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Webinar - COVID-19 vaccination for pharmacist immunisers

Webinar - COVID-19 vaccination for pharmacist immunisers - August 2021

Frequently asked questions

In what settings can NSW pharmacists immunise?

A pharmacist immuniser in NSW may administer vaccines, including COVID-19 Vaccines to eligible patient groups under the Commonwealth vaccination program in the following settings:

  • Retail (community) pharmacy (approved under Schedule 5F of the Health Practitioner Regulation National Law NSW). For COVID-19 vaccine administration, only those pharmacies participating in the Australian Government COVID-19 vaccination program Residential Care Facility
  • General practice. For COVID-19 vaccine administration, only those practices participating in the Australian Government COVID-19 vaccination program Aboriginal Medical Service. For COVID-19 vaccine administration, only those services participating in the Australian Government COVID-19 vaccination program.  Local Council Clinic. For COVID-19 vaccine administration, only those councils participating in the Australian Government COVID-19 vaccination program 
  • Private hospital. For COVID-19 vaccine administration, only those hospitals participating in the Australian Government COVID-19 vaccination program.
  • Public hospital and health service. For COVID-19 vaccine administration, only those hospitals participating in the Australian Government COVID-19 vaccination program.
  • Community health centre
  • A clinic operated by the Royal Flying Doctors Service. For COVID-19 vaccine administration, only those services participating in the Australian Government COVID-19 vaccination program
  • Staff Occupational Health Clinic (clinics held in the workplace to vaccinate staff)
  • A private home of a patient.
  • Public, private or independent school (clinics held to vaccinate students), provided the pharmacist immuniser has obtained approval to administer or supply a COVID-19 vaccine at the school from the relevant educational facility. Appropriate informed consent must have been provided by the parent/guardian
  • A premises where services are provided to:
    • homeless persons
    • persons with a disability
    • Culturally and Linguistically Diverse (CALD) populations
    • Aboriginal and Torres Strait Islander persons
    • refugees.

This includes vaccinating people with mobility issues whilst seated in their car if they are monitored continuously post vaccination.

In all settings the environment must comply with the NSW Pharmacist Vaccination 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.

What interval is required between the influenza and COVID-19 vaccination?

The Australian Technical Advisory Group on Immunisation (ATAGI) advises that COVID-19 vaccines can be co-administered (i.e. on the same day) with an influenza vaccine.

Does the community pharmacy need to have a separate entrance and exit for people receiving vaccines?

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. Refer to section 2.2 of the NSW Pharmacist Vaccination Standards for requirements. The pharmacist must also ensure compliance with all requirements specified by the Australian Government in relation to the COVID-19 vaccination program.

Pharmacies must have a COVID-19 Safety plan which should include maintaining physical distancing for all customers and patients, including during and following vaccination.

Can an intern pharmacist administer a COVID-19 vaccine under supervision?

Intern pharmacists (pharmacists with provisional registration and who have completed the relevant immunisation courses including the Australian Government training modules) in NSW are authorized to administer the COVID-19 vaccines, but only under the direct supervision of a pharmacist immuniser who holds certification to vaccinate for the relevant vaccine.

What should I do if the Australian Immunisation Register (AIR) record incorrectly shows that a patient has already received a dose of COVID-19 vaccine?

The patient should be directed to contact the Australian Immunisation Register (AIR) to have their record amended. The register 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.

What should I do if the patient advises they have received their first dose of a COVID-19 vaccine, but it is not recorded on the Australian Immunisation Register (AIR)?

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.

Which patients should be referred to their GP?

Pharmacist immunisers must not supply or administer the COVID-19 vaccine and must refer persons to a medical practitioner if:

  • The person is not able to consent to vaccination on their own behalf or, where the person is a child, they do not have a parent/guardian with them
  • The pharmacist is unsure that the person understands the information provided to them
  • The person has questions or concerns that the pharmacist cannot confidently and completely address
  • The patient has a contraindication or precaution (other than those who are pregnant or are on anti-coagulation therapy) to the vaccine as per the latest information and advice from Australian Technical Advisory Group on Immunisation (ATAGI) and the Therapeutic Goods Administration (TGA). Pharmacist Immuniser's must ensure they remain up to date on any new advice from ATAGI or the TGA regarding additional precautions or consent requirements for the COVID-19 vaccine.
  • The person has experienced a serious adverse event after the administration of a previous dose of the COVID-19 vaccine or an ingredient of the vaccine.

Why is such a rigorous consenting procedure required for COVID-19 vaccines?

