Phamabook - First Edition

International Pharmaceutical Students’ Federation

PHARMABOOK Pharmacy Profession Advocacy Campaign PharmaGap Booklet First edition

2022

PHARMABOOK

TABLE OF CONTENTS PHARMACY PROFESSION ADVOCACY CAMPAIGN PHARMAGAP BOOKLET

Preface………………………………………………………………………………………............................................. 2 Interview ……………………………………………………………………………………............................................. 3 BPhD Interview with Gabriele Overwiening, President of AKWL and ABDA (Federal Union of German Associations of Pharmacists) ( BPhD, Germany)......................................................................................................................................................................................................................... 4 A 2021 hell on earth ( LPSA, Lebanon) ………………………………………………………….. ..........................................7 The Million Dollar Question - Does the public know their pharmacists’ roles? (BEM FF UI, Indonesia) ……………………………………………………………………………………………................................................. 9 Overview of the CUIDAR+ Project, the development of Telepharmacy (FEBRAF, Brazil) ... .....................................................................11 Uncover The Facts Behind COVID-19 Vaccine ( BEM KMFA UGM, Indonesia) ………....…....................................................................13 Article ……………………………………………………………………………………....................................................16 Access to health data by Pharmacists ( APEF, Portugal) ……………….……………………. .....................................................17 Pharmacy-Based Intervention of Covid-19 Vaccine Acceptance Among Indonesian People ( BEM KMFA UGM, Indonesia) ……………………………………………………………………....................................................................................................19 Digital Health: Health Inequality and the Law for Pharmaceutical of It in Indonesia ( BEMF USD, Indonesia) …………………………………………………………………………………… .................................................................21 The Opioid Crisis in Canada and the Pharmacist’s Role in Tackling this Issue ( CAPSI, Canada) ……………………………………………………………………………………………. ..............................................23 Challenges in Pharmaceutical Practice in Brazil ( FEBRAF, Brazil) ……….………………................................................................ 25 Drug Distribution Disparity in Indonesia, When Will it End? ( HMF ‘AP’ ITB, Indonesia) …. ..................................................................27 Health inequality in Iran ( IPhSA, Iran) ……………………..………………………………….. .............................................30 Beirut, The Fear City of the Middle East ( LPSA, Lebanon) …...…………………………….. .........................................................33 Digital Health in Algeria during the Pandemic ( ASEPA, Algeria) …………………….……… .....................................................35 Verbal Interview ………..………………………………………………………………..........................................................36 ASEPA, Algeria - IPhSA, Iran - PSA, Taiwan………………………………………………...…. ..................................................37

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Preface Dear IPSF Pharmily, I am delighted to share with everyone the first Pharmacy Profession Advocacy Booklet for the PharmaGap campaign. A problem in one country isn't just an issue for its citizens, but for all humankind. Therefore, through listening and sharing our ideas and experiences, we can help each other. I hope this booklet could help all members to raise their awareness about the most crucial issues faced in the pharmacy profession internationally and get prepared to solve those issues as future pharmacists and health care leaders. I can do nothing but show my sincere gratitude to all of the contact persons and amazing ambassadors who took an adorable step to improve the pharmacy profession. Let's complete this mission by reading and sharing it.

Viva la pharmacie, viva la IPSF!

Ms. Mahsa Zaghian IPSF Pharmacy Profession Advocacy Coordinator 2020-21

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INTERVIEW

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“BPHD INTERVIEW WITH GABRIELE OVERWIENING, PRESIDENT OF AKWL AND ABDA (FEDERAL UNION OF GERMAN ASSOCIATIONS OF PHARMACISTS) AMBASSADOR: ROMAN PRATZKA BPHD, GERMANY The ABDA - Federal Union of German Associations of Pharmacists is the umbrella organisation of more than 60,000 (mostly community) pharmacists in Germany. The aim of the Berlin-based association is to join together and bring forward the common interests of this healthcare profession.

AKWL = chamber of pharmacists in Westphalia-Lippe Roman Pratzka: Ms. Overwiening, you are in charge of three pharmacies yourself. What are the everyday challenges that pharmacists face there? What challenges do you experience at work, e.g., in contact with patients?

Gabriele Overwiening: First of all, the patients are very grateful that we are there and that we are their contact persons. This is something that I have always experienced, but which is now taking on incredible proportions during the pandemic. [...] Now we are receiving tremendous gratitude with regard to the rapid antigen tests. [...] And now with digital covid vaccination certificates, I feel like we're giving people back a bit of their freedom. [...] What is exhausting is the occasional lack of appreciation of our pharmaceutical services by opinion leaders and politicians, who take our services for granted. Just like electricity from an electrical outlet. It will only be acknowledged once it is no longer available.

Roman Pratzka: Keyword digitalization: Many pharmacies still work with fax machines and are poorly equipped digitally. To what extent is this lack of digitalization and outdated communication perhaps also a problem in pharmacies?

Gabriele Overwiening: I can say with absolute certainty that only a small proportion of pharmacies have not really been digitalized well. The vast majority of pharmacies have a high digital affinity. The fact that we often still use fax machines is also due to other market players in the healthcare system.

Roman Pratzka: Keyword: interprofessional cooperation in general between physicians and pharmacists.

In some cases, I see communication difficulties in the pharmacy again and again, when there is a nonplausible prescription or when certain medications are not in stock. In such cases, the doctor has to be contacted. Oftentimes, they are not available, have little understanding and little time for pharmacists.

On the other hand, patients also have little patience when they have to wait at the counter for their medication. Do you also see these problems in the professional relationship between doctors and pharmacists, or is this less of a hurdle?

Gabriele Overwiening: At the moment, interprofessionalism is highly dependent on the personal relationship between local physicians and pharmacists. There are great examples where it works brilliantly, where they complement each other very well, and then there are catastrophic examples. [...]

For both professions, it will be crucial that we embark on the path to a digital future together. It is important that we as health care professionals always remember: a health care system has only one objective and that is the well-being of the patients. [...] That is why I will attach great importance to advancing interprofessionalism. What counts is the health of the patients.

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Roman Pratzka: Currently, it is also apparent in the case of vaccination. Vaccination in pharmacies is already being carried out in several model projects. However, doctors often give negative feedback.

Many German doctors do not want vaccinations to be administered in pharmacies, even though this has long been the standard in some EU countries. How can we ensure that we collaborate for the benefit of patients and don't create the feeling that we are working against each other?

Gabriele Overwiening: I believe that we need hands-on experience to do this. I experience that in theory mostly the problems and less the opportunities are deduced. However, once we get into the practising, the doing, the implementing, we realise that it does work out in the end. And the physicians will realise that we are not taking patients about to be vaccinated away from them, but we are reaching a different clientele - our vaccination offer will be a complement. [...] We will gather a lot of experience from the model regions and use the valid results to further substantiate our vaccination offer. I am confident that we will achieve a solid collaborative approach.

Roman Pratzka: You say that experience is the key to success here and that it is very important in order to improve the relationship. What are some concrete approaches? For example, experience can already be gathered during the studies through interprofessional education between medical and pharmacy students. What approaches can you think of?

Gabriele Overwiening: You are right. This is a fundamental question for the professions of physicians and pharmacists: How do we reach our next generation? How do we ensure the follow-up of a new generation?

What do our successors actually want? How do they envision their careers? When I talk to young people, I always hear from both sides that interprofessional cooperation is desired. This only diverges at a later stage. [...] Pharmacists come to the community pharmacy with a tremendous pharmacological knowledge only to be denied a say in the prescribed therapies. This is frustrating and does not foster pharmacological knowledge among pharmacists. And it would be good if we practised directly from the practical year onwards that pharmacists and physicians set out together for the well-being of the patients. [...]

Roman Pratzka: You mentioned it: Pharmacists bring an enormous amount of knowledge with them from their studies, but then we sometimes lack the competencies and the rights for certain activities. Do you see any problems there? That pharmacists should be granted more responsibilities and that more attention should be paid towards our competencies?

Gabriele Overwiening: I see it as an absolute necessity that pharmacists are given more decision-making authority in regard to patient safety (AMTS). I recognize that additional pharmaceutical services can become a foundation for this. [...] We are now doing rapid antigen tests. Why don't we want to do streptococcal tests? There are countries where that is already the case. [...] I think that decision-making authority is of great importance for professional satisfaction and the further development of pharmacological expertise. [...]

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Roman Pratzka: Finally, I would like to talk about the problem of supply shortages. Especially at the beginning of the pandemic, it was noticeable in the pharmacy: medications could not be delivered due to supply shortages. Do you think this is a problem that should be addressed more intensively or has the problem been solved in the meantime? Has it improved in the meantime?

Gabriele Overwiening: Delivery shortages are a recurring problem that persists. We solve most supply shortages by switching to other preparations, other companies, other dosages, other dosage forms. This is where our expertise and creativity are called for. However, I have to admit that dealing with supply shortages also takes up a lot of time in the pharmacy. That's a huge burden because it's not just a matter of finding an alternative. The alternative must also be accepted. This requires the education of the patients. And when we talk about adherence, that's a big effort. So I think that we have to address the issue of supply shortages permanently.

Roman Pratzka: Does that also have to happen on the part of politics concerning drug production? Often, the aim now is that production should be relocated back to Europe. Is that a necessary step and is that at all realistic?

Gabriele Overwiening: I think this step is desirable. However, I still consider this step to be quite unrealistic at the moment. [...] There is a balance between safety and economic efficiency that is not easy to strike. In some cases, we are becoming dependent because we value the acute economic benefit more than the long-term safety. This is a fundamental problem in our European world: Do we have a social market economy or do we only have a market economy? Does the quality of care dictate or does the price dictate? How will we evolve in that regard? I hope that safety and quality will continue to play an important role in the future. [...] I am an advocate of the social market economy. We have to pay attention to the economy, but the economy cannot be a substitute for safety and quality; the primary focus must be on safety and quality. Otherwise, the economy will no longer serve the people.

Roman Pratzka: You've compiled the biggest problems, exactly fulfilled the goal and also mentioned many possible solutions. I don't think we are facing a major problem that seems unsolvable. Or what do you think?

