Intro

Federica Santoro 0:15

Last week was a special week in the world of pharmacovigilance. It was the one time a year when drug regulators all around the world joined forces in the name of medicine safety. This global campaign is known as Med Safety Week, and its aim is to encourage people to report side effects. As it's led by us at Uppsala Monitoring Center, we thought it would be fun to celebrate it with a special two-part podcast here on Drug Safety Matters. My name is Federica Santoro, and in this second episode, I'll take you on a tour of three continents. That's right, you'll be hearing from three Med Safety Week ambassadors in Iraq, Luxembourg, and Namibia how they made the most of the campaign last year to shine light on medicine safety. So buckle up and enjoy the journey! If

Pharmacists as ambassadors

Federica Santoro 1:23

you followed the Med Safety Week hashtag on social media last week, you will have noticed just how many actors took part in the campaign. The official count was 97 organizations, 85 countries and 52 languages. But that doesn't even include smaller local actors or people like you who joined the conversation online during the week. But it hasn't always been like this. When Med Safety Week began eight years ago, before it was even called Med Safety Week, it only involved European regulators, and most of the campaign happened on social media. But these days, MedSafety Week is so much more than that. Not only does it involve regulators on virtually all continents, but the real buzz happens in real life. Over the years, more and more of the participating organizations have been reaching out to patients and healthcare professionals in person with extraordinary results. Now, bringing a campaign to life like that requires a lot of work. But regulators know they don't have to do it all on their own. A clever strategy is to find local partners who can help spread the message. And for Anne-Cecile Villemann, pharmacovigilance responsible person at the Ministry of Health in Luxembourg, the choice was obvious. Their new ambassadors would be the pharmacists.

SPEAKER_00 3:00

I would say that our greatest source of pride last year was the massive participation of Luxembourg's pharmacists in the campaign. It was our second time only taking part to the campaign, so that time we tried to do more than simply publish the campaign visuals and messages on social network. This goes with a will for our pharmacovigilance department to strengthen our presence on the ground as much as possible and to rely on the players of the health sector. Luxembourg is a very small country, so we have very small teams. And to increase our impact in terms of communication, it is essential for us that we look for ways to amplify our actions. So I'm part of the division of pharmacy and medicines within the Ministry of Health, and as such, we have a very close and privileged contact with the pharmacists. So we decided to reach out to them and ask them to be the ambassadors for the campaign. We did not know how many pharmacies would be interested in taking part, and that's why, yes, I'm very proud because to our great surprise, every pharmacy in the country turned up. So first we sent them a letter to the associations that represent the pharmacies to explain the campaign and the role they could play as guarantees of the proper use of medicines. We invited them to a video conference and we presented the tools to them, those that were going to be made available to them, and also said that they had the chance to ask questions before the campaign. And concerning the tools, we provided them with posters they could hang in the pharmacy, the videos for those who had screens in their pharmacies. We also produced what we called a reflex card that they could use as a discussion tool with the patients on the key messages of pharmacovigilance. On the card, there was also QR codes to the platform for ADR reporting in Luxembourg. And finally, we provided them with badges to wear during the campaign that were flagged ambassadors for the safety of medicines. So it provides a message that the pharmacist is a key

Regional pharmacovigilance centres

SPEAKER_00 5:29

actor.

Federica Santoro 5:29

But different settings, as we know, require different solutions. For Ban al-Shimran, pharmacist at the National Pharmacovigilance Center at the Iraqi Ministry of Health, running a successful communications campaign means tapping into an established network. The 17 regional pharmacovigilance centers that are spread across the country.

SPEAKER_01 5:59

The activities of the Mid Safety Week are included as one of their annual evaluation score domains. Once the material is received from the UMC, a national strategy is put together, the material is prepared, and official communications are completed. This is followed by a meeting with all the regional centers nationwide, showing them the national strategy, but they will in return apply different activities from the plan according to their regional settings. These activities are mainly conducted in the health institutions, but can include cooperations with the local media agencies or local universities. They can also hold training and awareness activities. This goes hand in hand with the social media posting and sharing. So this whole arrangement is what makes the campaign works for

Public relations partners

SPEAKER_01 7:00

us.

