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​In October 2019 the UCL School of Pharmacy PharmAlliance team were fortunate enough to meet with the School of Pharmacy Director, Professor Duncan Craig, for a truly insightful interview that covered a number of different topics.

1. What were some of the highlights of the Stakeholders’ Dinner 2019 for you?

I enjoyed the whole thing enormously. The presentations from the guests were fantastic, and I was extremely proud of our students for the articulate and intelligent way that they addressed the room.

I was also very impressed by their courage as well, because I’m not at all sure that when I was an undergraduate I would have dared to stand up and speak to an eminent group of guests. I have to say it was very nice hearing the comments from the stakeholder guests. They were incredibly impressed with the school and particularly with the students. I think having students on every table brought a bit of life and spontaneity to a formal occasion. Overall, it was a big success.

2. We heard you recently went to Abuja, Nigeria. What did you like best about the city?

I liked the people very much. It’s a big city and the number of people you meet will always be limited but I was made to feel very welcome.

The purpose of the visit was to talk to the Nigerian Sovereign Investment Agency (NSIA) about how UCL might be able to work with them to help boost the pharmaceutical sector in the country. Meeting various stakeholders within Nigeria who run various agencies provided me with an understanding of how the system works, and what the various barriers to getting safe and effective medicines into the country. It was a fascinating insight and I learnt a great deal.

3. What do you think students can gain from studying abroad and observing another country’s pharmacy system?

The wealth of benefit is very difficult to overstate. Going outside your comfort zone in a controlled and safe manner is the way that all of us grow. We encourage our staff to go on sabbaticals as well. I’ve moved around quite a lot and I’ve learnt an enormous amount from every move.

It’s really important to us that once our students leave the school, that they’ve got the skills but also the confidence to deal with whatever life throws in their direction — one of the ways you can do that is by studying abroad. You can see a different system and you can get different perspectives — you can then having something to compare this institution with other institutions and it’s quite nice to have that realisation early on in your studying career.

4. We know you are a huge advocate for PharmAlliance. Why do you think PharmAlliance is important?

PharmAlliance is important because it’s quality-driven. Although the three universities are in three different continents with three very different time zones, we have so much more in common than we do that differentiates us. All three universities are very high quality and we’re like-minded; we place as much emphasis on education as we do research — and the beauty of pharmacy is in both. We’ve learnt a huge amount from each other and we want our students to get the same benefit.

5. What more do you want to see from PharmAlliance in terms of activities?

We actually had the new Dean of Monash here earlier this week. I think probably the way that we’re going is to place more emphasis on student activities. Just think how much more we could enrich the student experience in all three institutions by creating a kind of free passage, either virtually or physically, to create opportunities for the students to actually do things together.
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I think we’re all agreed this is a huge benefit of PharmAlliance that we can emphasise more.

6. Students from the UNC PharmAlliance team have expressed interest in being involved in research alongside UCL and Monash. Do you think this is feasible as a long term goal?

I think that anything is certainly feasible. The relationships are definitely very good and we also see student engagement as a real priority. What we’d have to look at is how that engagement would manifest. For example, would it involve UNC students coming over for a while and shadowing fourth year MPharm project students? There are many many different models but I think that there are no intrinsic barriers to achieving this goal.

7. We heard that you’re editing a special issue of Pharmaceutics* about nanofabrication. Could you tell us a bit about nanofabrication and how it’s useful in pharmacy?

Nanofabrication is a fairly broad term. A few years ago people were focusing on nanoparticles as there are a lot of incredible things you can do with these. We’ve become particularly interested in developing relationships with engineers — we have strong mechanical, chemical and biochemical engineering departments at UCL and we’ve been looking into things that the engineers can make but we can think of new and interesting healthcare-facing uses for.

A number of UCL School of Pharmacy staff, including myself, have an interest in making nanofibres. In fact, a couple of my fourth year students are actually working in this area at the moment. These are long fibres with diameters in the nano size range. These nanofibres can be made multi-layered so that you can actually have one drug in one inner layer and then a different drug in the outer layer.

