FAQ: COVID-19 Vaccines Administration in Pharmacies

At this time, pharmacies will be using their own booking systems to schedule vaccine appointments. The online booking system and provincial customer service desk that launched on March 15 will only be used to support appointment bookings at mass immunization clinics. To support pharmacies, OPA has partnered with MedEssist Ltd. to offer a digital health solution that will enable community pharmacies across Ontario to meet the immediate demand for COVID-19 vaccinations. This effective patient-first, digital health solution is a web-based tool that can also be accessed on mobile. As Canada’s first and only inventory-based, patient-triaging platform for pharmacies, MedEssist’s system is designed to enable pharmacies to operate more efficiently and provide exceptional patient care while minimizing vaccine wastage. MedEssist’s innovative system has helped pharmacies across Canada to successfully manage a record-breaking flu vaccination campaign in 2020. More details and additional resources will be shared shortly. In the meantime, for more information, please send your inquiries to [email protected].

Pharmacies will be using their own booking systems to book patient appointments to receive COVID-19 vaccinations. Therefore, appointment times should be scheduled to coincide with the times that vaccine administration would be offered. Additionally, pharmacy staff should be made aware of the hours that COVID-19 vaccine administration would be available in order to communicate the information to patients. Pharmacies should also take into consideration factors such as the expiry date of a vial based on storage conditions, ensuring all doses from punctured vials are used within the appropriate timeframe and accommodating patient preferences where possible when determining vaccine administration times and appointment availabilities to avoid vaccine wastage and maximize the number of individuals vaccinated.

As part of the Ministry’s program for the administration of publicly funded COVID-19 vaccinations in pharmacies, there are no restrictions that limit the hours of operations and pharmacies are strongly encouraged to support the administration of the COVID-19 vaccine 24 hours a day/7 days a week, where permissible. However, pharmacies that will be operating outside of their normal business hours are required to submit a written request to the Ontario College of Pharmacists (OCP) to notify them of this change. The Designated Manager or Director Liaison of the pharmacy should update the hours when completing the annual pharmacy renewal or if they have already completed the annual renewal, an email should be sent to Pharmacy Applications & Renewals at [email protected] detailing the name, address and accreditation number of the pharmacy, the new hours of operation and the effective date of the change. This applies even if the pharmacy is only administering vaccinations outside of normal operating hours, (e.g., booking COVID-19 vaccination appointments an hour before they normally open but not providing any other pharmacy services during this time). Any questions relating to changing of hours (increase or decrease) can be forwarded to [email protected] as well.

It is recommended that pharmacies provide COVID-19 vaccinations by pre-booked appointments, however, pharmacies may choose to offer walk-in appointments if that suits their business needs. As the Ministry’s online pharmacy location finder will only direct patients to either a booking site or to call the pharmacy to book or inquire about procedures related to walk-in appointments, pharmacies are encouraged to communicate their booking procedures via voice recording on the pharmacy’s phone system, on the pharmacy’s website and/or by adapting OPA’s signage for the pharmacy. It is important to remember that regardless of the booking procedure, pharmacies are responsible for informing and educating the public on COVID-19 which includes ensuring that infection prevention and control measures are followed, e.g., limiting the number of people in the pharmacy, maintaining physical distancing between patients waiting in lines, etc. Pharmacies should also consider the need to manage the number of doses remaining to ensure no vaccine is wasted when determining the appropriateness to permit walk-ins.

In addition, for second doses, pharmacies are reminded that as part of the documentation requirements listed in the EO notice, a written or electronic record of the COVID-19 immunization administration must be provided to the patient, which includes the pharmacy’s contact information and date and time for the second scheduled dose (if applicable) at the same pharmacy location.

Yes. Scheduling of second doses and providing the date and time of this second dose appointment at the same pharmacy location to patients is a mandatory requirement for participating pharmacies. In addition, patients must be provided with instructions on how they can reach the pharmacy in the event they need to reschedule as well as how the pharmacy will reach them should there be a need to reschedule due to issues such as vaccine supply. With the recent government announcements about the plans to accelerate second dose appointments, OPA is working closely with the Ministry to ensure a consistent supply of vaccine doses will be delivered to pharmacies to meet patient demand for second doses. Additionally, as a result of increased vaccine supplies in Ontario, all participating pharmacies, will be able to order additional doses of Pfizer-BioNTech and Moderna vaccines through a quantity pre-book regardless of which vaccine the pharmacy was initially allocated.

