The International Pharmaceutical Federation (FIP) represents over 140 national organisations of pharmacists, pharmaceutical scientists and pharmaceutical educators, and over four million pharmacists worldwide. A key part of the mission of FIP is to advance pharmacy worldwide by sharing best practices and innovation and bringing together practitioners, researchers, educators and pharmacy leaders. In this article, we share with readers a snapshot of how our profession around the world has adapted to the challenges posed by the COVID-19 pandemic, and our thoughts on the how it is affecting the evolution of pharmacy practice.

The global health crisis that is COVID-19 has tested our health systems to their limits, even in the world's wealthiest and healthiest nations. This crisis has also made it clear that pharmacists, scientists and pharmacies are a crucial and integral part of health systems. Never have the demands on pharmacy been so great or so urgent. During this time of uncertainty and emergency, our profession has demonstrated its expertise, strength, courage and dedication to care to the highest level.

Pharmaceutical scientists have been involved in developing a vaccine, repurposing existing therapies and identifying effective treatments for COVID-19. Academics have worked to ensure the education of our students continued despite lockdowns so that we may have a workforce that is ready to meet the evolving needs of our people.

Hospital pharmacists continue to face huge intakes of patients into their hospitals, with many of them moving beyond their specialties to provide critical care and dealing with ICU drugs shortages. They have also played an important role in setting up field hospitals. Hospital pharmacists have contributed to advancing the knowledge about COVID-19 treatment, monitoring drug outcomes and collaborating in the constant updating of treatment guidelines.

Community pharmacists have performed triage, supported governments’ pandemic initiatives, and ensured patients have continued access to their medicines, in spite of the risk of infection. Colleagues from all sectors compounded disinfectants where there were shortages, and pharmacy students have been volunteering to reduce workforce shortages.

These are but a few examples of our profession's valuable contributions and there is an emerging body of literature shedding light on the experiences and actions of frontline pharmacists in the fight against COVID-19. Ung, for example, has described pharmacists’ role as a public health educator in Macau with regards to local information regarding the pandemic evolution and hand hygiene and infection prevention measures1. Furthermore, pharmacists partnered with the government to ensure an optimal supply of face masks and were encouraged to detect symptoms and refer patients when necessary. Okereke et al. have described similar roles played by community pharmacists in African countries, such as educating populations on safety and infection prevention recommendations as well as answering inquiries regarding investigational treatments2. Wang, however, has highlighted the specific local challenges that pharmacists in Africa face, particularly in the sub-Saharan region where it is estimated that only 15% of the population have access to basic handwashing facilities and it has been reported that 41 countries have only 2,000 ventilators between them, and 10 have no ventilators at all3. Against this backdrop, pharmacists are helping to prevent spread of the virus by offering a place where people can wash their hands and, in the absence of running water, promoting the use of alcohol-based hand sanitisers. These pharmacists must often also counter public mistrust of the authorities, with some people thinking that the pandemic is a government ploy to receive international donor monies and being more concerned with problems of poverty than COVID-193. These findings corroborate pharmacists’ responsibilities in counselling and promoting disease prevention and infection control as first-line health professionals.

Pharmacists have also been called on to ensure adequate supplies of health products and medicines, and to manage shortages. Furthermore, Cadogan and Hughes describe frameworks in the United Kingdom and Canada in which pharmacists ensure the continuity of health services through new professional activities and expanded scopes of practice4. For example, at a time when routine or elective check-ups with physicians have become unavailable or reduced, formulary and drug scheduling models have been adapted to enable community pharmacists to assess and manage patients for minor ailments. Expanding prescribing roles for pharmacists may also contribute to alleviating the burden on health systems.

Pharmacists across the globe continue to play leading roles in the fight against COVID-19. Song et al. describe the importance of pharmacists’ clinical role in China and a framework for pharmaceutical care for patients hospitalised with COVID-19 in which recommendations are made regarding multiple themes, such as evidence-based treatment options, management of drug interactions, and therapy monitoring5. International collaboration between pharmacists in the United Kingdom and Pakistan have also led to the development of more cohesive, translated guidelines for pharmacy personnel6.