*Pharmaceutics is an international, peer-reviewed journal that contains research papers on the latest developments in pharmaceutical technology.

8. Do you have any tips on editing for students who are involved in or interested in pharmacy media and journals?

You tend to think of editing in terms of sitting in front of a screen and changing things but in fact, the real skill with editing is in your relationships with other people.

Finding ways to suggest to somebody that you’d rather they did something in a different way without causing them offence. Finding ways of gathering ideas that trusted colleagues may have in a way that synthesises into something that’s actually practical. Changing the type is the easy bit. It’s getting the team together — getting the personal relationships and the trust sorted out — that leads to success.

9. What is your vision of UCL School of Pharmacy in ten years’ time?

Our school’s mission statement starts off by saying that we want to make a positive difference to pharmaceutical healthcare. We aim to accomplish this by producing excellent graduates, doing impactful research and by providing professional leadership.

In ten years’ time I would like somebody to look at what has been achieved in relation to these three cornerstones and for them to find that the school has made a real difference outside its immediate environment.

Thank you to Director Professor Craig for your time! We hope that the aspirations of both PharmAlliance and UCL School of Pharmacy will be achieved!

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Happy New Year Everyone! As we celebrate, it is easy to forget that we are still in the middle of flu season! In the United States, flu season starts in October and continues through February. Last February, the state of North Carolina reported, through North Carolina Department of Health and Human Services (NCDHHS), at least 35 deaths from the flu. Many cases go undiagnosed or unreported, so it is likely that the actual number is higher. While the strain of flu is slightly different each year, getting vaccinated is always important to prevent catching and spreading the common sickness. According to the Center for Disease Control, the strain for the flu shot has changed recently.​1 The changes are as follows:

• The A(H1N1)pdm09 vaccine component was updated from an A/Michigan/45/2015 (H1N1)pdm09-like virus to an A/Brisbane/02/2018 (H1N1)pdm09-like virus.
• The A(H3N2) vaccine component was updated from an A/Singapore/INFIMH-16-0019/2016 A(H3N2)-like virus to an A/Kansas/14/2017 (H3N2)-like virus.
• Both B/Victoria and B/Yamagata virus components from the 2018-2019 flu vaccine remain the same for the 2019-2020 flu vaccine.
• Additionally, all regular dose and recombinant vaccines are quadrivalent, meaning that they will protect against four different influenza virus forms

Kansas and Brisbane are the locations that the strains were discovered for the 2019-2020 flu season and are predicted to be prevalent. The flu is always mutating, so this prediction may or may not work. Even still, the flu shot usually grants at least some form of protection and is recommended each year.

Pharmacists have a major role in vaccinating communities against the flu. Starting in October 2019, North Carolina law allowed pharmacists to administer the flu vaccine to patients 10 years of age and older without a prescription. The new law also allows pharmacists to vaccinate patients from ages 6 to 10 years old with a doctor’s prescription.2,3 Prior to this legislation, patients had to be at least 14 years old to get their flu vaccine at a pharmacy. Furthermore, pharmacists are now allowed to give the HPV and hepatitis A vaccine to adults. This increases the impact that pharmacists can have on increasing vaccination rates in local communities. Staying current with all vaccinations is especially important as more and more individuals are choosing to forgo immunizations. In 2019, the CDC reported that only 75.2% of patients 24 months old received all seven recommended vaccines (MMR, DTaP, Hep B, 2 doses of Hep A, rotavirus, and influenza).4 Downward trends in vaccination rates have prompted some practices to take action. Blue Ridge Pediatric & Adolescent Medicine in Boone, North Carolina, implemented a “no shots, no service” policy and will not treat patients if they are not vaccinated for non-medical reasons.5 While this may seem harsh, the overall goal is to protect other patients and their families from potential disease exposure. It is important to remember that vaccinations both protect individuals and contribute to the immunity of the whole community.

