It has been a busy start to the year at the Priory Community Pharmacy in the West Midlands town of Dudley. Situated on a small high road of shops among residential streets, alongside a hardware wholesaler and a shuttered salon called Hairs & Graces, it has remained open throughout the pandemic, serving customers and reassuring patients.
“People are coming in for their medication and the phone has been ringing all day – asking us questions about Covid, the flu jab, or life in general,” says Olutayo Arikawe, 44, a pharmacist who has worked there for nine years – one of eight regular staff members.
As well as the usual services you would expect at a high street chemist, the Priory Community Pharmacy is providing companionship and communication in a world of uncertainty.
“Sometimes people just want somebody to talk to because they haven’t spoken to anybody in a long while. So they know we’re there and I’ve got a very good relationship with all my customers, patients and the community in general,” says Arikawe. “A lot of people know me. They always come to ask me questions or to have a chat with me.”
Since December, the pharmacy has also been providing free rapid coronavirus tests for people without symptoms – Dudley Council was the first local authority in England to use pharmacies to roll out this testing regime, and Arikawe was the first pharmacist to carry one out.
Yet there is one vital service Arikawe is unable to provide or even promise for her customers: the Covid-19 vaccine.
“It’s embarrassing,” she tells me. “When we heard about the vaccine, people keep asking me: ‘Are you going to offer it? If I can have my flu jab here, why can’t I have my Covid jab here?’
“I’ve been doing flu jabs for over ten years now, so I kept reassuring people that we would be able to offer it, but now when they come in and ask I say: ‘Well, for now, we can’t. It’s the government, not me!’”
At the end of November last year, NHS England invited pharmacists to apply to become a Covid “vaccination site”.
However, the criteria were significantly restrictive: successful applicants would need to be able to deliver over 1,000 vaccinations a week, be open seven days a week 8am-8pm, and have fridge space to store 1,000 doses at once. Most pharmacies cannot accommodate this set-up, and NHS England knew that. It remarked in the application instructions:
“We expect to commission fewer community pharmacy sites than GP primary care network-led centres. We do not expect the majority of contractors will be able to meet these requirements and expect them to continue their very important role in flu vaccination, particularly of the new 50-64 year-old cohort, and provision of other pharmaceutical services.”
It appeared the regular high-street chemists had been written off before the vaccine programme had even begun.
The Priory Community Pharmacy’s application was rejected by NHS England. This was without a “cogent reason”, Arikawe argues. She believes it was on the grounds of requiring “more manpower” – an obstacle she says could easily be overcome.
“We can acquire more people and there are enough who can work – we’ve got locum pharmacists who can be called upon any time, and we’ve actually discussed this and they are willing; a lot of them are offering flu jabs and are trained to provide travel vaccines already.”
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Pharmacists already play a vital role in the Covid-19 vaccine programme. They have been ensuring vaccine quality and preparing the vaccinations for use in existing sites, which are currently GP hubs, hospitals, care homes and new vaccination centres.
The Pfizer BioNTech vaccine in particular is complex to work with, needing to be stored at a temperature of -70°C. Pharmacists are on hand to ensure it is all used within its expiry date.
“Typically you’ve got two pharmacists involved in that process, in pretty much every single GP hub throughout anywhere in England where that’s being delivered at the moment,” says Mark Koziol, a pharmacist and chair of the Pharmacists’ Defence Association.
On top of supervising the actual medicine, some pharmacists are also involved in setting up community pharmacy-led hubs – local vaccination points in places such as church and village halls, scout huts, or marquees in green spaces. These are “high-volume, hub-type operations”, however, limited to the biggest pharmacies (Boots and Superdrug, for example), and are not generally situated in individual high-street chemists.
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At the moment, only six pharmacies in England have started inviting people for Covid vaccine appointments. This differs from Boris Johnson’s assertion at PMQs on Wednesday 13 January that “200 pharmacies” were part of the vaccine programme’s “huge network”, which he said was “going exceptionally fast”. The previous week, on Wednesday 6 January, he asserted that the government had already signed up “hundreds” of pharmacies to the programme.
On Thursday 14 January, the government said its plan was to open up 200 such pharmacy-led sites within the next two weeks. Yet the reality two days earlier was that these 200 potential vaccination services were still being assessed by NHS England, and only being lined up in the coming weeks, rather than specifically a fortnight.
[see also: The UK government’s vaccine nationalism is not only distasteful – it’s dangerous]
“The number delivering Covid-19 vaccines this week is below ten,” says Sandra Gidley, a community pharmacy locum and president of the Royal Pharmaceutical Society. “Next week that’s being expanded, and there’ll be, I think, about 20. These numbers are all with a pinch of salt really.”
There are around 11,500 community pharmacies in England and around 13,500 community pharmacies in the UK, so having six pharmacies currently delivering the vaccine is “a drop in the ocean”, says Gidley.
“I estimate we could do about three vaccinations an hour,” says Arikawe, who has done the maths for her own pharmacy. “We’re talking about at least a minimum of 20 maybe a day. And I’m just one pharmacy – if as many pharmacies as possible in the UK are doing the same thing at the same time, imagine how many people we could reach.”
If each pharmacy in England alone could vaccinate 20 people a day, this would meet half the government’s target of two million a week. Simon Dukes, chief executive of the Pharmaceutical Negotiating Services Committee, which represents high street pharmacies in talks with the government, has said that pharmacies have the capability to vaccinate around 1.3 million people every week.
Koziol is even more optimistic: “If each one only vaccinated, say, 25 patients per day, you would be able to vaccinate more people in community pharmacy settings than you would be able to vaccinate in the GP hubs.”
