The International Pharmaceutical Federation, a World Health Organization (WHO) partner, is organising World Pharmacists Day on 25th September 2024. The day will be marked as an opportunity to recognize and celebrate the pivotal role of pharmacists in delivering healthcare to communities globally.

Whilst WHO recognizes pharmacists as “integral to our health care systems”, it is questionable whether it acknowledges the diverse roles of pharmacists across various healthcare systems. One reason for the absence of a broadly acceptable definition of a pharmacists’ role in global health may be the professional disparities existing between different geographies and regulatory landscapes. Pharmacists’ professional opportunities in a developed country can be wider, more versatile and more advanced, compared to that of a developing country. A health care system’s maturity is directly linked to the economic health of a country, and so can substantially influence pharmacists’ professional opportunities.

In low- and middle-income countries, pharmacists face social barriers, limited community awareness, and conflicts with medical staff. Lack of human resources and investments are also challenging for developing the role of clinical and community pharmacists. According to the WHO, globally about 2 billion people struggle have access to essential medicines. However, pharmacy practice in Low-Middle Income Countries (LMICs) is often poor, despite their high need, for several reasons – unaffordability or unavailability of medicines, legal restrictions, poor public awareness, low investment by the governments etc. Addressing these deficiencies is essential to enhance pharmacists’ role as an effective healthcare provider.

Pharmacists’ Role in Global Health

To understand pharmacists’ role in global health care, there is no better example than their response to the COVID pandemic. In late December of 2019, when WHO’s China country office picked up an online media statement by the Wuhan Municipal Health Commission on cases of ‘viral pneumonia’ in Wuhan, the WHO’s global Epidemic Intelligence Unit was already on full alert. Coordinating with scientific communities across the globe, by early 2020, WHO was gearing for the worst pandemic humanity had faced yet.

During this time some of the many roles played by pharmacists across the world – both developing, developed and advanced countries are highlighted:

Digital Age: Tele Pharmacy

During the COVID-19 pandemic, healthcare workers faced numerous new challenges, yet pharmacists played a crucial role in maintaining stability within the healthcare system by taking on additional responsibilities and adapting their practices to meet the increased demand for medical services. Tele-pharmacy became an essential service, offering virtual consultations and home delivery of medications. In the United Arab Emirates (UAE), Tele-pharmacy was implemented in various healthcare facilities, making the UAE one of the first countries in the Middle East to introduce this service. In February 2020, the Department of Health (DOH) established standards for the delivery of pharmacy medications. Additionally, the first licensed and approved mobile application for healthcare products, “800 Pharmacy,” was launched, offering 24/7 delivery of over the counter (OTC) products, supplements, and prescription-only medications (POM) across the UAE

Trust and Collaboration: How US and Europe worked with Developing Countries

During India’s devastating second wave of COVID-19, as oxygen and life-saving supplies ran low, the UK sent ventilators and concentrators, the EU provided aid, and the US lifted its export ban on raw materials, allowing India to produce more AstraZeneca vaccines and other critical medicines. Let’s examine how the UK and US managed their own crises and extended help to others.

A group of scientists in Europe and the Americas was already in action. Sarah Gilbert et al from Oxford, United Kingdom, with over 10 years of research focus in coronavirus as a family of viruses, were already exploring development of what would later be the ‘Oxford COVID vaccine’. This would later be taken over by AstraZeneca. Meanwhile in Germany, Ugur Sahin and Özlem Türeci, a team of scientists originally focusing on developing cancer drugs, were exploring translating their relatively unknown technology of mRNA-based drug candidates into a rapidly-producing COVID vaccine, later known as BioNTECH COVID vaccine. This would later be taken over by Pfizer. Whether involved in pre-clinical or clinical investigation, formulation, quality assurance or regulatory compliance, pharmacists’ role in these groundbreaking, life-saving global researches was vital to overcoming the COVID pandemic.

By mid-2020, as COVID was spreading globally, frontline healthcare professionals were fighting a war with little or no therapeutic options available. The earliest drug candidate was Remdesivir, a redundant, early clinic-failed antiretroviral drug. As it was an unlicensed medication for COVID at the time, it had to go through a series of clinical trials. In the UK, the Department of Health and the National Institute of Health Research (NIHR) were coordinating the roll-out of Remdesivir study. Clinical Trials Pharmacy Teams across NHS Hospitals led on drafting Investigational Medicinal Product (IMP) site-level management plans, including IMP dose preparation steps in sterile areas with compressed time windows to meet the high number of study participants. A wide range of pharmacy expertise was pulled in order to support the study’s delivery. Pharmacists experienced in conducting early Phase I &II trials were brought in to manage critical IMP International Council for Harmonisation-Good Clinical Practice (ICH-GCP) components such as Quality Assurance, Protocol Development, IMP storage, Dispensing, Accountability, Study Document Control and internal Trainings.

