The hope of being a role model guided the efforts of Francisco Jiménez and Kyle Melin – members of the School of Pharmacy of the University of Puerto Rico (UPR) – to face the pandemic. Both had the opportunity to work with community pharmacies: places that, in addition to distributing medicines and providing public health services to the community, administered vaccines against COVID-19.
In Puerto Rico, the Coronavirus was experienced differently than in any other part of the United States. The UPR experts recall that the government measures that restricted the movement of people were more aggressive, there were total closures of commercial activities after five in the afternoon, and the use of vehicles was set daily based on plate numbers.
These actions were combined with what Jiménez and Melin described as a "sense of collective responsibility" on the part of Puerto Rican community, which was summed up in complying with the use of a mask and social distancing and the awareness of young people to abide by preventive measures to protect the elderly at home.
With just over 3 million inhabitants, Puerto Rico had reached more than 107,000 cases of COVID-19 and 1,280 deaths by December 2020, when the vaccination process for health personnel began. One year later, the island had 74.7% of the population immunized, a higher percentage than any other US state or territory. The overall vaccination rate for the United States as a country was 60.1%, according to figures from the Centers for Disease Control and Prevention (CDC).
The numbers for Puerto Rico for December 2021 placed it behind only the two Latin American countries with the best percentages of vaccinated inhabitants: Chile, with 85.6%; Cuba, with 84.1%; and Uruguay, with 76.6%. Despite the reality that more than half of the population lived in poverty, and, adding transportation difficulties and the challenge of getting vaccines to rural communities, the island ended 2021 with a rate of 1.03 deaths for every 100 thousand inhabitants, a figure that was below that of the entire United States, which was 2.37 per 100,000 inhabitants.
One of the success factors in the excellent implementation of the vaccination process in Puerto Rico was relying on community pharmacies to make immunizations more accessible. According to Francisco Jiménez, "almost half of the vaccines were administered in community pharmacies." By April 2023, in Puerto Rico about 90.9% of the population had received at least one dose of the vaccine and 84.1% had completed the primary series.
Vaccines not only help the population's well-being; for Kyle Melin, they also "support local micro-economies, which in turn support the economy in general." In the opinion of the UPR professor, vaccination in Puerto Rico through community pharmacies was "a unique opportunity to talk about the importance of vaccines and keeping people healthy."
Bonnie Kruse, Director of Development for OneWorld Community Health Centers in Omaha, Nebraska, shares this position. OneWorld provides medical, dental, and psychological services to underserved and low-income communities in South Omaha. For Kruse, vaccines "allow people to work safely and without as much risk of becoming infected or spreading diseases to other people with whom they work."
The business sector was one of the most affected by the pandemic in the United States and the rest of the world; Consequently, the vaccines came to alleviate the problems that COVID-19 had generated in the workplace. As part of his work, Kruse participated in the organization of vaccination days in small and medium-sized companies, which helped people feel more secure when visiting these commercial premises.
“Vaccines are important for business owners because when you have two or three employees away (because of the virus), it negatively affects your production and your productivity. They have to take responsibility that their employees have access to what they need to be healthy (…) It has been incredible how companies let us come in, set tables, talk to people, and do what we have to do to help keep them safe”, Kruse explained.
This situation had a particular impact in the Latino communities throughout the US. Hispanics in the U.S. were the group most likely to be classified as essential workers, making them more vulnerable to the virus by not being able to work remotely or virtually. A new dilemma arose when vaccines became available: miss work or get vaccinated.
And the response to this dilemma is when the commitment of organizations such as community pharmacies throughout Puerto Rico and OneWorld Community Health Centers was vital to bring vaccines to people. In the case of Latino communities, both institutions worked with the "Vaccines for All" program of the National Alliance for Hispanic Health (Alliance), with which they shared the same mission: to reduce disparities in health care to Latinos and let people know the importance of getting immunized against COVID-19.
Kruse estimates that nearly 69% of OneWorld Community Health Centers’ patients are of Hispanic or Latino descent. For this reason, the partnership with the Alliance and its efforts to support community health workers was essential to getting the vaccines to the Latino populations.
“Our community health workers made a great effort. We knocked on doors, and we went to companies (…). Some people had no choice because their employers demanded it, but making them feel good about their decision to get vaccinated was essential.”
Contribution to the future
The case for community pharmacies administering vaccines and the work of OneWorld Community Health Centers and community health workers are considered valuable models that should be incorporated into the health system. The good outcomes extend beyond health as these efforts had a positive impact on the economy and business activity. This is what Francisco Jiménez, Kyle Melin, and Bonnie Kruse believe.
“The community pharmacy is an excellent resource for providing health information, educating people, making recommendations, and allowing the population to make an objectively informed decision. We have made significant contributions to public health, which should be reproduced in many diseases and disorders. We are in the right place with the proper knowledge. We need to continue to build on this position and be allowed to provide more services.
In turn, Melin expressed that the "Vacunas para Todos" program has benefited Latino populations with the accessibility provided by community pharmacies, for which he recommended taking advantage of "this force that already exists and use it to increase access to care and important health services, such as vaccines against COVID-19 and other vaccine-preventable diseases”, to combat barriers in accessing the health system.
For her part, Kruse commented that having brought the vaccines to public places and companies through community health workers, dispelling misinformation and barriers, helped Hispanic communities understand what can happen if another pandemic occurs in the future and what they should do. In her opinion, "this made people not take their health for granted."