Opinion: Come for an eye exam; leave with an immunization

In California, the professional organizations representing dentists and optometrists are in talks with state officials to expand their job descriptions to include administering vaccines. Oregon has already begun training and certifying dentists to give vaccines. And at least half the states have considered allowing dentists to administer COVID vaccines once they’re widely available, according to the American Association of Dental Boards.

That list is likely to grow, because the U.S. Centers for Medicare & Medicaid Services recommended in October that states consider expanding their list of vaccine providers.

The dentists and optometrists seeking permission to vaccinate patients against COVID-19 and other diseases argue that their help will take some of the pressure off hospitals and doctors’ offices.

This wouldn’t be the first time health professionals other than doctors administered vaccines during a pandemic.

Nursing students, EMTs and midwives in a handful of states were granted temporary and limited authority to administer flu vaccines during the H1N1 swine flu pandemic of 2009-10. Dentists in Massachusetts, Illinois, New York and Minnesota also were temporarily deputized as vaccinators.

Since then, Minnesota and Illinois have adopted laws to allow dentists to give flu shots to adults. And last year, Oregon became the first state to allow dentists to give any vaccine to any patient, whether a child or an adult.

So far, more than 200 dentists and dental students in Oregon have completed the training course offered by the Oregon Health & Science University’s School of Dentistry, with 60 others expected to finish by the end of this month, said Mary Pat Califano, an instructor who helped develop the hands-on part of the training.

Students spend around 10 hours in online classes. They then undergo hands-on training during which they practice injections on a shoulder pad before practicing injecting a partner with saline. They’re taught how to counsel patients about vaccines and avoid injuring patients’ shoulders when giving the shots.

Once dentists pass an exam, they can register with the Oregon Health Authority and begin getting their staff trained to handle vaccines and procuring a fridge to store them.

The goal, Califano said, is not to replace family doctors or primary care physicians, but to supplement them. The federal Agency for Health Research and Quality found that, in 2017, 31.1 million Americans saw a dentist but not a physician.

In California, the state dental association is exploring options for gaining vaccine authority, which would likely require the legislature to step in. This year, California passed a law allowing pharmacists to administer COVID vaccines approved by the U.S. Food and Drug Administration.

Dr. Bill Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University, said these proposals for expanding the vaccine workforce are promising.

Flu vaccines, which are relatively low-risk and simple to administer, would be the perfect candidate to stock in dental and optometric fridges to start.

But Schaffner doesn’t believe dentists and optometrists will play a major role in the COVID immunization effort. It would take too long to pass legislation to expand the scope of practice for every professional who wants it in every state, he said.

And because some COVID vaccines have specific shipping and subzero storing requirements, they will probably be distributed only to specially trained personnel at a small number of locations, he said.

While the California Department of Public Health said the state’s current vaccine infrastructure is sufficient for flu shots and routine immunizations, it is “carefully considering the need to include additional types of immunizers” to get Californians vaccinated against COVID-19, according to a statement from the department.

The California Optometric Association said it is in talks with Gov. Gavin Newsom’s vaccine task force about how to get optometrists into the mix, and it is exploring legislative options as well.

“We can serve the dual role of assisting with vision needs and protecting from COVID,” said David Ardaya, a California optometrist who chairs an association committee that is looking into the issue. “Our whole hope is to assist our nation in regaining its health and in returning to a sense of normal.”

Frank Giardina, an optometrist in Nipomo, Calif., has already gone through a certification program. The 20-hour course is the same one taken by pharmacists who are learning how to give all vaccines.

Giardina pointed to the shingles virus as an example of why optometrists are well suited to give vaccines. The virus can infect the eyes, and even though he’s allowed to treat shingles, he can’t give a vaccine to prevent it.

For now, he’s holding out hope he will get permission to administer vaccines, including for COVID-19. He envisions a world in which a patient comes in for contact lenses and he can offer them a flu or COVID vaccine while they’re there.

“If you’re trying to vaccinate all these people, especially in rural areas,” Giardina said, “you need whoever you can find.”

Rachel Bluth writes for Kaiser Health News. These stories are part of the Solutions Journalism Network, a nonprofit organization dedicated to rigorous reporting about responses to social problems. Read the original story online here.