Before social media

The discovery that thalidomide had teratogenic effects some sixty years ago was a turning point in the history of medication safety. The catastrophe maimed at least 20,000,  and killed 80,000 babies globally (Evans 2014). However, despite its apparent global impact in the late 50s, the story may have only resonated with an expert audience or at least only the 46 countries directly affected. The view that the effects of thalidomide were not experienced in Africa has been challenged by some authors (Klausen & Parle 2015).

Information communication technology was still undeveloped, and personalised computing and the internet were not readily available in the late 50s; print and radio were still the mainstream media for communication and information dissemination. Information therefore often did not travel far and ordinary consumers in low- and middle-income countries were the least informed about the repercussions of disasters such as thalidomide. Notwithstanding, the thalidomide disaster led to the creation of effective drug monitoring regulatory systems across the African continent and the world at large.

 

Social media today

In the last two decades, the information communication technology landscape has transformed to become more efficient, with the internet as the main driving force. Internet usage is still increasing at a fast pace with an estimated 4.1 billion users as at December 2018 (Statista 2019) . Also, the proliferation of affordable mobile phones has kept businesses and services connected more than ever (Friedrich et al. 2010). Patient information seeking behaviour has also changed, with surveys in the USA suggesting 59% of the adult population seek health information online. (Lengsavath et al. 2017).

In fact, social media has now become the conduit through which information is accessed and disseminated without geographical boundaries on the internet. Global usage is estimated to be more than 3 billion, with Facebook® (77%) and YouTube® (13%) being the most commonly used platforms (Chaffey 2017). Although problematic because of the quality of evidence, research has shown the potential benefit of reporting adverse drug reaction/events (ADR/E) online through social media monitoring (Lengsavath et al. 2017).

Africa has one of the fastest internet penetration rates in the world (35.2%), with social media users growing to about 200 million worldwide. In 2018, internet users had increased 20% compared to 2017 to 453,329,534 (GlobalWebIndex). This trend definitely signals new ways of collecting medication safety data and communicating risks.

 

Pharmacovigilance system strengthening

Despite the potential for the continent, pharmacovigilance in Africa is still relatively under-established compared to other parts of the developed world. Thus, after the World Health Organization (WHO) Programme for International Drug Monitoring (PIDM) was established in 1968, it took 24 years for the first two African countries to join. Currently with 34 full members and 7 associate member, pharmacovigilance systems and regulations are still basic in this region. A review of individual case safety reports (ICSR) data showed that only 0.88% of global reports were generated by African countries (Ampadu et al. 2016)

The situation is improving though. The African Union adopted the New Partnership for Africa's Development (NEPAD) in 2001 to ensure economic development and integration between African countries. Subsequently, eleven Regional Centres of Regulatory Excellence (RCORE), including a specific focus on pharmacovigilance, were established under the African Medicines Regulatory Harmonisation Programme (AMRH). Ability of these selected countries to maintain a vibrant online media presence online may influence consumer interaction about medication safety, thereby increasing awareness.

 

Online engagement with African medicine regulatory authorities

A review of online social media presence on African medicine regulatory authority websites are presented in table 1. South Africa had the largest internet and social media users, but the review suggests there was no active engagement with consumers on social media through their regulatory agency website. Similar to the global position as mentioned above, in Africa Facebook®, YouTube®, and WhatsApp® are the most preferred social media handles. However, searches for these links on regulatory authority websites showed that only a few were engaging in them: Uganda was the only regulatory website with a WhatsApp® link. In addition, only Tanzania and Nigeria had links to YouTube® on their websites, albeit no recent content and broken links respectively; only two contents were found for Tanzania and these were more than 8 months old.

 

COUNTRY/ REGULATORY AUTHORITY

INTERNET USERS

SOCIAL MEDIA USERS (Facebook)

SOCIAL MEDIA/ELECTRONIC ENGAGEMENT ON REGULATORY AUTHORITY WEBSITES

Tanzania/ FDA

23,000,000

6,100,000

Facebook*, Twitter, Instagram*, YouTube* and electronic ADR reporting

Kenya/PPB

43,329,434

7,000,000

Electronic ADR reporting

Ghana/FDA

10,110,000

4,900,000

Electronic ADR reporting

Burkina Faso/DGPML

3,704,265

840,000

Twitter*, Facebook*

Uganda/NDA

19,000,000

2,600,000

Facebook*, WhatsApp, LinkedIn, Twitter, electronic ADR reporting

Zimbabwe/MCAZ

6,796,314

880,000

Twitter, Facebook, Electronic ADR reporting

Nigeria/NAFDAC

98,391,456

17,000,000

LinkedIn, Facebook*, YouTube*, twitter, electronic ADR reporting

South African

SAHPRA

30,815,634

30,815,634

NIL

*the link from the website was broken, not active or no media content posted in the last four months. (Date of review March 2019)

Table.1 Comparison of online engagement of selected African national medicine regulatory authorities using their social media presence.

 

The way forward

There is need to harness the potential of social media in pharmacovigilance in Africa. The growing internet penetration rate and social media use on the continent could be a conduit to disseminate and collect medication safety issues. Low levels of engagement by regulatory authorities and stakeholders on social media through their websites, however, stifles the opportunity to communicate directly with consumers. The novelty of social media as tool for collecting ADRs therefore requires further research, but its potential to promote medication safety cannot be underestimated. Tailored content on pharmacovigilance could increase consumer awareness and the need to report medicine related harms.

 

References

Ampadu, H.H. et al., 2016. Adverse Drug Reaction Reporting in Africa and a Comparison of Individual Case Safety Report Characteristics Between Africa and the Rest of the World: Analyses of Spontaneous Reports in VigiBase®. Drug Safety, 39(4), pp.335–345.

Chaffey, D., 2017. Digital marketing strategy advice - Smart Insights Digital Marketing. Smart Insights. Available at: http://www.smartinsights.com [Accessed May 2, 2019].

Evans, H., 2014. Thalidomide: how men who blighted lives of thousands evaded justice | Society | The Guardian. The Guardian.

Friedrich, R. et al., The rise of Generation C Implications for the world of 2020. fifthera.com.

Klausen, S.M. & Parle, J., 2015. ‘Are We Going to Stand By and Let These Children Come Into the World?’: The Impact of the ‘Thalidomide Disaster’ in South Africa, 1960–1977. Journal of Southern African Studies, 41(4), pp.735–752.

Lengsavath, M. et al., 2017. Social Media Monitoring and Adverse Drug Reaction Reporting in Pharmacovigilance. Therapeutic Innovation & Regulatory Science, 51(1), pp.125–131.

Statista, 2019. Global digital population as of January 2019 (in millions). Statista. Available at: https://www.statista.com/statistics/617136/digital-population-worldwide/ [Accessed May 2, 2019].

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