Response to future outbreaks should involve community pharmacies

Community pharmacy in Semarang, Indonesia
Community pharmacy in Semarang, Indonesia

Community pharmacies play a crucial role in responding to the pandemic, but they require access to guidelines and equipment, a new study in Indonesia reveals

PINTAR press release, 17 March 2022

Drug retail outlets such as community pharmacies and private drug stores could help to reduce pressures on health system facilities during future pandemics by providing accurate and timely advice and treatment to clients.

But to play this important role effectively, governments should increase efforts to directly engage community pharmacies in outbreak response efforts and provide them with accurate guidelines and adequate supplies of protective equipment.

Researchers from Australia, Indonesia and the UK analysed the knowledge and practices of 4,716 pharmacists and pharmacy technicians from across Indonesia’s 34 provinces, one third of which were in Java. The results of the online survey, conducted between July and August 2020, were published in The Lancet Regional Health – Western Pacific.

“We saw that when pharmacists and pharmacy technicians have access to accurate guidance and information, many are willing to actively participate in in response efforts, for example by providing advice to clients, distributing leaflets and participating in surveillance activities,” explained Dr Yusuf Ari Mashuri from Universitas Sebelas Maret, Surakarta, Indonesia, who led the survey. “Clear advice from trained health professionals is crucial to combat the COVID-19 misinformation that spreads on social media.”

The study exposed the fragility of medical supply chains for infection control products such as hand sanitiser and other personal protective equipment (PPE), a challenge experienced in many low and middle-income countries.

Drug retail outlets as first point of health care contact

Community pharmacies and private drug stores play an important role in serving the community as they are often the first point of contact within the health system, particularly in rural areas.

Many studies have explored the actions and experiences of public sector health workers during the COVID-19 crisis but far fewer have focused on pharmacists and pharmacy technicians working in private drug retail outlets.

“Our study shows how important these frontline health workers are and the challenges that they face during the current pandemic in Indonesia,” says Professor Tri Wibawa, from Indonesia’s Universitas Gadjah Mada, who co-led the study.

“And our results are an important contribution to the scientific community. This is certainly one of the largest surveys to date of pharmacists and pharmacy technicians working at drug retail outlets in a Southeast Asian country during the COVID-19 crisis.”

There are increasing calls for pharmacists and pharmacy technicians to play a more active role in responding to public health crises, including in outbreak surveillance, health education, drug trials, vaccine delivery, testing, and programmes to support patient in adhering to medical treatment. These roles become critical when clinical services are heavily committed, especially in countries where health systems are under-resourced.

Drug retail outlets and the fight against antibiotic resistance

Results of the survey point to frequent antibiotic use among people with COVID-19 who attended drug retail outlets in Indonesia. This can contribute to the global threat of antimicrobial resistance, because antibiotics are not an effective treatment for viruses

Around one third of participants mentioned having dispensed antibiotics to clients suspected of having COVID-19. Pharmacy technicians were more likely than pharmacists, , who are authorized and better trained in dispensing prescription-only medicines, to report selling these medicine including antibiotics

There are approximately 135,000 licensed community pharmacies and private drug shops in the country. Although over-the-counter sales of antibiotics is prohibited by law, non-prescription dispensing is common in Indonesia. Studies have reported increased misuse of antibiotics in the community during the COVID-19 pandemic.

Professor Virginia Wiseman, from the Kirby Institute at UNSW Sydney and the London School of Hygiene & Tropical Medicine, who co-led the study, said: “Major public health threats, such as the current pandemic or the ongoing rise of antimicrobial resistance, require responses that involve the entire health system.

“In countries like Indonesia, where private drug sellers are such a critical part of the health system, we must mobilise them very quickly. The different roles that we saw them playing during the pandemic must be well integrated into the national management of the pandemic. And this is an ideal time for countries such as Indonesia to begin doing this.”

The COVID-19 survey is part of PINTAR (Protecting Indonesia from the Threat of Antibiotic Resistance), a larger study that aims to improve antibiotic dispensing in the community and combat the spread of antimicrobial resistance.

Both studies are led by the Kirby Institute of Australia’s University of New South Wales (UNSW) in collaboration with Universitas Gadjah Mada and Universitas Sebelas Maret in Indonesia, the Indonesian Ministry of Health, the London School of Hygiene & Tropical Medicine and University College London in the UK, and The George Institute for Global Health at UNSW Sydney. The research is supported by a grant from the Indo-Pacific Centre for Health Security (DFAT) under the Australian Government’s Health Security Initiative.

Read the paper in The Lancet Regional Health – Western Pacific

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