Webinar - COVID-19 vaccination for pharmacist immunisers - August 2021
A pharmacist immuniser in NSW may administer COVID-19 Vaccines to eligible patient groups under the Commonwealth vaccination program in the following settings:
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.
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.
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 2.3 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.
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.
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.
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 information 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 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 includes:
When vaccinating children in a school setting, all the same requirements for informed consent must be met.
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.
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 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:
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.
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.
COVID-19 vaccine doses in a syringe that have been drawn up in advance of use, must be used within the time specified by the vaccine manufacturer. Advice on expiry times is provided in the vaccines Product Information. This advice must be reviewed regularly to monitor for any changes.
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.
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 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.
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.
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.
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 five variants of concern (VoC) since the start of the global COVID-19 pandemic. The WHO has classified the variants as Alpha, Beta, Gamma, Delta and Omicron. They also monitor Variants of Interest (VoI) and Alerts for Further Monitoring. Data for efficacy against Omicron is currently being collected.
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.
People with SARS-CoV-2 infection can be vaccinated as soon as they have recovered from their acute illness or can defer vaccination for up to six months after onset of the SARS-CoV-2 infection.
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.
Past infection reduces the risk of reinfection for at least 6 months. A two-dose primary schedule is recommended in previously infected people and is safe and well tolerated. People who have prolonged symptoms from COVID-19 beyond six months after the initial illness can be vaccinated on a case-by-case basis.
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.
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.
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 Vaxzervia (AstraZeneca) 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 should delay the second dose until they are no longer acutely ill. If concerned, 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 Vaxzervia (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 Vaxzervia (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 Vaxzervia (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 Vaxzervia (AstraZeneca) vaccine.
TTS is rare. It is currently estimated to affect about 1-2 per 100,000 people who receive the COVID-19 Vaxzervia (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.
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:
The pharmacist immuniser must review all relevant training modules when notification of updates are received.
The mRNA vaccines should not be administered in individuals who have experienced:
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.
Very large clinical trials have shown that Spikevax vaccine is effective in preventing COVID-19 in people aged ≥12 years and older. Adults who had two doses of Moderna Spikevax were about 94 percent less likely to become ill from COVID-19 than people who did not get the vaccine. The vaccine was also effective in people aged over 65 years (86%) and in adolescents aged 12-17 years.
A very large clinical trial showed that Pfizer Comirnaty vaccine is effective in preventing COVID-19 in people aged 12 years and older. People who had two doses of Pfizer Comirnaty were about 95 per cent less likely to get symptomatic COVID-19 than people who did not get the vaccine. It was equally effective in people over the age of 65 years, as well as people with some stable pre-existing medical conditions.
