Gearing up for third vaccine doses for the immunocompromised

While pharmacists and physicians await details on the rollout, the National Advisory Committee on Immunization (NACI) recently recommended that some immunocompromised people receive three doses of an authorized mRNA COVID-19 vaccine. On September 10, the Public Health Agency of Canada (PHAC) released its updated advice on third doses. PHAC points out that these doses are considered part of a primary vaccine series—the number of initial doses of vaccine given to induce an immune response and provide initial protection—rather than a “booster” dose, which is used to boost the immune system when protection from a primary vaccine series shows signs of waning over time. Studies show that immunocompromised individuals (for example, those being treated for cancer, as well as organ transplant recipients who take immunosuppressive drugs) who had a reduced immune response after two doses of a mRNA vaccine can have an increased immune response after a third dose, notes PHAC. Eligible patients will require a letter from their physician to receive a third dose, but pharmacists can assist in identifying candidates through their medications once the rollout begins. “Some of the patients who have been identified under this immunocompromised model will be on certain medications that we’ll be able to run some reports from to proactively screen them and follow up with them to see if they meet the criteria,” says Joel Donnelly, manager of Lovell Drugs in Kingston, Ont. Because Lovell Drugs is situated in Hotel Dieu Hospital, the pharmacy works closely with the Hospital’s cancer centre and renal unit, facilitating collaboration with physicians on third doses. “Those patients could be notified from their clinics that they could come here and get the vaccination done,” says Donnelly. “With these strict criteria, it’s a lot easier for the doctors to identify the patients directly and have somewhere to refer them to get the shot if they can’t have it done in their physician’s office.” Barbara Violo, owner of Junction Chemist Pharmacy in Toronto, says most people with immunocompromised conditions are under the care of a specialist, so it would be simplest for those physicians to issue a letter to patients. “I identify the patients mostly when they refill a prescription or because they ask me,” she says. “But I think we can collaborate with physicians. When we see [an eligible] patient, we can advise them to get a letter from their doctor.” Most pharmacists would also be willing to run drug searches for local physicians to help identify these patients, she says. Unlike those Violo is currently vaccinating with first and second doses, she doesn’t expect vaccine hesitancy to be a major problem with immunocompromised patients. “I’ve had a lot of interest in the third dose, so I think most people who will be getting it want it.” Pharmacists are not yet authorized to administer third doses, but “with the success we’ve had with the first and second [COVID-19] vaccine doses and flu shots, it seems like a matter of time,” says Donnelly.

Gearing up for third vaccine doses for the immunocompromised

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