One year into COVID-19 vaccination, pharmacists across the country have learned a great deal. Guidance from federal officials changed rapidly and misinformation spread all over social media, but through it all pharmacists have been the trusted voice of confidence for patients seeking answers to all sorts of questions about COVID-19 vaccines. With these changes came new opportunities for pharmacists to learn together. On a regular basis throughout 2021, a group of 20 invited pharmacy personnel from across the nation—including pharmacy technicians, student pharmacists, pharmacy residents, and practicing pharmacists—virtually gathered together to learn from each other. Participants were encouraged to share stories about successes and challenges to gain practical knowledge and enhance patient confidence in the COVID-19 vaccine. The project, called the APhA COVID-19 Vaccine Confident Learning Collaborative, was funded in part by a collaborative agreement with CDC and will extend into its second year in 2022. A direct result of these discussions has been the APhA toolkit (see sidebar). Pharmacy Today spoke with a few of the participants to learn how this experience improved what they put into practice while it also helped them ignite the profession of pharmacy as one of the leading voices during this time. Elizabeth Skoy, PharmD, said pharmacists need to ask patients if they have gotten the COVID-19 vaccine. “We are a trusted profession and we need to be confident in talking to patients about the vaccine,” said Skoy from North Dakota State University (NDSU) School of Pharmacy. Skoy, who is also a frequent collaborator with NDSU’s Center for Immunization Research and Education (CIRE), said she has always felt this way as someone who “lives and breathes vaccination.” But the learning collaborative reinforced her feelings about the importance of pharmacy “stepping up.” Pharmacists should not be afraid to ask patients about their concerns if they have not been vaccinated, and they need to be prepared to answer each and every question. “The first time you answer those questions it can be a little scary, but you get used to it,” said Skoy. “The more I talk about it, my own confidence increases because it’s not new anymore; it’s just what I do.” Studies show that when a provider asks a question and has a one-on-one conversation with a patient about vaccination, the patient is more likely to accept it. “I think where we are now is getting to the people who do not have that opportunity—those who don’t have a primary care provider or go to a pharmacy regularly,” Skoy said. “A lot of that is your college student population. Getting a captive audience is something we’ve found to be very effective, but it’s not always easy to do.” She said she gained so much from the resource-sharing that was part of each group session. “Someone would say our state health department made this infomercial on this topic and this is how they did it—so there is less recreating the wheel,” said Skoy. During one session, someone shared a success story about increasing immunization rates on a college campus through “strike zones,” where immunization providers “strike” a certain area of a college campus, like a dorm building, knock on doors, and have the vaccine available right there for anyone interested. Skoy looked into using that strategy on NDSU’s campus. “I got some really great [additional] ideas from other people of how they tackled issues,” said Skoy. “Maybe what they were dealing with wasn’t 100% what I was dealing with, but a lot of the ideas or approaches were transferrable.” She said she found the experience with the learning collaborative invaluable—to have a group come together and cover hard topics on what was happening at the moment and what was to come was very meaningful. “Having discussions around that brought forth this feeling that ‘wow I’m not alone, others are dealing with this,’” said Skoy. “There was some validation that, no matter where you are or who you are serving or what your practice looks like, on a day-to-day basis this is an issue.” Chichi Ilonzo Momah, PharmD, explains the learning collaborative through a comic book reference. “In the comics world, there’s the Avengers,” said Momah, who is clinical pharmacist and owner of Springfield Pharmacy just outside of Philadelphia. “Individually, they have their strengths, but when the Avengers assemble, it’s amazing what can happen.” She said everyone came to the sessions to talk about their experiences, but they’d leave with so many ideas and the confidence to know what to do moving forward. “It kept us ahead of the game,” said Momah. “I feel like we were more proactive.” For Momah, the experience gave her the self-confidence to be able to speak impromptu about COVID-19 vaccines. “Coming out of this collaborative, I felt empowered—like I could get a call from anyone. It could