Dean Carla White is highly regarded as a confidant by BIPOC students at the UNC Eshelman School of Pharmacy (ESOP). As Associate Dean for Organizational Diversity and Inclusion, Dean White is a champion for equity and inclusion. She leads by example, allowing humility and transparency to guide her everyday actions. She shared her story with me via Zoom interview on February 8, 2021.
Christian Brown: How did being Black impact your studies?
Carla White: I’ve always loved being Black. The diverse intellect, creativity, and perspectives within Black culture truly enriched my life experiences. This started with my grandmother. Everyone in the community respected her. She was a relentlessly regal individual that was proud of her Black culture and an advocate for social justice in Pennsylvania. At only 18 years old, she was one of the first and youngest people to testify before Congress [for Civil Rights]. She was my example. I knew nothing else but to love myself.
CW: In undergrad [at WVU], my roommate and I were the only Black girls in the dorm, and everyone would come to our room to hangout. I believe most people enjoy learning about various cultures. While in pharmacy school at the University of Pittsburgh, there was only one other black student in my class, and I believe no more than 4 in the entire School of Pharmacy.
CW: Reflecting back on that, I did not feel connected as a student. Pharmacy school felt more like a process rather than an experience. It’s interesting that, currently, I sit on the School’s Board of Visitors, and feel more connected now as an Alum.
CB: How has being Black impacted your career?
CW: After a few years in community pharmacy in Pittsburgh, I moved to Oregon in the early 90s. There were so few people of color that customers would knock over displays while staring at me behind the counter.
CW: I started with WRAL-TV Raleigh [NC] in 1999. In the media, people would address news anchors and reporters by name and say, “Wow, it’s this person,” but about me they would say, “Wow! That’s the Black pharmacist at WRAL.” To others, being Black was more important than my knowledge or expertise. It’s the first thing that people would say. It was absolutely crazy.
CW: It was a consistent theme across every area of my professional career. When I was a pharmacy manager and a district manager, colleagues would have to frequently point out what my role was. Bias is prevalent and hard to mitigate without a commitment to acknowledge and educate. It leaves you seeing the world through a narrow lens.
CB: That’s powerful. And you’ve been a leader in so many different roles from founding a consulting group to working in women’s health and infectious disease to directing pharmaceutical care labs at ESOP. Will you share how you came into your most recent position as Associate Dean for Organizational Diversity and Inclusion?
CW: Oh, I’m so ashamed! I said “no” twice! I didn’t want my career to be aimed in the direction of D&I. I was afraid that the work would be further marginalized. People would think, “Of course the Black faculty member would do this,” and “Of course this kind of work would be important to her.” I was also concerned that this could potentially be a window dressing measure and not a real commitment. To add to that, I wasn’t an expert in the field- personal experiences bring tremendous insights, but they don’t make you an expert or necessarily mean that you have an interest in DEI.
CW: Then the [former] Dean sent in reinforcements- someone else to ask me to take the position, and I started to give it some thought. The Dean expressed that he was deeply committed to improving D&I. So I accepted the position. And now, I’m delighted that he pressed the issue. It is one of the most fulfilling aspects of my career, and it’s amazing to see the value that our investment in strategy development has brought. The great teamwork with my colleagues has led to tremendous progress and opportunity. It’s really cool to see former students in leadership roles!
CW: There’s certainly more work to do. Faculty are realizing that it’s everyone’s responsibility to contribute towards cultural transformation to produce a diverse pharmacy workforce. This is a priority for the School, and we are leading in this space.
CB: Thank you so much for your candor and honesty. How did it feel to be the only Black faculty member for so long?
CW: We get used to being the only one. When there is no representation, profound loneliness and isolation can be experienced. It’s also a challenge recruiting BIPOC faculty. They want to wait until we are a diverse faculty. I am often asked “Carla, how do you do it?” Community and advocacy are critical.
CW: It’s also important to realize that singular interventions aren’t going to fit for the whole BIPOC “group.” For example, when I was a SNPhA advisor, the African students and Black students members would often gravitate into separate groups based on their cultures. There are differences in these cultures that should be celebrated and respected as such. Often, people think these cultures are interchangeable through composition diversity metrics.