Gabriele Overwiening: I can see that we have now (through COVID) once again proven how agile we are, how flexible we are, how creative we are, how resilient we are. In particular, it became clear how willing we are to change, to evolve. With the strong new generation that I see emerging, I am firm of the belief that we will take care of the problems as they come, as challenges, and as an opportunity for the German pharmaceutical community. As a result, we will continue to partially reinvent the profession so that we can continue to develop to benefit society in whatever way it develops.

Roman Pratzka: Thank you very much for the interview.

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A 2021 HELL ON EARTH WITH PHARMACIST MARWA SALEM AMBASSADOR: MOHAMMAD W. YAMOUT LPSA, LEBANON

It’s clear to anyone who’s brushed through international news recently that the economy in Lebanon has been in freefall for a while, and that the skyrocketing currency’s inflation rate makes this one of the toughest crises in history.

This inflation rate has not only decreased the population’s purchasing power but also induced a forced shortage of drugs. Medications are subsidised by the (currently absent, as by the date this is written) government, however, this is not a solution.

Pharmacist Marwa Salem has given us an overview of the situation in this interview Mohammad: “please tell us briefly about yourself” Marwa: “I am a pharmacist that has graduated from the Lebanese international university of Beirut (LIU).

I have been working in the community pharmacy field for more than 11 years and this has been the worst year ever in my entire life, and entire career.”

Mohammad: “What is the most critical problem that the pharmacy profession faces in our country?”

Marwa: “ The economic collapse has led the importers of pharmaceuticals and the medication warehouses to stop distributing medication. They import these medications at an uncontrolled 1 dollar rate of 19,00020,000LL (rising constantly) and yet they have to sell it at a 1$=1500 rate, meaning that they are losing the difference in currency rate. Some medications are subsidised by the Lebanese national bank (BDL, Banque du Liban) but this subside has been lifted from most medications, rendering their rate 12,000, the importers would still be losing the difference in currency, and this has stopped them from distributing medications fairly and adequately, we receive 1-2 boxes of medication at every shipment, and these shipments arrive once or twice a month. Some medications have been cut off from the market, made inaccessible without any replacement, like colchicine and tamoxifen that have been unavailable since the beginning of the year. The crises have many reflections, and the medication shortage is by far one of the lowest points anyone could reach in a country. This is our health! We cannot compromise that.

We used to receive as many medication boxes as we asked for, but now we receive the bare minimum of 12 boxes and that’s even if the company warehouses accept to send us medication”

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Mohammad: “ What group of the population is the most affected by this crisis?”

Marwa: “it’s a vicious cycle. A wheel that rolls and alternates between stepping on the pharmacists and stepping on the patients. Patients have reached a state where they take their chronic diabetes and antihypertensive medications every other day rather than every day. And some even 3-4 times a week because they want what little medication they have left to last them as long as possible. We warned our patients to find and leave enough medication for their chronic needs up to 3-4 months, hoping that the crisis would be resolved, we had no idea that we would be rolling down to hell. The pharmacists are also severely affected by this crisis because they have to face the patients, and their nagging, their hurt and the desperate looks on their faces every day, every single day. We try our best to handle the situation with empathy, but we are tired. Our mental health cannot take any more” Mohammad: “ What steps can be taken to stop and prevent these challenges in our society?”

Marwa: “we have been asking the ministry of public health for a long time to support national medications that are made and distributed in Lebanon, and we would help support the sales of these medications in the local community, rather than importing these medications from outside and paying dollars for it, a currency that has now almost disappeared.

Some people think that since the drugs are subsidised by the ruling authorities, and that because this is the reason they’re not available, the drugs should simply not be subsidised anymore. This doesn’t take into consideration that more than half of the Lebanese population is now living in poverty (by the international standards). The solutions for this have to come from a national and institutional level since the economic crisis is the one that has dragged on all of this.

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THE MILLION DOLLAR QUESTION - DOES THE PUBLIC KNOW THEIR PHARMACISTS’ ROLES? WITH APT. NADIA FARHANAH SYAFHAN, M.SI., PH.D. AMBASSADORS: HEIDI & LIMEY BEM FF UI, INDONESIA

Please give us a brief introduction about yourself. Could this be changed to "Please, tell us about yourself:" I am Nadia Farhanah Syafhan, a clinical pharmacist and lecturer in the Faculty of Pharmacy, Universitas Indonesia.

What is the biggest challenge that pharmacists in Indonesia are currently facing in our primary health care system?

Looking into the current situation, pharmacists in Indonesia are currently facing several challenges which hamper the sustainability of pharmacists’ service delivery in primary healthcare settings. These challenges include: a. Macro-level challenges. For instance, constraints related to the healthcare system that are associated with lack of recognition and decisive support from healthcare authorities; b. Meso-level challenges. For example, organisational and cultural barriers of pharmacists’ services; and c. Micro-level challenges in terms of individual pharmacists’ competencies. The problems arise due to pharmacists’ lack of knowledge in particular topics, as well as lack of communication skills and teamwork, which lead to the lack of confidence in service provision and interprofessional collaboration.

From the aforementioned issues, the biggest challenge is building trust with healthcare authorities, other healthcare practitioners, patients, and society regarding the fact that pharmacists are medicine experts holding the responsibility to deliver safe, effective, and quality medicines. In addition, the involved stakeholders should also trust in the certainty that pharmacists’ role is essential, thus, it is necessary for pharmacists to be integrated into a healthcare team. Distrust has been a major obstacle for pharmacists to achieve optimal health outcomes.

What do you think is the best way to raise the public’s awareness regarding these problems?

Concerning these problems, the public’s awareness can be raised by showing the fact that pharmacists exist beyond the roles of dispensing medication in several ways. Pharmacists can deliver their roles with more engagement with the patients, such as having a thorough discussion about the patients’ concurrent or past medication, ensuring the safety and efficacy of the medication being dispensed, and maintaining proper adherence by giving information and recommendation through the right patient counselling process. Last but not least, all of these engagement efforts must be continuous, documented, and evaluated.

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What do you think we as pharmacists should do to help solve these problems?

Since the integration of pharmacists into the healthcare delivery process is essential, pharmacists should be more actively involved in patient care, such as contributing towards the process of medication review, patient counselling, or therapeutic outcome monitoring. This expanded pharmacist’s service could lead to better health outcomes and improved quality of life. To provide these expanded services, pharmacists must enhance and increase their clinical, communication, and interprofessional skills by participating in professional development programs including workshops, training and being actively involved in peer and expert discussions. Pharmacists are also encouraged to be involved as agents of change and propelling “the smart use of medicine” movement.

What can aspiring pharmacists like us do to help solve the aforementioned problems in Indonesia’s primary healthcare system?

As for aspiring pharmacists, they should first follow the curriculum prepared by their own universities.

Pharmacy education in Indonesia has adapted its curriculum to better prepare pharmacy students entering their real-life pharmacist practice through implementing problem-based learning which promotes their clinical knowledge and skills development. This is done in hope that the expected high passing rate of the pharmacist’s licence exam could be achieved. Pharmacy students are also expected to be actively involved in organisations comprising other healthcare majors students such as medicine, dentistry, or nursing students to give them an early exposure towards interprofessional collaboration, participating in pharmacy profession awareness campaign, internship programs in healthcare settings, and also brainstorming activities associated with policies surrounding the healthcare system.

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OVERVIEW OF THE CUIDAR+ PROJECT, THE DEVELOPMENT OF TELEPHARMACY WITH DR. AGNES AMBASSADOR: LAURA TREVISAN FECHNER FEBRAF, BRAZIL

The telepharmacy practice has been expanding due to Covid-19. The state of Rio Grande do Sul (RS) in partnership with some Pharmacists organised the CUIDAR+ program, and one of the branches of this project is the Tele-pharmaceutical care service, and as the first strategy: complementary follow-up mostly with patients with chronic respiratory diseases who use special medicines. The objective of the program is to provide clinical services remotely, avoiding the need of displacement, and increasing the access to monitoring services.

Willing to know more about the Project, we talked with Dr. Agnes Gossenheimer, Coordinator of the program CUIDAR+. From the very beginning of our conversation, she seemed very excited to share her collaboration in the Program CUIDAR+ with pharmacy students from all over the world!

During our conversation, Dr. Agnes explained how the project CUIDAR+ and the Telepharmaceutical care work.

Could you give a brief overview regarding this initiative? Perhaps this could be written as ".... overview of this initiative" The telepharmacy program started with users with ASTHMA and COPD and is now moving towards the treatment of diabetic patients as well. It takes place in three meetings: the first is to collect information about the use of medications, how the disease is controlled; the second addresses more adherence to treatment and whether there are problems related to pharmacotherapy, also performing necessary interventions; in the third meeting, the monitoring of the patient's care plan begins. The focus of the program, as in every pharmaceutical activity, is the patient.

How does the pharmacist's patient follow-up process work?

The pharmacotherapeutic follow-up carried out by the pharmacist is a clinical service, which aims to carry out a review of the pharmacotherapy, following the patient regarding the correct use of medication. We assess correct use, necessity, use, safety, effectiveness, adherence, aiming to check and have positive clinical results.

Is it always the same pharmacist responsible for that patient's case or are there several other pharmacists?

Usually yes, because it facilitates the bond between patient and pharmacist. The pharmacist who started the treatment will carry out the subsequent appointments.

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What should we expect for the future of telepharmacy and the CUIDAR+ project in Brazil?

The project CUIDAR+ is a program of the government of the Rio Grande do Sul state that aims to promote pharmaceutical care in the state and municipalities, mainly in the pharmacy of special medications (FME), under state management. The Pharmaceutical Telecare is part of the CUIDAR+, and works as a service provided by the state, aimed at special/specialised medicines, with remote monitoring of patients. This telepharmacy program started with users with ASTHMA and COPD and is now moving towards the treatment of diabetic patients as well. It takes place in three meetings: the first is to collect information about the use of medications, how the disease is controlled; the second addresses more adherence to treatment and whether there are problems related to pharmacotherapy, also performing necessary interventions; in the third meeting, the monitoring of the patient's care plan begins.

What was the most challenging part of the entire project construction? A: I think the most challenging part was how to innovate and how to overcome lack of confidence and fear with innovative practises.

