Shingrix supply problems worry pharmacists

On May 1, 2023, the Quebec Ministry of Health (MSSS) announced free use of the Shingrix subunit recombinant shingles vaccine for all immunocompromised adults and those over 80 years of age, as part of the Quebec Immunization Protocol (PIQ). While the first category has already received the second dose in the shortest recommended interval, i.e., two months, as recommended by the MSSS, it is now the turn of seniors aged 80 and over, for whom the recommended interval was 10 months after the first dose.“We started vaccination in May and then in the summer with doses provided by the MSSS,” confirmed Christophe Augé, a pharmacist-owner affiliated with Familiprix. "But quite quickly, the product fell out of supply.” While the vaccination campaign for the second dose for seniors is fast approaching, the low level of stocks worries pharmacists. “Barely one dose per pharmacy per month”The pharmacist explains that he managed to get his hands on three doses in September, and nothing else since. “The quantities are ridiculously small and the doses were barely in stock with our wholesalers before they flew off the shelves, despite the limit per pharmacy,” he continued.Familiprix's head office stated: “This summer and this fall, we received barely more than one dose per pharmacy per month. . . . Recently the allocation has doubled, but with 400 pharmacies, we have not even the equivalent of three vaccines per pharmacy per month. This is clearly insufficient.”The Association of Pharmacist Owners (AQPP) said that it has “raised awareness” to the government about this problem, and is working to resolve it. “Pharmacists were easily able to identify patients meeting the eligibility criteria for free shingles vaccine. On the other hand, the doses available for the Shingrix vaccine in pharmacies are rather low compared to the demand in our network. Several members have to cancel appointments and redirect patients, which is unfortunate.” Read: How effective is herpes zoster (shingles) vaccine in the real-world setting?Questioned about these supply disruptions, the MSSS criticizes and points the finger at the wholesalers from whom pharmacies obtain their supplies. “Product availability is currently not an issue. Doses are still available at the provincial vaccine distributor so that wholesalers can restock. Regional establishment depots and wholesalers are supplied at the same time. Wholesalers are therefore responsible for delivery and organizing distribution among the different community pharmacies. As of Feb. 6, no wholesaler has come to collect 100% of its planned allocation until the end of March. Pharmacies must therefore refer to their wholesaler to place orders.” “Around fifty appointments to cancel”However, at the beginning of February, the stock for the month of March was not yet available. And wholesalers have been asking for more doses for several months, says Hugues Mousseau, general director of the Quebec Association of Pharmacy Distributors (AQDP). “The Ministry (of Health) has supplied 100,000 doses since the beginning of May, and we receive vaccines twice a month. We have no control over the quantities made available since it is distributed by the Ministry, and we are doing our best to distribute them as quickly as possible. But today we must limit the number per pharmacy, as with other drugs in shortage,” he explained. But Augé said: “The AQPP advises us to check with our wholesalers, but they do not have doses. We were asked to do part of the vaccination work, but along the way we were cut off from products. Nothing is moving forward, and in the meantime, I have to send patients away. I have around 50 appointments that I will not be able to keep. I will have to use my staff to cancel these appointments, tell patients to look elsewhere and create discontent. I'm not the only one, we're all in the same situation. Some of my colleagues did not even give appointments at 10 months.” The pharmacist-owner wonders if the vaccination centres will be able to welcome all these new patients and meet demand. Read: Study examines the safety of COVID-19 XBB.1.5 vaccines in older adultsCould these possible cancellations or postponements of appointments have consequences on the health of patients? Several studies show that the shingles vaccine remains effective even if the second dose is given later than expected. According to the work of researchers at the Vaccine Study Center in Oakland, California, the effectiveness of the vaccine after a single dose is 70% during the first year and 45% during the second year. After two doses, this effectiveness increases to 79% in the first year and 75% in the second year. Similar effectiveness was observed in people who received the second dose later than recommended, even more than a year later. To date, the Shingrix vaccine has been administered to less than 13% of the population aged 50 and over in Quebec, compared to 24.7% in Ontario (excluding adults eligible for the free vaccination program in Ontario) according to the brief from the manufacturer GSK sent to the Ministry of Finance.10,000 doses available from mid-FebruaryFor his part, Hugues Mousseau wants to be reassuring: the alerts from pharmacists and wholesalers have already started to bear fruit, according to him. “Shingrix allocations for pharmacies have been increased three times since the program was launched last May. Thousands of doses are expected to arrive by the end of March. It’s a new program, and the Ministry is aware of the reality on the ground.”The March stock was released by the Ministry, confirmed the AQPP in a message sent to its members on Feb. 14: “Following discussions with the authorities, a new increase in doses was allocated to our network. The allocation of doses for March, i.e., approximately 10,000 doses, will be brought forward and available from wholesalers in the second half of February. An additional allocation of 8,000 doses will be granted for the month of March.” However, the AQPP is concerned that “demand could still exceed the supply of vaccines,” and advises pharmacists to favour booster doses and to wait until they have received the vaccines to confirm appointments.Read: Q&A with Pharmacy U presenter Sherilyn Houle: ‘I recognized that immunizations and travel health were my passion.’The MSSS thus ensures that it remains, “proactive in its approach and in its collaborations in order to meet the needs of the various vaccination partners in Quebec, including community pharmacies,” by adjusting the allocation of vaccines according to needs, but said, “the planning of vaccination appointments depends on the distribution schedule established in collaboration with partners.”In the presentation of his budget in March 2023, Finance Minister Eric Girard announced nearly $125 million over five years to offer free access to vaccination against shingles to 800,000 people. Today there are 439,715 people aged 80 and over in the province, according to Statistics Quebec, and that age group accounts for 80% of shingles cases each year.This article was translated from its original French and was first published on our sister site Profession Santé.

Shingrix supply problems worry pharmacists

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