be the White House [calling] to talk about this and I’m not afraid, I’m not shy,” she said. “Yes, we are clinicians and it’s all about the science for us, but sometimes you know the science but don’t know how to communicate the science. So that confidence to speak on it was so important.” She recalled an instance where she was invited to speak about the COVID-19 vaccine at a Baptist church in her community. “What scared me was that you didn’t know what questions you were going to get,” Momah said. Since she was seen as an expert, she wanted to confidently respond to questions. The resources that were shared during the sessions helped her educate patients. “We have everything we need to do what we have been called to do,” said Momah. “There are so many resources out there—don’t be afraid to ask questions, or don’t feel like you are not good enough to do this. We have the training. We have the knowledge, the education, and the resources.” Ken Chak, PharmD, MBA, said all pharmacists have had to learn to be resilient and adaptable as the profession shifted so much during this time. The learning collaborative sessions provided a unique opportunity for pharmacists to learn and grow from each other, he said. “It was interesting to see how many parts of the country [experienced] similar barriers, with different approaches to resolve them,” said Chak, who is pharmacy practice coordinator for the Kroger Company in Michigan. “My assumption is that pre-pandemic, virtual meetings were seldomly utilized,” Chak said. “Having this new ability to virtually come together from all over the country at the same time has proven beneficial for many industries. The pandemic shifted our way of communication, which lent an opportunity to have this learning collaborative team come together.” For Chak and other pharmacists, it’s been vital to be a reliable resource to patients, to answer questions or field any concerns about the COVID-19 vaccine. “At the end of the day, we want our patients to make their own informed decision to see if the vaccine is right for them and their kiddos,” said Chak. He said he encourages all pharmacists to lean in on their own network of fellow pharmacists, physicians, nurses, and other providers to learn from each other. “Pharmacists continue to play a vital role in the health care sector, and this is the time for our profession to continue to take the leading role,” Chak said. Gretchen Garofoli, PharmD, BCACP, a clinical associate professor of pharmacy at West Virginia University, served as the facilitator for the session discussions. In her experience, she’s found patients to be hesitant about the COVID-19 vaccine for multiple different reasons. “The biggest thing I’ve learned and that was reinforced through this collaborative is that we really need to just listen to patients because everyone has a different reason as to why they may be hesitant,” said Garofoli, who encounters several different patient populations in her practice. Garofoli was vaccinating long-term care facility patients when doses became available in December 2020; pharmacists in her state were integral to the success West Virginia had with a smooth vaccine rollout early on. She was able to incorporate some messaging techniques she heard from others during the learning collaborative sessions into her own practice. Some of these messages came from as far away as Alaska. During the first learning collaborative session on April 28, 2021, Coleman Cutchins, PharmD, BCPS from the State of Alaska Department of Health and Social Services, shared a graphic with the group that he uses to educate patients and others on how the vaccine approval process works. That question from patients has come up too often from patients, especially when the COVID-19 vaccines were first rolling out. The graphic was eventually incorporated into the APhA toolkit. “There is a lot of confusion out there, so being able [to access] reputable resources [is important],” said Garofoli. She said pharmacists in the learning collaborative have been able to use and develop resources that will help the profession as a whole address challenges placed before them. As pharmacists and others know too well, many patients are getting information about COVID-19 vaccines from social media, and these sources tend to support and reinforce what they already believe to be true. “The toolkit has so many good references and it points to the original resource,” Garofoli said. For instance, the toolkit cites the American College of Obstetricians and Gynecologists for information about COVID-19 vaccines for pregnant and breastfeeding individuals. “People might have an aversion to government organizations for one reason or another, so showing other professional organizations or peer-reviewed literature is extremely important,” Garofoli said. And it’s not just patients who may need education. “We