There is no history in the RS of having any group responsible for pharmaceutical care. Telecare is something that is not in Resolution, nor recommended within the Regional Council of Pharmacy. We saw that there was a need to develop this project. People first need to know the new and adapt to the new models.

Any advice for future pharmacy students here in Brazil, or maybe from other parts of the world who would like to start projects in this area?

My tip is: keep studying, and studying patterns that work well in certain places, so that we can check what we can adapt to each reality. Study what is most innovative, study what is happening in the world, what has already been done and think about people's needs. Always focusing on who the service is aimed at.

Special Thanks goes to Dr. Agnes Gossenheimer, André Koga Salles, Diana Rosa Benitez Machado, Francisco Matheus Ferreira Dias, and Gabrielle Gimenes Lima

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UNCOVER THE FACTS BEHIND COVID-19 VACCINE WITH DR. DEWI KARTIKAWATI PARAMITA, DEPARTMENT OF HISTOLOGY & BIOLOGY, FACULTY OF MEDICINE, GADJAH MADA UNIVERSITY AMBASSADORS: JESSLYN NADIA, DEA PURNAMA PUTRI BEM KMFA UGM, INDONESIA

Could you explain to us the details of vaccines?

Vaccines are biological substances produced by living organisms or viruses, or the organisms or viruses themselves that are attenuated or inactivated, which are injected or administered orally to humans or animals, for increasing immunity against certain diseases.

Could you tell us what are the benefits of vaccines?

Vaccines will increase immunity against a disease. By administering a vaccine for the same germ that infects that person, a person will gain immunity without experiencing illness caused by the organism. For example the Covid-19 vaccination. With the SARS-Cov-2 vaccination, the immune system in our body will be induced to produce immunity without being preceded by an illness. In addition, because the vaccine dose is measured, the immunity produced will be sufficient to fight back infection.

Could you give us the reasons why people should be vaccinated, especially during this Covid-19 pandemic?

The first reason is that we have immunity to certain germs or diseases so we are protected from being infected, or if infected it won’t be severe or even asymptomatic. If a large proportion of the population already has immunity, most of them won’t get sick when they meet someone with the disease. For example, 80% of the population already has immunity to COVID-19. If 5 people meet someone who is sick with COVID-19, then 4 out of 5 people won’t become sick and won’t spread the disease. Therefore, vaccination is important not only for oneself, but also for the common good because it prevents the transmission of disease, and can even prevent the transmission of infection.

Could you give us confidence about the safety of vaccines?

The manufacture or development of vaccines is carried out through various stages. Starting from the preclinical stage in the laboratory (the in vitro level), then in vivo in experimental animals, after that it enters the clinical trial stage in humans which includes three phases. Since preclinical trials are in vitro and in experimental animals, safety becomes the main concern. Then in each phase of clinical trials, safety evaluation is always a priority in addition to the effectiveness and several other factors. If it passes all these tests, the vaccine will get permitted from competent authorities to be circulated and used.

Therefore, the vaccine that has been circulating has passed the test for safety.

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Could you explain how vaccines work in our bodies?

Vaccines can be derived from different components (SARS-Cov-2 virus, inactivated virus, SARS-Cov-2 virus components, protein, mRNA, DNA), which will be processed in different ways in our body. For RNA and DNA vaccines, a protein formation process that is encoded by RNA or DNA will be carried out first.

After the protein is formed and given the SARS-Cov-2 inactivated virus, the protein or virus will be taken up by dendritic cells and processed into small components (peptides). The peptides will be presented to T cells by dendritic cells, especially T helper cells who are going to activate the B cells. The activated B cells will differentiate into plasma cells and produce specific antibodies against SARS-Cov-2. These antibodies can detect and catch the virus when it enters the cells. On the other hand, if the protein encoded by the SARS-Cov-2 RNA or DNA vaccine is formed, the protein processed by the dendritic cell will activate the T cell and become a cytotoxic T cell (can kill virus-infected cells), dendritic cells, T cells (helper and cytotoxic), and B cells (immune cells).

Could you give us an explanation of why those who have been vaccinated still possibly get infected?

One of the antibodies that is expected to be formed after vaccination is neutralising antibodies, whose function is to catch the virus before it enters the body, for example it’s still in the respiratory tract cavity.

However, there aren’t enough studies showing whether vaccination produces neutralising antibodies or not. In addition, the SARS-Cov2 virus has a mechanism to escape from the immune system, in this case it escapes from neutralising antibodies. People who have been vaccinated are more protected, even if infected, usually the symptoms are milder or have no infectious symptoms.

Why does each type of vaccine have different levels of effectiveness?

Because each type of vaccine comes from a different main component (e.g. live attenuated germs, inactivated germs, their components, e.g. proteins, mRNA, DNA). In addition to the main components, vaccines also contain other components, such as adjuvant, whose function is to strengthen the antigens in the vaccine. The main and additional components in this vaccine will be processed by the immune system differently. Theoretically and proven in research, vaccines with different components can induce an immune response. However, because the components are different, different results are also very possible. The vaccine must have an efficacy of more than 50% to be approved by the competent authority to be used. Once approved and used, active monitoring of effectiveness and safety continues.

Why does each type of vaccine have different side effects?

When the vaccine is injected or inserted into the body, the immune system will be activated in the body.

The reaction that will occur is an inflammatory reaction, which can be local, but systemic reactions can occur. Generally, the effects (post-technical follow-up conditions/AEFI) from various types of vaccines are basically the same, which are pain, swelling, fatigue, dizziness, fever, pain in muscles or joints, and maybe some other symptoms. Symptoms of vaccine side effects usually disappear within 1 or 2 days.

Serious or fatal side effects are few. If so, there may have to be a concomitant condition.

Could you explain why the Astrazeneca vaccine has pre-vaccine effects difference for those who are under 30 years old and over 30 years old?

In the UK, it was found that 79 people who have been vaccinated suffered from blood clots and 19 of them died. Of those 19 people who died, 3 of them were under 30 years old. After being analysed, people who are under 30 are predicted to have the highest risk of vaccine side effects or in Indonesian kejadian ikutan pasca imunisasi (KIPI).

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Why was the Covid-19 vaccine not recommended for children under 18 years old before?

Vaccinations for COVID-19 are vaccines that are being developed with the acceleration of time. Due to pandemic conditions, a Covid-19 vaccine was developed within 18 months while vaccine development usually takes up to 10 years under normal conditions. Therefore, there was no clinical trial data for those under 18 years old, because clinical trials of the Covid-19 vaccine initially only included participants aged 18 years and over. However, along with the increasing time and need, a Covid-19 vaccination study proved that vaccination for children under 18 years old is safe and effective.

Does the third dose of vaccine with a different type have any side effects?

Side effects that may arise are similar to the first or second vaccine.

If someone is exposed to Covid-19 infection and then declared cured, does the second vaccine have to wait three months after being declared cured? How will the second dose of vaccine affect Covid-19 survivors?

In such cases, and coincidentally various studies were carried out on mRNA vaccines, these survivors only need one vaccination, not twice. Up to about 3 months after recovering from COVID-19, they still have immunity. Therefore, it is recommended to get vaccinated again after 3 months. In cases like those asked, it is better to get a second vaccine after 3 months of recovering from Covid-19. In several studies that I conveyed to Covid-19 survivors, vaccination can increase antibody levels several times.

Is there a possibility of a prolonged effect on someone who has been declared cured of COVID-19?

If someone is infected with the SARS-Cov2 virus, they can suffer from COVID-19 with symptoms the at can be mild to severe or even fatal to death. If the illness is severe enough, when it recovers, there is a possibility of leaving defects or abnormalities. When we recover, our immune system is induced to produce immunity against SARS-Cov2.

Is there any possible consequence when someone who is infected with Coronavirus gets vaccinated?

In general, immunisation or vaccination must be carried out in healthy conditions because the principle of vaccination is to introduce germs or components of germs into the body. The body will react in the form of inflammatory reactions to induce the immune system. If a person is positive for Covid-19, that means an inflammatory reaction is also taking place in their body. If this person is vaccinated, it will cause a severe inflammatory reaction and may be bad.

In your opinion, what strategies can be used for overcoming public doubts about the Covid-19 vaccine after hearing news about the severe side effects?

Education. Medical personnel must understand well about the principle of vaccination, how to give it, how it works and its side effects. In addition, medical personnel should be also provided with simple counselling on how to convey a persuasive but good message. So that people get the right information in the right way.

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ARTICLE

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ACCESS TO HEALTH DATA BY PHARMACISTS AMBASSADOR: CAROLINA SIMÃO APEF, PORTUGAL

According to the guidelines on Good Pharmacy Practice Standards for Quality of Pharmacy Services, developed jointly by the International Pharmaceutical Federation (FIP) and the World Health Organisation (WHO), ''Pharmacists should have access to, contribute to and use all necessary clinical and patient data to coordinate effective medication therapy management, especially when multiple health-care are involved in the patient's medication therapy, and intervene if necessary''. [1] Additionally, the FIP recommends in its eighth development objective entitled ''Working with Others'', the need to continue and integrate care through communication systems, data sharing, co-decision, and co-accountability, [2] in order to contribute to the development of health care of better quality and centred on the patient.

On the legislative scope, in Portugal, access to health data by health professionals is facilitated. This is necessary as a way to promote more and better health care to the population. Thus, safeguarding access to data only by professionals who have a duty of professional secrecy, such as pharmacists. [3] Evidence points to the need to share health data with Pharmacists at different levels of patient care, however, in Portugal, this is not always the case. Community Pharmacists, as community outreach professionals, still do not have access to users' health data, therefore, are prevented from making decisions based on accurate and complete information. This limitation hinders the work of the professionals, who are often the user's first contact with health care, reducing the quality of counselling and monitoring of the user's medication.

The Portuguese Pharmacists' Association and the Shared Services of the Ministry of Health (SPMS), in 2019, signed an agreement defining the access of Hospital Pharmacists to the electronic clinical record of users of the National Health System. [4] This was an important step and is now also required for other areas of action such as Community Pharmacies.

