Facing a shortage of pharmacists, drugstores nationwide are urging people to make appointments for COVID-19 shots rather than walking up — even as the Biden administration promotes vaccination as the key to ending the pandemic and relies on pharmacies as the main supplier. 

Between flu season and the rush for COVID-19 vaccines, both neighborhood and chain pharmacies in some places are experiencing a crush of demand. A tight labor market could pose an extra obstacle to vaccination as infections tick up.

Husein Ghrouf, a 31-year-old pharmacist, said he was working more than 80 hours per week at his CVS store in New York City before he quit in October because of burnout. 

“Right now, all the pharmacies are rejecting people that are walking in for the booster and telling them to make an appointment. Before, it was never really like that,” Ghrouf said. “But right now it is, because we don’t have the extra help. … What they’re doing is just putting that workload on regular staff.”

The demands are so great that Ghrouf pushed a regional executive visiting his store to give pharmacists lunch and bathroom breaks. 

“It’s so overwhelming, the amount of work and not having any help, that I don’t even get to use the restroom,” he said. 

CVS, which recently announced it would close about 10 percent of stores, plans to hire 20,000 more people, including some pharmacists or pharmacy technicians, Mike DeAngelis, the company’s senior director of corporate communications, said in a statement to CQ Roll Call. 

DeAngelis said CVS is also rolling out more consistent breaks. 

“While our pharmacists have always had the ability to take breaks, we’ve begun the process of adding a prescheduled daily break time to create a predictable and consistent daily pause,” DeAngelis said. 

Appointments create barriers

While appointments help keep things organized amid the intense workload, they pose an extra obstacle to boosters, the Biden administration’s primary tool to keep the omicron variant at bay.

“Anytime there’s a barrier, and that barrier could be geography, or going on to the website repeatedly and not being able to get an appointment … it does prevent someone from getting a booster right away, but it also may discourage them,” said Jen Kates, senior vice president at the Kaiser Family Foundation, a nonpartisan think tank.

In Bristol, Conn., Shirley Marsh’s 72-year-old mother was turned away from her COVID-19 booster appointment last week. 

Marsh’s mother, a widow living on her own, thought she had done everything to prepare, doing a dry run drive to the pharmacy the previous day and stocking up on groceries in case she experienced side effects.

But come appointment time, a pharmacist said her name was not properly registered. Although she had her vaccine card in hand from the same location, the pharmacist told her to try again online and come back another day. 

“I would think they would want to do anything they could to avoid turning away somebody who says, ‘I want to be vaccinated,’” Marsh said.

The barriers suggest flexibilities Congress granted in pandemics through emergency legislation known as the PREP Act might not be enough. The Public Readiness and Emergency Preparedness Act allowed pharmacy technicians to administer shots and pharmacists to administer some medications independently of a doctor’s note.

Pharmacies have taken on an even larger role in the vaccine rollout since the Biden administration moved away from mass sites and help from the National Guard and the Federal Emergency Management Agency, which both were deployed recently to assist with the devastation from tornadoes in the South and Midwest. 

The National Association of Chain Drug Stores, which represents national chain pharmacies, including CVS, estimates that 2 out of every 3 shots happen in a pharmacy.

The group acknowledged the labor concerns.

“We’re in the middle of a global pandemic,” said Sara Roszak, NACDS senior vice president. “Demand is at historic levels.”

And 70 percent of pharmacists are struggling to fill staff positions, according to a November National Community Pharmacists Association survey.

Ghrouf attributes the pharmacist shortage to what he sees as low pay —  he said he got a 1 percent raise and two $300 bonuses during the pandemic — and burnout. Many of his friends or former colleagues sought medical leave or simply left pharmacies altogether because of exhaustion.

“They put the workload on us without really sharing the profits in terms of extra help,” Ghrouf said.

The stress on pharmacists can have a real impact on individuals and the national vaccination rate. 

“They need to match the resources with the need,” Marsh said. “You can’t just push a message of: ‘Get boosted. It’s super important’  . . .  and then be turning people away.”

Pharmacies’ perspective

The challenges in some areas mirror snags in the early vaccination push, when shots were scarce. But now vaccine supply is ample.

About 25 percent to 75 percent of appointments are available at big box pharmacies across the country, according to the NACDS. But that varies widely from community to community, and waits appear increasingly common. 

At most independent pharmacies, it takes a week or two to get a vaccine appointment, explained Kurt Proctor, the National Community Pharmacists Association’s senior vice president of strategic initiatives. 

The Biden administration is encouraging Americans to get boosted as soon as possible, and public health experts are urging unvaccinated people to practically run to get a shot. As of Monday, 28 percent of the U.S. population remained unvaccinated and only 26.6 percent of all adults had received a booster shot.

Tana Kaefer, a pharmacist in Richmond, Va., said appointments help her small, locally owned pharmacy not waste vaccine supply, as each vial contains a certain number of doses. 

“People walking in all the time … that leads to burnout real fast,” she said. 

That wasn’t always the case. Early in the year, when the COVID-19 vaccination effort was new, Kaefer’s pharmacy had ample volunteers to help distribute shots to anyone who walked in off the street. Pharmacists pulled extra hours, and volunteers helped staff waiting rooms and vaccination lines.  

Now it can be difficult to fully staff vaccination clinics.

“In the beginning of the pandemic … everybody was like, ‘We’ve got to vaccinate as many people as possible, and we’re willing to do all of this,’ but now it’s kind of dwindled,” she said.

Underserved communities

The lack of walk-in appointments hits underserved communities especially hard. Minority communities that already have low vaccination rates are falling even further behind.

Many of the vaccination sites that the Biden administration stood up in underserved communities at the beginning of the vaccination effort have since shut down. Pharmacies that extended hours to vaccinate their communities have tried to restore normal hours. 

“It’s become very challenging for a lot of folks in minority communities to be able to find the time and find the access to be able to go and get their shots,” said physician Alice Chen, a senior adviser to Made to Save, an organization that helps increase access to COVID-19 vaccines.

To fill in the gaps, groups like Made to Save or the Black Equity Coalition began launching weekend pop-up vaccination sites in communities where fewer people may have received the shot.

For example, Made to Save is working with Proyecto Vida Digna, a Texas organization, that is hosting a Christmas event with COVID-19 vaccinations, immigration services and holiday games. The Black Equity Coalition is hosting “shots at the shop” events at Pittsburgh barbershops.

Events that pair information with vaccine opportunities are becoming more common.

“We are feeling amazed by some of the gaps we’re seeing,” said Black Equity Coalition consultant Ayanna King. “That’s part of the reason why we’re so busy right now.”