Annex: National experiences from PGEU members

Belgium: Community pharmacies support nuclear and radiological emergency preparedness through iodine tablet distribution

In Belgium, the nuclear and radiological emergency plan provides for the pre-distribution of iodine tablets through community pharmacies. Pharmacists proactively inform citizens and distribute iodine tablets during predefined campaign periods and outside these periods upon request.

Distribution focuses on vulnerable groups, including children aged 18 years and under, pregnant women and breastfeeding women, as well as institutions such as nurseries and schools. In addition, one box is provided per address as part of the preparedness strategy.

The pharmacist acts as the final link in the chain: pharmacies deliver the tablets, educate citizens on their proper use, collect old batches and ensure proper destruction through the designated collection system. This approach strengthens continuity and preparedness and is based on an agreement between the government and the pharmacy sector.

This model is considered a best practice because it is close to the population, rapidly scalable and supports public health protection in the event of radio-iodine incidents. Pharmacists receive a small fee for this service to the community.

Spain: Community pharmacies ensured continuity of pharmaceutical care during floods, power outages and the COVID-19 pandemic

Community pharmacists’ intervention during the Valencia floods in 2024: During the DANA disaster in Valencia, the pharmaceutical profession and the Valencia Pharmaceutical Association offered an immediate, effective and deeply humane response.

This serious natural disaster left thousands of people without basic services and affected around 200 pharmacies, 92 of which were inoperative for several days. However, there was no shortage of medicines at any time. Thanks to the dedication, professionalism and commitment of local pharmacists, many of whom were also victims, and the coordination of the Valencia Pharmaceutical Association (MICOF), together with NGOs such as Farmamundi, the Red Cross and Caritas, and the support of the Ministry of Health, the continuity of pharmaceutical care was guaranteed.

Donation campaigns and recovery funds were activated, more than 600 volunteer pharmacists were mobilized, campaign first aid kits and pharmaceutical care points were set up, pharmacies were reopened where possible, and home care was provided to the most vulnerable patients. This ensured the distribution of medicines and healthcare products during the emergency.

Pharmacy response during the power outage in April 2025: Although the power outage on 28 April affected the normal operation of many pharmacies across the country, making it difficult to dispense medicines, the vast majority remained open and served the public. This demonstrated once again their commitment to public health and continuity of treatment.

Thanks to the activation of contingency plans by the General Pharmaceutical Council of Spain and the Regional Pharmacists Chambers, electronic prescription systems remained operational and data loss was avoided. More than half a million dispenses were carried out between 12:30 p.m. and midnight. The following day, with supplies largely restored, more than 1.8 million dispenses were carried out. Awareness-raising activities were also conducted to inform the public about the importance of consulting a pharmacist if they had questions about medicines requiring cold storage.

Collaborative dispensing of medicines: Collaborative dispensing of medicines is a service implemented in several Spanish regions, including Andalusia, Aragon, Cantabria, Catalonia, Castile-La Mancha, Madrid, Navarre and Valencia, since the COVID-19 pandemic. It facilitates the dispensing of hospital medicines from community pharmacies.

This service allows patients, mostly chronic or immunocompromised patients, to collect their hospital medicines from their nearest community pharmacy. It is a healthcare coordination service between hospital pharmacists and community pharmacists, with the collaboration of the country’s main pharmaceutical distribution warehouses. The service proved extremely convenient for patients during the pandemic, when hospitals were under severe pressure, and its success is demonstrated by its continuation in several regions after the pandemic.

Germany: Community pharmacies supplied protective masks to high-risk groups during the COVID-19 pandemic

During the coronavirus pandemic, legislators in Germany tasked pharmacies with supplying protective masks to high-risk groups. Insured persons who belonged to a high-risk group with a significantly increased risk of severe or fatal disease progression after infection with the SARS-CoV-2 coronavirus were entitled to protective masks.

At the beginning of 2021, around 35 million people were entitled to obtain such masks at the expense of the state. Details on the specific terms of the entitlement, the type of protective masks, the number of protective masks covered by the entitlement, and the distribution and dispensing of the protective masks were regulated by the Federal Ministry of Health in the Coronavirus Protective Mask Ordinance.

Eligible citizens received vouchers from their health insurance companies, which they could present at a public pharmacy of their choice to receive a set of six protective masks for a co-payment of €2. In this way, pharmacies throughout Germany supplied patients with more than 250 million protective masks at the beginning of 2021.