Federica Santoro 7:00

Sometimes the most valuable collaborations are the ones you set up within your own organization. For Frida Shiwetha, Medicines Information and Safety Pharmacist at the Therapeutic Information and Pharmacovigilance Center in Namibia, collaborating with communications experts is key. By liaising with the Public Relations Office at the Ministry of Health and Services, where the center is based, Frida gave Med Safety Week a level of visibility in Namibia like never before.

SPEAKER_02 7:32

We had a lot of assistance as well as support from the Public Relations Office of the Ministry, whereby they communicated and opened the doors for us with the relevant people to speak to through the national broadcaster, and we were able to get an interview on the National Broadcasting Corporation TV as well as their national radio station to create awareness about the Med Safety Week campaign and also why reporting is important. The Public Relations Office was also kind enough to allow us to make use of the ministry's LinkedIn page as well as the ministry's Facebook pages so that we could post the content and the material that we received for the campaign, which was really nice. And another activity that also stood out was we held a panel discussion by four various healthcare professionals, specifically a representative from our office, the TIPC, as well as a pharmacist who is involved at primary healthcare level. We also were joined by a medical doctor as well as a registered nurse, and we really just wanted to present to the Namiban people what we talk about, break down the technical lingo that we use so that they're able to understand what we do and why it's important for them to be involved in the campaign.

Simple but effective materials

Federica Santoro 9:01

The main materials in the campaign are three short animated videos featuring colorful cartoon characters who experience side effects after taking medicines. The messages on the videos are deliberately short and simple, so they will be understood by a wide audience across countries and cultures. According to Frida in Namibia, that simplicity is exactly what makes the campaign so effective.

SPEAKER_02 9:30

I believe that we got very good reactions. And I think also what makes the campaign material stand out is that it has wording that they can understand. It's in English, it's simple, it's also colorful, so it attracts attention, and the animations also make it easy for them to be able to see exactly what's going on. There's a patient popping a poll, then all of a sudden they're reacting. They see a healthcare professional who has like a yellow paper which represents a yellow safety form or adverse reaction form. So it's really that which I saw in the positive light.

Dealing with trolls

Federica Santoro 10:07

Overall, audiences have responded positively to Med Safety Week over the years. But occasionally, regulators have had to deal with negative, even aggressive responses on social media, as Ban from Iraq explains.

SPEAKER_01 10:23

All different types of responses, both positive and negative, were noted. Regarding the on-site activities, the feedback was mostly positive. The healthcare professionals were engaged, the patients were interested. But uh on social media, this is more mixed. This is maybe partially related to the fact that we used the official Ministry of Health channels, and some of the audience were already preoccupied with other national health matters and used our posts to express opinions irrelevant to the subject

Measuring impact

SPEAKER_01 11:01

matter.

Federica Santoro 11:01

Social media trolls aside, regulators agree that Med Safety Week is a valuable initiative to strengthen pharmacovigilance in their countries. And even though it can be tricky to quantify the impact of a campaign like this, there are ways to measure the positive effect of specific activities. Like Aunt Cecile and her colleagues in Luxembourg noticed when working with pharmacists.

SPEAKER_00 11:27

The pharmacists welcomed the campaign immediately and were happy to participate because they had a visible role, and that's what they told us also after the campaign. They were happy to be visible as healthcare professionals. After the campaign, we also proactively sought feedback from them, and many of them said that they would like to take part in the next campaign, if any. They also voluntarily sent us pictures of themselves with the badges in the pharmacy in front of the posters. They also sent us written feedback and statements, and this was very nice as we were able to use this to communicate further after the campaign and also to illustrate publications, articles with it in local newspapers. So I would say regarding the participants that everyone was happy and kind of proud of having participated. Then regarding the impact on patients, it was our second participation, so it's difficult to measure for now. However, what we can note is that the pharmacists are more and more willing to report cases of pharmacovigilance. They are also more likely just to contact us directly if they have questions about the safety of medicines. And what we have noted in particular is that they also contact us now to report cases of suspected misuse or abuse. So this is of great value. So we we can see already an impact.

Gaining internal support

Federica Santoro 13:00

But of course, as with any complex project that requires buy-in from multiple parties, challenges remain. One problem that all three organizations cite is the lack of resources, not only as a dedicated budget, but as time to devote in-house to, as Anne Cecile from Luxembourg describes.

