BETHESDA, MD 16 October 2009—Pharmacists in Maine are preparing to vaccinate patients against influenza, as the state ends its status as the only one without a law allowing qualified pharmacists to administer vaccines.

Maine Public Law Chapter 308, An Act to Allow Pharmacists to Administer Certain Immunizations, was signed into law June 9, with an effective date of September 12. Emergency rules crafted by the state board of pharmacy went into effect October 1, defining the requirements for pharmacists in the state to exercise their new practice privilege.

Doug Dunbar, assistant to the commissioner of the Maine Department of Professional and Financial Regulation, said Rite Aid Corporation and

In late August, 20 of the approximately 1700 active, registered pharmacists in Maine attended the first course in the state to fulfill the requirements for instruction, said Kenneth McCall, chair of the Department of Pharmacy Practice at the University of New England College of Pharmacy in Portland.

"The first participants were very eager to embrace this new scope of practice," McCall said.

He described the course's attendees as mostly community pharmacists representing a mix of ages. "It was a very motivated group, very much involved in the program in terms of questions but directly participating in the discussion and ready for the hands-on activity."

McCall said a second course, scheduled for September 26 in Bangor, had already drawn 21 registrants at the start of the month. Plans are in the works for more classes throughout the state in the coming months.

Before vaccinating patients, Maine pharmacists must complete 20 hours of pharmacy-board-approved training leading to a certificate of administration from the pharmacy board. McCall expects course attendees to begin administering seasonal influenza vaccines this fall on receipt of pharmacy board certification and to administer H1N1 vaccines when they become available.

Maine's law allows certified pharmacists to administer all forms of influenza vaccines to people over age nine years without a prescription. Certain other vaccines, including pneumococcal and herpes zoster vaccines, can be administered by prescription to patients who are under the care of a primary care provider.

The vaccination bill was introduced in late March, midway through the state's six-month annual legislative session. The legislation began moving quickly in early June, shortly before the World Health Organization declared an influenza pandemic.

The pharmacy board's emergency rule cited the "immediate threat to public health" posed by the pandemic 2009 H1N1 influenza virus as a reason to act quickly to implement the legislation.

Other jurisdictions have similarly cited the H1N1 threat as a reason for expanding the ability of pharmacists and other health care providers to vaccinate the public.

The District of Columbia Board of Pharmacy adopted emergency rules in August declaring that pharmacists need only one protocol or standing order set to administer influenza and pneumococcal vaccines to adults. Previously, the board required physician-specific protocols and standing orders. The intent of the emergency rules is to increase the number of pharmacies providing vaccination services against seasonal and H1N1 influenza, according to the board.

Regulators in Massachusetts passed emergency rules in August allowing licensed and properly trained members of designated health care professions—specifically pharmacists, dentists, and paramedics—to administer influenza vaccines. The rules are meant to expand the pool of available vaccinators to meet what state officials expect to be an enormous demand for seasonal and pandemic influenza vaccines over a short period of time. The state health commissioner decides when to invoke the emergency provisions.

Massachusetts pharmacists have had vaccination privileges since 2000. But Kathy Keough, executive director of government affairs and continuing education at the Massachusetts College of Pharmacy and Health Sciences, called the process of vaccinating "cumbersome" for the profession.

Specifically, pharmacists may only administer influenza vaccines to adults. A prescription, physician directive, or standing order must be in effect to permit vaccination.

The emergency rule allows pharmacists to vaccinate people 12 years or older against influenza but still requires a prescription or physician order to be in place.

Keough said enthusiasm for vaccine administration among Massachusetts pharmacists has not been strong enough to support more than one training program per year at her school in the past. But that has suddenly changed.

She said a training program in September drew 110 registrants and still had a "huge waiting list," prompting the school to organize a second session in October. Registrants have mostly been in practice a decade or more and come from a variety of backgrounds, Keough said.

"People are telling us they don't even care about the cost," she said. "The pharmacists themselves are saying: I want to make sure that I'm not missing out on being able to vaccinate."

Keough said her school teaches immunization skills to pharmacy students as an elective class, using a program approved by the American Pharmacists Association (APhA).

McCall said Maine's immunization training program is similar in content to APhA's but has a different origin. The program meets Accreditation Council for Pharmacy Education standards through a contract with the Texas Tech University Health Sciences Center, McCall's former place of work.

In addition to providing immunization training to already-licensed pharmacists in Maine, McCall said he is eager to begin teaching vaccination skills to the inaugural doctoral class of the University of New England College of Pharmacy, which will graduate its first students in 2013. The college is one of two pharmacy schools in the state, both of which welcomed their first-ever doctoral students this summer.

"We will embed within our program immunization training that meets the state board's standards," McCall said. "So our future graduates will be immunization capable."

McCall said his new home state was "overdue" to pass legislation allowing pharmacists to vaccinate patients.

"We've seen such a success in other states in terms of accessibility for vital immunizations in rural and urban areas alike. So the model is there," he said of pharmacists as vaccinators. "It's a very well-recognized role across the country, and now we have our chance."

ASHP supports the role that properly trained pharmacists can play in administering vaccines and supporting and promoting vaccination activities. The Society's stance on pharmacists as vaccinators is outlined in the ASHP Guidelines on the Pharmacist's Role in Immunization.