It is also clear that COVID-19 has necessitated a rethink of how we all operate so that progress in health care in general is not hampered. Pharmacists at the University Hospital in Ancona, Italy, for example, have been key in developing a “direct-to-patient procedure” to enable the shipping of investigational medicinal products to the homes of trial participants so that clinical trials can continue7. We have also seen more home delivery pharmacy services and pharmacists being authorised to perform repeat dispensing of prescription medicines to patients with chronic conditions. We note, in particular, adaptations in Spain and Portugal to allow continued care, particularly through greater collaboration between sectors. One example is the collaboration between community and hospital pharmacy and pharmaceutical distributors to make it more convenient for vulnerable patients to receive their medicines and reduce the burden on hospital services.

Perhaps one of the biggest shifts we have witnessed during this pandemic, is the adoption of technology in response to restrictions imposed by lockdowns and the consequent reduction in our contact with others. Many pharmacies, pharmacy organisations and pharmacy stakeholders have adapted to provide telepharmacy services. For instance, in April 2020, the Australian Federal Government announced that pharmacists could deliver funded medication review services via telehealth in order to ensure that vulnerable patients could still receive this important service. For example, Shane Jackson, a member of FIP's Community Pharmacy Section executive committee, has been providing the service from his pharmacies in Tasmania, Australia. He reports that patients are becoming more accustomed to using telehealth for their medical appointments and other allied health services and estimates that 10-25% of his services are now being delivered by telehealth8.

Pharmacists themselves have developed systems of working that harness technology. For instance, in a presentation during the FIP Virtual 2020 programme clinical pharmacist Lesley Douglas shared how Dr Gray's Hospital, Elgin, UK, assured services for cancer patients during lockdown by creating an IT model that allowed chemotherapy ordering and verification by a pharmacist working remotely9. An outpatient unit at Dr Gray's allows patients to receive systemic chemotherapy close to home instead of having to travel 65 miles to Aberdeen Royal Infirmary (ARI). Therapy is prescribed by specialists at the ARI and a pharmacist at Gray's orders the parenteral to be supplied by the ARI before blood test results are available. This is because same day delivery is not possible due to the distance between the hospitals. Implementation involved enabling a National Health Service (NHS) device in the pharmacist's home to be connected to the NHS network by installing direct access connections on Microsoft servers, and ensuring a secure WiFi connection to the patient management system, NHS email, intranet and clinical guidelines, and the hospital's chemotherapy prescribing and administration system.

As well as helping patients through the COVID crisis, digital technology is helping pharmacy students, too. Pharmacy educators around the world have moved online so that they can continue to deliver curricula. For example, in April, after it had been forced to close its doors, Obafemi Awolowo University, in Nigeria, began to deliver microbiology lectures to its third- and fourth-year pharmacy students via Zoom10. They have demonstrated that online learning is a valuable alternative even in resource-limited settings and despite challenges of network disruptions and access to electricity. Educators have also been conducting assessments remotely. Keele University in the UK, for instance, redesigned its competency based assessments so that they could be carried out using Google Meet software11.

Scientists are also harnessing technology. Participants at FIP's virtual Pharmaceutical Sciences World Congress in October 2020 heard about virtual platforms developed to enhance research, including the COVID-19 Pharmacology Resource Centre which has an in silico workbench that allows researchers and clinicians to simulate the pharmacokinetic profile of therapeutics that are being tested in clinical trials. Another example is N3C, a centralised secure enclave launched by the US National Centre for Advancing Translational Sciences in September, which allows access to medical records data of people diagnosed with COVID-19 in order to improve collaborative analytics.

The increased use of IT to allow continued care, research and education is something our entire profession must be prepared for. However, a recent survey by FIP indicates that a large proportion of pharmacy schools and faculties do not yet offer digital health education or training12. Furthermore, the survey indicated that many practitioners are lacking familiarity with emerging digital health technologies such as blockchain, bots, digital medicines and artificial intelligence, and only a small fraction of these respondents had received continuous educational development on digital health. With increased complexity of health conditions and ageing populations, digital health can be the key to addressing many unmet needs in health services. A capable and digitally enabled pharmaceutical workforce is required to make use of the full potential of digital health and ways forward have been proposed by FIP12. In addition, FIP will be developing a global competency framework for digital health in pharmacy education and this will facilitate national, regional and global implementation of FIP Development Goal 20 (digital health).