Why is it so important for Community Pharmacists to have access to health data? In Portugal, a large percentage of the population is polymedicated. A European study called SYMPATHY, which involved the Faculty of Pharmacy of the University of Coimbra and Lisbon, and which aimed to study the impact of polymedication on the elderly population, estimates that 40% of people who are polymedicated do not do it properly [5], This leads to a high percentage of hospitalizations and health complications that could be avoided.

The access by the Community Pharmacists to the patient's health data and to the medication that they administers would be useful information that allows the professionals to understand if the dispensing of the medication requested by the user was safe and, in the last case, act on drug-drug or drug-pathology interactions.

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In a reality where patients are unaware of the true impact of the drugs they administer and where they sometimes hide the information about the drugs they have acquired in other Pharmacies, it has never been so urgent to extend the sharing of health data to the Community Pharmacists. Such a decision would lead to substantial gains in health, as it would not only make taking the medication by the patient a safer process, reduce hospitalizations triggered by drug interaction phenomena in polymedicated patients, but also allow the Community Pharmacists to provide more targeted, reasoned, and personalised counselling.

Thus, allied to the technical-scientific knowledge of a pharmacist, the sharing of information regarding the patient's pathology and therapy would ultimately lead to a more fruitful and efficient pharmaceutical intervention as well as great gains in health.

A concerted effort involving health regulators, representatives of the pharmaceutical sector and the Patient Associations is needed to reach an agreement that is practical, safe, and comfortable for everyone. For the moment, the object of discussion and advocacy by the stakeholders of the pharmaceutical sector has been the authorization to share the patient's health data with the Pharmacists during the period in which the patient is in the Pharmacy.

The Portuguese Pharmacists' Association has been working in this area since 2017, not only by continued work with the Shared Services of the Ministry of Health but also, by sharing the Pharmacists’ view on the possibility of accessing health data in several hearings and meetings between this Association and the National Data Protection Commission.

Additionally, stakeholders in the pharmaceutical sector have developed several workshops for Pharmacists, with the aim of raising awareness and promoting the development of digital and cybersecurity.

The truth is, there are several challenges and barriers underlying this theme. From the need to adapt all information systems, to concerns about data protection and reduced digital literacy among healthcare professionals.

Access to Pharmacists for health data has been at the forefront of the demands of stakeholders in the pharmaceutical sector and we know that step by step, we will make the actual process and contribute to the improvement of health care.

[1]https://www.who.int/medicines/areas/quality_safety/quality_assurance/FIPWHOGuideline sGoodPharmacyPracticeTRS961Annex8.pdf [2]https://www.fip.org/fip-development-goal-8 [3]Access to health data -working document-. National Council of Ethics for the Life sciences.

[4]https://www.ordermfarmaceuticos.pt/pt/noticias/farmaceuticos-hospitalares-com-acesso-a electronic-clinical-registry of users/

o-

[5]https://www.dn.pt/lusa/estudo-considera-urgente-plano-nacional-de-polimedicacao-nos-id osos-emportugal-8538765.html

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PHARMACY-BASED INTERVENTION OF COVID-19 VACCINE ACCEPTANCE AMONG INDONESIAN PEOPLE AMBASSADORS: NI MADE LALITA GITA GAYATRI & RIZKI AMEILIA PUTRI BEM KMFA UGM-INDONESIA

Indonesia is going through critical times because of the Covid-19 pandemic. Many big income resources like tourism have been shut down causing the economy during the year 2020 to decline. This may affect other life aspects as well, such as health and social. To overcome this problem, Indonesia should stop SARS-CoV-2 from spreading and infecting people. One of the most effective ways is through achieving herd immunity. Herd immunity could happen if most of the population is immune to Covid-19 thus it can provide indirect protection to others who aren’t immune. Immunity can be developed if a substantial part of the population either gets infected or vaccinated. But, to let a large number of people get infected is quite risky as it can increase the death rates and allow the virus to mutate. Therefore, vaccination is the best way to reach herd immunity.

Since SARS-CoV-2 is a new virus hence no vaccine is available to fight its spreadability in the early pandemic. Several countries including Indonesia started their research to develop vaccines against this virus. As a response to the emerging situation, the former Health Minister, Terawan Agus Putranto, initiated Nusantara and Merah Putih (Red and White, Indonesia’s national flag reference) vaccines research.

However, the Nusantara vaccine is facing controversy as the Food and Drugs Agency (BPOM) stated that it doesn’t meet the requirements, thus the vaccine wouldn’t be commercialised and its development is only for research purposes. Yet, the massive production of Merah Putih vaccine is expected in early 2022 after it is granted Emergency Use Authorization (EUA) on the completion of its clinical trials. As it takes a long time to wait for homegrown vaccines to be available in Indonesia, we have to import some vaccines from other countries. BPOM holds a crucial role in making sure which vaccines are suitable to be distributed and pass the clinical trials.

In the meantime, the government had made health protocols such as the obligation to wear masks, wash hands, avoid crowded gatherings, and physical distancing. But these health protocols aren’t well promoted in some areas and some people don’t even want to trust the virus’ existence, causing Covid-19 cases in Indonesia to reach its peak before the widespread execution of the vaccination program. The first batch of the Covid-19 vaccine arrived in Indonesia on December 6, 2020 with the launch of the first vaccination program on January 13, 2021, As of August 2021, there are five vaccines approved for use in Indonesia, these are Sinovac, Sinopharm, AstraZeneca, Pfizer, and Moderna.

In fact, there are some problems with increasing the Coronavirus vaccination rate, such as , the number of the first dose of vaccines is not enough. In the beginning, the elderly patients, with an age range of at least 60 years, were prioritised to get the first and second doses of Coronavirus vaccination. However, based on the new mutation of the Covid-19, called Delta, the government pushes the adult and the children to get the vaccines. Also, the amount of vaccines has run out. The first vaccine in Indonesia is Sinovac which ran out in May 2021. Then, the existence of AstraZeneca vaccine is targeted to adults with a minimum age range of 18 years . The other problem is the non-compliance of people towards vaccination.

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Furthermore, some local groups of Indonesian have rejected the Covid-19 vaccinations. There is a lack of trust from the society towards the Indonesian government in the arrangements for distributing and developing COVID-19 vaccines. On the other hand the lack of trust in the vaccine industry because of pharmaceutical companies’ long-standing negative reputation, mostly contributed to the anti-vaccine movement and vaccine hesitancy. There are some hoaxes about conspiracy theories through the online chatting app that are promoted by anti-vaccine groups. To manage those who are hesitant for vaccination, the government restricts people’s mobility and would give passes to only those with vaccine certificates even if they want to get into malls and other tourist attractions. Hence the anti-vaccine movement slowly decreases.

At least, all health actors work together to build an understanding of Indonesian people to get themselves vaccinated for Covid-19. The most important thing is to simplify the registration of vaccines by facilitating an application and increasing public places used for mass vaccines. There is an application called SpeedID to sort the queue digitally. Until this article has been written, the vaccination rate of the second dose of Coronavirus vaccine in Indonesia is at 7.56 percent. It is a very small number of the Indonesian population. However, one of Indonesia's provinces has successfully accomplished the Coronavirus vaccination. Based on the latest data from the official website of the Ministry of Health of the Republic of Indonesia on August 1st, 2021 regarding COVID-19 vaccination, Bali became the province with the highest number of first doses of vaccination, which was 102.43 percent of the initial target. We hope the vaccination rate would increase rapidly so herd immunity can be achieved and people can manage to live their pre-pandemic lives and build the economy stronger.

References: 1. Anonim.

2021.

The First COVID-19 Vaccine Arrives in Indonesia.

Retrieved from URLhttps://kemlu.go.id/chicago/en/news/9864/the-first-covid-19-vaccine-arrives-in-indonesia 2. Anonim.

2021.

5 Vaccines Approved for Use in Indonesia.

Retrieved from URL https://covid19.trackvaccines.org/country/indonesia/.

3. Anonim.

2021.

Vaksinasi COVID-19 Provinsi.

Retrieved from URL https://vaksin.kemkes.go.id/#/provinces.

4. D’souza, Gypsyamber., & Dowdy, David. 2021. What is Herd Immunity and How Can We Achieve It With COVID-19? Retrieved from URL https://www.jhsph.edu/covid-19/articles/achieving-herd-immunitywith-covid19.html.

5. Oktavia, Maria Helen. 2021. Indonesia Gearing Up to Produce Homegrown Covid-19 Vaccines. Retrieved from URL https://go.kompas.com/read/2021/04/20/162812474/indonesia-gearing-up-to-producehomegrown-covid-19-vaccines?page=all#page2.

6. Oktavia, Maria Helen. 2021. BPOM: Indonesia's Merah Putih Vaccine to Kick Off Production in 2022.

Retrieved from URL https://go.kompas.com/read/2021/04/17/074443674/bpom-indonesias-merahputih-vaccine-to-kick-off-production-in-2022?page=all#page2.

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DIGITAL HEALTH: HEALTH INEQUALITY AND THE LAW FOR PHARMACEUTICAL OF IT IN INDONESIA AMBASSADORS: GUSTI AYU MADE WIDIARI, VICTORYA BASULE BEMF USD, INDONESIA

The COVID-19 pandemic has resulted in many changes in the world's health system, as well as in Indonesia. The treatment environment is also changing rapidly and more and more health professionals such as doctors and pharmacists, one of which is practising health services by maintaining social distance and not meeting face-to-face, are working to slow the spread of the virus , In 2020, the Indonesian Ministry of Health issued a Circular Letter of the Minister of Health HK.02.01/MENKES/303/2020 which stated that telemedicine services are health services carried out by doctors using information and communication technology to provide quality health services. In addition to providing medical consultation services, telemedicine also includes teleradiology, tele-electrocardiography, telepathology, and telepharmacy performed by other health professionals . Telepharmacy is the telecommunications of patients and pharmacists without direct interaction that provides pharmaceutical services such as monitoring, patient counselling, prior authorization and authorization of refills for prescription drugs, and monitoring of formulary compliance with the help of teleconferencing or video conferencing. This service is provided through a retail pharmacy website or through a hospital, nursing home, or other medical care facilities.

Telepharmacy has the potential to expand access to pharmacy care from cities to villages. The implementation of this system can also provide pharmaceutical services to remote areas that were previously difficult to obtain, improve patient safety through counselling, reduce transportation costs, and several other pharmaceutical services. The application of this technology is closely related to the quality of technology, medical procedures, decision making, and human interaction in a holistic integrated manner. .