CW: In conversations with some Latinx students, I listened to their frustrations on hearing about extracurriculars. As a School, we, as well as our accrediting body, promote extracurricular engagement. However, for some, taking care of their families was top priority, even while in pharm school. Perhaps there is an opportunity to broaden our communication and priorities, and certainly increasing societal equity has a role in this. All this to say, that dimensions of diversity are multifaceted and diverse strategies are needed to build an inclusive community.
CB: You’re right. Celebrating BIPOC differences is important. Thank you so much for taking the time to share your story. You’re an inspiration!
CW: Thank you for the opportunity.
Introduction written by: Christian Brown, UNC Class of 2023; PharmAlliance Student
Ensuring equity is an active process, particularly when the world is falling apart. In Black communities, it seems like we are always teetering on the edge- reaching out for support from backs turned. There is an uncommon resilience that is, fortunately or not, common to Black people. This force commands us to find our balance and strengthens us to lend a helping hand. We return to our roots; we give back; we come full circle. Future pharmacist Jodelie Bellot knows what it is like to feel the earth give way, and she is committed to helping others pick themselves up and dust themselves off.
“I was born in Haiti and spend most of my childhood there; however, this childhood was abruptly cut short on the afternoon of January 12th, 2010. That afternoon, my once home in Port-au-Prince was ravaged by a devastating earthquake of a magnitude of 7.4. The whole country was plagued with ruin; everywhere I looked was in a state of emergency. Experiencing and witnessing such destruction at a young age really shifted something in me. This gave me a great push to be involved in the healthcare field, and after much reflection, I decided to become a pharmacist. As a pharmacist, I would be able to contribute to my community if something like this would’ve happened again. This journey wasn’t easy: I faced many challenges and setbacks, but I am dedicated to meet my end goal. I am currently a 3rd-year student serving the community through a similar crisis such as the COVID-19 pandemic. I worked all throughout the pandemic from staffing at my local pharmacy to procuring COVID tests and administering the COVID vaccine. I am so glad that I am in the position where I can serve my community in such disasters and I will continue to do so once I complete my studies for my PharmD in 2022.”
Jodelie Bellot, PharmD Candidate in NY
Introduction written by: Christian Brown, UNC Class of 2023; PharmAlliance Student
Why is being Black a problem? As a Black woman and a Black future pharmacist, I constantly surprise people. I talk like I have an education; I walk like I have a purpose; and I live like I have a right. Unfortunately, this is not true for many patients who look like me.
We’ve been demonized and ignored and treated as less than human. We are locked out of mainstream society- told to swim against the current and “better ourselves,” only to meet the dam of double standards. This is not a model for health.
What we need are role models, such as Dr. Blaise Ndukwe of Kalamazoo, Michigan, to show Black patients that we, too, can wear white coats.
“As the only black pharmacist employed with Gull Pointe Pharmacy at the time, I felt a duty from the first day I stepped into that pharmacy to advocate for black and brown patients. While I enjoyed my interactions with all of the patients I assisted, my interactions with black and brown patients, specifically, always felt more special. The way they looked at me, the way they spoke with me. There was always some level of respect and awe there. To be the only young, black, male pharmacist at that pharmacy and one of the only black pharmacists in the city of Kalamazoo, MI. That duty to represent weighed heavily on my shoulders and I fully embraced it. My most memorable encounter was with a black patient who had come through the drive-thru for his monthly refill. The cashiers noted him as a “problem patient” because he never “knew what medications he needed to pick up.” Instead, I saw him as someone who needed more devoted time from a pharmacist. I offered to sit down with him to review all of his medications and he accepted. A few days went by, and I never heard from him again. Then one day, he walked in unexpectedly and asked for me. Sitting down with him to review his medications was an opportunity for me to not only educate him, but for him to open up to me about his experiences at the pharmacy. He talked to me about the personal struggles he faced in his life as a black man and the things he does now to give back to his community. As I listened to him speak, I realized how important it was for him to finally see a pharmacist who looked like him. I realized just how important it was for him to finally see a pharmacist he could be unapologetically black with. Our conversation meant a lot to him, not just from an educational perspective, but also a personal one. He left the pharmacy that day knowing that he had an advocate, someone who would have his back when the other employees labeled him as “difficult” and “drug seeking.” He left that day knowing that he had an advocate who looked like him. He never let me forget just how much our interaction meant to him. Whenever he called he would ask to speak to me, and if I was unavailable, he would let the technician know to tell me how grateful he was for my help. We developed a friendly relationship, and sometimes he would show me pictures of his garden. I always enjoyed my interactions with him. Those moments truly made me feel as though I was fulfilling the duty I gave myself when I first stepped into Gull Pointe Pharmacy.”