On the other hand, the greater application of virtual practices has also emphasised the importance of face-to-face contact. One example comes from Kantonsspital Baden, Switzerland13. At the start of the pandemic, the hospital's pharmacists stopped going on ward rounds in order to protect patients and, where possible, worked from home. However, after a month of performing their clinical duties online, the pharmacists decided to return to the wards because writing clinical recommendations is difficult if you do not know the patient. In addition, the pharmacists also analysed the effect of decreased face-to-face interactions on the impact of their interventions and had found that acceptance rates had decreased significantly — to around 40% compared with 90% when pharmacists were present on the wards. Their conclusion was that digital solutions can have advantages and save time but will “never replace” personal contact; clinical pharmacy services are best delivered face to face.

Certainly, face-to-face contact is required for the administration of vaccinations. We know that prevention is better than cure and a global survey over 99 countries and territories conducted by FIP last year found pharmacy-based vaccination being available in at least 36 countries and territories and had been proposed or was undergoing development in a further 16. We note that during this pandemic vaccination rates have fallen, with family visits to healthcare providers still below pre-pandemic levels and influenced by vaccine hesitancy or unemployment during COVID-19. However, since the development of COVID-19 vaccines, we are seeing more countries recognise the easy accessibility of pharmacy as a further solution that should be utilised in their vaccination programmes. Some recent developments compiled by FIP are presented in the table 1 and it is our hope that progress in this area gained during this pandemic remains post-pandemic, with more pharmacists able to vaccinate and the range of vaccines they are able to administer increasing.

Another role that has expanded for pharmacists during this pandemic is in testing. We have seen pharmacies in Australia, France, Spain, Switzerland and the UK offering COVID-19 testing services24–27 and FIP has urged governments to support in-pharmacy COVID-19 testing to help bring pandemic under control28. Diagnostic testing is one of the most important aspects in controlling a pandemic and it is both an ethical and a public health priority for access to testing be expanded, the federation has said28. It is our hope that the waiving of rules necessary to expand pharmacy-based testing will continue after this pandemic and that authorities learn that they have been overly restrictive and those restrictions are contrary to the highest quality of care, and that pharmacy practice in this area will be advanced. There are a number of conditions that pharmacists could be testing for effectively, including influenza and streptococcus.

This pandemic has made visible all the benefits for communities of having competent pharmacists and a dense network of pharmacies. It has made clear that pharmacists and pharmacies are a crucial and integral part of health systems, greatly contributing to making them efficient and sustainable. The burden of diseases that existed before COVID-19 remain, and some are likely to worsen because of the socio-economic problems brought about by COVID-19. Sadly, more than 2 million people have now died from COVID-19, but for instance, 1.6 million people died of diabetes in 2016 and seasonal influenza is associated with up to 500,000 deaths each year. Antimicrobial resistance has not gone away: the existing problems in health systems have not evaporated and new pandemics are possible. Moreover, the World Bank has warned that the pandemic could drive many people back into poverty29, people under lockdown are having less social interaction and exercise, with an increased risk of physical and mental health problems, and our health systems are already being confronted with these wider health impacts of this pandemic. Pharmacists will be needed more than ever to prevent ill health and ensure patient safety.

When considering the top 10 threats to global health identified by the WHO in 201930 it was evident then that pharmacists can play an active role in all of them. These threats have only been expanded upon and the pharmacy profession can also play roles in the 13 urgent health challenges for the next decade defined by the WHO in 202031.

The pharmacy profession takes an even greater role in public health, with new services around prevention (including testing and vaccination) emerging alongside services for patient safety and non-communicable diseases, all of which are crucial for delivering primary health care. FIP signed up to the Astana Declaration32 in October 2018, where ministers and professions pledged to build sustainable primary health care. Since then, FIP has led the agenda to encourage action from our profession. In 2019, FIP regional conferences for the Eastern Mediterranean and European regions elicited commitments to action on primary health care from pharmacy leaders and FIP will be working on gaining similar commitments in other regions in 2021.

In the future, the reconfiguration of health systems with the insertion of pharmacies as places of service delivery based on primary health care. Pharmacists are already becoming more integrated into health systems and FIP's member organisations are seizing the opportunity to advocate for this. For example, in the USA, lobbying for provider status has accelerated during COVID-19.

The future and the potential of the pharmacy profession are exciting, but depend on having enough pharmacists with the right skills. The FIP Development Goals for the entire pharmacy profession, launched in September 2020 provide a comprehensive key resource for transforming our whole profession33. Pharmacists must keep up to date, not only with clinical knowledge but with technology to enable practice at a higher level, supported by tools such as national frameworks for advanced practice based on the FIP Global Advanced Development Framework34. More pharmacists will be able to enhance their professional profiles through specialisms and we must give focus to working with others interprofessionally, so that we can become more integrated in healthcare teams in order to provide universal health coverage.