Meanwhile, in Standard of Care settings, pharmacists were working hard in fighting the pandemic. These include the settings: Wards & Clinics (Clinical Pharmacy), IP & OP Pharmacies, Production, Medicines Safety, Advanced Therapies, Medicines Information, Quality Assurance, Governance, Procurement, Stores & Supply Chain.

Its clear that it is an urgent matter for a government to set aside better portion of the budget for health needs of its people, including drug research. And a system must be developed ready to face any health emergencies, with pharmacists, who were always invisible in India’s and other developing countries frontline health missions.

Highly Advanced Roles: Consultant-Pharmacist-led Clinics

In 2024, the pharmacy workforce of the internationally-recognized London NHS Hospital Trust totals over 600, demonstrating the depth and breadth of their involvement in delivering healthcare to the local population. An In-patient / Out-patient Clinic run by a Consultant Pharmacist can produce comparable clinical outcomes to a Consultant Physician, who would otherwise, in a collaborative setting, need support from a Clinical Pharmacist in making optimum therapy decisions.  Several NHS Hospitals have rolled out Consultant-Pharmacist-led Clinics, focusing on managing long-term health conditions more efficiently by allowing Consultant Physicians to focus on diagnoses and development of early treatment plans. These pharmacists are professionally accredited by the UK’s General Pharmaceutical Council (GPHC) and their competencies are periodically reviewed to ensure the provision of high quality of service.

Beyond Secondary Care settings (hospitals), in Primary Care (community pharmacy) pharmacists are revolutionizing their services. In 2024, the UK’s Department of Health acknowledged the crucial role of pharmacists, as the first point of call for the public in managing their minor ailments. Pharmacists in England can now prescribe medications for a number of minor ailments including infected insect bites, shingles, sinusitis, sore throat and uncomplicated urinary tract infections. NHS England also rewards community pharmacy contractors who deliver on three quality dimensions, via the Pharmacy Quality Scheme: clinical effectiveness, patient safety and patient experience.

Fighting Global Challenges: Antimicrobial Resistance

Pharmacists have a crucial role in the development, delivery and governance of a strategic vision for a nation’s health, given the profession’s diverse and advanced knowledge profile, skillsets and competencies. Pharmacists are pivotal to achieving some of the global health milestones, such as safe use of antibiotics and preventing antimicrobial resistance (AMR). According to a Lancet study, AMR poses an important global health challenge in the 21st century, pointing to the continued increase in AMR mortality resulting in 1·91 million attributable deaths and potentially 8·22 million AMR-associated deaths in 2050. In the UK, Antimicrobial Pharmacists, in collaboration with Consultant Microbiologists, make clinical decisions on antibiotic selection, treatment regimens, Formulary decisions and jointly bear responsibility for performance quality metrics linked to various infections, such as MRSA and Clostridium Difficile.

Emerging Therapies: Pharmacists’ Role in Delivering Advanced Therapies

In England, the Advanced Therapy Medicinal Products (ATMPs) Programme is part of a Highly Specialized Services portfolio comprising therapies involving Genes, Somatic Cells and Tissue Engineered Products. Since 2022, the programme prepares the NHS for new, complex products such as chimeric antigen receptor (CAR)-T cell therapy. These products require greater level of commissioning support and Highly Specialist Pharmacists take a lead role in the associated national policy-making and project delivery. At the local level, they chair the local ATMPs Committee and steer the policy-making, formulary adoption, specialty handling, dose calculation, formulation and clinic dose administration. As more and more ATMPs are licensed by international regulatory bodies, such as the FDA and MHRA, a flood of Advanced Therapy Investigational Products (ATiMPs) are undergoing Clinical Trials. This new therapy area will become mainstream and pharmacists’ role in its clinical delivery will only be intensified.

Governments, Professional Bodies:  A Paradigm Shift required in Pharmacists’ Role

An array of experts is involved in the chain of health care delivery. Whether in pre-clinical, clinical or licensed stage, safety of a medication is paramount; Pharmacists are the safety net before the Medication reaches a patient. Governments, policy makers, professional bodies and patients’ Advocates across geographies should recognize the crucial role of pharmacists in delivering health. Incorporating more an more Pharmacists at various levels of healthcare systems is crucial to achieve advanced global health outcomes.

Moncy Mathew (L), Highly Specialist Clinical Trials Pharmacist, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Muhsina Mubaraka(R), Pharmacist, Dubai