have a lot of health care professionals who might have been spreading misinformation,” said Garofoli. “As pharmacists, knowing how to professionally handle that and providing reputable resources [is important].” The collaborative identified useful resources and messaging to support pharmacists’ discussions with patients and their communities, she noted. She advises pharmacists to take advantage of their network. “If you don’t have the answer, know that there are a lot of folks you can reach out to who are very involved in the vaccination efforts and can answer questions,” she said. Right as CDC authorized the Pfizer COVID-19 vaccine for children ages 5 to 12, Garofoli had an hour-long conversation with a colleague who works for a retail pharmacy. They had been selected as a pediatric COVID-19 vaccine site, but this pharmacist had rarely given any pediatric immunizations aside from an occasional flu shot. “She asked me what she needed to know, and I walked her through some tips,” Garofoli said. CDC outlines how to build health care personnel’s confidence in COVID-19 vaccines in 6 steps▪Encourage senior leaders to be vaccine champions.▪Host discussions where personnel at different levels can provide input and ask questions.▪Share key messages with staff through emails, breakroom posters, and other channels.▪Educate health care teams about COVID-19 vaccines, how they are developed and monitored for safety, and how teams can talk to others about the vaccines.▪Educate nonmedical staff about the importance of getting vaccinated.▪Make the decision to get vaccinated visible—and celebrate it! ▪Encourage senior leaders to be vaccine champions.▪Host discussions where personnel at different levels can provide input and ask questions.▪Share key messages with staff through emails, breakroom posters, and other channels.▪Educate health care teams about COVID-19 vaccines, how they are developed and monitored for safety, and how teams can talk to others about the vaccines.▪Educate nonmedical staff about the importance of getting vaccinated.▪Make the decision to get vaccinated visible—and celebrate it! Lead with listening▪Do not make assumptions about whether your patients will choose to get vaccinated or the reasons for their decisions.▪Begin with an open-ended question, such as “What are your thoughts on getting a COVID-19 vaccination today?”▪Actively listen and seek to understand the patient’s point of view.▪Recognize that these conversations can take time and may continue over the course of multiple encounters.Use patient-centered communication techniquesView Large Image Figure ViewerDownload Hi-res image Download (PPT)▪Use open-ended questions to promote dialogue. Ask about readiness to vaccinate and what questions or concerns they may have.▪Paraphrase any information shared to show that you have heard and understood it.▪Praise measures already taken to protect themselves or their children from COVID-19, like mask wearing and physical distancing. Then frame vaccination as a safe and effective way to help protect them and their loved ones from getting COVID-19.▪Ask for permission to share more information on COVID-19 vaccines. This will foster openness and connection.Respond to questions and concerns with empathyView Large Image Figure ViewerDownload Hi-res image Download (PPT)▪Respond to questions and concerns in a non-judgmental, respectful, and empathic way.▪Provide accurate answers using clear, simple language. Explore questions patients ask most often about vaccines (see URLs below).▪Some concerns may stem from mistrust in the medical establishment or the government as a result of collective or individual mistreatment and traumas. Acknowledging past traumas may promote patients’ trust in you and your message.▪Acknowledge uncertainty about what we don’t yet know about COVID-19 vaccines. This can help build trust. ▪Do not make assumptions about whether your patients will choose to get vaccinated or the reasons for their decisions.▪Begin with an open-ended question, such as “What are your thoughts on getting a COVID-19 vaccination today?”▪Actively listen and seek to understand the patient’s point of view.▪Recognize that these conversations can take time and may continue over the course of multiple encounters. ▪Use open-ended questions to promote dialogue. Ask about readiness to vaccinate and what questions or concerns they may have.▪Paraphrase any information shared to show that you have heard and understood it.▪Praise measures already taken to protect themselves or their children from COVID-19, like mask wearing and physical distancing. Then frame vaccination as a safe and effective way to help protect them and their loved ones from getting COVID-19.▪Ask for permission to share more information on COVID-19 vaccines. This will foster openness and connection. ▪Respond to questions and concerns in a non-judgmental, respectful, and empathic way.