Specific to the future of community and hospital pharmacy, FIP's Community Pharmacy Section has published its vision of pharmacists being at the hearts of their communities and a vision for hospital pharmacy is set out in the FIP's Hospital Pharmacy Section's Basel Statements35,36. These documents contribute to transformation in these two specific sectors of practice.

Through necessity, COVID-19 has removed a number of obstacles to expansion of pharmacy services. Things that the pharmacy profession has been advocating are happening more quickly and red tape to legislative changes being removed. But the doors that this pandemic has opened for our profession stay open. This crisis has given pharmacy the opportunity to demonstrate that its services are valuable to patients and to health systems and that they are feasible and ready to be implemented in many settings. Now is the time to gather the data and evaluate the outcomes of our achievements during this pandemic. FIP has long since collected data through a number of global surveys and is growing this capacity, noting the positive findings of surveys conducted by national professional organisations. For example, a survey commissioned by the General Pharmaceutical Council of Spain after the first month of lockdown found that37:

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  Spain's pharmacy network provided care to over 30 million people.

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  2.2 million citizens received telephone care from their pharmacist.

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  850,000 citizens received pharmaceutical care at home, especially those over 65.

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  More than 90% of the population acknowledges the public service provided by pharmacies during the coronavirus crisis.

The data and intelligence that our profession generates will create powerful advocacy to enhance pharmacy practice, education and workforce, building on the underpinning science and evidence base of the profession. FIP has conducted a survey across all its constituencies to measure the impact of COVID-19 on the roles of community and hospital pharmacists, including the implementation of services that did not exist before the pandemic. The findings will be published in due course.

We know that the effects of globalisation will continue which continue to demonstrate why FIP is much needed. In January 2020 — just six days after the World Health Organization declared the new coronavirus outbreak a Public Health Emergency of International Concern, FIP published international guidance to support pharmacy teams around the world38. It is because of the position of the Federation as the global leader of pharmacy that action was so responsive and concerted. An international taskforce was convened, including experts from China with valuable early experience. In the following months as the situation developed, workplans were adapted to support our profession with advocacy and policy tools to facilitate response at country level. FIP also issued a call to action listing 23 urgent measures that governments must put in place in order to ensure the continuity of pharmaceutical care around the world39. A repository of international resources on the FIP COVID-19 Information Hub is available at FIP web site www.fip.org/coronavirus.

This pandemic has heightened many global issues that FIP has been working on, including falsified medicines (with many medicines producers in lockdown, increases in counterfeits have been reported), misinformation, patient safety, vaccination and vaccines hesitancy, medicines shortages, inequities of access to medicines, and lack of investment in science. More information on these issues and the responsive work are to be found at FIP web site www.fip.org/. FIP recognises the importance of sharing experiences and knowledge and solving global problems in solidarity.

No disease in recent history has brought the value of the pharmacy profession centre stage as much as COVID-19. Indeed, a number of ministers and heads of state have praised and thanked pharmacists for their service and such recognition, in addition to the evidence of these actions, should urge governments to support expanded roles by pharmacies in a sustainable manner as well as scientific research.

This pandemic has also brought to the foreground the prevalence of health inequities and inequalities, first in terms of access to treatment and now in terms of access to immunity. We are witnessing younger, healthier people in richer countries being vaccinated before people at greater risk but who happen to live in poorer countries, which is worrying. Equity of access to medicines and healthcare is a core component of FIP's vision and work and we will continue to advocate on this topic and will support the efforts of the WHO and other organisations on this important issue.

Tedros Adhanom Ghebreyesus, director general of the WHO has said: “If there is anything positive to come from this pandemic, it must be a safer and more resilient world”40. Perhaps the greatest lesson to be learnt from COVID-19 is that international cooperation is crucial to finding effective and sustainable solutions not only to the consequences of this pandemic, but also to the many other health problems we face.

All over the world, pharmacists are standing up to the challenge of COVID-19 and showing their commitment to the communities they serve. FIP is proud to represent them and as “One FIP”, and “One pharmacy,” the profession will emerge from this pandemic bigger and better to ensure the 21st century will be the century of pharmacists together.

No funding was received for this article.

No conflicts of interest.