In the West Midlands alone, where Arikawe’s pharmacy is based, pharmacies could be helping deliver 300,000 shots a week, according to the Labour MP and candidate for the West Midlands mayoralty, Liam Byrne, who recently held a meeting of pharmacists in his region.
“That would mean the top six priority groups were vaccinated by 12 February and everybody over the age of 50 could be jabbed by 20 March if we threw everything at it, if pharmacies were part of the team,” he says. “So instead we’re going to go slower, and the result of that will be more deaths, more livelihoods lost, definitely more lessons lost because we’re going to be in lockdown for longer.”
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Failing to prioritise high-street chemists in the vaccine rollout appears to be a major oversight. As late as Tuesday 5 January, Dukes was saying that the industry’s offers to help in the rollout had been “met by a de facto silence”.
“It’s been so frustrating,” says Gidley. “Pharmacists are health professionals, they see a role they could easily do, and feel like they’ve been overlooked or snubbed.”
Now that pharmacists, their customers and the Labour Party have begun asking questions about this oversight, the government has started stepping up its activity, I hear from numerous sources.
“Things started moving, meetings started happening, there has been a lot of activity on this in the past week so it’s looking more optimistic,” says Gidley. “It’s probably NHS England realising that they might have missed a bit of a trick.”
The Labour leader Keir Starmer called for 24/7 vaccinations in a speech on Monday 11 January, and two days later, the government announced a pilot for 24/7 vaccinations – U-turning on the Prime Minister’s original position that there was “no clamour” for appointments after 8pm.
“It looks as though there have been a few rockets fired in various directions and there is now a lot of activity, so I think we will see community pharmacy playing a part in this, but I can’t as yet say when,” says Gidley.
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Why weren’t high-street pharmacies prioritised in the first place? They are, after all, best placed to provide such a service. They deliver the flu vaccine every winter, among other jabs, they are known and trusted by local residents, and they are easier to access than mass vaccination centres: 95 per cent of the population live within 20 minutes of a local community pharmacy.
Arikawe has heard customers complaining about having to make the trip to the superhubs, because of the length of the journey and concerns about taking public transport, “whereas their pharmacy is just down the road”, she says. “They can walk to us almost all the time, so from the point-of-view of a patient, I don’t think it’s really good enough.”
“In a typical week, you’ve got six million people visiting a community pharmacy somewhere in the country – that’s more people who go to all of the other primary healthcare providers put together: the GP surgeries, opticians, dentists,” says Koziol.
Pharmacists could also play a vital role in quelling any reservations locals may have about receiving the vaccine – whether through language barriers, lack of trust, or the spread of rumour and misinformation.
[see also: Does vitamin D really help combat Covid-19?]
“If the local pharmacist is telling them ‘you need to do this, I’ve done it, my family’s done it, and here are the reasons why’, they’re likely to be more enamoured by that message than hearing somebody on the news channel at 6 o’clock doing a press conference,” says Koziol.
“Community pharmacists are really well known locally, they’re often local boys and girls, been to school locally, really well plugged in to churches, mosques and temples,” says Byrne. “It’s just bizarre that we’ve ended up leaving them out.”
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It is unclear why there is this gap in the government’s plans.
Any arguments about lack of space or inability to maintain social distancing fall short when you consider pharmacies have managed to deliver flu vaccinations in this context, as well as stay open for in-person consultations throughout the pandemic.
One explanation could be that the Pfizer BioNTech vaccine was deemed too difficult for most high-street pharmacies to handle because of its storage temperature – and as it was the first to be approved, long before the Oxford AstraZeneca vaccine, mass vaccination centres were prioritised in planning.
It will also take time for supplies of both vaccines to come through, meaning the most urgent bottleneck to consider is the number of doses, not access to appointments. This does not explain decisions in planning about which sites to prioritise, however.
Other, less forgiving, viewpoints abound. Many pharmacists feel they have been an afterthought throughout the pandemic response – from lacking the necessary PPE during the first wave to initially missing out on the death-in-service benefit offered to other health workers.
I have heard a number of theories as to why this may be. One is that the government has a centralising instinct and therefore ignores local solutions, prioritising shiny new infrastructure projects instead of repurposing (or, perhaps, “levelling up”) what’s already there. Another is that most figures in senior positions at NHS England and other relevant authorities are medics rather than from a pharmaceutical background. (“I literally think they don’t think of us”, says one source.)
Even now that their potential appears at last to be plain to those in the top circles, there is still no indication of when – if ever – the thousands of high-street pharmacies will be able to offer their customers a Covid-19 vaccine.
“The approach should be almost like the Dunkirk rescue where 1,000 small ships went out – you had the big aircraft carriers, these were the big vaccine supercentres, but actually it was 1,000 small ships that added the capacity that got all the troops off the beach,” says Koziol.
Back in Dudley, Olutayo Arikawe prepares for another week of anxious customers asking when she can vaccinate them against Covid-19.
“We don’t feel good being left on the backburner all the time,” she tells me. “We shouldn’t have to tell the government what we’re able to do – they’ve seen us there on the front line during the beginning of the pandemic, we were open, even when most GPs and other services were closed to face-to-face service.
“I believe they should know what we are able to do now, and we shouldn’t need to be begging to do what we can and know how to do best.”
An NHS spokesperson said:
“Pharmacies are already working with GPs to deliver the vaccine in many areas of the country. As more supply becomes available, community pharmacists able to administer large numbers of vaccine will play a role in the NHS’s phased vaccination programme, the biggest in the health service’s history.”
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