Assessing COVID-19 Impact on Pharmacy Practices

We adopted a similar comprehensive strategy applied in Bangladesh (Haque et al., 2020a (link)), and subsequently used among other Asian countries (Godman et al., 2020a (link); Haque et al., 2020b (link)), building on previous knowledge of activities across Africa just before and after the first cases of COVID-19 were identified in Africa (Ogunleye et al., 2020 (link)). This included a questionnaire survey among community pharmacies in Africa including Ghana, Kenya, Namibia, Malawi, Nigeria, and Zambia as well as among three comparative Asian countries including Bangladesh, Pakistan and Vietnam. Box 1 summarises the open ended questions building on published studies (Haque et al., 2020a (link); Haque et al., 2020b (link)). Impressions were requested if this was the only information available due to issues of confidentiality and culture as no payment was made to pharmacists for the information provided (Godman et al., 2020a (link); Haque et al., 2020a (link)). The objective was to assess the current situation regarding usage patterns, prices, and availability of selected medicines and PPE used in prevention and management of COVID-19 soon after the start of the pandemic. The baseline was early 2020, i.e., just before active preventative measures in a number of the countries. More specific data on actual changes in utilisation and prices was asked if this was available; however, this did not include asking the pharmacists to break down changes in utilisation patterns and prices per month as this was deemed too problematic for this initial study. In addition, it was envisaged there would be limited impact of seasonality in view of year-round influenza activity in some African countries and no real pattern in others (WHO, 2012 ; Dawa et al., 2020 (link); WHO Regional Office for Africa, 2020 ) although research is ongoing in this area to address current knowledge gaps (Sambala et al., 2018 ). In addition, generally limited use of hydroxychloroquine in immunological diseases such as rheumatoid arthritis with concerns over its effectiveness compared with other disease modifying therapies (Rempenault et al., 2020 (link)). A more detailed description of the questionnaire can be found in Haque et al. (2020a) (link).
We did not factor inflation into the impressions as the study period only covered a short time, and per annum inflation in the chosen African countries typically ranged between 6 and 16% per annum (Focus Economics, 2020 ; Trading Economics, 2020a ; Trading Economics, 2020b ; Trading Economics, 2020c ; Trading Economics, 2020d ; Trading Economics, 2020e ).
The Asian countries chosen for comparative purposes had instigated similar activities to prevent the spread of COVID-19 as those seen in Africa and where there can be high patient co-payments for medicines (Godman et al., 2020a (link)).
Convenience sampling was again used to select pharmacists through emails, telephone contact, personal contacts and other mechanisms similar to the studies across Asia (Godman et al., 2020a (link); Haque et al., 2020a (link)). As before, there was no sample size calculation as there was no previous data to base calculations upon at the start of the study and this was a pilot study with a minimum of six pharmacies contacted in all countries apart from Namibia to determine the need for additional follow-up studies.
The findings were subsequently consolidated into categories in a tabular format to aid comparisons between regions and countries, with more specific data available in country publications (Haque et al., 2020a (link); Haque et al., 2020b (link)). We believed that there would be price rises and shortages in other countries apart from Bangladesh. However, the nature and extent would depend on ongoing programmes within the country.
We also explored the situation regarding the preparedness of community pharmacists in Namibia to the pandemic to help enhance future guidance to Governments and other key stakeholder groups. This included questions on i) Key measures/interventions the pharmacy has put in place during the pandemic to curb the spread of COVID-19 in the community (maximum of three from a pre-arranged list of seven known activities); ii) Suggestions on the role (current and new) of pharmacists/pharmaceutical technicians/pharmacist assistants during current and future pandemics (up to three from a pre-arranged list of five potential activities); iii) The main challenges experienced by pharmacy personnel during the pandemic (maximum of three from a pre-arranged list of seven known activities); iv) Changes in utilization, prices and shortages of pertinent medicines and PPE used in the prevention and management of COVID-19 from the beginning of March to end June 2020 (Supplementary Appendix A1). The study was extended to the end of June to provide greater insight.
Potential future guidance for governments, pharmacists and patients will build on the experiences of the pharmacists and others involved in the study in Namibia and across all the studied countries, the co-authors and previous suggestions documented in Ogunleye et al. (2020) (link).
Ethical approval for this study was not required according to our national legislation and institutional guidelines. However, as before in Bangladesh, all pharmacists freely provided the requested information having been given the opportunity to refuse to participate. This is in line with previous studies undertaken by the co-authors in this and related areas including analysis of policies to enhance the use of biosimilars and the rationale use of medicines, pricing policies as well as issues surrounding shortages and generics, which typically involved direct contact with health authority personnel and other key stakeholders (Godman et al., 2014 (link); Godman et al., 2015 (link); Moorkens et al., 2017 (link); Godman et al., 2019 (link); Gad et al., 2020 (link); Godman et al., 2020a (link); Godman et al., 2020b (link); Godman et al., 2020c (link); Godman et al., 2020d (link); Haque et al., 2020a (link); Miljković et al., 2020a (link)).