▪Provide accurate answers using clear, simple language. Explore questions patients ask most often about vaccines (see URLs below).▪Some concerns may stem from mistrust in the medical establishment or the government as a result of collective or individual mistreatment and traumas. Acknowledging past traumas may promote patients’ trust in you and your message.▪Acknowledge uncertainty about what we don’t yet know about COVID-19 vaccines. This can help build trust. Vaccine confidence toolkitThanks to the feedback and discussion by learning collaborative participants, pharmacists can find information they need to build vaccine confidence in their patients. A toolkit resource on APhA’s website includes background information, webinars, knowledge testing, and patient resources.Patient resources are in multiple languages. An interactive timeline breaks down how vaccines are developed and approved, and several videos include quick tips from participants about how they’ve found the information and resources on APhA’s Vaccine Confident website useful in their practice. Thanks to the feedback and discussion by learning collaborative participants, pharmacists can find information they need to build vaccine confidence in their patients. A toolkit resource on APhA’s website includes background information, webinars, knowledge testing, and patient resources. Patient resources are in multiple languages. An interactive timeline breaks down how vaccines are developed and approved, and several videos include quick tips from participants about how they’ve found the information and resources on APhA’s Vaccine Confident website useful in their practice. Phases of clinical trialsPhase 1 20–100 healthy volunteersResearchers try to answer these questions: ▪Is this vaccine safe?▪Are there any serious adverse effects?▪How does the vaccine dose relate to any adverse effects?▪Is the vaccine causing an immune response?Phase 2 Several hundred volunteersView Large Image Figure ViewerDownload Hi-res image Download (PPT)Researchers try to answer these questions: ▪What are the most common short-term adverse effects?▪What’s the body’s immune response?▪Are there signs that the vaccine is protective?Phase 3 1,000+ volunteersView Large Image Figure ViewerDownload Hi-res image Download (PPT)Researchers try to answer these questions: ▪How do disease rates compare between people who get the vaccine and those who do not?▪How well can the vaccine protect people from disease?Phase 4 Vaccine is approvedView Large Image Figure ViewerDownload Hi-res image Download (PPT)Researchers continue to assess: ▪FDA approves a vaccine only if it’s safe, effective, and benefits outweigh the risks.▪Researchers continue to collect data on the vaccine’s long-term benefits and adverse effects. Researchers try to answer these questions: ▪Is this vaccine safe?▪Are there any serious adverse effects?▪How does the vaccine dose relate to any adverse effects?▪Is the vaccine causing an immune response? Researchers try to answer these questions: ▪What are the most common short-term adverse effects?▪What’s the body’s immune response?▪Are there signs that the vaccine is protective? Researchers try to answer these questions: ▪How do disease rates compare between people who get the vaccine and those who do not?▪How well can the vaccine protect people from disease? Researchers continue to assess: ▪FDA approves a vaccine only if it’s safe, effective, and benefits outweigh the risks.▪Researchers continue to collect data on the vaccine’s long-term benefits and adverse effects. Tips for vaccinating childrenParia Sanaty Zadeh, PharmDPharmacists participating in the year 2 APhA COVID-19 Vaccine Confident Learning Collaborative session, held in November 2021, shared strategies for reaching pediatric populations to build COVID-19 vaccine confidence in parents and caregivers. Common themes that emerged during the session included cultivating welcoming spaces that are still safe and effective environments as well as facilitating child-friendly vaccination experiences with small incentives and rewards for children.Chichi Ilonzo Momah, PharmD, from Springfield Pharmacy in Pennsylvania, said that she makes her pediatric vaccination drives “look like a party” to create an enjoyable experience for children. Her pharmacy brought in a balloon artist and gave each child a balloon after receiving their vaccine. Donning a superhero costume, Ilonzo also turned into Superwoman and affixed superhero bandages to each child’s arm after their vaccination.Damika Walker, PharmD, from Grubbs Pharmacy in Washington, D.C., shared that her pharmacy hosted the “Lollipop Challenge.” As soon as the children were in place for their vaccine, they had a race to focus on opening a lollipop wrapper. This created an effective distraction for the children, especially if they were anxious about needles. When