-Blaise Ndukwe, PharmD
Introduction written by: Christian Brown, UNC Class of 2023; PharmAlliance Student
February in America is Black History Month. In the annals of pharmacy history, there is precious little concerning Black pharmacists. Leo Butts of Wisconsin wrote the first scholarly work compiling the contributions of Black pharmacists in 1920. He chose the topic for his Degree of Graduate in Pharmacy thesis and was encouraged to pursue this work by his mentor, Nellie Wakeman, the first woman instructor at the University of Wisconsin School of Pharmacy (1). Still today, we see minorities supporting minorities to reach their full potential. Throughout his writing process, however, Butts expressed his disappointment that there was “scarcely a reference to the Negro in pharmacy” in the greatest pharmacy history library in the US (2).
In his thesis, Butts acknowledges a truth that characterizes the Black experience: “it is absolutely necessary for the colored druggists to give not only as good but better services than his white competitors, if he is to be even moderately successful (2).” His work predates the National Pharmaceutical Association by 27 years (3). The only national option for the 1400 Black pharmacists at the time was to join the physicians and dentists in the National Medical Association (2,3). Only in the American South were state organizations available, and their main focus was improving sanitation in Black neighborhoods.
In only 16 pages, Butts recounts the most complete history of Black pharmacists to date.
Five years later, another student pharmacist writes on the subject. Mozella E. Lewis, likewise, bemoans the lack of Black recognition, and seeks to fill the gaps: “Mention has not been made…because our people have been timid and no other people have thought enough of us to give us serious thought (4).” Even so, Lewis’s words are tainted with the Eurocentric disdain of her African roots as, after extolling the progress of Greeks and Hebrews, she complimentarily concedes that her ancestor, “in his savage way, was a great pharmacist.”
Her thesis contains lists of names, cities, and achievements of Black pharmacists beginning with James T. Wormeley, the first graduate of the Pharmaceutical College of Howard University. He graduated in 1870 from the program started three years prior. Following the list of Howard graduates, Lewis lists Black graduates from White institutions, approximately 100 in total, along with their successes. She closes with this:
These statistics give us an idea of what the Negro has done in pharmacy, and should encourage the young Negroes interested in this work to improve the many branches of this science in which the Negro has become famous and further develop those phases in which he seemingly has not yet entered to any great extent, so that the Negro will be an outstanding light in the development of pharmaceutical science (4).
Written by: Christian Brown
1. Bond G. Leo Butts, UW Pharmacy Pioneer . UW Madison School of Pharmacy Historical Alumni Information. https://pharmacy.wisc.edu/alumni-friends/events-awards-programs/historical-information/leo-butts-uw-pharmacy-pioneer/. Accessed January 13, 2021.
2. Butts LV. The Negro in Pharmacy. 1920.
3. NPhA - Home. https://nationalpharmaceuticalassociation.org/. Accessed January 14, 2021.
4. Lewis ME. History of the Negro Pharmacist. Am Drug. 1925.
With roughly 71 million COVID-19 vaccine doses administered worldwide, 24.5 million doses given in the United States alone, humanity is experiencing one of the largest-scale global health efforts in history. There are dozens of different COVID-19 vaccines in various stages of development throughout the world that have the potential to be approved. As of writing this article, the World Health Organization (WHO) has identified 63 vaccine candidates in the clinical phase. Currently, the vaccines authorized for emergency use in the United States are the Pfizer-BioNTech and Moderna mRNA vaccines. These vaccines are a great first step into widespread vaccination, but there are several barriers limiting their use.
One of the biggest challenges for mRNA vaccines is their extremely strict storage requirements for stability, which are not unique to the Pfizer or Moderna formulations. The Pfizer vaccine is supplied as a frozen, 5-dose vial that is stored between -80ºC to -60ºC and has to be thawed and diluted prior to administration. After dilution, they have to be stored between 2ºC to 25ºC and used or discarded within 6 hours from the time of dilution. The Moderna vaccine also comes in multi-dose vials but has slightly less strict temperature requirements. They are stored frozen between -25ºC to -15ºC, but can be stored refrigerated between 2ºC to 8ºC up to 30 days prior to first use. Another limitation is that the Pfizer vaccine is recommended for people aged 16 years and older, while the Moderna vaccine is approved for people aged 18 years and older. If these mRNA vaccines have so many drawbacks, what other options will there be in the future?
