Pharmacy can help fight against Ebola
As West African countries struggle to manage the current Ebola outbreak, more needs to be done internationally to improve the capabilities of the local pharmacy workforce.
West Africa is currently in the grip of a terrifying outbreak of the Ebola virus disease (EVD). As of 26 August 2014, 3,069 people have been identified with the virus, of whom 1,552 (50.6%) have died. The outbreak currently involves Sierra Leone, Guinea, Liberia, Nigeria and, most recently, the Democratic Republic of Congo, and there are fears that it may elude stringent precautions and spread into further territories.
Governments and the international community are trying to bring the epidemic under control and to contain its spread. Some of the measures taken so far to limit the possible spread of Ebola to other countries include quarantining whole communities in affected areas, closing borders and reducing flights to affected areas. At the time of writing, British Airways, among other airlines, had stopped flights to Liberia and Sierra Leone — two of the most badly affected countries.
As the epidemic continues to wreak havoc within one of the world’s poorest regions, pharmacists, both in the affected countries and internationally, should reflect on what role their profession should play in epidemics such as this. In a 2012 article in The Pharmaceutical Journal, my colleagues and I called for pharmacists in developing countries, particularly those in Africa, to take a stronger position in the battle against the enduring epidemics of HIV/AIDS, malaria and tuberculosis. Little did we know then that Ebola would be spoken about in the same terms.
The situation on the ground has been exacerbated by weak healthcare systems, including pharmaceutical logistics and product management systems
Previous Ebola outbreaks had always been brought under control without the mayhem we have witnessed in West Africa over the past few months. The situation on the ground has been exacerbated by weak healthcare systems, including pharmaceutical logistics and product management systems. By the last week of July 2014, the health system in Liberia had collapsed, while those in Sierra Leone and Guinea were clearly overwhelmed. In Liberia, to reduce infection rates, curfews have been imposed and normal daily activities, such as attending school and work, brought to a halt.
Pharmacy-led interventions for epidemics can begin at the local level. In many countries, pharmacies — and medicine stores in some developing countries — are an initial point of contact for healthcare within the community. Consultation with pharmacists or counter staff is free and easily accessible. This puts pharmaceutical outlets among the best places to implement community-based interventions. For outbreaks of Ebola, pharmacists and counter staff could be trained to provide basic information to the public, including how to report suspected cases, ways to minimise the risk of transmission and what people can do to deal with suspected infections in their communities.
Moreover, pharmacists are a respected cadre in the community and from this vantage they can help to dispel myths and rumours that in some instances have been not just misleading but outright dangerous. One example is the notion that mass baths with salty water protect against Ebola. Pharmacies and medicine stores can serve as distribution points for educational leaflets and information about the disease.
To serve in these ways, the onus is on pharmacy to act — it should not wait to be invited to the table.
Pharmacists working in the public sector need to be equipped with the logistics and pharmaceutical management skills required when an epidemic strikes. In some of the world’s weakest healthcare systems, pharmaceutical management activities — for example, quantification of needs, procurement planning, distribution support and inventory management — are often performed by international organisations with specialist expertise. Expatriates are often brought from elsewhere to perform these functions for countries such as Liberia. This leaves the local pharmacy workforce inadequately skilled to perform these functions.
It is critical that pharmacists take steps to strengthen the skills of local staff in the areas of logistics and pharmaceutical management
However, when an epidemic is called, international organisations’ first response is, understandably, to evacuate their staff. This deprives already weak systems of essential technical support at a time it is most needed. It is therefore critical that pharmacists take steps to strengthen the skills of local staff in the areas of logistics and pharmaceutical management. Although there is certainly a role for external technical assistance, this should be tailored towards building in-country capacity.
With West Africa facing one of the worst epidemics of modern times, renowned international pharmaceutical organisations, such as the International Pharmaceutical Federation (FIP), the Commonwealth Pharmacists Association (CPA), the Royal Pharmaceutical Society (RPS) of Great Britain, the American Society of Health-System Pharmacists (ASHP) and the Association of American Colleges of Pharmacists (AACP), should consider whether the people they represent are defined by international borders. The crisis might be far from their doorsteps yet, as the current crisis rages on, pharmacists in Africa call for support from their global counterparts and colleagues in more affluent countries.
I do not advocate for pharmacists to travel to affected regions to provide support, but solidarity could be borne through highlighting the crisis at international pharmaceutical events and collaborating with those in the affected countries to come up with local solutions.
International pharmaceutical organisations can also assist with mobilising resources to improve the training and functions of pharmacists in the affected countries. Although this does not provide immediate relief to a struggling system, it can prepare people for similar challenges in the future. Furthermore, pharmacists in the UK, the US, Canada, Australia and other Western countries can provide materials and supplies to strengthen the pharmacy profession in affected countries, such as recent editions of the British National Formulary (BNF), which would enable pharmacists to make decisions based on the latest information. At the moment, there are only two BNFs in the school of pharmacy in Liberia.
International pharmaceutical organisations can also assist with mobilising resources to improve the training and functions of pharmacists in the affected countries
Also, as a long-term measure to address challenges like Ebola, more training scholarships should be made available to pharmacy practitioners in Africa. Such interventions are required to help prevent a repeat of the current healthcare crisis.
A sustainable response to epidemics requires appropriately trained people. In most pharmacy schools in Africa, there is very little on public health in the curricula. The Ebola epidemic has demonstrated that pharmacy courses, not only in the affected countries but also in other African countries, need to have a stronger focus on public health. To have pharmacists who appreciate their ability to contribute to the community in a broad sense, educators and organisations need to promote public health as a core component of pharmacy training, alongside pharmaceutical management and logistics. In time, the local pharmacy workforce could be in a position to design interventions and form part of a cohesive response to disease outbreaks.
Epidemics such as the current West Africa Ebola outbreak know neither geographical borders nor professional boundaries. The outbreak has jumped from three countries sharing borders — Liberia, Guinea and Sierra Leone — to countries further afield, namely Nigeria and Democratic Republic of Congo. As the world fights to contain the illness, there is no way to predict where it may strike next. All remain vigilant.
It is imperative that pharmacists consider how to spread appropriate health messages to the communities they serve. For global pharmacy, the situation in West Africa illustrates just how far the healthcare and pharmaceutical infrastructure needs to improve in the countries affected.
Lloyd Matowe is programme director, Liberia, at Pharmaceutical Systems Africa, an organisation that provides pharmaceutical consulting services in developing countries.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20066289
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