However, looking at Indonesia's geography for people who still live in disadvantaged areas, borders and islands, it is difficult to get optimal services. In these areas, there are still many basic health facilities that do not meet service standards, lack of standard health service guidelines, availability of facilities, completeness of facilities, drugs, medical devices, and health workers. This creates an increasingly large gap in society because in strategic areas the community can easily access health services and even accelerate technology to optimise them, but in the non strategic area, the community is further away from adequate health services due to limited facilities so they are unable to apply technology and communicate with the internet to get optimal service .

As mentioned above, telemedicine services have been regulated from the beginning in Permenkes No. 20 of 2019 which updated as Circular Letter of the Minister of Health HK.02.01/MENKES/303/2020, namely before the pandemic, but until now there has been no regulation for telepharmacy, especially for buying drugs in marketplaces such as Shopee, Tokopedia, Blibli and other marketplaces that are available in Indonesia. Suboptimal use of the internet can be described by the provision of various types of drugs in uncontrolled marketplaces such as in offline pharmacies, where buyers can easily get drugs that should require a doctor's prescription to be redeemed, such as hard drugs, narcotics class drugs, and Psychotropic drugs. Abuse of the drugs mentioned above is easier to happen because of the difficulty of monitoring both during promotions, purchases, and or transactions.

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Due to the absence of good monitoring and regulation, several cases are rife, such as the circulation of hard drugs that are sold freely and can be easily purchased by buyers. This is also accompanied by weak laws regarding restrictions on product sales in the marketplace which are written in the Circular Letter of the Minister of Communication and Information No. 5 of 2016, because judging from the position of this regulation, it has not been entered into legislation that can be a strong guideline for being able to trade drugs in the marketplace (Ariyulinda, 2018). The legislation that will be issued is also expected to help pharmacists protect consumers, namely providing consumer rights: submit a drug; ensuring the fulfilment of the rights of consumers of drugs: ensuring the dosage, labelling, monitoring of drugs; protects consumers from inappropriate drugs: prescription screening, packaging, counselling; hep to increase her/his (consumers) awareness of rights: to provide information about drug.

Therefore, a regulation that can provide solutions to both parties is needed, both for the seller (registered pharmacist) and the buyer, it should be published together with the regulation for online treatment or telemedicine. For a long time, the Pharmaceutical Law Draft has existed to be used as a guide to pharmaceutical law in Indonesia. However, until now, there is no certainty that the draft will become a valid law. In fact, in the era of the pandemic, telepharmacy is very much needed to be able to provide drug preparations more safely, more easily, and save more time and energy to go directly to the pharmacy. Therefore, many activities that encourage the advancement of the draft of pharmaceutical practice law are carried out to preserve the name of the pharmaceutical profession in Indonesia and tighten supervision laws by the Indonesian FDA. The escort activities to guide that the draft law can be ratified are carried out by various parties concerned with the pharmaceutical profession, both by IAI (Indonesian Pharmacists Association) and by Pharmacy Students Federation of Indonesia.

References: Ariyulinda, N., 2018. Urgensi Pembentukan Regulasi Penjualan Obat Melalui Media Online. Jurnal Legislasi Indonesia, 15(1), 37-48.

Elson, E. C., et al., 2020. Use of telemedicine to provide clinical pharmacy services during the SARS-CoV-2 pandemic.

American Journal of Health-System Pharmacy, 77, 1005–1006, https://doi.org/10.1093/ajhp/zxaa112 Sari, N., 2015. Protecting Consumer Medicine in Indonesia: Examining the Role of Pharmacist. Jurnal Hukum IUS QUIA IUSTIM, 22(1), 95-115.

Sianipar, B. H., 2015. Kebijakan pengembangan telemedicine di Indonesia. Kajian Kebijakan dan Hukum Kedirgantaraan, 1(1), 42-62.

Wikipedia, 2021. Telefarmasi - Telepharmacy Ensiklopedia, https://id.wikiqube.net/wiki/Telepharmacy, accessed on August 3, 2021. Yulianti, 2020. Pendekatan Telemedicine Dalam Rangka Menekan Penyebaran Covid-19, https://www.mutupelayanankesehatan.net/3500-pendekatan-telemedicine-dalam-rang kamenekan-penyebaran-covid-19, accessed on August 3, 2021.

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THE OPIOID CRISIS IN CANADA AND THE PHARMACIST’S ROLE IN TACKLING THIS ISSUE AMBASSADOR: RITA HUANG CAPSI-CANADA

The federal government of Canada has announced that Canada is in the midst of an opioid crisis and that the growing number of overdoses and deaths caused by opioids is a public health crisis. (1) The Canadian Centre on Substance Abuse and Addictions reported that there were more than 11,500 opioid related deaths between January 2016 and December 2018. (2) The Covid-19 pandemic has worsened the opioid crisis. In 2020 alone, there were 6,214 apparent deaths related to opioid toxicity, of which 96% were unintentional. Since the onset of the pandemic, 5,148 apparent deaths related to opioid toxicity have occurred in the period between April to December 2020. This represents an 89% increase from the same time period in 2019, when 2,722 opioid related deaths were reported. (3) Commonly prescribed for pain, opioids have the potential to cause problematic use due to the production of a euphoric feeling of well-being after their consumption. The current opioid crisis is the result of multiple complex factors. First, patients who are prescribed opioid analgesics may have a misunderstanding or lack of awareness of their addictive risk. Oftentimes, they have a lack of awareness or inability to access other medications to help manage pain. When patients seek treatment for pain, physicians are often prescribing opioids more frequently and for larger amounts. For individuals who may become addicted through the use of prescription opioids, they often turn to illicit opioid use when they cannot get prescriptions anymore.

Often, these illicit opioids are laced with fentanyl and its analogues, which dramatically increases the risk of overdoses due to its potency, even in trace amounts. Physiological, social and biological factors can predispose individuals to addictions. These risk factors include genetics, mental health, trauma, and social determinants of health such as poverty or lack of stable housing. Those who are suffering from opioid addiction, they are often faced with stigma from the public and from health care providers when they try to seek help. There is also a lack of comprehensive care to respond to all the mental and physical needs of the individual that occur concomitantly with the addiction. (2) The pandemic has contributed to the worsening opioid crisis. Several factors include being cut off from the normal drug supply, an increasingly toxic illicit drug supply, limited accessibility to services, and feelings of stress, isolation and loneliness that can exacerbate mental illnesses. (3) Previous to and since the announcement of the opioid crisis in Canada, federal and provincial governments have been working closely with health care providers and the public to raise awareness of and solve this issue. Here, pharmacists have played an important role. As the final point of contact when a patient is prescribed an opioid analgesic, pharmacists educate patients about their medication and the risks associated with it - including addictions and overdose. To provide further education to patients, Health Canada requires pharmacists to place a warning sticker on all dispensed narcotic prescriptions, warning patients that opioids have the potential to cause dependence, addictions, and overdose. This is accompanied by a pamphlet that includes information such as recognizing the signs of an overdose, side effects of opioids, not sharing opioids, and keeping them out of the reach of children. (4) Pharmacies across the country also promote the returning of unused narcotic prescriptions to the pharmacy for safe disposal. This provides assurance that the medication does not fall into the wrong hands.

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Pharmacists are actively involved in harm reduction strategies aimed at reducing the negative consequences of drug use. One of the strategies is through dispensing of long -acting opioid agonist treatment - methadone and buprenorphine/naloxone (Suboxone). Both medications are long-acting agonists of the μ opioid receptors and act to reduce cravings and signs and symptoms of withdrawal. They allow patients to regain stability and work towards recovery. Pharmacists that dispense these medications to patients often develop close relationships with them and are able to guide them to other community resources. Another harm reduction strategy is through education and provision of naloxone, a complete μ opioid antagonist that can temporarily reverse an opioid overdose to allow time for the individual to reach a hospital.

The Canadian Pharmacists Association (CPhA) has released the Opioid Action Plan with recommendations to improve how pharmacists help prevent prescription opioid misuse and abuse before it begins. There are three main recommendations in the plan. The first recommendation is to: Accelerate the implementation and integration of drug information systems (DIS) with electronic health records (EHRs) in every province and territory. This electronic drug information system would allow pharmacists to monitor opioid prescribing and dispensing no matter where the patient receives the prescription and identify patterns of misuse and abuse. The second recommendation is to: Support the creation and adoption of collaborative professional practice tools and guidelines. These guidelines would provide evidence based recommendations to prescribers on how to prescribe opioids and promote inter collaborative care. The final recommendation is: Designate pharmacists as practitioners under the Controlled Drugs and Substances Act. Often pharmacists are presented with opioid prescriptions where the dose or quantity is above what is recommended. Implementation of this recommendation will allow pharmacists to adapt opioid prescriptions, such as reducing the dose, or prescribing non-opioid alternatives. (5) Currently, CPhA is advocating the government to implement this plan to allow pharmacists to better help their patients.

Through providing education and care to patients and advocating for increased support, pharmacists are playing an essential role in combating the opioid crisis in Canada. In Canada, the scope of pharmacy practice is constantly expanding. Pharmacists and pharmacy students are also receiving more education about the opioid crisis and what they can do to help their patients and their community.

References: 1. Responding to Canada’s Opioid Crisis. [Internet]. Government of Canada; May 2021 [cited 2021 Jul 17]. Available from: https://www.canada.ca/en/health-canada/services/opioids/responding-canada-opioid-crisis .html 2. King S, Katan C, Pana P. Opioids. [Internet]. Canadian Centre on Substance Use and Addictions [cited 2021 Jul 17]. Available from: https://www.ccsa.ca/opioids 3. Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid and Stimulant Related Harms in Canada. [Internet]. Public Health Agency of Canada; Jun 2021 [cited 2021 Jul 17]. Available from: https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/ 4. Opioid Warning Sticker and Patient Information Handout, and Risk Management Plans. [Internet]. Government of Canada; Mar 2019 [cited 2021 Jul 17]. Available from: https://www.canada.ca/en/health-canada/services/drugshealth-products/drug-products/ap plications-submissions/policies/warning-sticker-opioid-patientinformation-handout.html 5. Opioid Crisis. [Internet]. Canadian Pharmacists Association; Nov 2018 [cited 2021 Jul 18]. Available from: https://www.pharmacists.ca/advocacy/issues/opioid-crisis/

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CHALLENGES IN PHARMACEUTICAL PRACTICE IN BRAZIL AMBASSADOR: GIOVANNA SOUSA SILVA AND LAURA TREVISAN FECHNER FEBRAF, BRAZIL

According to the Federal Council of Pharmacy, responsible for regulating Pharmacist profession and advocating for its valorization and following Brazilian Law, 72 areas are described as Pharmacist attributions including Clinical Pharmacy, Public Health, Hospital Administration, Molecular Biology, Clinical Biochemistry, Community Pharmacy, Pharmacoepidemiology, Industrial Pharmacy, among others(1).

