Pharmacist and intern pharmacist vaccinators

Extended skills training for pharmacists was launched in March 2024.

This is a new authorisation process for experienced pharmacist vaccinators. Pharmacist vaccinators will need to access and complete the IMAC online education course Extending Vaccinator Skills (Whole-of Life).

To access this course the vaccinator must declare they are a pharmacist vaccinator and upload all required documentation to support this. The vaccinator must confirm awareness of the requirements for providing these additional services.

• See the onboarding guide and checklist available under "Immunisation service" here.

The course will update and increase your knowledge of the National Vaccination Schedule for those aged 5 and under, with specific reference to those under 3 years of age. The course is a refresher and will not replace the two-yearly update course requirement.

On completion of the course and theory assessment, the pharmacist vaccinator can apply for authorisation via the national authorisation portal and will be able to download a letter of “authorisation with conditions”.

The conditions are:

• Able to work without a standing order or prescription, administering NIS vaccines. When administering to those aged under 3 years old, the vaccinator will need to be directly supervised by an experienced vaccinator with at least 6 months' experience.
• The vaccinator must complete all the clinical sections of the clinical skills workbook prior to a clinical assessment.

On passing the clinical assessment along with confirmation of workbook completion the vaccinator will be issued an updated authorisation with the conditions removed.

To provide a funded influenza vaccine programme from a community pharmacy, the pharmacy must have a signed contract with their respective Health New Zealand - Te Whatu Ora district. Please contact your District Pharmacy Portfolio Manager if you have any questions regarding the contract process.

‍COVID-19

To administer any COVID-19 vaccine, all pharmacist vaccinators, intern pharmacist vaccinators and provisional vaccinators need to produce evidence that they have completed the online Aotearoa NZ COVID-19 Vaccinator education course.

On completion of the course, you can administer the associated vaccine to the appropriate population.

Note: COVID-19 Vaccinator Education Course AstraZeneca was discontinued September 2022 following the announcement by Health New Zealand - Te Whatu Ora of the discontinuation of AstraZeneca in Aotearoa.  

When vaccinating for COVID-19, please make sure you are using the most up-to-date resources available to you, i.e., the screening tool, the consent form and 'after your immunisation' leaflet. 

The COVID-19 Vaccine Operating and Planning Guidelines is a great source of information.

‍

Influenza

Pharmacist vaccinators and intern pharmacist vaccinators can administer influenza vaccines to anyone from 3 years of age.  Please refer to our Influenza programme page for up-to-date clinical information and eligibility criteria for influenza vaccines.

At the start of each influenza vaccine season community pharmacists should:

• review their brochures, handouts, and other resources to ensure they are appropriate for that year, and dispose of/recycle expired resources and order current documentation
• update any Standard Operating Procedures (SOP) relevant to best practice and ensure they align with any new guidelines released
• read the new Flu Kit handbook and make it accessible to all staff
• pre-order vaccines in accordance with instructions provided 
• communicate the key messages and any programme changes to all staff
• use updated consent form 
• encourage all staff to receive the influenza vaccine
• record all influenza vaccinations into AIR.

‍

Measles, mumps and rubella (MMR) vaccine

For more information see the IMAC fact sheet MMR immunisation: Key messages and chapters 12 (Measles), 14 (Mumps) and 19 (Rubella) in the current Immunisation Handbook.

We have created a short video showing the process of drawing up Priorix.

‍

Tetanus, diphtheria, and acellular pertussis vaccine (Tdap)

Pharmacy access to funded Tdap vaccine has been extended for all eligible people, however the current medicines classification for Boostrix means it can only be administered (by pharmacist vaccinators), to people aged 18 years and older, or to pregnant woman aged 13 years and over. In addition, a pharmacist vaccinator must have access to the necessary information to determine eligibility and to assess the person’s suitability to receive Tdap.

Eligible criteria in a pharmacy setting include:

• A single dose for pregnant women in the second or third trimester of each pregnancy (recommended to be administered from 16 weeks, preferably within the second trimester); or
• A single dose for parents or primary caregivers of infants admitted to a Neonatal Intensive Care Unit or Specialist Care Baby Unit for more than 3 days, who had not been exposed to maternal vaccination at least 14 days prior to birth; or
• An additional four doses (as appropriate) are funded for (re-)immunisation for patients post haematopoietic stem cell transplantation or chemotherapy; pre or post splenectomy; pre- or post-solid organ transplant, renal dialysis and other severely immunosuppressive regimens; or
• A single dose for vaccination of patients aged from 65 years old; or
• A single dose for vaccination of patients aged from 45 years old who have not had 4 previous tetanus doses; or
• For vaccination of previously unimmunised or partially immunised patients; or
• For revaccination following immunosuppression; or
• For boosting of patients with tetanus-prone wounds. (For extra guidance contact 0800 IMMUNE (0800 466 863) or follow the IMAC flow chart. When assessing wounds, a pharmacist vaccinator should refer to another healthcare professional if required, for example the person’s general practitioner, after hours clinic or emergency department.

