How to raise the line of defence of pharmacists in a rampaging pandemic

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That the terrible Covid-19 pandemic offers a profound learning curve, is undeniable. The number of new cases in India are increasing by more than 50,000 every day. Some metro cities are emerging as the new epicentres of the virus. In the coming four to six weeks, the country’s health infrastructure will be tested to the optimum, as the coronavirus will hit a peak by then.

An analysis of medical infrastructure and other data of the top 10 affected countries shows that India lags far behind on the resources required to deal with a crisis of this magnitude.

With the country’s less-than-adequate health framework putting up a brave if somewhat one-sided fight, the significance of emergency preparedness & response (EP&R) in the health sector could not be more relevant than today.

During the pandemic, pharmacy professionals (PPs) in India have continued to provide EP&R - medication, supplies and services. PPs roles in India are wide-ranging – from incorporating dispensing, stocking, manufacturing, quality assurance, clinical trial management, academia and research.

Raft of healthcare challenges

India's public-private healthcare system is complex and of variable quality. Lacunae in pharmacy education, training and lack of resolution around pharmacist roles have, however, presented challenges in offering health services to patients.

According to a research study published in the journal, Social and Administrative Pharmacy, by a team of scholars from USA’s Pittsburgh University titled Emergency preparedness and response (EP&R) by pharmacy professionals in India: Lessons from the Covid-19 pandemic and the way forward, PPs are actively involved in offering essential pharmacy services during the pandemic, despite minimal EP&R training. Based on lessons learned in the last few months, regulations are identified, and recommendations provided to broaden PP roles and enable them to be better prepared and actively engaged in EP&R for future emergencies.

According to the journal, PPs responded, saying they would like to be trained for COVID-19 and other emergencies. Engaging PPs in policy making and developing a cadre of EP&R professionals to serve and respond is the first step to address this gap to Covid-19 and beyond, say experts.

In April this year, the Indian Pharmacists Association (IPA) wrote a letter to Prime Minister Narendra Modi with a request to empower them with a more defined role and extend their services to patients during the pandemic. It called upon the Prime Minister to authorise registered pharmacists to conduct Covid-19 tests along with other services and suggested the concept of 20-days prescription drugs supply.

Emphasising their concern about the shortage of healthcare providers in six lakh villages, the letter written by Abhay Kumar, National President, IPA, recommended a few additional measures in the existing policy to empower pharmacists to extend their services during the virus outbreak.

It also pleaded that they be allowed to interpret, counsel patients on test results and available treatments, initiate treatment and ensure that appropriate legal and regulatory authorities support their call.

A welcome initial step was taken by the Ministry of Health and Family Welfare, when it requested the Pharmacy Council of India, the accrediting body for PharmD education, to prepare a state-wise national list of pharmacists who could be enrolled as part of the COVID Warriors Health Force and by turning State Pharmacy Councils into nodal offices.

Worldwide, pharmacists are actively providing services amidst the pandemic, including Triage services — the word is derived from the French verb trier, meaning shift or select; mainly used in medical emergencies — seeing patients and reducing the burden on healthcare facilities like hospitals and general practitioners.

They are also working to provide home deliveries, as well as attending to dispensing medicines to patients coming to pharmacies with the other ailments. Pharmacy associations across countries have issued guidelines to pharmacists in dealing with the pandemic.

Dr Mahaveer Golecha, Associate Director, Indian Institute of Public Health, (IIPHG) Gandhinagar, told this writer that ‘’Emergency medical and critical care services can play a significant role in designing and implementing an effective approach against Covid-19. Maximising these services during a pandemic by carrying out phone triage, home testing and telemedicine OPDs, significantly decreases visits to hospitals and allows early identification of those with virus tendencies. These activities contribute to the efforts to contain the spread of disease.”

Rising to the challenge

According to him, India must move speedily, marshal its financial and human resources, build temporary COVID-19 treatment facilities and procure necessary respiratory care equipment, including PPEs, hospital beds, oxygen-flow masks and ventilators. “Governments and policymakers must do all they can to prevent the scarcity of necessary resources. India will need to address the decades of underinvestment in public health system and social health, which may leave it struggling at this time of crisis,” points out Golecha.

The journal, Social and Administrative Pharmacy, points out that policymakers developed a response strategy that they refer to as the Pune Plan, which relied on powers sanctioned by the Epidemic Act of 1897 and resources made available by the Union health ministry, state health department and a government diagnostic laboratory in Pune.

On the ground, however, much needs to be done. Dr SK Kulkarni, Emeritus Professor, in the special issue of the Association of Pharmaceutical Teachers of India (APTI) Bulletin dedicated to Covid-19, raises some uncomfortable points: ``Back here in our country, community practice of pharmacy is in dire straits. The so-called PharmD graduates are hesitant or not willing to take-up community pharmacists’ work for which this course was originally envisaged. PharmD graduates are not even considered as part of healthcare delivery. Will they be able to advise/guide the frontline doctors on specific medications for Covid-19?”

While the World Health Organization's (WHO's) global strategy for pandemic control focuses on national planning, state-level and local experience in a country as vast and diverse as India indicates the importance of local adaptability as an essential feature of the planning process.

The Public Health Foundation of India (PHFI) has reached certain important conclusions:

***A cultural shift is needed to recognize pharmacists as healthcare providers with accompanying authority and legislation.

*** Pharmacy curricula need to include EP&R, public health topics and training.

*** Pharmacy groups and professionals need to cooperate and collaborate to advocate for the profession’s growth.

*** During emergencies, additional authority, or expansion of powers to empower the profession should be included in the legislation.

In response to emergencies, the National Disaster Management Authority (NDMA) was enacted in 2005 to address disaster preparedness and response, including a National Disaster Response Force (NDRF), which has 12 battalions trained and equipped to respond to natural and man-made disasters.

Currently, there is no mention of PPs in the Act or among the NDRF battalions. Clearly, there is need for PPs to be included in the NDRF battalions and on task force planning and responses to chemical, biological, radiological and nuclear emergencies. India will, hopefully, be better equipped to handle calamities in the future, if that happens.

Ranjit Bhushan is a senior journalist based in Delhi.