In 2020, around 234 300 Pharmacists were registered in regional class councils subordinated to the Federal Council(2). The Pharmaceutical profession evolved alongside society which led Pharmacists to assume a technicist role. However, there have been a rescuing of the role of the Pharmacist as a Health professional, including the adherence to the current legislation and, the growing practice of Pharmaceutical prescription, the insertion of Pharmacists in multidisciplinary teams aiming to provide care, security and proper orientation of patients in a daily basis. This has shown the complexity of the role of Pharmacists in the Brazilian Health Care System, Industry, Health Surveillance and society(3).

Health Care Systems around the world are facing challenges concerning budget constraints, the high prevalence of chronic non-communicable diseases, and the increase in problems related to pharmacotherapy that lead to morbidity and mortality related to medicines. Such challenges affected the Pharmaceutical profession as well. According to World Health Organisation, Pharmacists should be more involved in solving problems starting from a product-centred approach to care, carrying out activities aimed at promoting rational use of medicines and other health technologies, having its practice redefined based on the needs of people, family, caregivers, and community, e.g. pharmacotherapeutic follow-up, health education, health screening, medication reconciliation and pharmacotherapy review(4).

According to Martins-de-Freitas et al. (2016), the main difficulties Pharmacists face are lack of professional recognition considering low wages and little recognition by society, non-acceptance by the team in which the Pharmacists perform their activities, high range of attributions or activities, and technicist and mechanised view of the profession missing a humanised and holistic approach.

Nonetheless, the Pharmaceutical professional in the Brazilian context plays a vital role in Drug Therapy Management, contributing to the patient's health condition improvement. That said, Pharmacists are a gateway to the health system due to the easy access citizens have to pharmacies both in terms of free counselling and by geographic distribution(4). Brazilian Unified Health System (SUS), universal access to health as an expression of citizenship. I.e.,2021 The role of a Pharmacist is to ensure the essential medicines aimed at tackling priority diseases such as non-communicable diseases are accessible and to ensure their quality, efficacy and safety, as well as promoting the rational use of medicines in order to reintegrate Pharmaceutical Care into SUS(5).

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Another challenge concerns the dispensing of medication on Health Care facilities such as a primary care facility, a hospital or a pharmacy or drugstore participating in the Popular Pharmacy Program, where the computerised program for drug dispensing is being implemented poses an obstacle to a therapeutic support system which incorporates a proper set of automated evaluation of prescriptions, e.g., screening for therapeutic duplicity, adverse reactions, drug interactions, adequate dose ranges, alerts for similar names and so on(6).

According to Freire et al. (2019), the environment used for the storage and dispensing of medication is another obstacle due to it being considered inadequate for assuring staff and patient safety and being insufficient for the purpose of administration, receipt, and storage of health products such as medication on account of lacking physical space, and controlled humidity and temperature.

Ultimately, the number of Pharmacists in the SUS is insufficient to build a Systemic Pharmaceutical Care from the logistical aspect to the provision of Pharmaceutical Assistance. Nonetheless, the efforts performed by Pharmacists are gaining recognition and achieving the goal of reinserting this professional as a Healthcare Provider(7).

References 1.

Brasil Áreas de atuação Conselho Federal de Farmácia.

Available on <https://www.cff.org.br/pagina.php?id=87>.

2. Brasil - Dados 2020 - Conselho Federal de Farmácia. Available on <https://www.cff.org.br/pagina.php? id=801&titulo=Dados+2016>.

3. Serafin, C., Correia-Junior, D., & Vargas, M.(2015) Perfil do farmacêutico no Brasil: relatório. Brasília: Conselho Federal de Farmácia.

Available on <https://www.cff.org.br/userfiles/file/Perfil%20do%20farmac%C3%AAutico%20no% 20Brasil%20_web.pdf>.

4. Martins-de-Freitas, G. R. Pinto, R. S., Luna-Leite, M. A. Silveira-de-Castro, M., Heineck, I. (2016) Principais dificuldades enfrentadas por farmacêuticos para exercerem suas atribuições clínicas no Brasil.

Rev. Bras.

Farm.

Hosp.

Serv.

Saúde São Paulo v.7 n.3 35-41.

Available on <http://www.v1.sbrafh.org.br/public/artigos/2016070306000982BR.pdf>.

5. Bermudez, J. A. Z. Santos-da-Costa, J. C. Carvalho-de-Noronha, J. C. (2020) Desafios do acesso aos medicamentos no Brasil. Rio de Janeiro: Edições Livres. Available on 2021 <https://www.arca.fiocruz.br/bitstream/icict/41803/2/Desafios_do_Acesso_a_Medica mentos_2020.pdf>.

6. Freire, I., I. L. S., dosSantos, F. R., dosSantos-Barbosa, J., Oliveira-da-Silva, B. C., Souza-da-Silva, I., Lessa-de-Freitas, A. A. (2019). Conhecimento e atuação dos profissionais da farmácia sobre a dispensação dos medicamentos. Arquivos de Ciências da Saúde, v. 26 n.2 p. 141-145. Available on <https://www.cienciasdasaude.famerp.br/index.php/racs/article/view/1372>.

Doi: https://doi.org/10.17696/2318-3691.26.2.2019.1372.

7. Oliveira-de-Melo, D. Cardozo-de-Castro, L. L. (2017) A contribuição do farmacêutico para a promoção do acesso e uso racional de medicamentos essenciais no SUS. Ciênc. Saúde coletiva. 22 (1). Available on <https://scielosp.org/article/csc/2017.v22n1/235-244/>. doi: https://doi.org/10.1590/141381232017221.

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DRUG DISTRIBUTION DISPARITY IN INDONESIA, WHEN WILL IT END? AMBASSADOR: FAIRUZ AISYA ALZURA, JAYSON WILBERT HMF ‘AP’ ITB , INDONESIA

Until now, there are still some problems in the health sector that need attention and action to overcome them. We believe that every country has its own emphasis on health problems, including Indonesia, which still has several unanswered and unsolved problems. On this occasion, we will talk more specifically about health inequity in Indonesia. Quoted from WHO (World Health Organisation), health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. In Indonesia, there are at least 4 main obstacles that need to be addressed regarding this issue.

1. Archipelago state. Consisting of more than 17,000 islands, the distribution of food and health is often hampered because remote areas cannot be reached only by land route. This uneven geographical distribution leads to inadequate supply and resources. Despite the distribution difficulty, the biggest problem in drug distribution is the difficulty of obtaining drug logistics information. There are regencies in one province which have excessive availability of drugs, but on the other hand there are regencies that lack drugs.

2. Economic condition. As one of the LMIC (Low Middle Income Countries), around 40% of 269 million people in Indonesia live on less than US$ 3.10 per day. In addition, the health sector only gets 5% of the State Revenue and Expenditure Budget and is divided among each local government. This number shows the difficulty of providing equitable health services for the community.

3. Poor access and connectivity. The serious inequality in factors affecting access consists of transportation costs, travel time to health care facilities, availability of health insurance or guarantees, and ability to pay.

4. Low healthcare professionals to Indonesian population ratio.. The average pharmacist ratio to population per 100,000 population is only 1:35 and this disparity becomes a serious matter in almost all regions.

Regarding the pandemic that is happening right now, especially in Indonesia, there has been a surge in drug demand and our country has been facing a lot of problems relating to the drug distribution equivalence. The ministry, in collaboration with the State-owned Enterprise and private pharmaceutical industries, continues to monitor the availability of drugs in the field, ranging from industry, pharmaceutical wholesalers, hospitals to pharmacies. The drugs are distributed to hospitals and pharmacies to be accessible to the public. To meet the increasing demand for drugs, the government calls on the pharmaceutical industry to increase production capacity, speed up importation and distribution of drugs.

Also, these industries and the public are urged not to hoard drugs.

Other than high drug demand, our country has also been struggling with medical equipment distribution equivalence. Medical equipment is different from other kinds of tools because it is a set of tools whose quality must be ensured so that they can reach users in a good and safe condition.

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The safety, quality, and benefits of imported and domestic medical equipment circulating in Indonesia has a distribution process that is in accordance with the guidelines by Regulation of the Minister of Health, that the distribution of medical equipment can only be carried out by facilities that already have a MedicalEquipment Distribution Permit (MEDP) and must be carried out in accordance with the provisions of the Good Method of Distribution of Medical Equipment. MEDP will be issued based on the company's eligibility to distribute medical devices safely and correctly. The distributor of the medical equipment is either a Limited Liability Company, cooperative, or individual company in the form of a legal entity that has a license for the procurement, storage, distribution of medical equipment in large quantities (according to the provisions of the applicable legislation).

The development of information and communication technology (ICT) has increased tremendously in all fields of life, including in administration health in Indonesia. ICT is not only to improve the service effectiveness and accessibility of health data, but also to assist in monitoring and evaluating health programs. The obstacle that often appears in pharmacies is the control process drug stock that is still done manually by looking at the drug sales book. This causes a lot of data errors and a relatively long time to check the drug stock. During the COVID-19 pandemic, the increasing demand for medicines and health supplements has reduced many people’s accessibility to the medicines they need. Due to the uneven stock of drugs in each region and the difficulty of finding the desired product, the government has created an online site to check the availability of drugs at the nearest pharmacy (farmaplus.kemkes.go.id). However, there are still many people who still do not know about the existence of this site and also drug stock data is only available for some large pharmacies such as Guardian, K-24, Watsons, etc. Not all people have easy access to these large pharmacies, because in general, large pharmacies are located in the centre of the city. Large pharmacies tend to be far away from the outskirts of town and people are having trouble accessing transportations which is also expensive for some. It is necessary to make online data information of drug stocks in small pharmacies, so that people can easily monitor the existence of the desired drug.

