Pandemic Preparedness of Private Retail Pharmacies in Ghana: Lessons from COVID-19 and Readiness for Disease X

Background: Private retail pharmacies represent a critical but underutilized frontline resource in pandemic prevention and response, particularly in low- and middle-income countries. Despite their strategic importance, evidence from both high-income and LMICs reveals persistent and systemic gaps in emergency preparedness among community pharmacies. The spectre of Disease X makes it urgent to evaluate how prepared these facilities are for future health system shocks.
Methods: Adhering to the Standards for Reporting Qualitative Research checklist, this study employed a qualitative design in which data collection was structured deductively around the WHO Health Systems Framework while thematic analysis proceeded inductively from the interview data. Semi-structured, face-to-face interviews were conducted with lead pharmacists from 32 purposively selected private retail pharmacies across the Greater Accra and Central Regions of Ghana. Sampling continued until data saturation was achieved. Data were audio-recorded, transcribed verbatim, and subjected to narrative analysis. Trustworthiness was ensured through dependability, confirmability, reflexivity, and member checking. The WHO Health Systems Framework underpinned both data collection and analysis, with findings mapped onto its six building blocks.
Findings: Findings revealed that prior to COVID-19, the vast majority of pharmacies had no structured emergency preparedness and response plans, and were not familiar with the concept of health system shocks. Their response to the pandemic was therefore largely reactive rather than proactive, driven by government-issued safety protocols rather than facility-level planning. While pharmacies adopted infection prevention and control measures at the height of the pandemic, gaps persisted across the financing, information systems, and governance building blocks. Post-pandemic, most pharmacies reverted to pre-crisis operations, suggesting a pattern of crisis fatigue. Only three pharmacies reported maintaining enhanced preparedness protocols after the pandemic subsided. Critically, 31 out of 32 respondents had no knowledge of Disease X, rendering them unable to plan toward the next potential pandemic.
Conclusion: The findings reveal deep structural and knowledge-based gaps in the pandemic preparedness of private retail pharmacies in Ghana. In the context of global momentum toward strengthening pandemic prevention frameworks, including the adoption of the WHO Pandemic Agreement in May 2025, the pharmacy sector in Ghana requires urgent, systematic capacity building.

Disease X, COVID-19, pandemic preparedness, private retail pharmacy, community pharmacy

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