More information can be found in chapters 6 (Diphtheria), 15 (Pertussis) and 20 (Tetanus) of the Immunisation Handbook.

Provisional pharmacist vaccinators cannot administer Tdap. Health New Zealand is encouraging provisional pharmacist vaccinators to complete the vaccinator foundation course to become an authorised pharmacist vaccinator and deliver a broader scope of vaccinations.

‍

‍Human papillomavirus (HPV)

Pharmacist and intern pharmacist vaccinators may administer HPV vaccine to people aged 9-45 years. Funding is available for those eligible up to 27 years. The approved vaccine is Gardasil 9. 

More information can be found in the IMAC fact sheet Human papillomavirus (HPV) and chapter 10 (Human papillomavirus) in the current Immunisation Handbook.

‍

Meningococcal disease

Pharmacist vaccinators may administer meningococcal vaccines to people aged 16 years and over. There are two different types of meningococcal vaccine; conjugated and polysaccharide. 

Pharmacist vaccinators should be familiar with the range of vaccines and reasons for using different ones. For more information see the IMAC fact sheet Purchase of non-funded meningococcal vaccines for detailed information on meningococcal vaccines and Chapter 13 Meningococcal disease in the current Immunisation Handbook.

‍

Herpes zoster (Shingles)

Shingrix is a non-live adjuvanted recombinant protein subunit vaccine. Shingrix vaccine is indicated for the prevention of herpes zoster (shingles) in individuals aged 50 years and older and in adults aged 18-49 years who are at increased risk of herpes zoster. It can be administered to these age groups by pharmacist vaccinators, and those eligible can receive Shingrix funded.

Refer to chapter 23 Zoster (herpes zoster/shingles) in the current Immunisation Handbook.

When planning a vaccine delivery service, the pharmacist needs to consider vaccine storage, staff training, the physical requirements regarding consultation and waiting space, and emergency and vaccine equipment.

Cold chain management

It is expected that each pharmacy has its’ own site-specific cold chain policy.

Cold chain management in pharmacies is regulated as part of the pharmacy licensing framework administered by Medicines Control. Visit the Manatū Hauora (Ministry of Health) website page National Immunisation Programme cold chain management to read the FAQs on Cold Chain Compliance for Community Pharmacies. The FAQs for immunisation coordinators on vaccine Cold Chain Compliance for community pharmacies is also available.

Community pharmacies who are offering or who plan to offer vaccination services are responsible for complying with all requirements within the Standards (including appropriate equipment, monitoring, recording, and policies and procedures) outlined in the National Standards for Vaccine Storage and Transportation for Immunisation Providers 2017 (2nd Edition). You can also find more information on IMAC's cold chain page.

An addendum to the National Standards for Vaccine Storage and Transportation for Immunisation Providers 2017 (2nd Edition) – Addendum June 2021 provides national cold chain standards for management of the Pfizer-BioNTech COVID-19 vaccine. The Standards apply to all immunisation providers once they have received the vaccine from the national store and must be read in conjunction with the National Standards.

Immunisation Coordinators will continue to provide community pharmacies with:

• Cold chain advice (e.g., when purchasing new cold chain equipment)
• Assistance with cold chain breaches or failures
• Clinical assessments for pharmacists who have completed their vaccination training course
• Three yearly spatial logging of pharmaceutical refrigerators (it is the pharmacist's responsibility to contact their Immunisation Coordinator to arrange this).

Refer to the pharmacy-specific Cold Chain Policy or visit our webpage Regional advisors and local coordinators to obtain the contact details for your local Immunisation Coordinator.

Training pharmacy staff/first aid management

Community pharmacists offering a vaccination service must ensure that all staff are familiar with the service being provided and their role in that service. ALL frontline staff must be aware of the risk of anaphylaxis following immunisation and the pharmacy procedure for its management. It is important to note that while a pharmacist vaccinator requires a CORE immediate - Adult and Child certificate (including management of anaphylaxis and the administration of adrenaline), at least one other member of the team must be able to call for emergency support and have a basic first aid certificate. This is to be always adhered to when vaccination services are provided.

Ordering vaccines

Funded influenza vaccines are ordered through Healthcare Logistics (HCL). HCL cater for most non-funded vaccines as well.  Minimum quantities apply and orders can be placed online. 

COVID-19 and funded MMR/Boostrix/Bexsero/MenQuadfi and Shingrix vaccine orders are placed through the CIR inventory portal. 

Other vaccines can be ordered through the pharmacy’s pharmaceutical wholesaler. 

Policies/procedures/SOPs

Pharmacy vaccination standard operating procedures (SOPs) should be a mainstay of the pharmacy’s vaccination set up. They are a living document that detail written instructions describing the specific steps to follow in activities under defined conditions.  They ensure the continuity of processes and show that there are strategies in place for risk management and harm minimisation. These SOPs should be site specific and sit alongside the pharmacy’s site-specific cold chain policy.  All vaccination staff should be familiar with these policies and know where to find them.

Pharmacists and other staff should be familiar with their local procedures around sharps management and injury, resuscitation/anaphylaxis management and incident reporting.