France: Community pharmacies support treatment continuity during medicine shortages

Over the years, pharmacies in France have gained options to help patients whose treatment is in shortage, including during crisis situations. Following directions from national health authorities, pharmacists may compound medicines when the manufactured product is missing.

Pharmacists may also replace the missing prescribed medicine with another substance, another pharmaceutical form, another medicine based on the same active substance, or another dosage through therapeutic substitution. They may also dispense the exact prescribed quantity.

Community pharmacists also implement official decisions to restrict dispensing to patients already taking the medicine, or to dispense medicines officially imported on an exceptional basis while reassuring patients. In doing so, they take care of patients, inform them about the situation and available solutions, and support continuity of treatment in a fair way.

Netherlands: Regional contingency planning and crisis coordination support continuity of care

In the Netherlands, the presence of regional emergency representatives from both pharmacists and doctors supports structured preparedness and response at local and regional level. This model facilitates joint planning across pharmacies within a locality and wider region.

The model includes mutual support arrangements, agreed contact points and communication channels, as well as practical continuity measures when routine services are disrupted, such as alternative workflows if IT systems or power supplies fail.

A central element of this approach is that preparedness does not over-rely on the creation of large contingency stocks at pharmacy level. Because crises are difficult to predict and demand for specific medicines may shift rapidly, disproportionate stockholding can be costly and may unintentionally tighten general availability elsewhere in the supply chain.

Regional planning therefore prioritizes procedures to rapidly assess which medicines are needed, what is available, and through which logistical pathways supplies can be secured and delivered. For larger-scale crises, the approach assumes nationally anchored governance for allocation and triage decisions, supported by a clear escalation framework to ensure consistency across regions and reduce the risk of unequal access or hoarding.

Denmark: Pharmacies maintained medicine supply and public health support during the COVID-19 pandemic

During the COVID-19 pandemic, Danish pharmacies played a central role. Large parts of Danish society were shut down, but pharmacies remained open as usual and implemented special rules on physical distancing between customers in order to prevent the spread of infection. Some pharmacies also established drive-in or pick-up solutions for the public.

Pharmacies played an important role in ensuring access to personal protective equipment and hand sanitizer. They also continuously implemented the authorities’ instructions on restrictions on the dispensing of certain medicinal products. These measures were intended to prevent and mitigate supply shortages.

In addition, cooperation was established on the rapid implementation of a system for the automatic, daily reporting of stock levels for critical medicines. This arrangement has since been made permanent.

This experience demonstrated the capacity of pharmacies to support public health preparedness and maintain continuity of medicine supply during a crisis.

Portugal: Community pharmacies responded to public health emergencies and territorial crises

During the COVID-19 pandemic, community pharmacies in Portugal became a natural place for people to receive care close to home, at a time when the health system was under exceptional pressure. Pharmacies played a major role in the roll-out of rapid antigen testing, offering wide coverage together with professional advice and immediate guidance. They also took part in the vaccination campaign, helping to speed up vaccination and making it easier for people to be vaccinated in a familiar, safe healthcare setting.

At the same time, community pharmacies were involved in arrangements to dispense certain hospital medicines locally. This was not only about reducing hospital visits or preventing new infections; it allowed patients, many of them chronic or vulnerable, to continue their treatment with professional supervision, personal counselling and continuity of care, delivered nearby, safely and with greater comfort.

This experience showed the value of community pharmacies as providers of qualified, proximity-based care, while also pointing to the need to further develop clear frameworks, sustainable funding and preparedness arrangements so that these models can be activated more quickly and consistently in future crises.

Beyond the pandemic, community pharmacies in Portugal have shown strong capacity to respond to natural disasters and major disruptions affecting local communities. During severe wildfire events, the abem Emergency Fund was activated, allowing pharmacies to dispense essential medicines free of charge to families directly affected, ensuring that treatment was not interrupted at a moment of acute social and economic vulnerability.

More recently, during a nationwide power outage and the floods linked to storm Kristin in January 2025, pharmacies continued to support their communities under very difficult conditions. Night on-call services were maintained by pharmacies close to the affected areas, activities were temporarily relocated when premises were damaged or inaccessible, and patients continued to receive medicines and professional advice despite operational constraints.

These situations illustrate how community pharmacies combine resilience, solidarity and professional proximity in times of crisis, while also highlighting the importance of strengthening coordination, back-up solutions and recovery mechanisms to support this role in the future.