When pharmacist Erin McCreary moved to Pennsylvania in 2018, she didn’t anticipate ever having to administer vaccines. She’d taken a vaccination certification course back in pharmacy school six years earlier, but it wasn’t part of her job description as an infectious diseases pharmacist at the University of Pittsburgh Medical Center. That’s why she wasn’t concerned about the state pharmacy board rule that pharmacists had to file their certificate within two years of receiving it or they’d have to take the course again.

“Well, now, of course, COVID-19 happened,” McCreary told The Verge. She wanted to sign up to help with COVID-19 vaccination efforts, so she emailed the board asking if they could waive the requirement. “I have my pharmacists license, I have my certificate from 2012,” she says. The board said no, she says, and that she had to retake the 20-hour course.

Many pharmacists who work in community practices or drug stores give vaccines regularly and are set to help with COVID-19 vaccination efforts. But plenty of others, like McCreary, work in hospitals or academic medical centers and don’t normally give shots. Pharmacists who fall into that category in some states have been stuck navigating bureaucratic red tape before they can volunteer to help, at a time when health care centers and health departments need to scale up the contingent of people able to put shots in arms.

“All of that is just delay, and time, and pushes back the available people that are able to do these,” says Monica Mahoney, the clinical pharmacy coordinator of infectious diseases at Beth Israel Deaconess Medical Center in Boston.

The Department of Health and Human Services put out a guidance in September saying that any pharmacist could give a COVID-19 vaccine. In order to perform the vaccinations, though, they’d have to complete a training and certification program. “It’s not like you can just say, I’m going to go give vaccines today, and learn on the job,” says Debbie Goff, an infectious diseases pharmacist at the Ohio State University Wexner Medical Center.

Those courses are offered by groups like the American Pharmacists Association, which has seen a big uptick in interest in the certification program. Around 17,000 people have taken the course in the past few months, Daniel Zlott, senior vice president of education and business development for the American Pharmacists Association, told The Verge.

Today, most pharmacists take the course as part of their regular schooling. (Pharmacy schools started integrating them into curricula around a decade ago.) Those who work in community pharmacies or at chains like CVS also usually have to be certified — giving vaccines, like the flu shot, is often a bit part of the job. But a swath of older pharmacists (who went to school years ago) or who don’t work in a community setting fall into a gap.

“When we graduated, we weren’t trained in providing the vaccine. There’s a lot of barriers and red tape, and additional hurdles that we have to jump through,” Mahoney says.

The course itself is the first barrier: it’s a 20-hour course, involving both instructional hours and an in-person component where pharmacists and technicians have to perform injections under supervision. The American Pharmacists Association training is a great program, says Jason Gallagher, a clinical pharmacy specialist at Temple University Hospital in Philadelphia.

“I actually thought it was excellent. I learned from it, stuff I thought I already knew. But it’s overkill for what you need in order to actually vaccinate someone with a single vaccine that needs to be done millions of times,” Gallagher says. He thinks it could be condensed down to a few hours of instruction specifically targeted at the COVID-19 vaccine. McCreary agreed. “I feel like states could work together, and potentially organizations could work together, to come up with a crash course,” she says.

The courses are also expensive and can run $350 or $400. Gallagher had his payment covered by his employer, but he says he has colleagues who decided not to take the course — and, by consequence, not participate in COVID-19 vaccinations — because of the cost.

After obtaining certifications, pharmacists have to get clearance from their state pharmacy boards in order to immunize. Every state handles that process in a different way. Some want paper certificates mailed in before they sign off, Mahoney says. Others might want certain documentation notarized. Gallagher is getting certified in New Jersey, which asks for that step. “I had to have my application notarized, but for that, you go to a bank — and many bank lobbies aren’t open,” he says. “It’s silly things like that.”

The Pennsylvania and New Jersey state pharmacy boards did not respond to requests for comment by publication.

There’s a huge need to add to the COVID-19 vaccination workforce. Right now, at Temple University Hospital, vaccinations are limited by the number of people available to give them, Gallagher says. If he gets cleared, he’d be able to contribute to the effort and get more people in the community vaccinated.

McCreary is currently taking a certification class and hopes to pitch in with the vaccination effort. Pharmacy chains like CVS and Walgreens are also hiring as many vaccinators as they can for short-term stints as they prepare to deliver shots to the broader community. “One of my friends applied for a job, and she told me she got a job offer the next day,” McCreary says. The friend works as an inpatient pharmacist, and the chain asked that she come in for a few shifts whenever she’s able. “Healthcare is 24-7,” McCreary says. “Maybe you work a weekend, so you have Wednesday off, and go vaccinate all day.”

Gallagher says he’s frustrated these kinks haven’t been worked out earlier in the vaccination process. “It doesn’t seem like it’s an all hands on deck operation to get everyone in the door and helping,” he says.