Introduction
According to the World Health Organization (WHO), a pandemic is the
worldwide spread of a new disease1. Viral pandemics are
caused by viruses that possess a surface protein to which the majority
of people lack immunity, which then spreads between people within the
population extending beyond national
borders2. Historically,
many viral pandemics have been documented. The most notorious of these
is the Spanish influenza pandemic of 1918–1920, which was caused by the
H1N1 virus and was responsible for about 40 million deaths worldwide3. Other pandemics
include the Asian Influenza (1957) caused by the H2N2 virus, the Hong
Kong Influenza (1968) caused by H3N2 virus2, the Severe Acute
Respiratory Syndrome (SARS) which occurred in 2003 and was caused by
SARS coronavirus (SARS-CoV)4, and the Middle East
respiratory syndrome (MERS) which occurred in 2012 and was caused by
coronavirus (MERS-CoV)4. Recently, on the
31st of December 2019, a case of pneumonia of unknown
cause in Wuhan was reported to the WHO Country Office in China1. It was later
identified as coronavirus disease-2019 (COVID-19) caused by the novel
coronavirus officially called SARS-CoV-2, belonging to the family
Coronaviridae5. The Coronavirus genome consists of a
single strand positive sense ribonucleic acid (RNA) 4.
The virions (virus
particles) are enclosed in a lipid envelope characterized by the
presence of crown-like spikes on the surface which have led to the
nomenclature -where ‘corona’ implies the crown like appearance created
by these bulbous spikes.4. SARS-CoV-2 usually
causes mild symptoms such as fever, dry cough, and sore throat. However,
it can sometimes lead to fatal complications such as severe pneumonia,
pulmonary edema, acute respiratory distress syndrome (ARDS), organ
failure and septic shock6. The spread of the
virus to many countries around the world in a short space of time with
no clear treatment or vaccine in sight as yet, is alarming and has
resulted in high workload for healthcare teams globally7-9. Effective strategies currently followed to slow
the spread of the virus included hygiene practices such as proper hand
washing, hand sanitizing and wearing facemasks and gloves (personal
protective equipment), in addition to social distancing and public
quarantine measures10.
The Middle East and North Africa (MENA), like other parts of the world,
have experienced several epidemics over the years. Outbreaks of
plague, smallpox 11,
cholera 12, and
meningococcal infection13 have all been
documented, especially in Saudi Arabia during the annual Pilgrimage
(Hajj ) as Muslims from more than eighty countries convene
together, which led the Saudi authorities to require all visitors to
immunize against certain diseases11,
12.
Community pharmacists (or retail pharmacists as they are known in some
countries) have a crucial role to play during pandemics14. One of the most
important role of community pharmacists is to ensure the availability of
effective therapy in addition to health education and health promotion
activities and vaccination provision 15-17. Moreover,
community pharmacists need to engage with patients, providing them with
counseling regarding the safety precautions to minimize exposure and
infection probabilities as well as psychological and mental health
support during a pandemic. Pharmacists would be expected to support
general health care teams in infection prevention, as well as alerting
public health officials of potential
outbreaks/cases18,
19. During pandemics pharmacists’ role
in managing minor ailments increases as doctors and hospitals become
overwhelmed 18,
19. The International Pharmaceutical
Federation (FIP) released a guideline during March 2020 stating the
needed information for pharmacists and the pharmacy workforce to help
them in dealing with the COVID-19 outbreak20, and acknowledging
the responsibilities put upon the pharmacists in the control of the
COVID-19 outbreak 20.
This mandate highlights the clear need for pharmacists to convey factual
evidence based and up-to-date information to the public21. In a study
conducted during the pandemic outbreak of H1N1, it was found that
patients rely on information provided by pharmacists and considered them
an effective educational source regarding the pandemic in addition to
trusting pharmacists as immunizers22. In previous
‘pandemic preparedness testing studies’, in the United States (US),
community pharmacists have expressed concerns that need to be considered
by policymakers, for example, about critical medicine shortages or
managing medicine hoarding17. Collating published
literature, it appears that there are various research studies published
to guide pharmacists on how to improve patient care services and outcome19,
23, 24,
however, pharmacists are still in need for more tailored and extensive
training to improve preparedness for emergency situations18. To prepare globally
uniform pharmacy response directives for pandemics, pharmacists’
awareness and perspectives around roles during pandemics in different
regions of the world need to be assessed. In light of the repeated
pandemic/epidemic experiences in the MENA region, the aim of this study,
therefore, was to assess awareness of COVID-19 amongst pharmacists from
countries located in the MENA and to assess their perspectives of their
role, barriers, and roles of the educational institutions and
pharmaceutical associations in preparing them to be able to deal with
the pandemic.