Despite the fact that the only COVID-19 vaccines currently available are mRNA vaccines, this vaccine type is actually relatively new and uncommon. To date, there are no other approved mRNA vaccines on the market. According to the WHO’s novel coronavirus vaccine landscape, only 7 of the 63 vaccines in development are RNA based. An additional 9 vaccines under development are DNA-based. In contrast, there are 20 protein subunit vaccines in clinical development. Another 16 vaccines in the viral vector class as either replicating or non-replicating varieties with or without additional antigen presenting cells are also identified. In the whole virus vaccine category, there are 9 inactivated virus vaccines and 1 live attenuated vaccine.
The latest vaccine that has been approved in the UK is a viral vector vaccine developed by AstraZeneca and the University of Oxford. The vaccine has a reported efficacy of 90% and is stable for refrigeration. Their clinical trials, which involved over 11,000 people, found the vaccine’s 90% efficacy figure in those that received a low dose followed by a standard dose. Surprisingly, in participants that received two standard doses the efficacy of the vaccine was only 62.1%. One of the major benefits of the vaccine is its price of $4 per dose, much lower than the $20 of the other available vaccines. However, there have been problems with supply and pricing. The UK has ordered 100 million doses, Australia has ordered 53 million, and the EU has a contract with AstraZeneca to provide up to 400 million doses in total, around 80 million of which were due this quarter. Unfortunately, AstraZeneca reported on January 22 that they will only be able to deliver 31 million doses to the EU and supply chain issues likely affect their other agreements as well. The U.S. still has not approved the vaccine due to delays in clinical trials.
Some other major viral vector vaccines production includes Jannsen/Johnson&Johnson’s vaccine, which also has an agreement for 400 million doses with the EU once its year-long clinical trial is finished. They launched their phase 3 trials in Latin America and the UK in fall of 2020. The Ganekaya Research institute in Russia is also developing a viral vector, called Sputnik V, that has just entered phase 3 trials. It has a reported effectiveness of 92% and can be stored at normal fridge temperatures. Another U.S. based biotech company, Novavax, has recently finalized an agreement with Canada to purchase 52 million doses and concluded talks with the EU for up to 200 million doses for their fridge-stable protein subunit vaccine. The French company Sanofi and England-based GSK also have a protein subunit vaccine that is stable at refrigerator temperatures and can even be stored at room temperature for a short amount of time. The EU has already confirmed the purchase of 300 million doses of their vaccine. Additionally, Sanofi has just finished settling an agreement to assist in producing 100 million doses of the Pfizer/BioNTech vaccine just hours before writing this article.
Information on vaccines in development in China is more difficult to obtain, but Sinovac’s inactivated vaccine is currently approved for emergency use in China. The country currently has the second highest number of vaccines given in the world at 15 million in total. Other countries have already reached agreements with Sinovac, such as Turkey approving 10 million doses of the vaccine. The latest figures of its effectiveness put it at around 50.4%, making it an unlikely contender at its reportedly $60/dose price tag. Sinopharm, which is a state-run company, is also developing two inactivated vaccines of its own. Reports of its efficacy are a little inconsistent but hover around 80% effectiveness. Regardless, the United Arab Emirates has already approved the Sinopharm vaccine earlier this month.
The vaccines mentioned in this article are nowhere near an exhaustive list of all the potential vaccines that may come out to protect against COVID-19, which is great news. As the effort to push for global immunity to the virus that turned the world on its head continues, it’s reassuring to know that several different options will eventually become available for the public in the coming years. More than likely, a set of gold-standard vaccines will be developed in the years to come that will join the likes of influenza on the list of regularly scheduled vaccinations.
Written by: Kervin Novido
As of 11 March 2020, the world has been in the midst of a pandemic. A once meaningless word to many, ‘coronavirus’ has taken the world by storm. In fact, Google revealed last December that ‘coronavirus’ was the top trending search for the UK in 2020. Coronaviruses are a family of viruses that cause infection in humans and animals. The one that led to the pandemic is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but is more commonly referred to as simply ‘coronavirus’. When an individual is infected with the virus, they may display mild symptoms or no symptoms at all. Consequently, if the individual displays more severe symptoms and potentially need to be hospitalised, they are said to have coronavirus disease or COVID-19. An insidious infectious disease, the impact of COVID-19 has been catastrophic. Since the beginning of the pandemic, one clear solution to eliminate this disease and aid in the return to normal life has been the development of an effective vaccine. With COVID-19 vaccines having been approved for use in the UK and worldwide, is the pandemic finally over?
