Introduction
According to the World Health Organization (WHO), a pandemic is the worldwide spread of a new disease1. Viral pandemics are caused by viruses that possess a surface protein to which the majority of people lack immunity, which then spreads between people within the population extending beyond national borders2. Historically, many viral pandemics have been documented. The most notorious of these is the Spanish influenza pandemic of 1918–1920, which was caused by the H1N1 virus and was responsible for about 40 million deaths worldwide3. Other pandemics include the Asian Influenza (1957) caused by the H2N2 virus, the Hong Kong Influenza (1968) caused by H3N2 virus2, the Severe Acute Respiratory Syndrome (SARS) which occurred in 2003 and was caused by SARS coronavirus (SARS-CoV)4, and the Middle East respiratory syndrome (MERS) which occurred in 2012 and was caused by coronavirus (MERS-CoV)4. Recently, on the 31st of December 2019, a case of pneumonia of unknown cause in Wuhan was reported to the WHO Country Office in China1. It was later identified as coronavirus disease-2019 (COVID-19) caused by the novel coronavirus officially called SARS-CoV-2, belonging to the family Coronaviridae5. The Coronavirus genome consists of a single strand positive sense ribonucleic acid (RNA) 4. The virions (virus particles)   are enclosed in a lipid envelope characterized by the presence of crown-like spikes on the surface which have led to the nomenclature -where ‘corona’ implies the crown like appearance created by these bulbous spikes.4. SARS-CoV-2 usually causes mild symptoms such as fever, dry cough, and sore throat. However, it can sometimes lead to fatal complications such as severe pneumonia, pulmonary edema, acute respiratory distress syndrome (ARDS), organ failure and septic shock6. The spread of the virus to many countries around the world in a short space of time with no clear treatment or vaccine in sight as yet, is alarming and has resulted in high workload for healthcare teams globally7-9. Effective strategies currently followed to slow the spread of the virus included hygiene practices such as proper hand washing, hand sanitizing and wearing facemasks and gloves (personal protective equipment), in addition to social distancing and public quarantine measures10.
The Middle East and North Africa (MENA), like other parts of the world, have experienced several epidemics over the years. Outbreaks of plague, smallpox 11, cholera 12, and meningococcal infection13 have all been documented, especially in Saudi Arabia during the annual Pilgrimage (Hajj ) as Muslims from more than eighty countries convene together, which led the Saudi authorities to require all visitors to immunize against certain diseases11, 12.
Community pharmacists (or retail pharmacists as they are known in some countries) have a crucial role to play during pandemics14. One of the most important role of community pharmacists is to ensure the availability of effective therapy in addition to health education and health promotion activities and vaccination provision 15-17. Moreover, community pharmacists need to engage with patients, providing them with counseling regarding the safety precautions to minimize exposure and infection probabilities as well as psychological and mental health support during a pandemic. Pharmacists would be expected to support general health care teams in infection prevention, as well as alerting public health officials of potential outbreaks/cases18, 19. During pandemics pharmacists’ role in managing minor ailments increases as doctors and hospitals become overwhelmed 18, 19. The International Pharmaceutical Federation (FIP) released a guideline during March 2020 stating the needed information for pharmacists and the pharmacy workforce to help them in dealing with the COVID-19 outbreak20, and acknowledging the responsibilities put upon the pharmacists in the control of the COVID-19 outbreak 20. This mandate highlights the clear need for pharmacists to convey factual evidence based and up-to-date information to the public21. In a study conducted during the pandemic outbreak of H1N1, it was found that patients rely on information provided by pharmacists and considered them an effective educational source regarding the pandemic in addition to trusting pharmacists as immunizers22. In previous ‘pandemic preparedness testing studies’, in the United States (US), community pharmacists have expressed concerns that need to be considered by policymakers, for example, about critical medicine shortages or managing medicine hoarding17. Collating published literature, it appears that there are various research studies published to guide pharmacists on how to improve patient care services and outcome19, 23, 24, however, pharmacists are still in need for more tailored and extensive training to improve preparedness for emergency situations18. To prepare globally uniform pharmacy response directives for pandemics, pharmacists’ awareness and perspectives around roles during pandemics in different regions of the world need to be assessed. In light of the repeated pandemic/epidemic experiences in the MENA region, the aim of this study, therefore, was to assess awareness of COVID-19 amongst pharmacists from countries located in the MENA and to assess their perspectives of their role, barriers, and roles of the educational institutions and pharmaceutical associations in preparing them to be able to deal with the pandemic.