London School of Hygiene & Tropical Medicine

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, according to a new study published in The Lancet Regional Health – Western Pacific.

However, to support them in this important role, 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 the Kirby Institute of Australia’s University of New South Wales (UNSW), London School of Hygiene & Tropical Medicine (LSHTM) and partners in Indonesia, the UK and Australia,  analysed the results of an online survey of pharmacists and pharmacy technicians from across Indonesia’s 34 provinces, including Java, during July and August 2020.

Professor Virginia Wiseman from the Kirby Institute at UNSW Sydney and LSHTM 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.”

Dr Yusuf Ari Mashuri from Universitas Sebelas Maret in Indonesia, who led the survey, said: “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. Clear advice from trained health professionals is crucial to combat the COVID-19 misinformation that spreads on social media.”

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.

The study also 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.

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.

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

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.

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.

Publication

Yusuf Ari Mashuri et al. The response to COVID-19 among drug retail outlets in Indonesia: A cross-sectional survey of knowledge, attitudes, and practices. The Lancet Regional Health – Western Pacific. DOI: 10.1016/j.lanwpc.2022.100420