SPEAKER_00 13:23

To me, the biggest challenge starting with this campaign was to convince in-house to put resources to prepare the campaign. UMC already provides a lot of material, but you still need a bit of local input to put this campaign to life and to adapt it to your country because there is a need for coordination first, and that takes a lot of time, then for the communication. Not only the communication to the external stakeholders, but also internally, so that everyone within the Ministry of Health is involved. This was a new campaign, and until recently, besides pharmacovigilance trainings to the staff or to healthcare professional, there had not been many external communication actions for pharmacovigilance. So it was a bit of a change of paradigm, and we had to be convincing on the need for such a campaign. I think that it will be easier now that last year's campaign was a success and was visible. So we will capitalize on that and continue on that path.

Finding external sponsors

Federica Santoro 14:32

In Namibia, the lack of internal resources meant that Frida and her colleagues had to look for external sponsors, people who were willing to support Med Safety Week and finance some of the activities.

SPEAKER_02 14:51

It can't only start with a campaign. It needs to be a language that we speak every day and something that is constantly in the ears and the eyes of the people. So making use of the previous campaign material, also sharing that with our possible sponsors who would like to get on board. We can always ask them to share that material on billboards. We can also ask them to assist us with printing of the material so that we can disseminate it to the healthcare facilities where they do not always have access to digital items where they can actually see all these animations or the campaign material. So sometimes the lack of the funding really makes it a little bit difficult. And also, we only have so much coverage to be able to advertise on social media. But if you really want high impact in getting the national broadcaster on board is key, and also other media outlets.

Engaging doctors

Federica Santoro 15:51

The lack of internal support is something that Bahn can relate to as well. But that wasn't the only problem the Iraqi Pharmacovigilance Center had to face.

SPEAKER_01 16:01

There are numerous challenges actually. One of them is not having an official social media channels, as I mentioned before, dedicated to the pharmacovigilance center. This is not permitted in our settings. Although using the official ministry channel provided broad audience, but as we mentioned, it also brought many trolls and irrelevant comments and potentially distorting the message. One last uh challenge we had is engaging different types of healthcare professionals, particularly the physicians. This is mainly attributed to the misconception that the pharmacovigilance activities are related to pharmacists only, which is a persistent challenge that we are still addressing actually.

Picking the right language

Federica Santoro 16:49

And then there are communication challenges. For Namibia, one of the most difficult things about the campaign was finding the right way to talk to the media. Terms like pharmacovigilance, signal detection, even adverse drug reactions sounded like a foreign language to them, and had to be broken down into simpler terms. And speaking of languages, which one do you pick in a country like Namibia that has more than 13 national languages? Here's Frida again.

SPEAKER_02 17:23

We solely ran the campaign in English. So we really tried to optimize it only in English. But knowing that our country has a diverse number of languages, maybe some people are not interested because it's in English. Whereas if it's in their vernacular, then they're able to better understand and can relate and probably even much better report. So I think that's also another aspect that we're going to work on proactively this year. Fortunately, we've also started with some of the planning around that. If we're not able to cover all the languages, perhaps we can cover some. But each year there's always like a stepping stone in an area of improvement.

Federica Santoro 18:06

Over in Luxembourg, a country 300 times smaller than Namibia, the challenges of communicating in a multicultural and multilingual society are very much the same. Here's Aunt Cecile again.

SPEAKER_00 18:20

In Luxembourg, we have almost 50% of the population that are foreigners. So we have to take this into consideration. I think this is very specific to our country. And so for the material and the messages of the campaign, it's important that we can provide it in many languages. Not only the official languages, Luxembourgish, French, and German, it's already free, but also if we can, if we have the time, and UMC gives us this possibility to have materials in different languages. So for Luxembourg, for instance, adding English, Portuguese, Italian has a real impact on the communication.

Adapting to different cultures

Federica Santoro 18:58

While in Iraq, another country where multiple cultures live side by side, the solution lies in the collaboration with regional centers, as Bahn explains.

SPEAKER_01 19:09

Iraq itself is a very diverse country and multicultural and has different settings in different regions. So this is one of the main reasons that uh the way we strategize our plan is uh not to implement a one-size-fit-all uh plan. So we just put a strategy that outlines the main topics of the campaign. And then uh the regional centers, when adapting this plan, they can modify it according to their uh available uh resources, according to their settings, according to the uh the general population level of health literacy. They can choose their target audience. Some of them had uh they had access to uh large billboards on the street, they put uh the videos there for free, actually. Some of them were not able to do so. So uh giving them the liberty to adapt their plan according to their own settings is very important.

