In the wake of COVID-19 and its new Delta variant, vaccination needs to be emphasized now more than ever — but an alarming number of individuals still are not fully vaccinated. Throughout the country, over 55% of Americans have received their first round of the Pfizer or Moderna shot, but only 45% have received their second. In some states, these rates are even lower, which creates serious setbacks that slow down the nation’s recovery process. As second shot non-compliance persists, community pharmacies must continue to prevent the spread, protect their communities, and fill in the gaps of vaccinations.

Second Shot Non-Compliance: The Case of Pennsylvania

There are many reasons why patients may choose to get the first round of the COVID-19 vaccine and forego the second. Whether it be adverse reactions to the initial shot, problems with access, or general skepticism, some patients may never complete their vaccines — no matter how much providers step in. When a large number of patients fail to complete their vaccine, though, it becomes an issue that deserves attention and calls for greater intervention. Case in point: Pennsylvania.

As of July 2021, an estimated 73% of residents in Pennsylvania ages 12 years or older — 8.15 million people — have received at least one dose of the vaccine, one of the highest rates in the nation. Of those vaccinated, though, only 6.5 million are reported to have received round two; the other 1.66 million have not (although Pennsylvania tracking measures have historically been inaccurate, making the exact numbers unclear).

Despite some uncertainty surrounding the exact numbers, it is still clear overall that many Pennsylvanians aren’t getting their second vaccine: an estimated 1 in 5 people, to be exact. This means that over one million people in the state (not including those who are completely unvaccinated) are at risk of contracting COVID-19, spreading it to others, and experiencing serious threats. This is particularly concerning when considering growing concerns about the Delta variant.

The Risks of the “Superspreader Strain”

The new strain of COVID-19, commonly known as the Delta variant, is more contagious and less responsive to treatment than previous strains of the virus. In fact, Eric Topol, executive vice president and professor of molecular medicine at Scripps Research Institution, calls the Delta variant “the most hypertransmissible, contagious version of the virus we’ve seen to date — it’s a superspreader strain if there ever was one.”

To put its transmission rate into perspective, new reports from the CDC show that 51% of new cases of COVID-19 are connected to the Delta variant. An even bigger concern, though, is that people who have received only one dose of the vaccine are at a much higher risk of contracting this strain, compared to their fully vaccinated counterparts.

Before the Delta variant, Moderna and Pfizer vaccines were 82% effective against COVID-19 with a single dose and 94% effective with two doses. However, with the new strain of the virus, one round of the Pfizer vaccine is only 33% effective. Two doses are 88% effective. This means that there is a 55% deficit in vaccine effectiveness from one shot compared to two. With numbers like this, which threaten to spread the virus even further, it becomes clear why states like Pennsylvania are facing a crisis.

The Role of Community Pharmacy: Eric’s Rx Shoppe 

Throughout the pandemic, community pharmacies have worked to test, treat, and support COVID-19 patients. With the rise of the Delta variant, they must continue to step up to improve second shot compliance rates and achieve the goal of herd immunity. Already, local independent pharmacies across Pennsylvania and throughout the nation are doing their part to improve vaccination rates.

A shining example of community pharmacy’s effectiveness — and its value — in achieving full vaccination is Eric’s Rx Shoppe in Horsham, Pennsylvania. While chain pharmacies throughout the state have lagged behind in vaccinating residents, co-owner Marc Ost has worked with his team at Eric’s Rx Shoppe to reach an almost perfect vaccine compliance rate.

Since January 1, 2021, using both the Pfizer and Moderna vaccines, Eric’s Rx Shoppe has achieved nearly 96% compliance — meaning that patients received both their first and second doses of the vaccine at the pharmacy (note: this compliance rate does not consider patients who may have gotten their second dose elsewhere, so the actual rate is likely even higher).

The Secret to Compliance

The secret to achieving better second shot compliance? Marc explains, “There are several things that we’ve done to get to where we are. The first piece of the equation is that we’ve set up a separate space in our shopping center, an office with three private rooms, specifically for vaccines. We’ve also brought in an additional six people to help our staff with vaccines. They’ve done an amazing job in getting everything done from answering phones to scheduling to billing, you name it.”

Marc’s team has also relied on administrative measures — like booking and billing systems — to vaccinate more patients and provide consistent follow-up. In terms of booking, Marc and his team developed a system that allowed patients to schedule their appointments for the first and second rounds of the vaccine at the same time. The ability to book in advance has increased the likelihood that patients return for their second shot.

For billing, the team has been able to streamline vaccine information with the help of their PioneerRx pharmacy software. Using the Bulk Patient Process feature, which was specifically designed in response to COVID-19 vaccination, they have been able to complete the necessary documentation and send it off in record time. “Because PioneerRx can integrate with SIIS and we can use the Bulk Upload feature, it’s been a million times easier to do everything. Because of it, we have been able to keep up with every client we’ve seen. The vaccines are all typed in PioneerRx and uploaded to SIIS within 24 hours of administration,” Marc explains, demonstrating the importance of workflow enhancements in a pharmacy software system.

Considering all of their efforts, Marc reveals that the number-one secret to high compliance is simply accommodating patients. He explains, “When it comes time for patients to get their second dose, we always try to accommodate them. Our thought process is, ‘If everything doesn’t go as planned, what do we do? How do we follow up and make sure patients get the second dose? Are we able to go to their house? Are we able to have them in-store?’” 

Part of accommodation means going to where patients are and increasing outreaches. Marc says that throughout the pandemic, especially in the beginning, “We would go out to local businesses, out to schools. We started with the high schools, with students 16 and up, and then eventually went to the middle schools… and had a very high completion rate. We also teamed up with some local politicians as well and did events. All of those events were for people who wouldn’t have gotten vaccinated otherwise. Because of those politicians’ outreach and their follow-up, they were able to get vaccinated.”

For Marc and his team, high compliance is made possible by going the extra mile.

Implications for the Industry

Not only do community pharmacies like Eric’s Rx Shoppe prove their value in addressing second shot compliance, but they demonstrate that they can tackle some of the most important issues in healthcare with knowledge, compassion, and innovation. 

Marc reports, “One of the bright spots of the pandemic has been independent pharmacies’ ability to not only adapt to new situations, but to take on new challenges and to reach more patients. Now, we have so many opportunities to increase the capacity of what a pharmacist is able to do.”


Of these opportunities, one of the most important is for independents to advocate for industry recognition and fair reimbursements from PBMs, Medicare, and third-party payers. If community pharmacy is to continue to lead the way in addressing pressing issues, improving critical numbers, and lowering community risks, they must receive the recognition and the reimbursements they deserve. It takes a community of leaders and innovators working together towards a common goal. It’s not just Eric’s Rx Shoppe or just PioneerRx - it’s Independent Pharmacy as a whole.

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