Edinburgh Research Explorer

Drug advertising rules and the patient safety paradox in Zimbabwe

Research output: Contribution to journalComment/debate

Abstract

Laws and regulations restricting the advertising of medicines are essential for protecting the public from harms due to inappropriate, dangerous, or counterfeit products. However, such restrictions may themselves become a health hazard if they prevent consumers from efficiently accessing the medicines they need; an unintended consequence that is currently affecting community pharmacy in Zimbabwe.

Zimbabwe is a low-income country in Sub-Saharan Africa plagued by a protracted economic recession and a dilapidated health system. [1] Zimbabwe’s Central Bank has had to ration resources across several priority sectors of the economy, including healthcare. [2,3] This has severely undermined the sector’s ability to import medicines, leading to significant gaps in pharmacy stocks, which are hindering the provision of key services. For example, two of the largest referral hospitals in the country recently had to suspend elective surgeries due to lack of antibiotics, pethidine, injectable morphine, fentanyl, adrenaline, sodium bicarbonate, metoclopramide and endotracheal tubes of various sizes [4,5], while many rural clinics now lack even basic painkillers [6].

The problem is also widespread among community pharmacies dispensing prescribed and over-the-counter medicines, and stock availability can be patchy and unpredictable. As a result, patients often find themselves having to trudge from pharmacy to pharmacy until they eventually find one that can dispense the medicines they have been prescribed or, as anecdotes suggest, accept “the next best thing.” Not only is this frustrating for consumers, it also has potential to make pharmacists unintentionally complicit in patient harm. Current advertising restrictions are compounding this problem because pharmacies lucky enough to hold certain medicines are legally prevented from promoting this fact, thus making it difficult for patients to make informed decisions. [7,8]

One of the challenges for health policymakers is the need to adapt strategies, regulations and laws to take account of local circumstances. In well served health systems with universal health coverage, such as the UK, preventing the advertising of medicines produces a net gain for consumers, since it avoids the predatory marketing of unnecessary, unsuitable, or unsafe drugs and helps to ensure that medicines are prescribed and dispensed by bona fide health professionals.

The situation in Zimbabwe today contrasts markedly with this ideal, however, and innovative approaches are needed to equitably and safely straddle the fine line between promoting services and protecting the public. These include regulatory innovations, to legally and safely adapt restrictions on the advertising of medicines for the Zimbabwean context, as well as digital and social innovations, which will enable more transparent, equitable, and accessible pharmacy information for consumers. Efforts to address each of these are underway, and have potential to act in harmony with other ‘good governance’ approaches, such as the use of mobile drug authentication tools, which are widely deployed in Africa to combat counterfeiting. [9,10] For example, in one innovative workaround known to the first author, community pharmacists have been using the secure social medium WhatsApp to enquire among their peers about available medicines, enabling them to advise their customers on which pharmacies to visit while avoiding direct advertising.

We welcome a dialogue with researchers, regulators, policymakers, and practitioners in resource-poor countries facing similar challenges and dilemmas, with a view to sharing ideas on innovative solutions for enabling equitable and safe consumer access to medicines.

Research areas

  • Global Health, Pharmacy, Advertising, Consumer, eHealth, Unintended Consequences, MEDICINES MANAGEMENT

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