America’s Pharmacies Can Do a Lot More Vaccinations

(Bloomberg Opinion) -- America’s vaccine distribution struggles have finally started to abate, with the average doses administered per day reaching 1.7 million last week. That’s phenomenal news, and it’s driven by many factors, from improved state-level execution to the public’s increasing acceptance of the vaccine itself. But there’s one other change that was likely a big contributor: the Biden Administration started shipping vaccine doses directly to pharmacies.

The pilot began a few weeks ago with about 6,500 pharmacies distributing a million doses per week, ticking up to two million in the next phase. But it can and should be quickly expanded — both in order to continue our recent vaccination success and also to help break any distribution logjams that emerge when additional vaccines are approved. 

The U.S. delivers over 175 million flu vaccines annually, with pharmacists responsible for roughly 25% of that in a typical year. It’s not hard to understand why pharmacies would be good at this. There are nearly 300,000 pharmacists in the nation certified to administer  vaccinations. And at least 86% of the U.S. population lives within five miles of a pharmacy. With inequality of access already influencing Covid-19 vaccine distribution, pharmacies are in the right place — everywhere — at the right time. Plus while overtaxed hospitals and medical centers struggle to expand vaccination hours, pharmacies tend to be open longer, or even round-the-clock.

Several states already rely on pharmacies to deliver most flu vaccines. And West Virginia, the state with the fastest and most complete Covid-19 vaccination record thus far, has used local pharmacies to deliver vaccines more than any other state — pioneering a combination approach in which the National Guard coordinates logistics while local pharmacies do the injections. 

Many of the pharmacy companies involved in the Biden administration’s plan already have plenty of practice delivering Covid-19 vaccines. For example, CVS and Walgreens spent the early weeks of the vaccine push leading distribution to nursing homes, sorting out the complex transportation and cold-chain storage requirements for the Pfizer-BioNTech and Moderna vaccines in the process. Large pharmacy chains have national logistics networks that can coordinate across states, while small pharmacies can fit into hub-and-spoke systems just as in West Virginia.  

And pharmacies will be even better positioned to distribute the vaccines likely to become available next. The Oxford-AstraZeneca vaccine, which has been approved for distribution in the U.K. and the European Union but not in the U.S., does not require cold-storage capabilities, allowing local pharmacies to play a bigger role. Likewise, the Johnson & Johnson vaccine and the Novavax vaccine can be delivered without cold storage. Both of those are currently showing strong results in trials, and the Johnson & Johnson vaccine is likely to be authorized for emergency use in the U.S. within weeks.

Expanding the pharmacy rollout does introduce some challenges. In particular, one of the reasons that the Covid-19 vaccine distribution has been much slower than annual flu inoculations is that checking documents for prioritization takes time and resources.

But as the supply shortage attenuates and we get further along in vaccinating the highest-risk groups, there will be less need for tight prioritization. And opening up more vaccination sites raises overall throughput, which could speed delivery for high-priority groups as well — especially once we add the next wave of vaccines into the mix.

Because pharmacies, especially the smaller pharmacies, are not currently being used at maximum capacity to deliver the Pfizer-BioNTech and Moderna vaccines, offering the Oxford-AstraZeneca and Johnson & Johnson vaccines more broadly through pharmacies would make it possible to add untapped, efficient capacity directly — even if we continue to use the current distribution methods and priority rules for the Pfizer-BioNTech and Moderna vaccines.

Vaccination is the best way to end the pandemic. Early data from Israel, which has vaccinated a greater share of the population than any other country, is already showing that Covid-19 can be beaten. But with new strains emerging and spreading internationally, the race against the clock has never been more urgent. Pharmacy involvement can help us get to the finish line.

The CDC reports a total of 174.5 million flu vaccine doses administered in the 2019-2020 season, and over 193 million doses administered so far for 2020-2021. A CDC assessment found roughly 25% pharmacy administration of flu vaccinations in the 2014-2015 season. More recent data from IQVIA suggests an even higher fraction administered by pharmacies (closer to 40%), but likely overestimates somewhat because the data set omits doses for which geographic information was missing, and pharmacy-administered doses are more likely to be geocoded.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Scott Duke Kominers is the MBA Class of 1960 Associate Professor of Business Administration at Harvard Business School, and a faculty affiliate of the Harvard Department of Economics. Previously, he was a junior fellow at the Harvard Society of Fellows and the inaugural research scholar at the Becker Friedman Institute for Research in Economics at the University of Chicago.

Alex Tabarrok is the Bartley J. Madden Chair in Economics at the Mercatus Center at George Mason University.

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