Vaccines are chemically weakened or dead forms of a pathogen, whereby a pathogen is a microorganism which results in disease. Once a person is treated with a vaccine i.e. they are vaccinated, their immune system is stimulated. This stimulation leads to destruction of the pathogen and the production of memory cells. This means that if a person was infected with the same pathogen in the future, the body remembers how to fight the pathogen. There are several types of vaccines which exist. The four main types of vaccines are live vaccines, inactivated vaccines, subunit vaccines and nucleic acid-based vaccines.
The first type, live vaccines, include commonly administered injections such as MMR and tuberculosis vaccines. As the name suggests, they contain the actual microorganism which causes the disease. However, they don’t make people ill due to attenuation, which is a process whereby the microorganisms are reduced in virulence (capability to cause severe disease). This is possible as vaccine developers only use the mutated strains of the organism that have a lower toxicity. However, as they still contain the actual disease-causing microorganism, they cause the body to produce many antibodies. This results in lifelong immunity against the disease.
The second type, inactivated vaccines, are made from dead microorganisms. They are safer compared to the live ones, but a higher dose is often needed as the bacteria and viruses don’t replicate inside the body. This makes them more expensive compared to live vaccines. An example of an inactivated vaccine is the polio vaccine. The third vaccine type are subunit vaccines, such as the hepatitis B vaccine. As the name suggests, they only include the antigen parts of the microorganism, which is the part that stimulates our body’s immune system.
The final vaccine type is the nucleic acid vaccine, which contains plasmid DNA or mRNA from the bacteria/virus that codes for the antigens that cause an immune response. These mRNA vaccines are considered safe and very effective, which is why they are increasingly being developed. The current vaccines against COVID-19 encompass the second, third and fourth vaccine types; for example, Sinopharm has produced an inactivated virus vaccine, AstraZeneca/Oxford has produced a subunit vaccine and Pfizer has produced an mRNA vaccine. Currently in the UK, the Pfizer, Moderna (another mRNA vaccine) and AstraZeneca/Oxford vaccines have all been approved for use.
A report published by Imperial College London’s Institute of Global Health Innovation (IGHI) and YouGov in November 2020 looks at people’s attitudes towards COVID-19 vaccines across 15 countries, including the UK. This report was based on survey responses from around 13,500 people and gives an insight into behaviours related to COVID-19. 65% of respondents in the UK reported being willing to get vaccinated in 2021 if a COVID-19 vaccine became available to them, which made respondents from the UK the most willing to be vaccinated among the countries surveyed. Overall, of all those surveyed, around half (51%) were willing to get a COVID-19 vaccine in 2021.
This also reveals how half of those asked, the other 49%, would be hesitant in getting a COVID-19 vaccine if it was available to them. This is not a new concept when it comes to vaccines; vaccine hesitancy has existed for many years and is in fact a global issue. The World Health Organization (WHO) recently listed vaccine hesitancy as one of their top 10 biggest threats to global health. Vaccine hesitancy is the scientific term for anti-vaccination; it is when people with access to vaccines delay or refuse vaccination. Vaccination is one of the most effective ways of eliminating disease across the world, with a staggering 2 to 3 million deaths prevented by vaccination every year. Nonetheless, vaccine hesitancy has grown in popularity in recent years, fuelled by misconceptions and misinformation. This could have potentially devastating consequences on public health.
The biggest concern people have regarding the COVID-19 vaccines is whether they are safe. Many are hesitant to be vaccinated as they feel the vaccine was developed too quickly, with the time taken from initial development to the deployment of the vaccines being approximately a year or less. Thus, people are concerned that long-term studies of the vaccines have not been conducted, and so are afraid of the potential long-term implications of a COVID-19 vaccine. An article published by the COVID Symptom Study addresses this concern. The COVID Symptom Study is the world’s largest ongoing study of COVID-19. The study is based on data provided by over 4 million people globally through the COVID Symptom Study app. It is a non-profit initiative launched by health science company ZOE in collaboration with King’s College London.