You can download the Management of anaphylaxis chart that describes the key features and management of anaphylaxis in pharmacies and includes the recommended adrenaline dose for all ages.

Vaccination and waiting areas

Prior to establishing a vaccination service, the pharmacist must ensure that they have a space that enables them to administer vaccines in a safe manner that provides for patient privacy and confidentiality. Consideration of where your client will wait for the post-immunisation wait time^¥ is also important.  They should always be within line of sight.  Your Immunisation Coordinator can provide advice on this. 

^¥ COVID-19 vaccination wait time is 15 minutes.  For other vaccinations the 20-minute waiting period continues to be the best option. However, adolescents aged 13 years or older and adults who are receiving only an influenza vaccination and who meet ALL of the following criteria may not need to wait for 20 minutes post-vaccination:

1. do not have a history of severe allergic reactions,
2. have been observed and assessed for any immediate post vaccination adverse reactions for a minimum of five minutes,
3. are aware of when they need to and how to seek post-vaccination advice,
4. will have another adolescent or adult with them for the first 20 minutes post vaccination
5. can contact emergency services if required.

Physical setup considerations/privacy

You should consider the organisation of your ‘vaccinating space’. To facilitate a conversation that provides for informed consent you should have at least two chairs available. Having this conversation while the client and/or you are standing is not good practice. It implies you are in a hurry and it is not comfortable for many people.

Can you access the adrenaline and emergency equipment quickly? Are you left or right-handed? The syringe and needle are placed in the sharps bin immediately after removing from the client's arm. Can you reach it? You may need to reposition chairs etc. to provide for your comfort and the client’s safety.

Do you require/have computer access in the room? Are patient leaflets and required forms, hand sanitiser, swabs, plasters etc accessible? This video discusses setting up your work area.

To revise vaccine administration please refer to Chapter 2 Processes for safe immunisation in the current Immunisation Handbook and your vaccinator foundation course training. All vaccinators must:

• Maintain the appropriate emergency equipment and check prior to administering vaccines
• Check that vaccines have been appropriately stored prior to administration
• Undertake a pre-vaccination check to ensure the correct vaccine is delivered to the client and that there are no contraindications or precautions that preclude delivery as per the pharmacist's pre-vaccination checklist and consent. This process includes checking the client’s immunisation history and any alerts or contraindications recorded in the Aotearoa Immunisation Register (AIR).
• Obtain informed consent, including about AIR and information sharing
• Deliver vaccines safely and dispose of the syringe and needle appropriately
• Provide verbal and written post-immunisation advice including details of who to contact in the event of an adverse event following immunisation
• Remind the client of the required wait time before leaving the pharmacy (depending on individual circumstances and vaccines being administered) 
• Enter the immunisation event into AIR.

The following videos provide a brief guide to vaccination and basic overviews of the preparation and administration of meningococcal, MMR, and Tdap vaccines. 

Priorix (MMR) vaccine video preparation

Boostrix: injection technique

Arexvy vaccine preparation video

‍

The Aotearoa Immunisation Register (AIR) is our new national register for vaccination activity. The Aotearoa Immunisation Register has replaced the National Immunisation Register (NIR) and the COVID-19 Immunisation Register (CIR).

Over their lifetime, New Zealanders can receive vaccinations from a range of health providers. At the moment, health providers can’t always get a full picture of a person’s vaccination history to help them and the consumer make the best health decisions.

The Aotearoa Immunisation Register (AIR) supports the vaccinating health workforce from all parts of the sector to record vaccinations and view vaccination history currently existing in national collections.

Please visit About Aotearoa Immunisation Register (AIR) – Te Whatu Ora - Health New Zealand to find out more about AIR.

The pharmacy vendors, RxOne and TONIQ, have made the necessary system changes to support you in claiming for the cost of the vaccine and the administration fee when a funded vaccine is given to an eligible patient. Please contact your software vendor if you have any questions about the changes.

Vaccinators must ensure that all untoward incidents are reported appropriately following local procedures, including their Immunisation Coordinator. The IMAC Vaccine incident reporting form for online completion should be used if a local/provider incident form is not available.

Adverse events following immunisation (AEFIs) should be reported to the Centre for Adverse Reactions Monitoring (CARM). Vaccinators should also notify their local Immunisation Coordinator when making a CARM report.

Immunisation data is collected through the AIR. However, community pharmacies may occasionally be asked to participate in audits, for example through PHO’s, DHB’s or pharmacy organisations or research projects, for example by IMAC. They may also choose to undertake their own audits within the pharmacy or pharmacy group.

Some pharmacies may offer an off-site immunisation service e.g., vaccinating staff in a workplace or patients in a rest home. The requirements for off-site programmes are outlined in Appendix 4 in the current Immunisation Handbook. Pharmacist vaccinators and intern pharmacist vaccinators must also meet the cold chain requirements for offsite vaccination described in the National Standards for Vaccine Storage and Transportation for Immunisation Providers 2017 (2nd Edition).  Community pharmacies are not required to apply to the Medical Officer of Health for programme approval.