children in Walker’s neighborhood heard about the challenge, many wanted to go to her pharmacy for their COVID-19 vaccine to join the friendly competition. Grubbs Pharmacy also provided a station with cocoa, tea, and snacks for children and their families waiting for their vaccine. After each vaccination, Walker gave each child a sticker and button praising them for getting vaccinated.Learning collaborative participants also talked about effective strategies and best practices to help make children feel comfortable during the vaccination process. One participant shared that they ask parents to hold the vaccine Emergency Use Authorization packet over the child’s shoulder, so they don’t see the needle if they are nervous. Stuffed animals and blankets can be used as comforting tools or visual distractions to make the child feel at ease if they fear vaccination. Complimenting children’s face masks can also be effective in making them feel empowered and involved in the process.Other ways to motivate children getting vaccinated are to state the name of the child whom the pharmacist is “making the vaccine specifically for” and speak directly in conversation with the child during the vaccination process using grade-appropriate language. These can help make the child feel special. Additionally, pharmacists can ask the child to dedicate their vaccination to a family member or friend—“who are you are getting the vaccine for?”—to bring a meaningful element to the experience.Learning collaborative participants also said pharmacists can emphasize to children the positive message and importance of why they are getting vaccinated and highlight what it means once they are vaccinated.Bottom line: it’s about keeping children happy and highlighting positive experiences throughout the process. Paria Sanaty Zadeh, PharmD Pharmacists participating in the year 2 APhA COVID-19 Vaccine Confident Learning Collaborative session, held in November 2021, shared strategies for reaching pediatric populations to build COVID-19 vaccine confidence in parents and caregivers. Common themes that emerged during the session included cultivating welcoming spaces that are still safe and effective environments as well as facilitating child-friendly vaccination experiences with small incentives and rewards for children. Chichi Ilonzo Momah, PharmD, from Springfield Pharmacy in Pennsylvania, said that she makes her pediatric vaccination drives “look like a party” to create an enjoyable experience for children. Her pharmacy brought in a balloon artist and gave each child a balloon after receiving their vaccine. Donning a superhero costume, Ilonzo also turned into Superwoman and affixed superhero bandages to each child’s arm after their vaccination. Damika Walker, PharmD, from Grubbs Pharmacy in Washington, D.C., shared that her pharmacy hosted the “Lollipop Challenge.” As soon as the children were in place for their vaccine, they had a race to focus on opening a lollipop wrapper. This created an effective distraction for the children, especially if they were anxious about needles. When children in Walker’s neighborhood heard about the challenge, many wanted to go to her pharmacy for their COVID-19 vaccine to join the friendly competition. Grubbs Pharmacy also provided a station with cocoa, tea, and snacks for children and their families waiting for their vaccine. After each vaccination, Walker gave each child a sticker and button praising them for getting vaccinated. Learning collaborative participants also talked about effective strategies and best practices to help make children feel comfortable during the vaccination process. One participant shared that they ask parents to hold the vaccine Emergency Use Authorization packet over the child’s shoulder, so they don’t see the needle if they are nervous. Stuffed animals and blankets can be used as comforting tools or visual distractions to make the child feel at ease if they fear vaccination. Complimenting children’s face masks can also be effective in making them feel empowered and involved in the process. Other ways to motivate children getting vaccinated are to state the name of the child whom the pharmacist is “making the vaccine specifically for” and speak directly in conversation with the child during the vaccination process using grade-appropriate language. These can help make the child feel special. Additionally, pharmacists can ask the child to dedicate their vaccination to a family member or friend—“who are you are getting the vaccine for?”—to bring a meaningful element to the experience. Learning collaborative participants also said pharmacists can emphasize to children the positive message and importance of why they are getting vaccinated and highlight what it means once they are vaccinated. Bottom line: it’s about keeping children happy and highlighting positive experiences throughout the process.