The article explains that the global health emergency created by the pandemic led to billions of pounds being committed to global COVID-19 vaccine research, as well as tens of thousands of people volunteering for the clinical trials of the vaccine. The level of funding for the vaccine meant that scientists all over the world were working on a vaccine and had the means to do so, making the process of vaccine development much faster. In addition, the large number of volunteers for clinical trials further increased the rate of vaccine development, as it can take many months or years to obtain enough volunteers. Furthermore, the genetic code of SARS-CoV-2 was identified quite quickly relative to the spread of disease (January 2020), so scientists were able to begin working on a vaccine immediately. The vaccines were not developed from scratch, rather they were developed based on existing safe and effective vaccine delivery systems. These were adapted to work against COVID-19. For example, the AstraZeneca/Oxford vaccine had been in development and testing for 15 years, having been previously developed to work against other related coronaviruses that cause SARS and MERS. In addition, compared to the past vaccines can be manufactured at a much quicker rate due to modern technology.
It is a culmination of these factors which led to the fast development of COVID-19 vaccines. If faced with vaccine hesitant members of the public, it is important to inform them that the safety precautions, clinical trials and tests for the COVID-19 vaccines were conducted as thoroughly as with any other vaccine. The spread of misinformation is especially worrying now as vulnerable patients who see or hear it may refuse the COVID-19 vaccine, thus endangering their life and the health of those around them. Ensuring we are fully educated about the history and development of this virus and its treatment can be what saves them in the future.
Authors: Amelia Ryan and Nusayba Ali
The time had finally come to start my final immersion at Duke University Hospital in Durham, NC. I was excited, but mostly nervous about what I would experience. This immersion would be like no other because we were facing the early stages of the COVID-19 pandemic. PPE was running low at most hospitals, screening was not being done enough around the country, and more people were becoming hospitalized due to COVID-19. I was worried for my own health, but I knew Duke had taken great measures and precautions for the safety of not only the patients, but healthcare workers as well.
On my first day arriving at Duke, I immediately saw signs for wearing masks on campus everywhere. At Duke everyone on campus even outside of the hospital were required to wear masks at all times. As soon as I entered the hospital my temperature was taken, I was asked questions regarding my symptoms, and was given a new sticker each day to wear to show that I was healthy. My first month of rotations was in cardiology. One concern in cardiology, was the resemblance of certain classic symptoms such as shortness of breath and cough for heart failure being similar to COVID-19. Fortunately, all patients were screened rapidly for COVID-19 when admitted, so the chances of these symptoms being COVID-19 were relatively low. Since I was doing my clinical direct patient care immersion, typically this would require rounding in patients’ rooms with the team to decide on diagnosis and treatment. However, with COVID-19 pharmacy students were not allowed to enter patient rooms, but we were able to still round with the team going door to door to make recommendations. I remember seeing some interesting patient cases such as a patient who was diagnosed with Takotsubo cardiomyopathy, otherwise known as broken-heart syndrome. This patient was a previously healthy female and had a normal ejection fraction until her husband unexpectedly passed away. Her ejection fraction in the hospital was around 20% and was immediately classified as a heart failure patient due to this syndrome.
During my second month at Duke I rounded in the pediatric floor. I loved working with and seeing all the children. It was devastating to see children in the hospital, however their resiliency and braveness at such a young age inspired me. All of the children I met from afar had such a positive attitude no matter what their diagnosis or illness was, which was truly astonishing to me. Some unfortunate few cases we saw at the hospital, which was new to all of the medical providers was MIS-C in regards to COVID-19. MIS-C otherwise known as multisystem inflammatory syndrome in children is a rare complication that can occur in this case due to an exposure to COVID-19 and can cause different parts of the body to shut down if not treated properly. I was able to present this new syndrome to the pharmacists along with treatment options.
Although my last immersion was not exactly how I expected it to be, I am prouder than ever to be a part of a healthcare team in a time like this when healthcare workers are vital in defeating this pandemic. My appreciation for all medical providers and frontline workers definitely heightened as they dealt with the most difficult challenges this pandemic offered. I hope to one day become a strong and resilient healthcare provider as they are.
Written by: Sarah Mouna
Are we to look forward to a future where people succumb to infections as they would have prior to the 1900s?