There are several things that the government and healthcare professionals, especially pharmacists, could do to overcome these problems. First of all, due to the uneven stock of drugs, the government could make a designated transportation system for each region. They also planned to make an online system for drugs and medical devices' stock in each region called the e-logistic system. This system will be a part of the National Health Information System. Besides that, the government also could make sure that each pharmacy and healthcare facility in each region have a stable network connection so that they could update and inform the needs for drugs and medical devices more often, thus the government could ship them on time. They also could predict the needs for the drugs and medical devices based on past needs and make orders to restock immediately.

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Secondly, to address the difficulty of finding the desired products or drugs, BPOM or National Agency of Drug and Food Control in Indonesia and Indonesia’s Ministry of Health could improve the online site that has been created, which is farmaplus.kemkes.go.id. As of now, the site only gives information about the stock of eight drugs, which include antivirus, antibiotic, and vitamin that are needed for recovery from COVID-19. For improvement, they could add the stock information of many other drugs. The government could also expand their cooperation with small pharmacies so the communities will have many choices of pharmacy to buy drugs. For the pharmacists, they could update the drug stock more often, for example twice a day, so that the drug stock information that was shown in the site will be the same as the actual drug stock in the pharmacy. To make the communities aware about this site, the Ministry of Health could put up an advertisement on television and social media as well as ask news programs to inform the site to their viewers.

References 1. Badan PPSDM Kesehatan. (2016). Rasio Tenaga Kesehatan terhadap Jumlah Penduduk (Per Provinsi) Per 100.000 Penduduk. Accessed through http://bppsdmk.kemkes.go.id/info_sdmk/info/renbut 2.

Doctorshare.

(2020).

Latar belakang (Background).

Accessed through https://www.doctorshare.org/latar-belakang 3. Fagasta, Tirta A, et al. (2017). Sistem Informasi Penjualan dan Pembelian Obat Apotek Nabila Care Bekasi. Jurnal Mahasiswa Bina Insani Vol.2 No. 1 ISSN : 2528-6919 4. Farmalkes, Setditjen. (2021, July 15). Kemenkes Menjamin Ketersediaan Obat Untuk Terapi COVID-19.

Kementerian Kesehatan RI. http://farmalkes.kemkes.go.id/2021/07/kemenkes-menjamin-ketersediaanobat-untuk terapi-covid-19/ 5. Kementerian Kesehatan Republik Indonesia. (2011). Tantangan Pembangunan Kesehatan. Accessed through https://www.kemkes.go.id/article/print/1428/tantangan-pembangunan-kesehatan-tahu n2011.html 6. Legalkes. (2021, June 28). Sertifikat Distribusi Alat Kesehatan. Accessed through https://legalkes.com/artikel-sertifikasi-distribusi.html 7. Susilowati. (2004). Ketidakmerataan akses pelayanan kesehatan rawat jalan di Indonesia. Accessed through http://etd.repository.ugm.ac.id/home/detail_pencarian/24633 8. Ulya, F. N. (2019). 6 Kendala ini Membuat Pelayanan Kesehatan di Indonesia Tak Maksimal. Accessed through https://money.kompas.com/read/2019/08/19/171503026/6-kendala-ini-membuat-pelay anankesehatan-di-indonesia-tak-maksimal?page=all 9. World Health Organization. (2017). State of Health Inequality: Indonesia. Accessed through https://www.who.int/docs/default-source/gho-documents/health-equity/state-of-inequa lity/12-decfinal-final-17220-state-of-health-inequality-in-indonesia-for-web.pdf?sfvr sn=54ae73ea_2 10. World Health Organization. (2018). Health inequities and their causes. Accessed through https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-ca uses 11. Mulyanto, J., Kringos, D. S., Kunst, A. E. (2019). Socioeconomic inequalities in healthcare utilisation in Indonesia: a comprehensive survey-based overview. BMJ Open, 9: e026164. Doi: 10.1136/ bmjopen2018-026164 12. National Academies of Sciences, Engineering, and Medicine; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11.

3, The Root Causes of Health Inequity.

Available from: https://www.ncbi.nlm.nih.gov/books/NBK425845/

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BRIEF INTRODUCTION ABOUT THE MEDICAL AND PHARMACEUTICAL FIELD IN IRAN MODERN MEDICINE AND PHARMACY IN IRAN: A BRIEF HISTORY AMBASSADORS: MINA JABBARI, FATEME AKHAVAN, YOUNES VAEZPOUR IPHSA,IRAN The pharmaceutical industry in Iran began in its modern form in 1920 when the Pasteur Institute of Iran was founded (1). In the field of drug production, Iran follows both USA guidelines and its own guidelines, which leads to the production of high quality and safe products. Iran has boosted scientific production in nanotechnology, biotechnology, biomedical engineering, bioengineering, biomaterials, and biophysics. For instance, the rankings of Iran were fourth in nanotech, 12th in biomedical engineering, ninth in bioengineering, and eighth in biomaterials in 2017 (2).

Iran is the first country in the East Mediterranean region that has the technical and scientific capability to export vaccines to various world countries (3).

In addition to the above, health, medical and pharmaceutical services in Iran are relatively well developed, and training doctors, pharmacists, and medical staffs who can serve the people of the country has always been one of the priorities. According to the ministry, 100% of urban and 98% of rural areas in Iran now have access to at least primary medical services (2).

Health inequality as an important Pharmacy Profession issue Health care is recognized as a fundamental right in most countries (4). Pharmacists are an essential part of the healthcare system. The primary task of pharmacists is to monitor and ensure the medicine dispensing accuracy to patients as well as to provide pharmaceutical consultations to other clinical professions. Pharmacist collaboration and alignment with other healthcare professionals are expected to increase the productivity and optimal utilisation of health care services (5). inflation rate and medical tariffs resulted in the majority of people not considering their health at the top of their priority list. So, the equal distribution of pharmacists in the country can help reduce drug-related morbidity and mortality, decrease the cost of services, and increase patient satisfaction (6).

The role of the pharmaceutical industries is providing the needs of the community by drugs with high quality, and suitable price (7). Some medicines are not currently manufactured domestically in Iran as their production is not economically justifiable because of low consumption. Financial and banking sanctions have limited the life-saving medicine trade, which harshly targeted the patients suffering from rare diseases (8).

Which Group of the population is most affected by health inequality?

Because economic problems and people's incomes directly affect health inequality, patients are one of the main victims of this issue. In fact, income inequality leads to inefficiency and the spread of injustice in the health sector. Population concentration in large cities can affect this issue both directly and indirectly.

Economic sanctions have also had a significant impact in recent years. With the shortage of some drugs and medical equipment in Iran, physicians and pharmacists are faced with more restrictions on treatments.

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On the other hand, the increase in the price of drugs has made the situation more difficult for patients and promotes health inequality on a global scale. Another issue is the small number of pharmacists and pharmacies in some provinces of the country. This issue affects both pharmacists and patients because it causes patients not to receive proper services, and also it makes pharmacists not be well used as an effective member of the health system. This inequality also exists in medical institutions, beds, and rehabilitation centers among the country's provinces, making things harder, especially for patients living in villages and small towns. (9,10,11,12) What steps have been taken to solve this challenge?

Over the past years, various measures have been taken to address health inequalities, and because deprived areas and villages have fewer facilities and are considered more vulnerable, there has been a focus on equipping these areas. Among the measures taken, we can mention these items: Establishing medical centres, creating health insurance, Increasing hospital beds, the Presence of specialised doctors in these areas, etc. However, it is clear that these measures have not yet been able to address health inequalities across the country fully. There is a need for a comprehensive plan that can compensate for the shortage of health workers regularly and simultaneously and expand the quality of health care. The issue of economic sanctions also remains (13,14).

Who are the key stakeholders and have positive influences in this process?

1-MoHME (Ministry of Health and Medical Education), IMC (Iranian Medical Council) and basic health insurance organisations, 2- MCLSW (Ministry of Cooperatives, Labour and Social Welfare), Parliament Health Commission, and the Vice-Presidency for Strategic Planning and Supervision of the MoHME, 3special councils and public/private hospitals, 4- 17 supplementary insurance funds and smaller stakeholders. (15) The Iranian government has made significant efforts to reduce health inequities through the establishment of a primary health care network (PHC). However, there is still a concern about fair access to health care (16). These deficiencies led the policymakers to adopt a reform known as the Health Transformation Plan (HTP). The most important goals of this program were reducing the Out of Pocket (OOP) and preventing referral of patients to centres outside the hospitals affiliated with the Ministry of Health for the purchase of medicines, laboratory and radiological equipment and services, strengthening special clinics, and promotion of outpatient care services, supporting the retention of physicians in deprived areas, etc. (17,18)

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Most of the pharmaceutical companies in Iran are owned by the government. The Iranian government can help the pharmaceutical industry develop by putting some limitations on importing drugs, exempting some companies from paying customs toll and duties, providing tax exemptions and low-interest-rate loans for those research-centred companies.

Government can differentiate essential and strategic drugs from other products, modify insurance policies (such as leaving OTC drugs out of insurance list and putting national products on that list), adjust drug prices along with putting some incentive prices, and alter prescribing behaviours of doctors and encourage them to prescribe generic drugs (19).

References 1. https://financialtribune.com/articles/economy-business-and-markets/19009/iran-to-be-4th-largestmideast-pharmaceutical-market.

