Community Pharmacist-Administered COVID-19 Vaccinations: A Pilot Customer Survey on Satisfaction and Motivation to Get Vaccinated

Round 1

Reviewer 1 Report

Interesting study aiming to better understand the expectations and satisfaction of COVID-19 vacinees in one Swiss canton.  A well conducted study with interesting results that show the major role that pharmacies can play in respond to pandemics.  A few minor notes:

 

• The questionnaire needs to be translated in English and added to the original version that is already in the supplemental materials.
• The authors need to discuss the possibility that due to the online only option, some older age groups may have not participated.
• Consider re-organizing the results and placing choice of pharmacy first, satisfaction second and motivation third.  This reviewer believes that ordering the results by importance may convey a better message.  The authors correctly discussed that people are already motivated they wanted the vaccines - they went to get vaccinated.

Author Response

 Revision of Manuscript on the external validation of the PAR-Risk
Score
Answers to Reviewers’ Comments
The authors would like to send their gratitude to the reviewers and the editor for taking the time
to review our manuscript.
To ease correspondence, we copied all comments into a table below. The reviewers’ comments
are on the left side; the authors’ answers are on the right side. Indicated pages and lines refer to
the version of the revised manuscript with track changes on.
Answers to Reviewers’ Comments
Page 2 / 2
Reviewer #1

Comment for the author	Authors response to the reviewer
The questionnaire needs to be translated in English and added to the original version that is already in the supplemental materials.	We now gladly provide the translated questionnaire items as a figure note.
The authors need to discuss the possibility that due to the online only option, some older age groups may have not participated.	We thank the reviewer for suggesting this additional and noteworthy limitation. We implemented the following sentence in our limitations section: “Additionally, the survey had to be completed online, which may have prevented older patients from participating.” p8-9, lines 305-306
Consider re-organizing the results and placing choice of pharmacy first, satisfaction second and motivation third. This reviewer believes that ordering the results by importance may convey a better message.	We gladly restructured the results section as proposed by the reviewer. This structure helps in having the important statements of our study first, and we thank the reviewer for proposing it.
The authors correctly discussed that people are already motivated they wanted the vaccines - they went to get vaccinated.	We thank the reviewer for acknowledging our discussion.

Reviewer 2 Report

The manuscript is reasonably well written. However, it is a survey of a limited number of subjects and parameters. The data does not add anything new to the field. So, based on the limited data, I don't think paper qualifies its possible acceptance in vaccines. 

Author Response

 Revision of Manuscript on the external validation of the PAR-Risk
Score
Answers to Reviewers’ Comments
The authors would like to send their gratitude to the reviewers and the editor for taking the time
to review our manuscript.
To ease correspondence, we copied all comments into a table below. The reviewers’ comments
are on the left side; the authors’ answers are on the right side. Indicated pages and lines refer to
the version of the revised manuscript with track changes on.
Answers to Reviewers’ Comments
Page 2 / 3
Reviewer #1

Comment for the author

Authors response to the reviewer

The manuscript is reasonably well written. However, it is a survey of a limited number of subjects and parameters. The data does not add anything new to the field. So, based on the limited data, I don't think paper qualifies its possible acceptance in vaccines.

We thank the reviewer for acknowledging our writing efforts. In this pilot survey, only a limited number of participants were recruited. The data, nevertheless, give insight into the pharmacy clients’ satisfaction, motivation, and reasons for getting vaccinated against SARS-CoV-2. We acknowledged the small sample size in the limitations section of the manuscript and deliberately refrained from making inadequate inferences. To address the reviewers concern, we now provide context for the sample size already in the abstract. The new abstract reads: “In response to the coronavirus disease 2019 (COVID-19) pandemic, Swiss health authorities approved and ordered two mRNA vaccines in 2021. The canton of Zurich was the second in Switzerland to allow community pharmacists to administer the COVID-19 mRNA Vaccine Moderna to the adult population. We aimed to pilot a customer satisfaction questionnaire regarding COVID-19 vaccinations in Zurich pharmacies. Questions focused on satisfaction with different aspects of the service, motivation for getting the vaccination, and reasons for being vaccinated in a pharmacy. Zurich pharmacies administered 68,169 COVID-19 doses until June 2021, and 421 questionnaires were filled. Respondents’ mean age was 43.5 (± 13.2) years, with 42.3% reported being women and 46.1% being men. 98.8% of respondents would have recommended the service to others. High levels of satisfaction were reported concerning pre-vaccination discussion (99.0%), pharmacies’ information level on COVID-19 vaccines (83.6%), general comfort with receiving the vaccination in a pharmacy (99.5%), injection technique (99.3%), and premises used (98.3%). Most respondents (56.6%) would have had the option of another vaccination provider, but the pharmacies were chosen for their opening hours, ease of access, and perceived trust. The availability of pharmacist-administered services may be an important contributor to a successful vaccination programme in Switzerland.” p.1, lines 22-23. We additionally amended our section on the aims of our study to further explain our reasoning. The section now reads: “Previous studies on vaccination in Swiss pharmacies considered well-known vaccines such as influenza and showed high levels of satisfaction and general comfort [11]. This is different for COVID-19, where mRNA vaccines are available and vaccination centres can provide the vaccination. The early rollout of the COVID-19 vaccination programme in community pharmacies of the Swiss canton of Zurich provided an opportunity to assess the service and to conduct a pilot study for a national survey. We aimed to (1) evaluate customer satisfaction with COVID-19 vaccinations in Zurich public pharmacies and (2) gain insights into the motivation to get vaccinated and for choosing a pharmacy as vac-cination site with a pilot questionnaire.” p.2, lines 62-70. We also thank the reviewer for giving us the opportunity to explain our submission to the special issue “COVID-19 Vaccination: Considerations for Public Health and Policy” of Vaccines. Although limited in its sample size, the study may still serve as starting point for health policy considerations and future studies. Customer satisfaction is an important, and adjustable factor regarding vaccination uptake, and the results from our pilot survey portray the small, yet important message of having an easy access to vaccination sites (e.g., through pharmacies).