While students at UNC have been trained on vaccination techniques, laws, and other practices in North Carolina and the United States, students have to take an elective course for international vaccinations for travel purposes. In addition, students don’t really learn much about international vaccination laws and practices. Students should take a chance to research these topics if they can! As previously mentioned, many providers are refusing to take patients who have not received their vaccinations. In Australia, this becomes more of a government and legal issue with legislations titled No Jab, No Pay and No Jab, No Play.6 Both were enacted in 2016 to combat increasing outbreaks of preventable diseases and vaccination misinformation concurrently. Basically, the former legislation says that a child must be fully immunized for parents to receive certain tax benefits. The latter says that a child must be immunized to attend childcare in certain areas. According to the National Centre for Immunisation Research and Surveillance (NCIRS), exemptions do apply but objection is not a valid exemption. Visit the NCIRS website to learn more.

There have been many vaccine myths and bits of misinformation spread by anti vaxxers and health-illiterate persons in the last few decades, some of which involve the US versus international immunization schedules. The most common is that the US gives much more vaccines than any other developed country.7 After taking a look at the vaccination schedules of other countries, one can find out that this myth is either false or exaggerated. While many European countries do not give as many vaccines overall, they do give more vaccines at an earlier age - this includes two doses of MMR and the chicken pox vaccine by the time a child is 15 to 24 months old. Some countries even give vaccines that the US does not give, such as the BCG and MenC vaccines. Another myth is that Japan banned the HPV shot. If a parent refuses the HPV shot for their child on the basis of this myth and its potential harmfulness, let them know that the HPV shot is still widely available in Japan - it is simply not actively recommended. All in all, the schedules are very similar between the US and other countries.

It is important for pharmacy students to be aware of changes in immunization policy. From the local to national, and even on the international scale, legislation is always being updated to reflect the latest science and societal needs. As pharmacists, we have the ability to immunize patients and play a major role in preserving the public health of our communities. Even as students, we can volunteer in flu shot clinics and educate the patient population about current legal changes and the importance of vaccinations. Be sure to keep up with local laws and engage with the community to see the positive change that you can make.
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Authors: Linda Allworth and Zane Colon

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1.     APhA. New NC law lowers age for pharmacy influenza immunization, expands vaccines foradults.https://www.pharmacist.com/article/new-nc-law-lowers-age-pharmacy-influenza-immunization-expands-vaccines-adults. Accessed January 22, 2020.
2.     Brown EA. New NC law lowers age for pharmacy flu shots, expands vaccines for adults. Asheville Citizen Times. https://www.citizen-times.com/story/news/local/2019/06/04/nc-law-lowers-age-pharmacy-flu-shots-expands-vaccines-adults-hepatitis-a-hpv/1337142001/. Published June 4, 2019. Accessed January 22, 2020.
3.         CDC. Influenza (Flu). https://www.cdc.gov/flu/season/faq-flu-season-2019-2020.htm. Accessed January 22, 2020.
4. Immunization Schedules from Other Countries. Vaxopedia. https://vaxopedia.org/2017/04/23/immunization-schedules-from-other-countries/. Accessed January 22, 2020.
5.     NCIRS. No Jab No Play, No Jab No Pay. http://www.ncirs.org.au/public/no-jab-no-play-no-jab-no-pay. Accessed January 26, 2020.
6.     Ovaska S. No shots, no service: Pediatricians take tough stands while vaccination rates for young children in N.C. drop. North Carolina Health News. https://www.northcarolinahealthnews.org/2019/05/07/no-shots-no-service-pediatricians-take-tough-stands-while-vaccination-rates-for-young-children-in-n-c-drop/.Accessed January 26, 2020.
7.     SUPPLEMENTARY TABLE 3. Estimated vaccination coverage with selected individual vaccines and a combined vaccine series* by age 24 months† among children born 2015-2016,§ by U.S. Department of Health and Human Services (HHS) region, state, selected local area, and territory – National Immunization Survey-Child 2016-2018, United States. 68.

