Some London pharmacies have said that they are ‘paying out of our own pocket’ to deliver the polio vaccination programme because of the increased time needed to vaccinate children.

Alongside other healthcare providers, pharmacies are offering polio vaccinations to eligible children aged one to nine, after signs of the virus spreading within London were confirmed in August.

However, some pharmacists offering the service have reported logistical issues, while others have pointed out they are receiving no increase fee or extra resources to carry out the programme.

The UK Health Security Agency (UKHSA) said that traces of the virus were detected in sewage in North and East London between February and July, suggesting some level of virus transmission. Of these, most were classified as a vaccine-like virus, but a few had sufficient mutations to be classified as vaccine derived poliovirus (VDPV2), which could, on rare occasions, lead to cases of paralysis in unvaccinated individuals. No patient has yet been diagnosed with polio.

All children aged between one and nine in Greater London were then offered a polio booster vaccine by 26 September, beginning in areas in North and East London, where the virus was detected.  Pharmacies receive the standard £10.06 Item of Service fee per vaccine.

Huge demand for the booster

Demand for the polio booster has been much more than expected, said Hassan Khan, CEO of Cullimore Chemist in North London, which has been delivering the service during September.

On the Saturday the walk-in service opened, he said the pharmacy had queues of over 100 parents waiting outside with their children and had to turn some away due to not having sufficient vaccine stock. Since then, ‘it has been near impossible to offer a walk-in service’, he commented.

It’s a similar story across London: Peter’s Chemist, in South-East London, is fully booked for the next four weeks of its after-school and Saturday clinics, while Valley Pharmacy, in South London, vaccinates over 100 children per session at its vaccine centre in a hired church hall.

Cullimore Chemist had already used up its initial order of 200 doses within the first week and doubled the order for the following week. Now in its third week, Mr Khan has ordered 600 doses and expects that these will all be used. ‘I don’t think any pharmacy anticipated how much demand there would be,’ he said.

The unexpectedly high demand has left no room for supply issues – when a delivery of vaccines was delivered a day late, Mr Khan said he had to cancel his afternoon’s appointments until the following day when they were able to restock.

Logistical challenges

Other contractors in the capital have also experienced some logistical challenges in delivering the service.

Sachin Patel, managing director at Lincoln Pharmacy in East London, said that his pharmacy was initially only able to order one strain of the vaccine, suitable only for children whose three primary doses and pre-school booster were up to date.

‘Not many people fit into that category,’ he told The Pharmacist. ‘So, if they're not vetted before they book an appointment or come to us because we're advertising that we're doing the polio, then we’re wasting our time wasting their time saying “Sorry, we don't have that vaccine; you're going to have to find somewhere else”. When from the start, we should have had access to all three [types] of those vaccines.’

Sachin Patel’s pharmacy now has access to all three types of the vaccine and is able to vaccinate children aged one year and above.

Vaccinating children

The polio vaccination is being offered to children in London aged 1 to 9 – and working with such a young age group comes with its challenges.

Shingo Kurimoto, pharmacy manager at Peter’s Chemist in South-East London, said that he was used to giving travel vaccinations and Covid jabs to children – and has a consultation room filled with distractions like Peppa Pig videos playing in the background.

Mr Kurimoto said that providing the vaccines to was very rewarding. ‘I love my job, I've been really lucky in that way,’ he said. ‘I'm really happy that we can offer this this year.’

He added: ‘We're healthcare professionals. We're on the front line and we can help protect the community. And that's what we trained to do.’

Similarly, Valley Pharmacy in South London set up a table with colouring and activities for children to do while they waited. ‘A lot of children actually say “we want to come back” because they have a good time, and it's a good experience with us,’ said pharmacist Ketan Patel.

He acknowledged that the process for pharmacies was ‘more involved’ when it came to vaccinating children, and that appointments were spaced to allow enough time.

‘It's something that we do plan for, so we make sure that we have enough resources,’ he said. 'We make sure that we only release enough capacity to make it comfortable.’

Funding the service

Both pharmacists and GPs have raised concerns about the resourcing of the service, with the London LCM warning that it would require ‘significant additional time’ to identify and potentially contact patients, as well as additional clinical staff and premises capacity to administer the jabs.

‘Obviously, there's no increase in fees, or just help with workforce, for this,’ explains Sachin Patel of Lincoln Pharmacy.

He is employing extra staff to deliver the vaccinations, including nurses and trained vaccinators as well as a prescriber who must be present to sign off the vaccine under a patient specific direction (PSD), as the polio vaccination programme is not a national scheme.

In North London, Cullimore Chemist have employed additional administrative staff to manage an email-based booking system, since there is no centralised NHS booking system. They are also working with around 100 volunteers to deliver both the polio and Covid vaccinations.

‘On the whole, I think people appreciate that we’re doing so much. Not many pharmacies are doing polio because it’s not really well funded,’ said Mr Khan.

‘Vaccinating a child can take up to half an hour, but the cost of delivering the vaccine is around £10. It’s not worth the nurses’ time,’ he said.

‘Yet we have to do it for the good of the cause,’ he added. ‘Everyone should be proud as a community of how this has been pulled together.’

Sachin Patel agreed. ‘We'll be doing this at a loss,’ he said. ‘But obviously, this is something that we find very important, especially in Tower Hamlets. And we know that we can hit the targets and do our best here at Lincoln Pharmacy. But we really, really hope that there is some support to help us keep going.’

A spokesperson for the NHS in London commented: ‘Children in London aged one to nine can get their booster or catch-up dose of the polio vaccine via a range of options, including GP practices and community pharmacies while 40 vaccination sites – available to all five to nine year olds – have been rapidly mobilised helping to accelerate the immunisation drive.

‘The NHS has contacted all parents in London with children eligible and we encourage them to take up the offer as soon as possible.’