This is to ensure that the patient has been thoroughly assessed for their suitability to receive a COVID-19 vaccine and to ensure the patient/parent/guardian is fully informed of benefits and potential harms of the vaccine prior to vaccination. The patient/parent/guardian must be advised to monitor for signs of an adverse event following vaccination and should be advised to seek immediate medical attention for any new or unexpected or severe symptoms, severe or persistent headache, stomach (abdominal) pain, chest pain, vomiting or visual symptoms, bruising or petechial haemorrhages, difficulty breathing, wheezing, a fast heartbeat or collapsing, chest pain, pressure or discomfort, irregular heartbeat, skipped beats or ‘fluttering’, fainting, shortness of breath or pain with breathing up to 6 weeks after vaccination with COVID-19 vaccine

The most common time period for onset of TTS symptoms is 4–30 days after vaccination.

The COVID-19 vaccines available in Australia are 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 vaccines is outlined in the NSW Pharmacist Vaccination Standards.

When vaccinating children in a school setting, all the same requirements for informed consent must be met.

How should informed consent be documented?

Informed consent must be documented either:

  • through written consent from each patient/parent/guardian to whom a COVID-19 vaccine is supplied (by way of administration) and retain a copy of that consent using the Australian Government Department of Health COVID-19 vaccination – Consent form for COVID-19 vaccination or
  • through the pharmacist using the Australian Government Department of Health COVID-19 vaccination – Consent form for COVID-19 vaccination and making a record of patient/parent/guardian responses to questions contained in that document, obtaining verbal consent from the patient/parent/guardian and the pharmacist retaining the record of consent in an electronic platform. The record must be able to be produced on request.

Where can I find more information on contraindications and precautions for COVID-19 vaccines?

Information on contraindications and precautions for COVID-19 vaccines are provided by:

  • the Australian Technical Advisory Group on Immunisation (ATAGI)
  • the Therapeutic Goods Administration (TGA).

All pharmacist immunisers must have access to these resources at all times when conducting vaccination clinics.

How do I report adverse events to vaccination?

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 using the National Adverse Events Following Immunisation (AEFI) reporting form. Additional advice is available on Adverse events following immunisation (AEFI).

What should I do if I cannot access consumables from the vaccination program?

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.

When should I upload information to the Australian Immunisation Register (AIR)?

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 vaccination 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:

  • through the use of pharmacy professional services software integrated with AIR (preferred option)
  • by direct upload into AIR via the Clinician Vaccine Integrated Platform (operated by the Australian Digital Health Agency) or HPOS on the AIR website.

Are there NSW Health resources to use in the pharmacy to promote COVID-19 vaccination?

Information to promote COVID-19 vaccination are provided in the On-boarding pack for approved Commonwealth providers. Also see additional resources for community pharmacy.

Where can I find COVID-19 vaccination information in languages other than English?

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

Where can I find the COVID-19 vaccine consent form?

See the COVID-19 vaccine consent form.

Can I set up the post vaccination patient observation area in the pharmacy car park or just outside the pharmacy to minimise the risk of spreading COVID-19?

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.

Can a patient receive a different vaccine brand for dose 1 and dose 2?

The current advice from the Australian Technical Advisory Group on Immunisation (ATAGI) recommends that, if available, the same COVID-19 vaccine brand should be used for the two doses of the primary vaccination course. An alternative vaccine brand for dose 2 should be used if there are specific medical contraindications or precautions, or the same vaccine brand is not available in Australia.

While it is preferable to use the same brand for both doses of the primary course, an alternative brand can be used for the second dose for other reasons. For example, if a patient is unable to access, or not accepting of a second dose of the same brand, since there are emerging data supporting the safety and efficacy of mixed schedules.

The recommended interval for administration of a second COVID-19 vaccine dose using any alternative brand is 4 to 12 weeks after the first dose, regardless of first dose brand. An interval longer than 12 weeks is acceptable if the second dose cannot be administered during this time window.

How long are doses of COVID-19 vaccine viable when drawn up into a syringe?

ATAGI recommends that, when possible, pre-drawn doses in syringes should be used within one hour if kept at room temperature, and within 6 hours if kept at 2–8°C. This is to minimise any risk of infection. However, regarding the Novavax vaccine, data on stability of pre-drawn doses in syringes are absent, and storing pre-drawn doses of this vaccine in syringes is not preferred.

What happens if the second dose of COVID-19 vaccine is missed or given late?

If the second dose of COVID-19 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.

If someone has symptoms but has a negative COVID-19 test, can I administer the COVID-19 vaccine?

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.

Can we transfer stock of COVID-19 vaccine between pharmacies?

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 vaccination 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. These provisions apply only to COVID-19 vaccines.

Can a pharmacist immuniser administer COVID-19 vaccine to women who are pregnant or breastfeeding?

Yes. Pregnant women with no other medical contraindication or other precaution may receive the Comirnaty (Pfizer) COVID-19 vaccine or Spikevax (Moderna) COVID-19 vaccine. A woman with any other medical contraindication or other precaution should be referred to a medical practitioner for vaccination. mRNA vaccines are preferred for women who are pregnant due to the amount of safety data available.