For additional guidance on second doses for all 2-dose COVID-19 vaccine series in Ontario based on current vaccine availability, please refer to the COVID-19 Vaccine Series Second Dose Eligibility Quick Reference. Ontarians who are eligible for their second doses may choose to return to the same site or channel where they received their first dose for their second dose appointment or may choose to book an appointment at a different site or channel including through pharmacies. Pharmacies booking second dose appointments for patients who did not receive their first dose at the same location should remind individuals to cancel any pre-booked second dose appointments at other locations if applicable.

Second doses of COVID-19 vaccines should be scheduled according to manufacturer recommendations and/or based on public health guidance. Since March 10, 2021, with limited exceptions, Ontario had been following NACI’s recommendations that in the context of limited supply of COVID-19 vaccines, the dosing interval between the first and second doses should be extended to four months for all Health Canada approved vaccines to maximize the number of individuals benefiting from the first dose of vaccine. For more information, please consult the Ministry’s document on Extension of the Second Dose.

On May 28, 2021, based on the increase of COVID-19 vaccine supply in Canada, NACI updated their recommendation on extended dose intervals to indicate that second doses should be offered as soon as possible, with priority given to those at highest risk of severe illness and death from COVID-19 disease after or concurrent with first doses for all remaining eligible populations. Subsequently, the government announced plans to accelerate second dose appointments beginning on May 31, 2021.

As of July 5, 2021, all Ontarians aged 12 years and over are eligible to book a second dose appointment with the interval between the first and second doses dependent on the vaccine product received for their first dose. Please refer to the COVID-19 Vaccine Series Second Dose Eligibility Quick Reference for more information.

Additionally, individuals with certain health conditions (refer to the Vaccine Clinical Advisory Group (VCAG) Recommendations on Exceptions to Extended Dose Intervals for COVID-19 vaccines for more information) continue to be eligible for a second dose at the interval as indicated in the product monographs for COVID-19 vaccines. These individuals include recipients of, undergoing or imminently starting:

• Transplants (including solid organ transplant and hematopoietic stem cell transplants)
• Hemodialysis or peritoneal dialysis
• An anti-CD20 agent (e.g., rituximab, ocrelizumab, ofatumumab)
• Stable, active treatment (chemotherapy, targeted therapies, immunotherapy) for malignant hematologic disorders (this excludes individuals receiving solely hormonal therapy and/or radiation therapy)
• Stable, active treatment (chemotherapy, targeted therapies, immunotherapy) for non-hematologic malignant solid tumors (this excludes individuals receiving solely hormonal therapy and/or radiation therapy)

With respect to when exactly the second doses for these special populations should be scheduled, it may depend on multiple factors and be patient specific. Pharmacy professionals should use their professional judgement to determine the most appropriate duration between doses and may wish to consider information from references such as:

• NACI’s Recommendations on the use of COVID-19 vaccines, Table 3 which provides information on the recommended immunization schedules and states that “The AstraZeneca COVID-19 vaccine clinical trial demonstrated optimal efficacy when the interval between the first and second doses was ≥12 weeks”.
• VCAG’s Recommendations on Exceptions to Extended Dose Intervals for COVID-19 Vaccines which identifies specific populations where there continues to be limited available data on vaccine efficacy and effectiveness and provides recommendations for these groups as well as specific considerations such as looking at when the individual is most likely to mount an immune response.

The timing of the vaccine may also be decided in collaboration with the treating provider in order to optimize the immune response from the vaccine series and minimize delays in management of the individual’s underlying condition. Of note, patient populations eligible for the shortened second dose interval due to medical reasons will require a letter from the hospital clinic/specialist to confirm that they are eligible to get a second dose appointment at the monograph interval, identifying the reason for the exception. The letter should be presented at both the first and second dose appointments. Pharmacies should keep on file a copy of this letter as well as any documentation to support this decision.

Pharmacy professionals are reminded that it is mandatory for pharmacies to have second dose appointments scheduled for patients prior to them leaving after receiving their first dose as per the documentation requirements listed in the EO notice, which state that a written and electronic (if applicable) record of the COVID-19 immunization administration must be provided to the patient, which includes the pharmacy’s contact information and date and time for the second scheduled dose (if applicable) at the same pharmacy location. In addition, patients must be provided with instructions on how they can reach the pharmacy in the event they need to reschedule as well as how the pharmacy will reach them should there be a need to reschedule due to issues such as vaccine supply.

As of July 5, 2021, youth aged 12 to 17 are eligible to book an accelerated second dose appointment if at least 21 days have passed since their first dose. Please note that currently these individuals are only eligible to receive Pfizer-BioNTech vaccine.

With schools restarting in September and the return to in-person learning for many students across the province, it is essential that as many individuals as possible in the youth population are vaccinated before school starts. Pharmacies may wish to consider how they can help support vaccination efforts for this population, such as holding a youth-specific clinic day for vaccine administration. As a reminder, although completing the school information is not a mandatory field in COVax_ON, it is encouraged to be completed whenever possible as this information will help with planning and guiding policy decisions for the upcoming school year.

