COVID-19: Community Pharmacy Practice in Africa

Dear Editor,In the 21st century, the world has seen a fair share of widespread infectious disease outbreaks that thrusts healthcare workers at the frontline, putting their expertise to work in containing them. The position of the pharmacists had been utilized in such crises with their role shifting from a product-centered to patient-centered care (1). Pharmacists are an essential part of healthcare team that performs exceptional roles in the containment of the earlier pandemics and global health crisis including Ebola and Zika (2). During the H1N1 influenza pandemic, community pharmacies were recognized by patients as convenient locations to receive pandemic influenza vaccinations (3) and in course of the 2010 to 2011 influenza season, 18.4 percent of adult influenza vaccines were administered in community pharmacies (4), this further reinforces the much-needed role pharmacists can play in responding to health emergencies. It has been reported that 93 percent of pharmacists would be willing to report to work in course of a future disease outbreak (5) such as COVID-19. Engagement of pharmacists in pandemics is vital due to their specialized knowledge in ensuring and supporting effective responses to diseases outbreak. For most community pharmacies in Africa, the major impact arises from the lockdown caused by the COVID-19 pandemic. The lockdown policy has been predicted to result into shortages of essential drugs, and inability of the pharmacy staff to work optimally. Community pharmacies in Africa are suffering setbacks in ensuring uninterrupted supply chain of medicines. Transporting machinery are subjectively stopped by law enforcement agencies and refused entry in order to curtail community transmission. This may result into drug scarcity and shortages. All these come with a considerable cost to community pharmacies leading to hike in prices of available medications with a potential impact on availability, accessibility and affordability of medicines. Before the emergence of COVID-19, community pharmacies are usually the first point of contact by public and patients for healthcare needs. Obviously, there is a potential for community pharmacists to be exposed to COVID-19 because they come in contact with patients who may have been exposed to the virus or infected (6). This will have a significant impact on the quality of healthcare delivery as there are tendencies that community pharmacists would exhibit reluctancy in the discharge of duties due to the fear of contracting the virus. While safety measures such as physical distancing and proper hand washing are being practiced, limited access to personal protective equipment (PPE) might contribute to their risk of contracting the virus. Since infections can be developed by pre-symptomatic and asymptomatic individuals, it is of utmost importance that pharmacists and community pharmacy workers protect themselves against disease exposure by keeping patients and members of the public at a safe distance (of at least 1 meter) and regularly disinfecting surfaces within the pharmacy premises (6). Through public precautionary measures advocated by the World Health Organization, governments and national health authorities, efforts are currently made around the world to “flatten the curve” and Africa is no exception (7). With the situation of the global lockdown, community pharmacies seem to have greater responsibility as the first point of contact to meet public health needs. Globally, amidst the strict lockdown policies, community pharmacies remain one of the few places that remain open to serve the populace (8). In Africa, as it is globally, community pharmacists and pharmacies are very vital and accessible amidst the heat of the pandemic by serving as direct contact for their patients as they remain on the frontline of public health. Community pharmacists are playing their roles in addressing public health crisis by contributing to the risk reduction through community engagements, emergency health services and crisis management (9). Various views have been circulating about the safety of the use of ACE inhibitors, ibuprofen, corticosteroids and angiotensin receptor blockers during the COVID-19 pandemic, which suggests an elevated risk of infection or elevated disease severity (10). The use of these medicines is widespread and any attempt to disrupt their usage has the potential of affecting both patients and the public, globally. As widely known, community pharmacists have their indispensable roles to play such as medication review, medical counseling etc. which will invariably affect treatment choices (10). For instance, in Nigeria, community pharmacists have engaged in enlightenment programmes aimed at debunking myths relating to use of chloroquine and other unapproved drugs for the cure of COVID-19. Also, in Kenya, community pharmacists are advocating for zero-tax implementation on drugs in order to allow for affordability in course of the pandemic (11). The International Pharmaceutical Federation (FIP) has released publication which serves as a resource for strengthening and preparedness of the community pharmacy workforce as front-line health workers during this pandemic (12). The roles of pharmacists in debunking myths about the disease and providing mental health supports during this pandemic cannot be deemphasized, but still underutilized. Community pharmacists also continue to play their role in ensuring regular supply of medicines to the public without interruption and to support response efforts (13) by spreading information on COVID-19-related precautions, including proper hand and respiratory hygiene measures, as well as ensuring ease of access to face masks and guidelines for proper use and disposal and the need to maintain physical distance (14). Additionally, COVID-19 diagnostics testing is a challenge in many African countries (15). This also provides an area worth exploring by community pharmacies upon availability of accurate and rapid diagnostic tests. The COVID-19 pandemic has affected community pharmacy practice in Africa and their roles in effective containment should continue to be utilized. This further reinforces the need for increased protective measures, well planned lockdown policies that allows for easy drug supply and sustained unrestricted movement of community pharmacists in order to reduce the incidence of transmission; a necessary step towards containing the pandemic in Africa.