Which vaccine should pregnant women who have received AstraZeneca COVID-19 vaccine as their first dose have as their second dose?

An mRNA vaccine 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 one of the mRNA vaccines, although the mRNA vaccines are 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.

Do the COVID-19 vaccines protect against the new strains?

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.

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.

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

Can a pharmacist immuniser administer COVID-19 vaccine in a person who has been previously diagnosed with COVID-19?

ATAGI recommends that people should wait for 3 months after confirmed SARS-CoV-2 (the virus that causes COVID-19) infection before they receive their next COVID-19 vaccine dose. The next scheduled dose should then be given as soon as possible after this period.People who have received an anti-SARS-CoV-2 monoclonal antibody or convalescent plasma should defer future doses of COVID-19 vaccine for at least 90 days.

Should antipyretics and analgesics be used prior to vaccination?

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 injection site pain, fever and myalgia, if required.

Can I administer subsequent doses of COVID-19 vaccine if the patient had a serious adverse reaction to a previous dose?

Pharmacists should refer any patients with a previous history of a serious adverse reaction or 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.

What symptoms should persons be advised to watch for post-vaccination in relation to the Vaxzervia (AstraZeneca) COVID-19 vaccine?

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:

  • severe or persistent headache, blurred vision, confusion or seizures
  • shortness of breath, chest pain, leg swelling or persistent abdominal pain
  • unusual skin bruising and/or pinpoint round spots beyond the site of vaccination.

The most common time period for onset of TTS symptoms is 4–30 days after vaccination.

Can the Vaxzervia (AstraZeneca) COVID-19 vaccine be given to a person with a history of clotting?

Patients should not receive the COVID-19 Vaxzervia (AstraZeneca) vaccine if they have a history of:

  • Cerebral Venous Sinus Thrombosis (CVST)
  • Heparin Induced Thrombocytopenia (HIT)
  • idiopathic splanchnic (mesenteric, portal or splenic) venous thrombosis
  • anti-phospholipid syndrome with thrombosis
  • anaphylaxis, thrombosis with thrombocytopenia (TTS) or other serious adverse event attributed to the first dose of the Vaxzervia (AstraZeneca) COVID-19 vaccine
  • history of anaphylaxis to a component of the Vaxzervia (AstraZeneca) COVID-19 vaccine.

Patients with a history of clotting should be referred to their medical practitioner for an assessment and review of most appropriate options.

What happens if a patient gets COVID-19 between the first and second dose of a COVID-19 vaccine?

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 should delay the second dose for 3 months. If concerned, they must be referred to their General Practitioner for consideration of their individual circumstances.

Can I charge for the COVID-19 vaccine or its administration?

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.

Do I need to do additional training before I can administer the COVID-19 vaccines?

Pharmacist immunisers must have completed a training course that complies with the Australian Pharmacy Council 'Standards for the Accreditation of Programs to Support Pharmacist Administration of Vaccines' (current version). The training course must be conducted by an Australian Pharmacy Council accredited pharmacy education program provider.

The pharmacist immuniser must ensure that they have completed training for all authorised vaccines that they intend to administer.

To administer COVID-19 vaccines, a pharmacist immuniser, in addition to the above requirements, must also successfully complete:

  • core COVID-19 training modules from the COVID-19 Vaccination Training Program developed by the Commonwealth Department of Health in partnership with the Australian College of Nursing
  • the relevant vaccine specific additional COVID-19 training modules from the COVID-19 Vaccination Training Program developed by the Commonwealth Department of Health in partnership with the Australian College of Nursing.

The pharmacist immuniser must review all relevant training modules when notification of updates are received.

Who should not receive an mRNA, i.e. Comirnaty (Pfizer) or Spikevax (Moderna), vaccine?

The mRNA vaccines should not be administered in individuals who have experienced:

  • anaphylaxis (a type of severe allergic reaction) to a previous dose of an mRNA COVID19 vaccine (i.e., Spikevax (Moderna) or Comirnaty (Pfizer) vaccine)
  • anaphylaxis after exposure to any component of the vaccine, including polyethylene glycol (PEG)
    myocarditis and/or pericarditis attributed to a previous dose of an mRNA COVID-19 vaccine (i.e., Spikevax (Moderna) or Comirnaty (Pfizer) vaccine)
  • any other serious adverse event, that following review by an experienced immunisation provider or medical specialist was attributed to a previous dose of an mRNA COVID-19 vaccine (i.e., Spikevax (Moderna) or Comirnaty (Pfizer) vaccine) and without another cause identified.

Can I administer a COVID-19 vaccine to a person on anticoagulant therapy?

Administration of any COVID-19 vaccine can only be to an individual without a precaution (other than those who are pregnant or are on anti-coagulation therapy) or a contraindication to COVID-19 vaccination, these patients must be referred to a medical practitioner.

Current as at: Friday 19 August 2022
Contact page owner: Health Protection NSW