Patients are strongly encouraged to receive their second dose at the same pharmacy location where they received their first dose. To facilitate this, pharmacies should either schedule second dose appointments at the same time as booking for first doses or schedule the second dose appointment before the patient leaves the pharmacy after receipt of their first dose.

However, to ensure patients can receive the vaccine at a time and place that is convenient for them, Ontarians eligible for an accelerated second dose may choose to return to the same site or channel where they received their first dose for their second dose appointment or may choose to book an appointment at a different site or channel including through pharmacies. Pharmacy professionals should follow the provincial guidance when it comes to scheduling second dose appointments and try to accommodate patients who may have gotten their first dose elsewhere where possible. Pharmacies booking second dose appointments for patients who did not receive their first dose at the same location should remind individuals to cancel any pre-booked second dose appointments at other locations if applicable.

No. As long as the patient meets the eligibility criteria as outlined in the EO notice, no other proof of residency is required. Patients who do not have Ontario health cards must bring in an alternate form of valid government-issued identification or one of the following acceptable forms of identification which includes their name and date of birth, such as:

• Birth Certificate
• Employee ID
• First Nations ID
• Passport
• MRN (Medical Record Number)
• Out of Province ID
• Driver’s License

Pharmacy professionals are still required to document the vaccine administration information for individuals who do not have Ontario health cards in COVax_ON along with the alternate form of identification. Please note that for billing purposes, the proxy ID should be used for the claim submission to the HNS and not the other forms of identification.

No. The proxy ID should only be used in cases where a patient does not have an Ontario health card number. Patients with an Ontario health card number are required to provide this to the pharmacy so that a claim for reimbursement through the HNS can be submitted.

No. As per the Moderna COVID-19 vaccine product monograph, Moderna is only indicated for use in individuals 18 years of age and older. The safety and efficacy in individuals under 18 years of age has not yet been established. Therefore, individuals must be 18 years of age or older at the time of vaccination in order to receive the Moderna COVID-19 vaccine. If a patient is 17 years of age and are turning 18 in 2021, the pharmacist may wish to refer the patient to another location administering Pfizer-BioNTech COVID-19 vaccine where the patient may be eligible if Pfizer-BioNTech is not available at the pharmacy.

No. As per the Pfizer-BioNTech COVID-19 vaccine product monograph, Pfizer-BioNTech is only indicated for use in individuals 12 years of age and older. The safety and efficacy in individuals under 12 years of age has not yet been established. Therefore, individuals must be 12 years of age or older at the time of vaccination in order to receive the Pfizer-BioNTech COVID-19 vaccine. Studies are currently being conducted to further evaluate the safety, tolerability and immunogenicity of the Pfizer-BioNTech COVID-19 vaccine in children 6 months to 11 years of age with results expected in the second half of 2021.

Any patient who meets the eligibility criteria as outlined in the Executive Officer Notice titled “Administration of the Publicly Funded COVID-19 Vaccines in Ontario Pharmacies – Eligibility” are eligible to receive COVID-19 vaccine through participating pharmacies. There is no requirement for pharmacies to validate the address of a patient to determine eligibility. However, please note that on March 14, 2021, the Ministry had indicated that it is expected that pharmacies would be focusing on vaccinating their own patients and local community. Pharmacies should use their judgement to support providing vaccinations to those within their region.

To help guide the scheduling of vaccine appointments, pharmacy professionals should use their professional judgement to determine patient priority taking into consideration various factors including but not limited to:

• NACI’s updated recommendation on extended dose intervals that based on the increase of COVID-19 vaccine supply in Canada, second doses should be offered as soon as possible, with priority given to those at highest risk of severe illness and death from COVID-19 disease after or concurrent with first doses for all remaining eligible populations.
• Provincial guidance on second dose eligibility
• Patient specific factors (e.g., individual risk factors, residents of Delta hot spot areas, etc.)

Pharmacy professionals who encounter patients who received COVID-19 vaccinations outside of Ontario/Canada should refer to the COVID-19 Guidance for Individuals Vaccinated outside of Ontario/Canada document which provides approaches to be undertaken by healthcare providers in various scenarios. In these situations, proof of immunization is required to verify the COVID-19 vaccine product received outside of Canada or Ontario. Second doses for all individuals who received a first COVID-19 vaccine dose outside of Canada or Ontario should still follow the intervals recommended by Ontario. Although no data are available on the safety or efficacy of receiving a COVID-19 vaccine currently authorized in Canada after receipt of a non-Health Canada authorized COVID-19 vaccine, in some circumstances people who received a COVID-19 vaccine not currently authorized by Health Canada may be offered revaccination with a Health Canada authorized vaccine.