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The new year is the time everyone commits to a change for the future. From personal 
health goals to restructuring institutions, the world moves to become more efficient through innovation and optimization. Problems in healthcare continue to be an issue of how to effectively connect providers, patients, and payers, but integrating technology into the healthcare equation is creating an opportunity to meet those challenges. Pharmacy is a key place for it to happen.

It is no secret that there are major companies worldwide creating new ways to deliver medication. Healthcare tech firm MedAvail have begun rolling out self-service kiosks capable of dispensing a prescription in under 90 seconds. Meanwhile, pharmaceutical giant Walgreens have begun testing drone delivery of medication. Pharmacy automation forecasting projects that revenue will grow 11% each year reaching $17 billion by 2023. In these cases, delivery is supervised by a licensed pharmacist that reviews medical history and offers patient counseling. These models are said to increase adherence and outcomes due to increased efficiency and care at the patient’s convenience. At the same time, other major companies are also investing in automation to stay relevant with competition. Scott Seidelmann, Chief Commercial Officer of Omnicell, a company that specializes in pharmacy automation, says, “It’s only a matter of time before people get their prescriptions from Amazon, but the impact that pharmacy has on the overall patient episode and its ability to influence not only patient care but economics across the continuum is driving the need for more automation.”

Telepharmacy is also a growing field impacting rural chains and medium-sized health systems. It is currently predicted to be worth $22 billion in 2020, with the U.S. holding 13% of the market. Telepharmacy has improved to the point that pharmacists remotely can now do many of the things in-house pharmacists can do which allows in-house pharmacists to focus on other healthcare initiatives improving the efficiency of the health system. Some startup companies have even launched Discharge Management Programs this year to handle patient transitions from hospital to home or hospice. Numerous patients often fail to stay adherent, and money subsequently is lost due to readmission. By connecting patients and providers with a pharmacist anytime and anywhere, patient safety and efficacy is once again improved, and time and money can also be saved.

A major addition to the digital health market is machine learning. IBM’s Watson Health is a division of IBM that facilitates clinical research and health care solutions through analytics, cloud computing, and artificial intelligence. Currently, Watson Health is working on being integrated into telehealth via a wearable device to monitor disease activity, health records, drug interactions, and even disease diagnosis at an accuracy level higher than a human.
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The shift from volume-based healthcare to a value-based care model has led to other shifts impacting pharmacy. There is room for pharmacists of today and tomorrow to incorporate technology to improve outcomes and expand their current role. Interesting to note, major companies are hiring “innovation consultants” that have pharmacy or medical backgrounds to come up with ways to make the “machine” run more smoothly. As we begin the new decade, pharmacists should be aware of how technology affects healthcare. It is also an exciting time, however, because the market is changing globally, and there is a growing need for pharmacists to be at the head of this change.

