AVAILABILITY AND STORAGE OF VACCINES IN COMMUNITY PHARMACIES

1.1 Introduction

Immunization is the process by which an individual's immune system becomes fortified against an agent (known as the immunogen). When this system is exposed to molecules that are foreign to the body, called non-self, it will orchestrate an immune response, and it will also develop the ability to quickly respond to a subsequent encounter because of immunological memory. This is a function of the adaptive immune system. Therefore, by exposing an animal to an immunogen in a controlled way, its body can learn to protect itself; this is called active immunization (Okwor, et al., 2012)

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

1.2 Background of Study

Immunization is an important means of controlling serious infectious diseases, and careful attention to vaccine storage is essential to ensure optimal vaccine effectiveness. The cold chain still remains a highly vulnerable element of any immunization programme, both in developing and in developed countries. Vaccine manufacturers recommend storage conditions for their vaccines and clearly state that they do not guarantee the potency of the vaccines if they have not been stored at the correct temperature.

The most important elements of the immune system that are improved by immunization are the T cells, B cells, and the antibodies B cells produce. Memory B cells and memory T cells are responsible for a swift response to a second encounter with a foreign molecule. Passive immunization is direct introduction of these elements into the body, instead of production of these elements by the body itself. Immunization is done through various techniques, most commonly vaccination. Vaccines against microorganisms that cause diseases can prepare the body's immune system, thus helping to fight or prevent an infection.

The fact that mutations can cause cancercells to produce proteins or other molecules that are known to the body forms the theoretical basis for therapeutic cancer vaccines. Other molecules can be used for immunization as well, for example in experimental vaccines against nicotine (NicVAX) or the hormone ghrelin in experiments to create an obesity vaccine. Immunizations are definitely less risky and an easier way to become immune to a particular disease by risking a milder form of the disease itself. They are important for both adults and children in that they can protect us from the many diseases out there.

Through the use of immunizations, some infections and diseases have almost completely been eradicated throughout the United States and the World. One example is polio. Thanks to dedicated health care professionals and the parents of children who vaccinated on schedule, polio has been eliminated in the U.S. since 1979 (American Pharmaceutical Association (Apha, 2013). Polio is still found in other parts of the world so certain people could still be at risk of getting it. This includes those people who have never had the vaccine, those who didn't receive all doses of the vaccine, or those traveling to areas of the world where polio is still prevalent.

Immunization is the most precious gift that a health care worker can give a child and it remains the most cost effective preventative health intervention presently known (South Africa, 2003; Cameroun, 2009). Vaccines are sensitive biological substances that gradually lose their potency with time (World Health Organization (WHO, 1998) and this loss of potency can be accelerated when stored out of the recommended range of temperature (WHO, 2004). Any loss of potency in a vaccine is permanent and irreversible. Consequently, a proper storage of vaccines at the recommended temperature conditions is vital so that vaccines' potency is retained up to the moment of administration (WHO, 1998).

Before the development and wide use of human vaccines, few people survived childhood without experiencing a litany of diseases including measles, mumps, rubella, chickenpox, whooping cough, and rotavirus diarrhea. In addition to these universal diseases of childhood, thousands of children each year suffered or succumbed to life threatening episodes of paralytic poliomyelitis, diphtheria, or bacterial meningitis caused by Haemophilus influenza type b (Hib) or Streptococcus pneumonia (Sutter, et al., 1999).

Vaccines are considered to be one of the most cost-effective preventive measures against certain diseases, and the Centers for Disease Control and Prevention (CDC) declared vaccinations to be one of the top 10 public health achievements of the 20th century (WHO, 1998), vaccinations have saved millions of lives since their introduction more than 200 years ago (WHO, 2004).

Community pharmacists are uniquely placed to provide support and advice to the general public compared with other health care professionals. The combination of location and accessibility means that most consumers have ready access to a pharmacy where health professional advice is available on demand (Bradshaw et al., 1998). A high level of public trust and confidence in pharmacists' ability to advice on non-prescription medicines is afforded to community pharmacists (Pharmacy Research UK., 2009). Although there is a general global move to liberalize non-prescription markets, pharmacies in many countries still are the main suppliers of non-prescription medicines (Tisman, 2010). Pharmacists are therefore in a position to facilitate consumer self-care and self-medication, which needs to be built on and exploited.

A recent survey of public health leaders (Rambhia, et al., 2009) identified pharmacists as playing a key role in vaccine administration and pandemic planning. Evidence in published medical literature suggests that pharmacies are uniquely positioned to influence previously difficult-to-reach populations (Crawford, et al., 2011; Westrick, 2010). A review of pharmacy-led immunization programs (Francis and Hinchliffe, 2011) concluded that pharmacies might be especially effective in immunizing high-risk, older adults who are more likely to need prescription medications and, therefore, use pharmacy services. Pharmacist interventions have been shown to improve medication adherence (Jiang, et al., 2010), provide increased access to health care expertise and advice, and perform a variety of primary care services (Taitel, et al., 2011).

Rutter, (2015) in his submission noted that the pharmacy has a long history of facilitating self-care, however, more than ever before, pharmacists and their staffs are being provided opportunities to expand their contributions which include involvement in routine immunization. Although considerable barriers still existif the community pharmacy is to maximize its potential there is urgent need to ask about pharmacists' ability and readiness to embrace change especially as it relates to vaccine storage (Rutter, 2015).

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Availability and Storage of Vaccines in Community Pharmacies.

1.3 Statement of Problems

More than 40,000 to 50,000 adult and child death could have been prevented annually in Nigeria if there was a successful routine immunization for certain preventable diseases of which include measles, herpes zoster, tetanus and a host of others (Abdhuraheem, et al., 2011). The federal government and donor agencies make so much effort and spend close to 50 billion dollars annually in the supply chain of vaccines but when these monies are spent and the purpose for which they are spent are not achieved due to a reduced potency of such vaccines or due to inadequate manpower for vaccine delivery to the target population.It can be said to be an investment in futility.

The underutilization of these widely available vaccines has created an opportunity for pharmacists to play a role in improving immunization rates and thus advancing public health. Community pharmacy-based vaccination services will go a long way to increasing the number of immunization providers and the number of sites where patients can receive immunizations. It is thus important to understand the current role of community pharmacy-based immunization in Delta state as well as to assess the level of availability of such vaccines in community pharmacies and the storage mechanisms and facilities available to them to ensure that the cold chain vaccine delivery process is maintained.

1.4 Aim and Objectives of Study

The aim of the study is to assess the Availability and Storage of Vaccines in Community Pharmacies. In achieving this aim, the following specific objectives were laid out as follows:

1. To determine the availability of childhood vaccines in Community pharmacies.
2. To determine the availability of adult vaccines in Community pharmacies.
3. To determine availability and adequacy of vaccine storage facilities in Community pharmacies
4. To explore variables that affect vaccine availability and storage in Delta state.
5. To explore variables that affect the involvement of community pharmacists in routine vaccination in Delta State.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Are childhood vaccines available in Community pharmacies?
• Are adult vaccines available in Community pharmacies?
• Are vaccine storage facilities available and adequate in Community pharmacies?
• Are there challenges facing community pharmacies with regards to vaccine storage?
• What is the association between Demographic variables and Pharmacists' Involvement?
• What are the variables that affect vaccine availability and storage in Delta state?
• What are the variables that affect the involvement of community pharmacists in routine vaccination in Delta State?