Answers to Reviewers’ Comments
Page 3 / 3

Reviewer 3 Report

This paper addresses, client satisfaction surveys, for those who received immunisation against COVID-19, at community pharmacies in the Swiss canton of Zürich. The study was based in participating pharmacies, in the Canton of Zurich, where vaccinees were invited to enroll in an online questionnaire assessing their satisfaction covering the procedure, revaccination discussion, pharmacy staff knowledge about the vaccines, the appropriateness of the facility, scheduling, and if they were happy to recommend the pharmacy to others. The reasons governing motivation to receive the vaccine, choosing the pharmacy to obtain the vaccine, and demographic information including level of education of the clients was also collected. The survey also collected information about the acceptability of booster vaccine via a pharmacy, if offered. 

 421 questionnaires were completed, an analysis showed a very high degree of satisfaction with all aspects of the vaccination programme. The main reasons for seeking vaccination, were in reducing the risk to oneself and others, ability to travel, and recommendations from the public health service in Switzerland. Virtually all the applicants would be happy to receive booster vaccine via a pharmacy. 

 This is a useful approach to assess user satisfaction, and reasons for accepting vaccination, against Covid-19 and other types of immunisations.The design, analysis and presentation of results is satisfactory. 

 The main limitation of the study was the potential bias, due to only some pharmacies participating in the study, and only 421 of 68,169 vaccinees participating in the study. This issue is addressed in the discussion and limits the generalisability of the findings. 

  

Comments to authors: 

1. The limitations of the study, inducing potential bias should be included in the abstract; namely what proportion of eligible pharmacies participated, and the proportion of total vaccinees who responded to the survey.
2. The level of satisfaction with the knowledge ability of the pharmacy, and the quality of the pre-vaccine discussion was remarkably high. It would be useful to include an outline of how the pharmacy staff were trained in these aspects, to help others designing similar programs.

Author Response

 Revision of Manuscript on the external validation of the PAR-Risk
Score
Answers to Reviewers’ Comments
The authors would like to send their gratitude to the reviewers and the editor for taking the time
to review our manuscript.
To ease correspondence, we copied all comments into a table below. The reviewers’ comments
are on the left side; the authors’ answers are on the right side. Indicated pages and lines refer to
the version of the revised manuscript with track changes on.
Answers to Reviewers’ Comments
Page 2 / 3
Reviewer #3

