High levels of AMR in Ukraine ‘a problem’ for the world

Pharmacists across the UK have been urged to get involved in tackling antimicrobial resistance (AMR) within conflict zones and humanitarian disasters as ministries look to the profession for solutions.

The call comes from academic pharmacist Oksana Pyzik who delivered a speech at the Pharmacy Show this weekend on work being done to support with medicines and AMR in Ukraine amid the Russian invasion.

Prior to the war, Ukraine was already considered one of the regions in the world with the ‘highest burden of AMR’, she told delegates at the conference in Birmingham.

‘It’s very common in this part of the world to be able to get antibiotics without prescription,’ she said.

But the situation was even more pressing following the Russian invasion, with high numbers of amputations and poor and unhygienic conditions, she noted.

‘AMR in Ukraine is a problem for AMR everywhere else in the world,’ said Ms Pyzik, who is a senior teaching fellow at University College London.

And she stressed that pharmacists in all countries are ‘the custodians’.

‘We can be global health leaders in both humanitarian spaces, in our communities and beyond,’ she added.

She urged pharmacy delegates to ‘roll up your sleeves’ and get in involved in tackling the issue, as she outlined work that had been done with the European Association of Employed community Pharmacists in Europe (EPhEU), PDA and the British Society for Antimicrobial Chemotherapy on the ‘Medicines to Ukraine’ campaign.

The EPhEU launched the campaign shortly after Russia invaded Ukraine in February 2022 when pharmacists in the country asked for support around the availability of vital medicines.

The campaign, which saw community pharmacies across the UK host posters to encourage people to donate, has raised over £3m.

During her talk, Ms Pyzik highlighted that as humanitarian disasters continue to unfold ministries are ‘specifically looking to work with pharmacists’ to find solutions on the ‘very specific health needs’ that occur as a result.

As part of the campaign, the team had asked the ministry in Ukraine ‘what can pharmacists do’ to help.

And in response, Ms Pyzik said they were told: ‘Yes, we need supplies, we need essential medicines, but we are also really struggling with antimicrobial resistance.’

There were challenges with delays in identification of bacteria causing infections and the sensitivity of these bacteria to antibiotics, as well as a shortage of the right antibiotics and cross-infection within healthcare settings in Ukraine, said Ms Pyzik.

Ms Pyzik explained the campaign team helped to support with infection prevention and control, to avoid hospital acquired infections spreading to the wider community, and also helped promote a focus on basic handwashing.

Workforce and staff training was also an area that needed support in Ukraine, she noted.

And following a meeting between those involved in the campaign it was agreed that there would be ‘a delegation that will receive additional training, either in Romania or Poland, so they can get more word experience and get best practice that way’.

There was also a lack of ‘clinical pharmacists’ and specialist healthcare roles and the campaign team explored how it could help ‘fill that gap’.

In addition, there was the risk of ‘false medications’ to be aware of, noted Ms Pyzik.

During war zones or crises such as the coronavirus pandemic, there is ‘always a risk for false medications or substandard medications to enter the supply chain’.

‘What happens is, if you can't get your what you need from your regular supplier, and you have bodies piling up, you're going to try and get it from anywhere that you can,’ she told delegated.

‘And that's where we see these unverified suppliers take advantage in situations and we saw this with Covid, such as with [personal protective equipment] PPE.’

She stressed that the project was not about telling colleagues in Ukraine what to do, but about helping them to ‘amplify’ their best practice.

With ‘superbugs’ estimated to kill around 2.7 million people and the World Health Organization ranking it as ‘one of the top 10 global health threats that we are facing’, the issue around AMR is a ‘really significant, global health threat’, said Ms Pyzik.

Ms Pyzik suggested pharmacists across the UK can help by supporting with this campaign or similar projects, and by connecting any key contacts they have with those overseas.

‘Sometimes our role is to bring everyone that needs to be at the table together, using your own voice,’ she said.

‘That is what I’ve always encouraged all my former and current students to do – to be an ambassador. You don’t need to be invited to do that.

‘You have the power to raise this as a very important part of global health pharmacy.’

Also during her talk, Ms Pyzik mooted a medicines project soon to be carried out in Africa, similar to that running in Ukraine.

Data released in June showed that nine in 10 community pharmacy teams in England engaged in antimicrobial stewardship activities in 2021/22 using the TARGET Antibiotic Checklist.

At the time, NHS England said that this was a ‘solid foundation’ ahead of the upcoming Pharmacy First Service, which will allow pharmacists to supply prescription-only medicines, including antibiotics where appropriate for seven common conditions.