging a patient any costs associated with the administration of the COVID-19 vaccination (including booking fees) is a breach of the requirements under the program.
The COVID-19 AstraZeneca vaccine is associated with a very rare risk of a condition called thrombosis with thrombocytopenia syndrome, or TTS. TTS is a rare event involving serious blood clots with a low platelet count. The blood clots can occur at different parts of the body, including the brain (this is called cerebral venous sinus thrombosis) and the abdomen (this is called idiopathic splanchnic vein thrombosis). The low level of blood platelets can cause bleeding. TTS is triggered by the immune system’s response to the COVID-19 AstraZeneca vaccine and is different from other clotting conditions. To date, the great majority of cases were after the first dose of the vaccine.
Not all clots that occur after having the COVID-19 AstraZeneca vaccine will be due to TTS. Other blood clotting problems occur commonly in the population. Annually, common clots such as deep vein thrombosis or pulmonary embolism (a clot in the lungs) will affect about 1 in a 1,000 people in Australia, unrelated to any vaccine. TTS is a unique, new condition that requires certain blood tests for confirmation as well a specific treatment based on haematologist advice.
Patients should be informed of the signs and symptoms of TTS at the time of vaccination. People who experience any of the following symptoms (particularly around 4 to 42 days after vaccination) should seek medical attention immediately:
Additional information is available in the Australian Governments COVID-19 vaccination – After your AstraZeneca vaccine.
TTS onset occurs around 4 to 42 days (most commonly 4 to 30 days) following vaccination with COVID-19 AstraZeneca vaccine.
TTS is rare. It is currently estimated to affect about 1-2 per 100,000 people who receive the COVID-19 AstraZeneca vaccine. For people under 60 years of age, the rate is currently estimated to be higher. These estimates will be updated as further information becomes available. Additional information is available on the TGA - COVID-19 vaccine weekly safety report.