2. https://financialtribune.com/articles/domestic-economy/99521/giant-strides-in-iran-s-healthmedical-sector 3. https://en.wikipedia.org/wiki/Healthcare_in_Iran 4. https://www.researchgate.net/publication/249998307_Equality_in_Distribution_of_Human_Resources _the_Case_of_Iran's_Ministry_of_Health_and_Medical_Education 5. https://www.researchgate.net/publication/343196101_Inequality_Analysis_of_Pharmacist_Distributio n_in_Iran 6. https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-020-01224-1 7. http://ijpr.sbmu.ac.ir/article_2307.html 8. https://www.tehrantimes.com/news/444403/Iran-capable-of-manufacturing-any-medicine-in-twoyears 9. http://journals.tums.ac.ir/payavard/article-1-6239-fa.pdf 10. https://www.researchsquare.com/article/rs-41977/latest.pdf 11. https://www.researchsquare.com/article/rs-52356/latest.pdf 12. https://irje.tums.ac.ir/browse.php?a_code=A-10-75-4&slc_lang=en&sid=1 13. https://irje.tums.ac.ir/browse.php?a_code=A-10-75-4&slc_lang=en&sid=1 14. https://iranjournals.nlai.ir/bitstream/handle/123456789/528379/6434F7ABD50ADEB4A12146E33E7 379CC.pdf?sequence=-1&isAllowed=y 15. https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-020-01224-1 16. https://www.researchgate.net/publication/282618836_Inequity_in_Health_Care_Financing_in_Iran_Pr ogressive_or_Regressive_Mechanism 17. https://resource-allocation.biomedcentral.com/articles/10.1186/s12962-020-0204-5 18. https://www.dovepress.com/explaining-socioeconomic-inequality-differences-in-catastrophic-healthpeer-reviewed-fulltext-article-CEOR 19. http://ijpr.sbmu.ac.ir/article_2307.html

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BEIRUT, THE FEAR CITY OF THE MIDDLE EAST WRITTEN BY: CALINE J. SAADE LPSA, LEBANON

You have most likely seen and heard of enumerated atrocities in Lebanon across widespread news outlets for the past couple of years; it would almost seem unusual if Lebanon was not headlining international news coverage. Lebanon has long been and currently is in a state of absolute chaos attributed to an incompetent ruling class, the peak of inflation rates, the devaluation of our currency (the Lebanese Lira), the Coronavirus pandemic, and following the Beirut explosion. This hasn't only rendered around 55% of the population under the poverty line according to UNESCWA (2021), but it has also prohibited the general population of its fundamental human rights, one of which is directly related to the pharmaceutical field; access to services and individualised medication.

The Pharmaceutical industry has always been of utmost importance yet is subjected to the highest levels of threat due to the gaps it faces.

Due to the general population's increasingly restricted purchasing power (even before the rising rates of poverty) and due to the overpriced physician consultations, citizens have always consulted pharmacists free of charge for counselling, guidance or even diagnosis; which defies our regulations and policies as pharmacists. Unfortunately, Pharmacists are still not recognized as an integral part of the health care body; mostly by other healthcare professionals Currently, the two most crucial healthcare challenges in Lebanon are, acute shortage of medications (both branded and generic types), and smuggling of medication. Smuggled medication could also be counterfeit, thus making the situation worse.

When tackling the former, according to the Medicine Importers Syndicate, Lebanon imports around 80% of its medicines. These are generally subsidised by the Central Bank rendering them somewhat still affordable amid inflation. However, the fear of an increase in pricing in the near future and lack of medication has prompted citizens to purchase their medicines at a more-than-needed basis. Unfortunately, Lebanese community pharmacies are not equipped with patient profiles and are subsequently unable to control patient purchases to maintain fairness in supply. Medication shortage is extremely concerning particularly in the case of chronically ill individuals (Diabetes, Cancer, Hypercholesterolemia, Cardiovascular Disease Patients…) since they find themselves unable to purchase neither their preferred medication nor a substitute. This would only exacerbate their medical condition, alter their functionality, worsen their quality of life and boost rates of morbidity and mortality.

Regarding the latter, Fraud has been on the rise especially due to medication shortage. Counterfeiting attempts most commonly target high demand and expensive medication as chemotherapeutic drugs, antibiotics and vaccines to name a few. Counterfeit medications are relatively cheaper than genuine medications, all while deceptively seeming legitimate to users due to similar packaging and labelling as genuine products. Therefore, patients trust the wrong suppliers which could lead to serious consequences.

Smuggling of genuine drugs also would lead to an increase in the artificial demand for medication further worsening drug shortages.

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Both the Pharmacists and the Patients are as affected by the issues mentioned above. The Pharmacy profession has been losing its integrity and credibility attributed to the lack of products and services which has led to the closure of many pharmacies or has left pharmacies with little to no profit. As for patients, the failure to optimise treatment regimens based on what is deemed most suitable for them has increased hospitalisation rates, morbidity and mortality.

On a brighter note, promising initiatives have unfolded to help make living circumstances slightly more bearable. Non-Governmental Organisations have played a very important role in satisfying the needs of the less privileged despite the limited funding they receive. These include Dawrati (Fighting Period Poverty), Relief International (Poverty Alleviation), Paracetamour and Lebanon Al Akhdar-‫)األخضر لبنان‬ Medical Relief) and others. In addition, Social Justice advocates have been of great help; spreading awareness and cases on their platforms and calling for action. As for the fight against counterfeit drugs, a newfound independent drug control laboratory is currently under study by the National Association for Social Health and the Academic Health Association in order to maintain medication uniformity and to decrease the rates of fraud and subsequent harm and hazard. In addition, the Ministry of Public Health has been working closely with the Order of Pharmacists in Lebanon (OPL) to secure a wide range of Generic drugs that are considerably more cost effective for both parties; the Pharmacists and the Patients. The OPL has also set a theoretical plan and a Memorandum of understanding regarding the establishment of electronic platforms such as an electronic patient profile with medication safety and management all while maintaining pharmacovigilance standards.

In conclusion, paving the way for reform in Lebanon requires far more than a theoretical approach.

Implementation using adequate allocation of resources is necessary for the best possible outcome. A collective and genuine effort by the government first, as well as.

The healthcare personnel and general population is required to uphold the standards and virtues of the pharmaceutical industry.

References: 1. ACT alliance alert: Lebanon crisis, 16 march 2021 - Lebanon. Reliefweb.int. Accessed July 5, 2021. https://reliefweb.int/report/lebanon/act-alliance-alert-lebanon-crisis-16- march-2021 2. Sacre H, Hallit S, Hajj A, Zeenny RM, Sili G, Salameh P. The pharmacy profession in a developing country: Challenges and suggested governance solutions in Lebanon. J Res Pharm Pract. 2019;8(2):39-44.

3. Everything you need to know about human rights in Lebanon. Amnesty.org. Accessed July 5, 2021. https://www.amnesty.org/en/countries/middle-east-and-north africa/lebanon/report-lebanon/

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DIGITAL HEALTH IN ALGERIA DURING THE PANDEMIC AMBASSADORS: ALYSSA BOUTNAF AND LYNA MERYAMA MEDJAHED ASEPA-ALGERIA.

The past decade has seen a rapid expansion in the adoption of technology around the world which has contributed to the creation of a new environment called the digital world. Therefore, the introduction of digitalization in the health system is today an essential element in supporting precision medicine, increasing access to information, as well as transforming care pathways while reducing facility costs and improving the patient’s experience by making more data available to them. The International Pharmaceutical Federation (FIP) considers the adoption of digital health in healthcare an ultimate goal and a top priority that could be the expectation of all healthcare professionals and patients.

As pharmacy students in Algeria, we face a controversy over the introduction of digitalization in the health sector. It should be noted that several measures have been taken in order to follow the massive growth of digital technology and to try to introduce it to support pharmacy students throughout their training course, for example through the adoption of the "blended learning" which provides courses through games and internet research orders, or the use of software such as digital platforms for exams (MOODLE platform) . Digitalization is also present during the registration, approval and control of pharmaceutical products through the use of the eCTD model, or during pharmacy inventory management.

With Covid-19 kicking in, we have seen, in Algeria -as everywhere in the world- an increase in the use of health technologies.

On the other hand, the pandemic has shown the increased lack of digitalization in health facilities. Health professionals are facing many issues that need to be addressed promptly: The lack of data structuring and the lack of interdisciplinary skills because the nursing staff found themselves at the intersection of health and IT which prevented the proper patient follow-up, and the correct delivery of drugs and medical equipment.

In addition, the lack of organisation of the dissemination of medical information on online platforms fueled the citizens' scepticism as to the reliability of this information.

Obviously, a lot of technology has emerged to adapt to the situation such as telemedicine and other mobile health applications, yet this remains insufficient to face a long term sanitary crisis. We found ourselves realising that if digital health had a bigger place in medical practises and was used more widely, it would've been somehow easier to transition from a non epidemical state to an epidemical state.

The health sector has the ideal predispositions in order to provide increasingly more digital health services to patients hence, it is necessary to establish an electronic management of patient records such as software and code bars which allow a better follow-up of the patient, also, we ought to establish an official platform that allows the control and communication of information to the public along with the use of software for prescribing and dispensing drugs and the enactment of laws that allow the control of these systems to avoid shortages.

However, education remains the first obstacle to overcome, mainly by exploiting human resources which are none other than the new generation synchronised with technology and very versatile that can breath new life to the digital world in Algeria, besides integrating digitalization into the student training, whilst taking into account the exact needs and requirements of the sectors of health.

To conclude, acknowledging our weaknesses is the first step towards the improvement of healthcare.

"Greatness is rarely achieved in good days, it's achieved through times of adversity and overcoming it."

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VERBAL INTERVIEW

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ASEPA, ALGERIA

IPHSA, IRAN

PSA, TAIWAN

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ACKNOWLEDGMENTS WRITTEN BY: PHARMAGAP AMBASSADORS EDITED BY: MR. NIRANJAN GANESHKUMAR MS. MAHSA ZAGHIAN MS. SHIDROKH KAMBAKHSH PROOFREAD BY: OSUOHA NGOZI ROSEMARY IBRAHIM ABDULMUMIN DAMILOLA YAHAYA FATIHU ANUM MUZAFFAR ILAYA OKDEM SEVVAL CELIKTEN BLESSING OZIAMA KAREENA MULCHANDANI MARIA YEOH TZE WEI (DESMOND)

DESIGN LAYOUT BY: MAURICIO ABEL MIRANDA JYOTSHANA POKHAREL

International Pharmaceutical Students’ Federation

PHARMABOOK Pharmacy Profession Advocacy Campaign PharmaGap Booklet