As scientists and pharmaceutical companies around the world race to find an effective vaccine against COVID-19, complicated questions are arising about how a vaccine will be manufactured and distributed and which populations will have first access.

Alison Thompson, Associate Professor at the Leslie Dan Faculty of Pharmacy, is an expert in the ethics of public health policies. She discussed the challenges of prioritizing access to a COVID-19 vaccine in a webinar hosted by the Faculty on May 21. Following her presentation, colleagues from the Faculty joined her to discuss challenges in the provision of pharmaceutical care related to the pandemic in community and hospital pharmacies, as well as in the drug supply chain.

Some global organizations, such as the World Health Organization and European Union, have started discussions among politicians, philanthropists and non-governmental organizations about how a vaccine will be shared globally. Thompson has been working with colleagues around the world to develop policy briefs to guide the conversation about ethical issues that may arise: How will billions of doses of a vaccine be produced in the limited number of sites around the world, and will resources have to be diverted from other life-saving vaccines to meet the demand? Who should receive the vaccine first? How do you ensure that countries and pharmaceutical companies act as good global citizens?

Thompson highlighted that the COVID-19 pandemic is a humanitarian crisis, with harms that are not felt equally around the world. Both in Canada and globally, people with lower income or socioeconomic status are more affected by both the virus itself and the restrictive measures to prevent its spread. She discussed how a vaccine must be thought of as a global public good, and its allocation should aim to bring the greatest benefit and protection to the most vulnerable people.

Pandemic has exposed cracks in drug supply system

With Thompson’s presentation on ethics framing the conversation, the panellists discussed challenges related to the allocation of pharmaceutical products during the pandemic.

Community pharmacies saw a significant increase in prescriptions being filled in early March. Kenny Tan, a community pharmacist and lecturer at the Faculty, discussed how recommendations from the Ontario government to prevent drug shortages due to this increased demand then put financial pressure on many patients through increased fees.

Hospitals also saw an unexpected increase in demand for certain drugs. Allan Mills, Director of Pharmacy at Trillium Health Partners and Assistant Professor–Status, shared that his hospital tried to prepare in advance for possible drug shortages, but they were surprised by the amount of medication each patient with COVID-19 needed while in the intensive care unit. To help manage the surge in demand for specific drugs, hospital pharmacists across Ontario and the country have been sharing information about alternatives that can be used.

Mina Tadrous, Assistant Professor–Status, explained that the pandemic has exposed the cracks that already existed within the broader drug supply chain, specifically when it comes to vaccines, which are produced in only a small number of sites around the world. When a vaccine is produced, countries and companies will need to share resources to manufacture and distribute the vaccine as quickly as possible, but there is currently no governance mechanism to address those who do not act as good global citizens.

The panellists agreed that pharmacists will play an important role in distributing the vaccine to quickly reach the target populations, as long as there are clear guidelines about who will receive the vaccine first.

The webinar was well attended and generated thoughtful questions and discussion.

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