Infectious Disease Outbreaks and Pandemic Preparedness

Infectious Disease Outbreaks and Pandemic Preparedness: A Pharmacist’s Perspective from Pakistan

By Naeem Mustafa, Pharmacist PharmaservePK | December 10, 2025

Infectious Disease Outbreaks and Pandemic Preparedness: 

As a community and hospital pharmacist in Pakistan, I have lived through the chaos of the COVID-19 pandemic firsthand: patients begging for remdesivir and tocilizumab on the black market, oxygen cylinders disappearing overnight, and parents terrified that routine childhood vaccines had run out. We pharmacists became the most accessible (and often the only) healthcare professionals for millions of frightened citizens.

Five years after the first case was reported in Pakistan, new threats — H5N1 bird flu with human cases, mpox clade Ib, Oropouche fever — are already knocking at the door. The next outbreak is not a question of “if” but “when.”  

This article is written from the counter and the ward — practical lessons and actionable recommendations that pharmacists, regulators, manufacturers, and the government must implement today, while we still have time.

1. Pharmacists: The First and Last Line of Defense

During COVID-19, pharmacies remained open while many clinics closed. We counselled, triaged, dispensed, and calmed panicked families 16–18 hours a day.

Yet we were never formally part of the national response.

What must change:

Include registered pharmacists in the National and Provincial Emergency Operations Centres as permanent members.

Train at least 50,000 pharmacists (community + hospital) in infectious-disease triage and outbreak pharmacovigilance through the Pharmacy Councils and HEC-recognized continuing education programs.

Give legal protection and indemnity coverage to pharmacists who follow approved emergency dispensing protocols.

2. Medicine Availability: We Cannot Repeat 2020–2022 Shortages

Paracetamol, azithromycin, ivermectin, vitamins — everything vanished because of panic buying and export bans by India and China (our main API suppliers).

Pharmacist-led solutions:

DRAP must create an Essential Medicines Buffer Stock managed jointly with Pakistan Pharmacists Association and PPMA — minimum 4–6 months for 100 critical molecules.

Allow emergency parallel importation with 72-hour fast-track licensing during declared public health emergencies.

Incentivize local manufacturers (Getz, Hilton, Sami, AGP, Ferozsons) with 5–10 year tax holidays if they set up API or mRNA/lipid nanoparticle plants now.

3. Vaccine Confidence Starts at the Pharmacy Counter

In 2021–2023, many hesitant patients asked me — not doctors — whether the COVID vaccine causes infertility or contains microchips. We pharmacists can be the most trusted voice if we are equipped.

Immediate actions:

Integrate pharmacists into the Expanded Programme on Immunization (EPI) — authorize us to administer vaccines (as already done in 70+ countries).

Launch a nationwide “Ask Your Pharmacist” campaign in collaboration with PSK, PPA, and DRAP.

Provide every registered pharmacy with verified WHO/DRAP fact sheets in Urdu, Pashto, Sindhi, and Punjabi.

4. Antimicrobial Resistance (AMR): The Silent Pandemic We Ignored

While fighting COVID, we over-prescribed azithromycin and meropenem. Pakistan already has one of the highest rates of carbapenem resistance in the world.

The next outbreak (bacterial superbug, fungal, or viral+bacterial co-infection) could be far deadlier if antibiotics stop working.

Pharmacists’ role:

Enforce the DRAP antibiotic sale regulations strictly — no sale without prescription, with real-time digital logging.

Run community-level Antibiotic Smart Use programs in collaboration with infectious-disease physicians.

Stock and promote WHO AWaRe “Access” group antibiotics over “Reserve” group wherever possible.

5. Oxygen and Critical Care Medicines: 

A National Emergency Stockpile

In 2021, patients died outside hospitals because liquid oxygen plants were only in four cities. Pharmacies were asked to “arrange” high-flow nasal oxygen — an impossible request.

What we need today:

Install medical-grade PSA oxygen plants in all 150+ district headquarters hospitals and major trust hospitals (current: <30 functional).

Maintain a 60-day national reserve of oxygen concentrators, BiPAP machines, and critical-care drugs (midazolam, propofol, atracurium, favipiravir, etc.).

Pre-position these items in provincial drug warehouses under pharmacist supervision.

6. Digital Pharmacy and Real-Time Monitoring

During the pandemic, we had no idea which medicine was short in which city until patients started fighting at counters.

Time to implement:

Mandatory integration of all wholesale and retail pharmacies with DRAP’s online Drug Sale License & Monitoring System by 2026.

Create a public dashboard showing real-time stock levels of 100 essential and emergency medicines — just like India’s CoWIN for vaccines.

Final Word from a Pharmacist

We do not need another commission or policy document that gathers dust. We need action today — when hospitals are quiet and supply chains are flowing.

As pharmacists, we are ready to do our part: counsel, dispense, vaccinate, monitor, and protect. But we need the government, regulators, and industry to trust us, train us, and resource us.

The next pandemic will not send a warning SMS. Let us prepare while we still can.

Naeem Mustafa  

Registered Pharmacist (Pharm-D, RPh)  

Founder – PharmaservePK  

Serving Health, Serving Pakistan