Need for more proactive use of pharmacists in the COVID-19 pandemic following lessons learnt from the Great East Japan Earthquake

www.jogh.org • doi: 10.7189/jogh.10.020309 1 December 2020 • Vol. 10 No. 2 • 020309 Maintaining an appropriate and sustainable supply of medical and health service products, including drugs, vaccines and sanitary materials, is of paramount importance in any crisis that impacts on public health in any population [1]. In the past, quackery spread during the Great Plague, and after World War 2 shortage of anti-infective agents and analgesics caused the spread of substandard and counterfeit drugs, leading to negative health impacts, including deaths [1]. In this regard, during the Coronavirus Disease 2019 (COVID-19) pandemic, which has spread rapidly around the world including Japan [2], constructing stable supply chains of resources such as drugs and other daily necessities should be essential for preventing undesired outcomes [1].

notebooks to record their work because the regular functioning of medical facilities had been rendered inoperable due to the tsunami [6], These efforts might help guide efforts in helping to cope with the COVID-19 pandemic.
Further, management of the living environment by pharmacists was also helpful during the GEJE, which could be applicable to the COVID-19 pandemic. Basically, pharmacists have controlled environmental factors in schools and other public facilities, such as temperature, humidity, water quality, dust level, and pests, in Japan [7]. For that reason, after the GEJE, pharmacists could have helped raise the awareness of evacuees to the appropriate use of disinfectants or sanitation of temporary toilets, as well as the temperature and humidity in evacuation sites. In Minamisanriku Town, Miyagi Prefecture, a municipality badly affected by the tsunami, evacuees were forced to live in narrow spaces because the main part of the evacuation center was used to store dead bodies and relief materials. Because water and sewage services were shut down for five months, the use of water other than drinking was limited to once a day. Hand sanitizer was very useful to disinfect and cleanse hands directly under the guidance of pharmacists in evacuation sites. It would be valuable during the COVID-19 pandemic for pharmacists to proactively intervene in the improvement of the living environment where infections are likely to occur.
Reflecting the GEJE, the training was started for "Pharmacy Disaster Life Support (PhDLS)" personnel who were destined to be responsible for the supply of drugs and the planning of pharmaceutical support activities in a large-scale disaster [8]. Large quantities of relief materials were haphazardly piled up at evacuation centers after the GEJE and on-site health care professionals (HCPs) were confused due to the mix of brand name drugs and generics. Pharmacists had checked the ingredients of drugs and suggested alternatives to prescriptions written by physicians based on availability. The practical role of such pharmacists is one of the most insightful and important points for future disasters preparedness.
However, it appeared that the lessons learnt in past major disasters, particularly with regard to drug or sanitary material were not applied during the COVID-19 outbreak in Japan. The role of pharmacists in the COV-ID-19 pandemic, including drug supply and pharmacotherapy planning ( Table 1), has been gradually reported [9]. On the other hand, according to Japanese guideline regarding "temporary pharmaceutical distribution at the large-scale disaster" [6], under the leadership of local governments, physicians, pharmacists, local pharmaceutical wholesalers and others have to work together and build systems to ensure drug delivery, with no shortages or coverage at the time of a disaster. However, supply systems had not functioned effectively during the COVID-19 outbreak, Management of living environment by pharmacist may be useful to prevent the spread of COVID-19 infection, given the experience that the sanitation management by pharmacist in evacuation centers after the GEJE.  and from March to June 2020, some HCPs were forced to use the same face masks for several days and wear rain gear or other alternatives to proper Personal Protection Equipment (PPE) and as a result, operations for infection control were inadequate in some hospitals [2]. Additionally, during the COVID-19 outbreak, PhDLS [8] had not been engaged in any activities, as far as we know. Those problems must be reviewed and we HCPs and stakeholders should revisit effective measures to prevent from such inadequate responses in future.
The current COVID-19 pandemic is projected to last for several years, based on past experiences with the Spanish Flu [10], and will require additional efforts of HCPs. In the aftermath of the GEJE, pharmacists contributed to the supply of drugs and improvement of the environment to meet the needs of patients in the affected areas [6]. The participation of pharmacists could help support the treatment for patients in the COVID-19 pandemic.
Finally, with regard to the supply of drugs and sanitary materials and management of the living environment, the table summarizes the problems encountered during the COVID-19 pandemic and the measures taken based on GEJE's experience [6]. We hope that lessons learned from the GEJE will be one of the catalysts for rethinking the role of pharmacists during the COVID-19 pandemic.