In the 1920s, Alexander Fleming’s discovery of penicillin kickstarted a whole new era of medicine. The impact was such that penicillin was used to treat pneumonia in soldiers on the battlefields during World War 2. And yet a century later in 2020, over 12,000 people die in the UK due to antibiotic resistance with the number increasing to over 700,000 worldwide. So how did antibiotics go from a “miracle drug” that could cure illnesses previously feared by physicians, to a source of concern for doctors worldwide?
After the discovery of penicillin in 1928, infections which previously resulted in loss of life were now being adequately treated by antimicrobials. Antimicrobials include antibiotics, antivirals and antifungals. They are vital in preventing and treating infections. An infection arises when a pathogen enters your body and begins to multiply, with a pathogen being a microorganism (such as bacteria) that causes disease. Antimicrobial resistance occurs when microorganisms no longer respond to the antimicrobials designed to kill them. When antimicrobials lose efficacy as a result of antimicrobial resistance, people can succumb to any number of infections. It has become increasingly apparent that antimicrobial resistance poses a real threat to mankind. In fact, antimicrobial resistance has recently been reported by the World Health Organization (WHO) as one of their top 10 threats to global health.
Antibiotics are an example of antimicrobials which are used very widely. They have applications in hospitals, community, food production and in veterinary production. The problem is that the more often antibiotics are taken, the less effective they are. This is because bacteria replicate very quickly- for example, E. coli undergoes mitosis every 20 minutes. During this process, mutations can occur. In general, the change is inconsequential but sometimes, the mutation can benefit the bacteria and give it characteristics that prevent it from being affected by an antibiotic. This trait is then favored via natural selection and the mutated strain quickly outnumbers the original strain. This means that when more people use antibiotics, different species of bacteria have a greater chance at developing these resistant traits. When doctors and GPs inappropriately prescribe patients with antibiotics for conditions like sore throat and sinusitis, it puts patients who genuinely need antibiotics at greater risk of harm. A study found that in general around 1 in 5 antibiotic prescriptions are issued inappropriately in the UK and considering how around 18 in 1000 inhabitants are prescribed antibiotics annually, one can imagine how great the number of people misusing antibiotics is.
Antimicrobial resistance requires urgent attention. If action is not taken to combat this phenomenon, many modern medicines could become obsolete. Overcoming antibiotic resistance has been a priority for WHO since 2015. World Antimicrobial Awareness Week is an organized effort by WHO to increase awareness of antimicrobial resistance globally and to encourage practices among the general public, health workers and policy makers, which will prevent further emergence and spread of antimicrobial resistance. Antibiotic Guardian is another initiative that is being undertaken to slow the spread of antimicrobial resistance, specifically that of antibiotic resistance. It is a campaign that was launched by Public Health England in 2014 and aims to encourage health and social care professionals, students, educators in the human and animal health sector as well as members of the public to take action against the spread of antibiotic resistance. By pledging to become an Antibiotic Guardian, you choose to perform a simple action which protects antibiotics against the threat of antibiotic resistance.
We can all do our part to stop antimicrobial resistance from spiraling out of control. Prescribers, such as doctors, should ensure that they are appropriately prescribing antibiotics and other antimicrobials, whilst patients should ensure that they take these medicines correctly and finish the full course of treatment. Good hygiene and infection control practices, particularly in healthcare settings, can also prevent infection and reduce the need for antibiotics in the first place. Immunization such as vaccinations are also very useful in preventing infections, further reducing the need for antimicrobials. These measures could reduce the use of antimicrobials and in turn, their misuse, such that we can avoid a future where people succumb to infections as they would have prior to the 1900s.
Authors: Amelia Ryan and Nusayba Ali
With all the technological advances of the modern age, it is reasonable that one might be led to think all drugs are developed through highly sophisticated, novel experimental methods and human ingenuity. There’s no way that a drug that cost millions of dollars to create could have come from a humble plant, right? In fact, of all the drugs approved from 1981 to 2014, only 27% were purely synthetic while 50% came from mimics, derivatives, or unaltered forms of natural products!1 There may be an air of exoticness or crudeness associated with natural products, but they are clearly prevalent even among the cutting-edge science of today and continue to occupy a significant space in medicine.
