December 1, 2021

Kristen Nichols, PharmD, and senior content management consultant for clinical effectiveness at Wolters Kluwer joins Drug Topics® to discuss the benefits of the coadministration of COVID-19 and flu vaccines in part 2 of this interview.

Drug Topics®: You mentioned a little bit about the buzz about misinformation. Can you clear up any confusion about how long [the COVID-19 and influenza] vaccines should be spaced apart? Does it matter which one you get first?

Kristen Nichols, PharmD: So, the flu vaccine and the COVID-19 vaccine don't need to be spaced apart at all—they can be given at the same time. I think I'm 2 weeks out from getting [them]; I did my COVID-19 vaccine on my left arm and my flu vaccine on my right arm. I got them at the same time. 

If you do have a patient, however, who is really opposed to getting them at the same time, it's definitely better for someone to get both vaccines—even if it's separated by a little bit—than to not get either, or to not get 1 of them. I have had some people who told me they just don't feel comfortable getting them at the same time. And so, what I would recommend, especially if that person hasn't been vaccinated against COVID-19 at all, is: I would do the COVID-19 vaccine first, given that that's associated with a higher risk and a significant risk of hospitalization. 

Do that one [first], and then…even a week is reasonable [to wait]. Almost all of your adverse reactions to vaccines happen within a week, and so that will give you time to tell—if you had a reaction—whether it was from the COVID-19 vaccine before getting the flu vaccine. 

That calculation might change a little bit in someone who's fairly young and healthy, but maybe has an underlying condition. Maybe, given that the COVID-19 vaccines are still shown to really prevent hospitalization and death, maybe the flu vaccine might want to go first, especially if you're seeing flu transmission in your community. Now, in my community in Indianapolis, we're not seeing flu transmission yet. So, I would still go towards COVID-19 first if somebody wants to space them.

Drug Topics®: That makes a lot of sense. Hopefully administering both at the same time will be be helpful for health care providers.

Nichols: Well, I think we have a lot of folks to vaccinate, and I know we have some staffing shortages.

In the beginning of the vaccination efforts, we had huge clinics and a lot of coordinated efforts, [but] a lot of those have been shut down. I think we're going to be seeing heavier reliance on our retail pharmacies and some of our other vaccination clinics. So, clearly being able to give both vaccines at the same time can really save a lot of time and effort for those providers and those pharmacists. 


I personally worked for a chain pharmacy that did long-term care clinic vaccinations, and I've received outreach from them in the last few weeks and know that they have some staffing needs. I actually just got an email from the COVID-19 vaccine clinic that I've been volunteering at from a local hospital, asking for more volunteers. So, I know there's definitely a staffing shortage, but also from that perspective of, our health care providers who are overwhelmed with the number of patients seeking care for COVID-19. If we increase the vaccination rates that can decrease the illnesses and hospitalizations, and hopefully burden on the health care system at large.

I will say one thing, that there have been errors reported in a recent ISMP [Institute for Safe Medication Practices] newsletter; they highlighted some of the errors where [the] flu vaccine was given instead of [the] COVID-19 vaccine or vice-versa. And so, when you're giving both on a busy day, it's still important to slow down and make sure you're only using 1 vaccine, 1 syringe at a time; pay really close attention.

Drug Topics®: With previous doses [of the COVID-19 vaccine], health care providers were recommending that patients not receive any other vaccine during a specific timeframe. Has this changed?

Nichols: That…recommendation at the beginning of the vaccination effort was really due to an abundance of caution, because we didn't really know exactly how people would react. Now, we have all kinds…we have a lot of data telling us what the reaction to the COVID-19 vaccines are. At this point, there's no need to separate from other vaccines, or any specific time they can be given with any interval.

Drug Topics®: Going off of that, how can pharmacists and health care providers encourage patients to get vaccinated?

Nichols: This is a really important question. And really, I think the answer is really pretty complex, but I'll do my best for now. 

I think taking the time to ask patients about whether they're vaccinated, and encouraging them to be vaccinated, is an obvious [question that can] help. I think building those relationships so that patients have someone they can trust—they trust you for, you know, their other medications and health care needs—having someone they can trust, that's going to be the best person to help dispel some of the misinformation out there. 

I think that is important too: being a source—a good source—for truthful information and staying abreast of all the misinformation that's out there. It can be really painful; it pains me to read about the things people are saying about the COVID-19 vaccines. But I think it's more important to know what those things are so you can investigate the science and know what isn’t true and what is true, so that when patients ask those questions you're not taken by surprise with them. 

I also think that actively listening to patient’s concerns and reserving judgment can be really important for building that trust and building that relationship. There are a lot of people that will let you share information and correct some misperceptions if you take that time to listen and hear what their real concerns are.

Watch part 1 here