​Author: Mori Crocker

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On to the main part of our trip, meetings. With the help of Dr. Andreia Bruno, we were able to book the “Hercules Room” at Monash University-Parkville Campus. Fully equipped with Zoom capable screens and secret cabinets of food and drinks, student leaders discussed not only different projects but also the sustainability and leadership of PharmAlliance student domain. UNC leaders (Clara Kim, Vraj Patel, Jenny Jin, Ember Lu) and Monash University leaders (Alisha Cloti, Kevin Wu, Brandon Pham) were in attendance, while Ruby Akkad from UCL called in from Toronto due to last minute visa issues.
This was the first time that student leaders were able to meet in person. We realized that the value of this face-to-face communication is vital, as the quality of the conversation was much higher and we were able to accomplish much more action items and structures. Ember and I had created meeting agenda templates beforehand, and each school was in charge of different sections of the meeting. Everyone created agendas before their meeting and came well prepared to host the meeting and guide discussions.
The first day was spent mostly discussing PharmAlliance student domain leadership so far. The leaders first drafted a mission statement of PharmAlliance student domain: While aligning with initiatives on the PharmAlliance level at the highest possible extent, collaborate on impactful and challenging pharmacy issues that are common between the US, Australia, and the UK. Then, students discussed about different issues with leadership that came up in effectively leading organizations. Students were able to share their experiences and also give advice on how to overcome obstacles.
The next day was spent on discussing the Medication Safety Comic series. We decided on logistics, themes, and different topics we want to be included in the comic series. While discussing all of the topics, we made sure that our end goal was having an element of collaboration in each step. Collaboration sometimes may be inefficient; In fact, there are tasks that could easily be done if it were just done within one campus group. However, the leaders were eager to implement collaborative portions across the project, as that is the main goal of PharmAlliance itself. Also, students and leaders in PharmAlliance truly value the unique international collaboration we are fortunate to be a part of, and wanted to take full advantage.
The last day was spent discussion the International Case Competition. Vraj Patel and Brandon Pham led the discussions on assessing what was good versus what could be better compared to last year. At the end of the meeting, the leadership team decided to make create interschool teams - i.e. each team will have students from two different countries! This was an exciting development compared to last year, where teams were composed of students in one school. This was again a decision made with the desire to increase collaboration among students across all three countries. We hope that the International Case Competition becomes a unique opportunity for students to learn about each others’ pharmacy practices.

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It’s no secret that the Opioid Crisis is here to stay. In the United States, over 115 people die from opioid overdose, including prescription opioids, heroin, and synthetic opiates like fentanyl. The Center for Disease Control and Prevention (CDC) estimates that the total cost of healthcare, loss of productivity, addiction treatment and criminal justice involvement totals to $78.5 billion a year in the US alone. Worldwide, it is estimated that 27 million people suffer from opioid use disorders but less than 10% of them who need treatment are receiving it. With opioid use and death from opiate use on the rise, how did we get here?
 
In later half of the 1990s, pharmaceutical companies had prescription opioid pain relievers on the market but there was concern for addiction. The companies reassured prescribers, pharmacists, and the medical community as a whole that patients would not become addicted to prescription opioid pain relievers. This led to an increase of opioid prescriptions, and widespread abuse of these medications before it was clear to the medical community that these were highly addictive. As addiction rose so did the rate of opioid overdose, by 2015 33,000 American had died from opioid overdose.
 
In present day, doctors are more reluctant to prescribe opioids and their costs on the black market have increased. This drives abusers to street drugs such as heroin. In order to keep up with demand, dealers and suppliers cut their heroin with high potency opioids acquired from overseas like fentanyl. Fentanyl is a synthetic opioid used in patients with severe pain needing long term pain management, and it is 50 to 100 times more potent than morphine. Most fentanyl-related harm come from illegally made fentanyl mixed into heroin, sometimes without the user’s knowledge.
 
The opioid epidemic has become a public health crisis with devastating consequences far beyond the users. There is a rising incidence of neonatal abstinence syndrome (infants born who suffer from opioid withdrawals), plus an increase in intravenous drug use increases the spread of HIV and hepatitis C. In order to combat this, some US states are offering safe needle programs and increasing overdose prevention intervention. One of these agents is known as naloxone. Naloxone is an inexpensive medication that can completely reverse the effects of opioid overdose and prevent death from opioid overdose. New opioid prescribing and dispensing programs have been started, along with continued education on safe opioid prescribing practices for prescribers.
 
The World Health Organization (WHO) recommends tackling the opioid crisis with a variety of treatment options, including psychological support, opioid maintenance treatments such as methadone and buprenorphine and supported detoxification and treatment with reversal agents such as naloxone. The WHO also supports countries where these treatment programs don’t already exist. The United States, and the world has acknowledged the opioid crisis, but we are a long way from solving it.