Two fields within the wide scope of pharmacy concerning natural products include pharmacognosy and ethnopharmacology. Pharmacognosy is the study of the biochemical and biological properties of drugs of natural origin as well as the search for new drugs from natural sources.2 Closely related, ethnopharmacology deals with the observation and experimental investigation of the biological activities of plant and animal substances used in the traditional medicine of past and present cultures of different indigenous groups.3 While one is in the realm of natural science and the other sits at the intersection of natural and social sciences respectively, the two are not mutually exclusive and both possess an acute understanding and appreciation of nature as a master chemist of diverse, complex molecules that provides invaluable resources for drug development.
From drugs that can treat cancer to medicines that help relieve a simple headache, the range of drugs that have been created from the trees and microorganisms that make up the background of our lives is astounding. A compound first isolated from the purple-pink flowers of the foxglove plant has been used for hundreds of years to treat a condition first referred to as “dropsy.”5 Although the name for the condition of fluid retention in the heart and lungs has become more refined under the category of heart failure, the same active ingredient in those dried, powdered leaves has been used for hundreds of years and even now is sold and dosed as the familiar digoxin.4
Scientists continue to isolate and discover viable structures from natural products as they have done for centuries past, but now they have the technology and innovations of today to help guide them in not only creating new drugs but also understanding current drugs. The therapeutic windows for dosing, toxicity, and other factors are becoming better elucidated as we are able to narrow down optimal doses and even generate synthetic antibody-type antidotes to drugs such as digoxin. On the other hand, researchers at universities are exploring novel compounds from natural sources in treating disease states. For example, the universal yet poorly understood state of pain is currently being treated mostly with opioids, another class of drugs isolated from the opium plant. Researchers at the Boston Children Hospital have found a potential delivery system for TTX, a neurotoxin found in pufferfish.6 This treatment could potentially reduce dependence on opioids and dosing frequency and combat the opioid epidemic plaguing the world.
However, the transition from traditional to modern society is not always so innocuous. The Matses people of Brazil and Peru remain isolated in one of the most carbon-rich, densest parts of the Amazon rainforest. As they are integrated into the outside world, the elderly medicinal shamans have found their knowledge at risk of being lost forever and have thus created an encyclopedic trove of information regarding their interpretations of disease states and various natural treatments, drawn from their environment in the rainforest.7 It is critical to preserve these wealths of knowledge passed down through generations of indigenous groups as they are disappearing at an alarming rate. As pharmacists, we have to keep in mind the important role traditional medicine continues to play in the lives of many patients who come from different cultural backgrounds.
The advancement of modern medicine provides life-saving therapies for millions around the world, but we also cannot forget the vast influences traditional medicine exerts. What connects the two together is the limitless opportunities that natural products offered in the past, continue to offer in the present, and, undoubtedly, will offer in the ages to come.
Authors: Aimee Ho and Anna Li
1. Newman DJ, Cragg GM. Natural Products as Sources of New Drugs from 1981 to 2014.JournalofNaturalProducts.2016;79(3):629-661. doi:10.1021/acs.jnatprod.5b01055.
2. AbouttheASP.TheAmericanSocietyofPharmacognosy.https://www.pharmacognosy.us/ what-is-pharmacognosy/. Accessed February 20, 2020.
3. Journal of Ethnopharmacology. Aims & scope - Journal of Ethnopharmacology | ScienceDirect.com.https://www.sciencedirect.com/journal/journal-of-ethnopharmacology/about/aims-and-scope. Accessed February 20, 2020.
4. Digitalis.https://www.ch.ic.ac.uk/vchemlib/mim/bristol/digitalis/digitalis_text.htm. Accessed February 20, 2020.
5. McLachlan A, McLachlan A. Weekly Dose: Digoxin, the heart medicine that may have givenusVanGogh'sStarryNight.TheConversation. http://theconversation.com/weekly-dose-digoxin-the-heart-medicine-that-may-have-given-us-van-goghs-starry-night-57980. Published August 23, 2019. Accessed February 20, 2020.
6. Liu A. Could a pufferfish toxin be a safe alternative to opioids? FierceBiotech. https://www.fiercebiotech.com/research/could-a-pufferfish-toxin-be-a-safer-painkiller-than-opioid. Published June 12, 2019. Accessed February 23, 2020.
7. Amazon tribe creates 500-page traditional medicine encyclopedia. Mongabay Environmental News. https://news.mongabay.com/2015/06/amazon-tribe-creates-500-page-traditional-medicine-encyclopedia/. Published December 20, 2018. Accessed February 23, 2020.