Reaching remote communities

Federica Santoro 20:09

Other times, the challenges are simply logistical. In Namibia, the second least densely populated country in the world, reaching remote communities requires careful planning. But as Frida points out, it's well worth the effort.

SPEAKER_02 20:28

The fact that Namibia geographically we have a large landscape. I won't be able to tell you specifically how big now, but we are also only a population of just under 3 million people that are scattered across a big country. So going out there and driving to these various healthcare facilities to actually interact and engage with the communities, with the community health workers, with the health professionals is really sometimes a challenge because even if we try to do something virtually, the impact is really on a face-to-face basis where you see and where you can really not only give out information but also with communication, you need to receive the feedback so that you know what you're doing right, what you're not doing right, why people are not hearing about the campaign. Because you work so hard to prepare for the campaign and to spread the word of reporting and adverse drug reactions, but getting back that feedback allows us to improve. Yeah, but the power lies in digitization, and that's what we're aiming for. And yeah, we can only improve on that.

Complementary perspectives

Federica Santoro 21:36

The theme of this year's Med Safety Week campaign was who can report? Patients, pharmacists, doctors, nurses. They all have a key role to play in the cycle of medicine safety. And when it comes to reporting side effects, it's crucial that they all do it. Why? Because each of those groups can give us Information that the others can't. Like the pieces of a puzzle that come together to form one image, bringing those different perspectives together helps build a complete picture of medicine safety. Here's Ban in Iraq again.

SPEAKER_01 22:17

Our database is comprised majorly of uh pharmacist uh reports. The thing about uh them uh most of the time they lack uh specific diagnosis. Most of the time they contain signs, symptoms, lab data, or what the patient is uh complaining from. But uh specific diagnosis is particularly lacking. That's when we need the physician to take part and uh give differential diagnosis and assess the case clinically. So their point of view is very important. Also, we have uh noticed during our uh COVID-19 uh reporting campaign, the patient uh reports contained a more detailed explanation of symptoms, and uh the chronology is very specific. The concomitant medications are uh thoroughly explained, so the patient's reports are also very uh informative in that matter. So all these different uh perspectives can generate uh higher quality data when combined together.

Motivating healthcare professionals

Federica Santoro 23:28

Of course, getting busy healthcare professionals to report side effects is no easy task, and much has been said in the pharmacovigilance literature about the roadblocks and possible solutions. For all three country representatives, giving the healthcare professionals feedback is crucial. That could mean sending thank you letters or writing periodic updates on reporting statistics, or explaining how the reports were processed and what action followed. It may seem simple, but it does help keep healthcare professionals engaged in the pharmacovigilance process, and including them in communications campaigns like Med Safety Week reminds them of their importance in that process. Here's Anne Cecile from Luxembourg again.

SPEAKER_00 24:17

I am convinced that it's also important to involve healthcare professionals more closely in the system, exactly like this, by making them participate in the communication and any awareness raising initiatives. I think really Med Safety Week is a very good example to start with to show them how the system works and that they are really very important stakeholders in this system. It's actually a very recent thing to do in Luxembourg, but I'm I'm really sure it pays off, and we have already seen an impact after these two years.

Plan early

Federica Santoro 24:56

Each year, Med Safety Week gets bigger and bigger, with new organizations embracing its call and committing to its mission. Ban, Friday and Ancécile have been in the game for a while. But if it's your first Med Safety Week, where should you start? Well, luckily, here's some advice from our veterans. First up, Ban and Iraq, for whom the keyword is early.

SPEAKER_01 25:23

First and most importantly is to do everything early, prepare early, plan early, communicate and coordinate early. Also, when doing the planning process uh of the campaign, you can go through the hashtag of the MetSafety Week through different uh social media platforms, see what can work for you and your settings. Also, you can get inspired to do more. Also, you don't have to do a big campaign from the first time. You can uh start with a smaller one and see how it can work and broaden that uh over time. Also, don't be discouraged from designing patient-directed activities, no matter what the general level of health literacy. And at last, consider preparing a standardized feedback form to be collected from all the parties involved in the campaign so that it can make it easier for you to measure the impact of the campaign when it ends.

