To dispense or not to dispense: Lessons to be learnt from ethical challenges faced by pharmacists in the COVID‐19 pandemic

Abstract

The year 2020 is facing one of the worst public health situations in decades. The world is experiencing a pandemic that has triggered significant challenges to healthcare systems in both high and low‐middle income countries ( LMIC s). Government policymakers and healthcare personnel are experiencing real‐life ethical dilemmas and are pressed to respond to these situations. Many possible treatments are being investigated, one of which is the use of hydroxychloroquine or chloroquine. These drugs are approved for use by patients with systemic lupus erythematosus ( SLE ), rheumatoid arthritis, and malaria. The demand for these products has increased, and the stocks are depleting for the patient population for whom the drugs are intended initially. Although both innovator and generic pharmaceutical manufacturers are making plans for increased production, there are challenges with global supply chains disruption and the retention of supplies for local markets. This may cause countries that rely on the importation of pharmaceuticals to be out of stock of supplies for an extended period. There are allegations of off‐label prescribing and hoarding. Pharmacists are the custodians and dispensers of medications and are faced with the task of assessing prescriptions and making decisions about the allocation of these products. This paper seeks to 1) highlight some of the ethical challenges of dispensing hydroxychloroquine by pharmacists during the COVID ‐19 pandemic, 2) identify some of the responses to these issues from various regulatory authorities in the USA , and 3) recommend approaches to assist pharmacists in their decision‐making process, especially in LMIC s.

Competing Health Risks Associated with the COVID-19 Pandemic and Early Response: A Scoping Review

“…Alongside the increase in demand, shortages in the immediate supply may reduce their availability for use in malaria prevention and control, especially in low- and middle-income settings, which rely on international supply chains. [84, 85] Importantly, resistance to CQ and HCQ has previously emerged, and further indiscriminate use due to COVID-19 may drive Plasmodium resistance in malaria-endemic areas and threaten the control of malaria. [74, 81, 83, 86]…”

Patterns of prescription dispensation and over-the-counter medication sales in Sweden during the COVID-19 pandemic

“…That three countries report similar phenomena regarding medication dispensing and OTC sales with the arrival of the SARS-CoV-2 virus, suggests that similar behavior should be anticipated at the start of pandemics in the future. Amidst the shortages of critical drugs widely reported by many countries, including Sweden, during the start of the COVID-19 pandemic the discussion among the international community on mitigation strategies was focused primarily on IV sedatives used to facilitate mechanical ventilation [18][19][20]. It should be acknowledged that stockpiling behaviors by large sections of the population can lead to depletion of national reserves of medications for chronic disease (e.g., diabetes, asthma [21]) as well as treatment of infection symptoms, and calls for consideration within such strategies to prevent shortages in future scenarios.…”

COVID-19: Lessons from the Pandemic

“…On the contrary, the rural life in our country, involves big verandas in the house with proper ventilation, and encourages open grounds and spaces. rural living also involves healthy and fresh eating habits and less of processed foods which helps in maintaining the immunity at higher level (Cox, 2020).…”