Comment for the author	Answer to the reviewer
This is a useful approach to assess user satisfaction, and reasons for accepting vaccination, against Covid-19 and other types of immunisations.The design, analysis and presentation of results is satisfactory.	We thank the reviewer for acknowledging our approach, including study design, data analysis, and presentation.
The main limitation of the study was the potential bias, due to only some pharmacies participating in the study, and only 421 of 68,169 vaccinees participating in the study. This issue is addressed in the discussion and limits the generalisability of the findings.	We thank the reviewer for recognising our section on limitations.
The limitations of the study, inducing potential bias should be included in the abstract; namely what proportion of eligible pharmacies participated, and the proportion of total vaccinees who responded to the survey.	We gladly included an additional sentence in the abstract, providing context for our numbers early in the manuscript. Please note the word count restrictions by the journal (200/200). The abstract now reads: “In response to the coronavirus disease 2019 (COVID-19) pandemic, Swiss health authorities ap-proved and ordered two mRNA vaccines in 2021. The canton of Zurich was the second in Switzerland to allow community pharmacists to administer the COVID-19 mRNA Vaccine Moderna to the adult population. We aimed to pilot a customer satisfaction questionnaire regarding COVID-19 vaccinations in Zurich pharmacies. Questions focused on satisfaction with different aspects of the service, motivation for getting the vaccination, and reasons for being vaccinated in a pharmacy. Zurich pharmacies administered 68,169 COVID-19 doses until June 2021, and 421 questionnaires were filled. Respondents’ mean age was 43.5 (± 13.2) years, with 42.3% reported being women and 46.1% being men. 98.8% of respondents would have recommended the service to others. High levels of satisfaction were reported concerning pre-vaccination discussion (99.0%), pharmacies’ information level on COVID-19 vaccines (83.6%), general comfort with receiving the vaccination in a pharmacy (99.5%), injection technique (99.3%), and premises used (98.3%). Most respondents (56.6%) would have had the option of another vaccination provider, but the pharmacies were chosen for their opening hours, ease of access, and perceived trust. The availability of pharmacist-administered services may be an important contributor to a successful vaccination programme in Switzerland.” p.1, lines 22-23.
The level of satisfaction with the knowledge ability of the pharmacy, and the quality of the pre-vaccine discussion was remarkably high. It would be useful to include an outline of how the pharmacy staff were trained in these aspects, to help others designing similar programs.	We agree with the reviewer that explanations on the specific training of the pharmacies was missing from the manuscript. We now included additional lines in the discussion section, which reads: “The high levels of satisfaction and general comfort (i.e., feeling comfortable) are comparable to results concerning influenza vaccinations [11, 17–19]. During the 2019/2020 influenza season, 99% customers (649 of 651) similarly felt comfortable with Swiss pharmacist administered influenza vaccinations [11]. As for influenza vaccinations, satisfaction also included the element pre-vaccination discussion. This was combined with a satisfaction with the pharmacies’ information level on COVID-19 vaccines. Pre-vaccination discussions and knowledge about the vaccines may be accredited to the extensive vaccination accreditation process for pharmacists (2.5 days of training followed by biennial refresh courses) and the pharmacists’ previous experience of conducting pre-vaccination discussions. In addition, various private course providers were approached by the local and national pharmacists’ associations to offer mandatory online lectures, practical workshops, and follow-up webinars specifically for COVID-vaccinating pharmacy staff. These efforts may contribute to disseminate quality information on COVID-19 vaccines in the population and help uptake of the COVID-19 vaccination.” p.8, lines 262- 275.

Answers to Reviewers’ Comments
Page 3 / 3

Reviewer 4 Report

this is a very interesting paper that aims to target the costumer satisfation on the main pharmacies in Switzerland.

I have just many concerns about the purpose of this paper , if it can fit with the journal vaccine purpose. Is it in line? I would like to address this question to the editor. It seems that this article is more based on the sociological field rather than science.

 

Another my concern is related the discussion. It is very poor on deep reflections.

Author Response

 Revision of Manuscript on the external validation of the PAR-Risk
Score
Answers to Reviewers’ Comments
The authors would like to send their gratitude to the reviewers and the editor for taking the time
to review our manuscript.
To ease correspondence, we copied all comments into a table below. The reviewers’ comments
are on the left side; the authors’ answers are on the right side. Indicated pages and lines refer to
the version of the revised manuscript with track changes on.
Answers to Reviewers’ Comments
Page 2 / 2
Reviewer #4

Comment for the author	Authors response to the reviewer
this is a very interesting paper that aims to target the costumer satisfation on the main pharmacies in Switzerland.	We thank the reviewer for acknowledging the interest in the topic.
I have just many concerns about the purpose of this paper , if it can fit with the journal vaccine purpose. Is it in line? I would like to address this question to the editor. It seems that this article is more based on the sociological field rather than science.	We are convinced that our manuscript is well suited for the special issue “COVID-19 Vaccination: Considerations for Public Health and Policy.” In addition, it fits one of the subject areas of this journal: "regulatory affairs, commercial utilization, policy, safety, epidemiology". The study may serve as starting point for health policy considerations and future studies on pharmacy vaccination efforts. Customer satisfaction is an important, and adjustable factor regarding vaccination uptake, and our results give first and transparent insight into it.
Another my concern is related the discussion. It is very poor on deep reflections.	We thank the reviewer for giving us the opportunity to revise our discussion. Please note that currently there is limited information on COVID-19 vaccinations satisfaction in other settings. We, hence, were only able to compare our results to results from influenza vaccination. We now amended the discussion by including a paragraph with additional reflections, which reads: “This report provides a pilot-tested questionnaire to assess consumer satisfaction with COVID-19 vaccinations in public pharmacies and, if adapted, in other providing settings, readily available for translation to other languages (Figure S1). The report also provides first information into satisfaction, motivation to get vaccinated, and for choosing a pharmacy as vaccination site during a period with new mRNA vaccines and when having other sites such as vaccination centres available as well. Despite the small sample size, the results allow health care policy considerations, because opening hours and ease of access were highlighted as primary drivers for actively choosing pharmacies. Opening hours and ease of access are modifiable factors in vaccination efforts, which may be increased by using additional vaccination sites as well (e.g., vaccination buses, pop-up clinics in shopping malls).” p.9, lines 313-323

Round 2

Reviewer 2 Report

I'm still not satisfied with the revision. However, I do partially agree with their response. 

Best Wishes, 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 4 Report

The article has been improved after my initial comments.

It sounds good for the publication

best

Author Response

Please see the attachment.

Author Response File: Author Response.pdf