A child first learns to avoid a candle light or hot lantern because it burnt him/her. Subsequently the child will literaly run away from any bright object, especially one that emits heat. The brain has a very strong Adrenergic system which registers sources of danger and will activate fear and apprehension as soon as such a signal is identified. The same effect is imparted by an Adverse drug reaction. The same goes for the Covid-19 vaccine.

As people all over the world start receiving shots of the vaccine they are beginning to realize that there are adverse reactions related to administering the vaccine. It is not the reactions that may be the problem, it's that they were not fore-warned, they did not know, they were not informed. Consequently they go and tell their family and friends. There have been reports of fainting, itching, redness at the area if inoculation, and even death. I once fainted when I was about 14 years old after my nurse administered a shot of the highly potent antipyretic Nolvagin (metamizol) to bring down my malaria fever. This was because the drug is a chemoreceptor trigger and caused me to vomit and suddenly lose energy.

Adverse drug reactions (ADR) are described as untoward, undesirable or unwanted effects observed by a patient during or after a medication has been administered or taken. They cause discomfort of various degrees and may cause injuries that are reversible or permanent. Many ADRs are life threatening and require emergency care in the ICU of a Hospital facility. ADRs are particularly popular amongst healthcare experts because they represent a major source of discomfort to the patients and the major reason the patient will stop taking the medication or be reluctant to take the medication in the first place. Thus ADRs affect patient compliance, adherence and persistence tremendously. 

Compliance is the ability of the patient to follow instructions on how to take the medication and other lifestyle modifications to support the medication therapy. Adherence is the patients willingness co-operate and collaborate with the healthcare provider on the guideline and play an integral role in his/her medication therapy. Though compliance and adherence are used interchangeably compliance is more instruction based which adherence is more of a collaboration. Persistence is the patient's ability to continue with medication therapy for the entire duration of treatment. For the purpose of discussing Covid-19 related ADRs I have simplified these definitions and narrowed their use. 

The interesting thing about ADRs is that they are not entirely the fault of the drug alone. The fault actually goes around or extends as follows;

·         It's the Drugs fault - if the drug was not compatible with the patients physiology or genetics.

·         It's the patients fault - If he or she failed to communicate any underlying condition, any other medication being taken, any other fruit or supplement being taken, any unusual food being taken. (Underlying conditions refer to illness/disease or disability - hypertension, Diabetes, kidney disease, Imunocompromised, genetic disease, etc )

·         It's the patients fault- if he or she fails to take the medication as advised (non compliance) is argumentative and uncooperative on how to take the medication (non adherence) or is  lazy about taking the medication for the length of time desired (lacks persistence).

·         It's the Healthcare providers fault - if he or she fails to advise properly on the proper mode of administration resulting in over dosage or under dosage (prescription error).

·         It's the Healthcare providers fault - if he or she fails to advise properly on what to avoid while using the medication.

·         It's the Healthcare providers fault - if he or she fails to put into consideration any underlying medical condition(s) (co-morbidities) the patient might have.

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Just last month a video was shared in one of my professional groups on Wattsap where a nurse who was the first to receive the Pfizer/Biontech Covid-19 Vaccine fainted on live TV shortly after receiving the vaccine. Later, news circulated that she claimed to suffer from a fainting condition, which was not listed in her medical history. Another recent story which is currently circulating is of a lady who lost the love of her life due to an ADR after taking the Covid-19 Vaccine. 

According to her very touching story "her husband Gregory Michael MD an Obstetrician with Mount Sinai Medical Centre (MSMC) in Miami Beach died due to a strong reaction to the COVID vaccine. He was a very healthy 56 year old, loved by everyone in the community delivered hundreds of healthy babies and worked tirelessly through the pandemic." Gregory was said to have been vaccinated at MSMC on December 18, 3 days later he observed a strong set of petechiae on his feet and hands which made him seek attention at the emergency room at MSMC. The Full Blood Count (FBC) done on arrival showed his platelet count to be 0 (A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.) he was admitted in the ICU with a diagnosis of acute Immune Thrombocytopenia caused by a reaction to the COVID vaccine. A team of expert doctors tried for 2 weeks to raise his platelet count to no avail. 2 days before a last resort surgery,  he had a hemorrhagic stroke caused by the lack of platelets that took his life in a matter of minutes. Gregory was said to be a pro vaccine advocate that is why he took the vaccine himself.''

Clinical Pharmacists role in advising and informing about potential Adverse Drug Reactions seem to have been underplayed here. Are the Pharmacists not being involved in Vaccine administration?

As the Federal government of Nigeria begins to roll out Vaccine supplies nationwide patient medication education on potential adverse drug reactions should be put at the forefront. And Pharmacists should be actively engaged to provide that information. There is not better placed professional on the planet trained to provide services in this role than a Pharmacist. While other professionals wait to hear of the adverse reactions experienced by other patients in other climes before understanding cause and effect relationships, Clinical Pharmacists are already trained in a unique position to foresee, predict, inform the patient and educate other professionals on what to expect and what actions to take should an Adverse Reaction Occur. 

The Covid-19 Vaccine program stands a risk of losing momentum due to negative publicity caused by ADRs. The Covid-19 Vaccine program in Nigeria cannot afford to wait for rumours or stories from the west about ADRs. A more proactive approach is needed otherwise vaccine uptake by the populace will be truncated as people begin to lose confidence in the vaccine due to bad press and negative publicity.  Pharmacists Drug Information Services are a structure already in place to carry out this sensitive role. Facilities lacking proper drug information units manned by a Pharmacist should be adequately equipped and staffed to share such information with the necessary authorities and carry out intervention where necessary. The NAFDAC yellow form for reporting ADRs are in the custody of the Pharmacists who are uniquely qualified to investigate and fill such forms to make reports to NAFDAC. 

Pharmacists counseling prior to vaccine administration is a way of giving the client a "heads up" on potential reactions that may be observed while receiving the Vaccine or after receiving the vaccine. Medication counseling is a form of full disclosure of the risks (major and minor) if any, inherent in taking the Vaccine and is a legal obligation of every healthcare expert.  

These points are meant to generate discussions and thought amongst the Healthcare provider community. Your comments will be treated with love.