It is important to note that individuals who have received a partial or complete COVID-19 vaccine series outside of Ontario or Canada should contact their local public health unit (PHU) to have their COVID-19 immunization record documented into COVax_ON. Historical first doses must be entered by the PHU into COVax_ON prior to booking a second dose appointment. OPA will update members if the guidance changes and pharmacies are provided the authority to document non-Ontario stock and out of province historical doses in COVax_ON.

Although in recent days pharmacies may have seen a decrease in the demand for COVID-19 vaccinations as compared to previous weeks, it is important that the momentum from the vaccine rollout is carried forward to ensure that all eligible Ontarians receive their first and second doses. In addition to individuals who may be vaccine hesitant to receiving any COVID-19 vaccine, in recent days there have also been many reports of Moderna vaccine hesitancy amongst patients. As one of the most trusted healthcare providers, pharmacy professionals have an important role to play in assisting the efforts to reach this unvaccinated/partially vaccinated population to provide education to address vaccine hesitancy. Some methods that could be used to increase vaccine uptake include:

• Checking the patient’s vaccination status when they receive other pharmacy services (e.g., filling a prescription, OTC consultation or during a medication review). This can be done by either asking patients whether they have received both doses of their COVID-19 vaccination and/or by checking the patient’s vaccination status using one of Ontario’s Clinical Viewers (if available).
• Generating a list from COVax_ONusing the Client Dose Admin Reports of patients who received their first dose of COVID-19 vaccine at the pharmacy location and who have not yet received their second dose, and actively contacting these patients to invite them to visit the pharmacy for their second dose.
• Utilizing the pharmacy’s website or social media to promote vaccination.
• Offering to provide education about COVID-19 vaccines and address vaccine hesitancy with patients and those in the community.
• Sending a general communication to patients on the pharmacy’s mailing list (if available) to encourage patients to contact the pharmacy about booking a COVID-19 vaccine appointment.
• Contacting other healthcare providers to identify opportunities for collaboration (e.g., primary care providers who can identify and refer patients who require vaccination to the pharmacy).
• Offering to conduct home visits (if possible) to administer COVID-19 vaccines to patients who may be homebound due to immobility.
• Holding a youth-specific clinic day for vaccine administration to encourage all eligible youth to be vaccinated before school starts in September.
• Working with local PHUs to address and support regional needs and strategies.

Furthermore, to address vaccine hesitancy, it is imperative that credible and accurate resources and tools are utilized to support discussions with patients. Some examples of resources include:

• Ontario Ministry of Health’s COVID-19 Vaccine-Relevant Information and Planning Resources(examples include About COVID-19 Vaccines, COVID-19 Vaccine Approval Process and Safety, Q&A for Health Care Providers on Mixed (Heterologous) COVID-19 Vaccine Schedules, COVID-19 Vaccine Information for Individuals who received a first dose of the AstraZeneca/COVISHIELD COVID-19 vaccine and other resources related to vaccine hesitancy)
• NACI’s Recommendations on the use of COVID-19 Vaccines

Centre for Effective Practice’s COVID-19 Resources (including one on Building confidence in Moderna: A guide for primary care providers using the PrOTCT framework)

Pharmacy professionals may be receiving inquiries from patients with respect to receiving additional doses of COVID-19 vaccine so that they can get two doses of the same vaccine, in cases where two different vaccines were used for their first and second doses, or where they received two doses of AstraZeneca COVID-19 vaccine and are concerned about their vaccination status for international travel. Currently, the Canadian government defines fully vaccinated as any individual who has received the full series of a vaccine, or a combination of vaccines accepted by the Government of Canada (Pfizer, Moderna, AstraZeneca, Janssen) and their last dose was received at least 14 days prior. Mixing of mRNA vaccines as well as mixing AstraZeneca and an mRNA vaccine is safe, effective and enables more Ontarians to receive their second dose sooner. Ontario continues to follow the advice of the National Advisory Committee on Immunization (NACI) which recommends that it is safe to mix these vaccines based on studies from the UK, Spain and Germany which have found that mixing vaccines is safe and produces a strong immune response. At this time, no guidance is available with respect to providing additional COVID-19 vaccine doses to patients who are fully immunized. The province will continue to monitor the data working with Health Canada, NACI and the federal government and the provincial and federal governments are working with the World Health Organization (WHO) and other countries to ensure that patients who received AstraZeneca COVID-19 vaccines as well as those who received mixed COVID-19 vaccines will have their immunization status recognized internationally. As more information becomes available, OPA will update members accordingly.