Let’s Talk Yellow Fever
Let’s talk Yellow Fever – why should you offer this in your pharmacy as part of your travel vaccination service?
Offering the yellow fever vaccine from a pharmacy turns your travel clinic in to a one-stop shop. There are many benefits to offering this vaccination – for both you professionally, and for your patient – but it also offers the possibility of increased revenue.
I am very fortunate to have found a job I love – working as a community pharmacist has brought me an incredible amount of joy. I get great job satisfaction on an almost daily (!) basis, and I really feel like I’ve found my niche with offering travel health services. There is an added bonus too – it keeps the boss happy. Offering travel vaccinations has seen my OTC sales soar, and has made a huge difference to the profit for my branch.
Being able to offer services to the general public makes healthcare and advice accessible – something we should all strive to achieve in a community setting. But why should a patient come to me over the pharmacy in the shopping centre? They have easy parking, good coffee next door, and a supermarket opposite for the weekly shop. Only thing is – they don’t offer the yellow fever vaccine, which would mean having to find somewhere else to obtain this vaccination. Why would you visit two pharmacies through choice to get yourself vaccinated? Answer is, you wouldn’t. Offering yellow fever makes your pharmacy stand out from the rest and encourages patients to visit you for all their travel health needs.
Often, patients book in thinking they need yellow fever when they don’t – but once you’ve made that initial impression and they’ve seen your services, they’re unlikely to go elsewhere.
The Maldives. A popular destination at the moment for holidays. You need a yellow fever vaccine IF you have travelled through or stopped at an airport for more than 12 hours, in a country with risk of yellow fever transmission. E.g. Manchester > Ethiopia > Maldives. This is a highly unlikely travel route, but this would necessitate a yellow fever vaccine depending on time spent in Ethiopia. The guidance on this is readily available, but on first reading it’s quite difficult to understand, especially if you’re feeling a little overwhelmed with information. For the Maldives, it reads ‘There is no risk of yellow fever in this country, however, there is a certificate requirement’ (Travel Health Pro). The guidance goes on to explain the transit information detailed above, but patient’s stop reading here, and panic.
So, what does the patient do? Searches the nearest pharmacy that offers Yellow Fever and books an appointment. This pharmacy needs to be you. Regardless of whether they need it, you’ve attracted their custom because you can offer what they (potentially) need. In the last 6 months this has happened to me 4 times. None of the patients needed yellow fever, but I supplied all their other vaccines, and in some cases malaria tablets – to a total of over £2500 ringing through my till – they simply came to me because I offered the vaccine they thought they needed.
Looking at trends of destinations is a good way to validate your decision to offer the yellow fever vaccine. Cheaper beach resorts are on the up – especially Gambia – and so this alone is a great reason to be able to offer this vaccination. The cost of applying for your yellow fever centre accreditation should be made back after 5 vaccinations if you’re priced competitively.
However, there are a few considerations attached to offering the yellow fever vaccine. All locations who vaccinate are registered specifically with NaTHNaC who allocate a yellow fever vaccination centre (YFVC) number. You need this to be able to give the vaccine, and order your stock, as it validates the documentation you must provide to the patient. When you’ve administered the vaccine, you must provide the patient with an International Certificate of Vaccination or Prophylaxis (ICVP). This is the proof they must carry and show at customs in certain countries to gain entry. The ICVP needs to be completed in a specific way – more on this in my top tips below.
As the yellow fever vaccine is a live vaccine, the administering professional must have completed specific training with NaTHNaC, passed an assessment, and be comfortable and competent in subcutaneous injection technique. Once you’ve registered with NaTHNaC as a YFVC, you have made a commitment to offer the vaccine, and you’re therefore expected to fulfil this (although it is a reversible decision).
As the YF vaccine is a live vaccine, there are increased risks following administration. The potential side effects are very rare, but in some cases fatal – so having the knowledge and the skill to inform your patient and complete a safe risk assessment is key.
All the above considered, the benefits far outweigh the risks. You’re providing a service that isn’t offered everywhere, making you stand out from the travel vaccination service crowd. You’re able to protect patients from a deadly disease, and you’re maintaining and improving your professional skills at the same time, with the added bonus of (most probably) vaccinating the patient from all the other nasties they could be in danger of contracting.
The added considerations may push you out side your comfort zone, but surely that’s a good thing? Community pharmacy can at times become monotonous and complacency is a common reason behind errors. Being able to offer something like this gives you a break from the norm and brings variety to your day.
My 3 top tips for offering yellow fever
- Order your vaccines in advance and request extra certificates at the point of ordering. Sometimes they are willing to send 1 or 2 extra certificates in case you make a spelling mistake, or to use as an example to copy from. The certificate you supply is an official document, to be written in a specific way – if it’s wrong it’s not valid – and it’s your fault! Take note of the date requirements – this should be written as 01 JAN 2019 as opposed to 01.01.19.
- Practise writing the certificates – there is a wealth of advice online in the yellow fever zone on the NaTHNaC website (nathnacyfzone.org.uk) – I make sure I use their example each time – and copy the format in detail.
- Mixing the yellow fever vaccine – Stamaril. This is the only vaccine available in the UK. When mixing, try not to expel any air into the mixed solution, as this creates tiny air bubbles which are very difficult to remove. Shaking this vaccine can have the same effect – gently agitate to disperse the powder. I’ve had to dispose of 2 mixed vaccines because of this – a loss of over £65 to my branch.
Valneva vaccine training have excellent videos on how to mix vaccines – and supply a great educational platform you can refer to with ease to refresh your skills.
Offering the yellow fever vaccine will give you the upper hand in travel health – make your branch and your services as attractive as you can. Competition is constantly on the increase, so get in first and make your services too good to miss. Repeat custom is heavily dependent on word of mouth, and you’ll find patients are more than happy to travel to you following a recommendation. Starting your travel service with a full range of vaccines will stand you in good stead for the future – you will hit the ground running.
Written by Siân Humphreys – Community Pharmacist, 6th March 2019