Start simple

Federica Santoro 26:26

For Anne-Cecile in Luxembourg, starting with simple activities is the best way to test the waters if you're new to the campaign. So think small scale first, build up over time, and don't forget your internal allies.

SPEAKER_00 26:43

Start simple. Not to be too ambitious for the first time. For our first participation to the campaign two years ago, we started with the basics. By that I mean that we we limited our communication actions to the use of the very nice material provided by UMC, so the visuals and the videos, and that is already a lot because there are the translations, there is yes, the coordination of the program, and also to get people to be involved internally. So I would stick to that for the first time, to get familiar with the campaign and the material. Another advice I would give it's important to identify the best targets for your country. They can be different from one country to another. So on the one hand, you have targets that need to be more aware or that do not really know about the pharmacovigilance system. And on the contrary, it's important, I think, to identify the targets that already contribute to the system and that are likely to promote the campaign, as we did here for the pharmacists. So the quick wins, as we say. And then in addition, what we did the first time to amplify the message is uh the internal communication within the Ministry of Health about the upcoming campaign, the dates of the specific week to put into each agenda, and the key messages. In our internal communication before the campaign, we emphasized on the fact that as employees within the Ministry of Health, not only the pharmacovigilance department, but each and every one of us had a duty to pass on the messages about pharmacovigilance and that everyone within the ministry could contribute to spreading these messages on social media. It takes a few minutes or even seconds to do. So I would also start with that for the first time.

Focus on what you have

Federica Santoro 28:47

For Frida in Namibia, much of what her colleagues said resonates loud and clear. Planning a campaign like Med Safety Week requires a lot of team effort, and she knows that can feel daunting for small or understaffed organizations. So here are some final words of wisdom from her.

SPEAKER_02 29:06

My advice is not to focus on what you do not have, but you need to focus on what you do have to start for the campaign. So you need to understand already what you want to communicate and what kind of responses you want to get back. So we know the aim is to have more reports coming in, right? But you really want to tell people why it's important. So maybe it's also not advisable to start off on a wide scale. Maybe just have one or two main initiatives that you can focus on and make a success of it. You can organize, let's say, a webinar and you can have it accredited so that the healthcare professionals attending, especially if that's your target audience, can also receive some continuing professional development points because we know that that's normally a plus. So one can start there, and then you can also start just with the campaign materials and disseminating that as far and wide as possible. Make use of the public relations office within your institution. Um, so it's just to start, just start. It's not difficult, but once you start, you'll realize the areas of improvement that you need to focus on and how you can build on your strengths. And last but not least, engage and involve the people who seem least likely to want to have anything to do with the Med Safety Week campaign because you are not only approaching them in the capacity of them being able to provide some kind of sponsorship or a radio station that can air the campaign for you, but you're targeting them also as the general public, right? You're speaking to them, and the message that you communicate to them, they will be able to cascade it down to their colleagues, to their family members, to their friends, etc. So, starting with the small circle, there is a lot of power in that, and just knock on whatever door and then keep going. It's a wonderful campaign to run.

Outro

Federica Santoro 31:25

That's all for now, but we'll be back soon with more conversations on medicine safety. If you missed the first part of this podcast, where I spoke to Mittel Jadeja from the UK's MHRA about underreporting and the origins of Med Safety Week, do go back and listen to it. Med Safety Week 2023 ended last week. If you missed that, look up the MedSafety Week hashtag on social media to get a flavor of the many conversations and activities that took place. If you'd like to know more about the campaign in general, check out the episode show notes for useful links. And if you like our podcast, do subscribe to it in your favorite player so you won't miss an episode. And spread the word on social media so other listeners can find us. Apart from these in-depth conversations with experts, we host a series called Uppsala Reports Long Reads, a selection of audio stories from UMC's Pharmacovigilance magazine. So do check that out too. Uppsala Monitoring Center is on Facebook, LinkedIn, and Twitter. And we'd love to hear from you. Send us comments or suggestions for the show, or send in questions for our guests next time we open up for that. For Drug Safety Matters, I'm Federica Santoro. I'd like to thank Frida Shiweda, Banal Shimran and Anne-Cecile Vilman for their time, Matthew Barwick for post production support, and of course you for tuning in. Till next time.