Advocacy Leader in Pharmacy Dr. Boyan Todorov: ‘Advocacy … is a skill that anyone can learn.’

SnapshotPresident, Health and Medicines Information Section of the International Pharmaceutical Federation (FIP)Education:Board certified pharmacist (Bulgaria, The Netherlands, and Switzerland), Doctor of medical sciences (The Netherlands)Describe your journey into the field of pharmacy and what inspired you to take on a leadership role in advocacy.My journey into pharmacy began in the late 1990s when Bulgaria, along with the rest of Eastern Europe, was undergoing significant transformations after the fall of Communism. The rapid changes and the need to build from the ground up were both daunting and exhilarating. My colleagues and I often reflect on that time, recognizing we had a once-in-a-lifetime opportunity to build up the model from inside as we worked in it all in the space of just few short years. We had to establish professional standards and a society, create a new pharmacy curriculum to provide the necessary skills for the evolving healthcare model, and align these with the rest of Europe. In the field of regulations, we had to achieve years of progress in just a few short cycles, all while continuing to provide high-quality patient care. Witnessing the impact we had on the healthcare system during these changes inspired me to take on a leadership role. The ability to influence policies, shape professional standards, and improve patient care felt limited only by our imagination.This boundless imagination pushed me to take the next step in 2001 when I was elected as the Secretary General for the International Pharmaceutical Students’ Federation (IPSF). I dreamed of what we could achieve as a profession globally by working together. Working for IPSF proved to be a hugely formative period for me as I collaborated with and learned from FIP leaders such as Peter Kielgast, Dick Tromp, and Ton Hoek. During this time, IPSF was pivoting towards official relations status with the World Health Organization and the United Nations Educational, Scientific, and Cultural Organization. This involved difficult conversations about membership and alignment of projects and policies. The most amazing opportunity from this time, however, was learning firsthand about pharmacy practices in more than 30 countries I visited during those two years, which afforded me a unique perspective.Advocacy, I realized, is a skill that anyone can learn, but being an effective advocate requires two things: a unique perspective and a lot of imagination. One must be able to envision the compromise and chart the way forward. These experiences taught me that true progress in pharmacy can be achieved through collective effort and the ability to imagine a better future.How do you envision the future of pharmacy practice, and what role do you see advocacy playing in shaping that future?Every pharmacist plays a crucial role in advancing community health. By educating patients about their conditions, guiding them on medication use, and providing health advice, pharmacists engage in daily advocacy for better public health. This commitment is at the heart of our profession.As pharmacists grow more confident and expand beyond traditional dispensing roles, we're witnessing a shift in how our contributions are recognized. For instance, investments in health literacy initiatives led by pharmacists have demonstrated significant health benefits for the communities they serve. While a new economic model is needed to formally acknowledge these contributions—whether it's in health literacy, vaccination services, or managing minor ailments—there are already promising examples of countries negotiating fee-for-service arrangements for these services.Looking ahead, I envision pharmacy practice evolving to embrace these expanded roles more fully. Advocacy will be vital in shaping this future, helping to establish new standards and economic models that reflect the true value of the diverse services pharmacists provide. By continuing to advocate for these advancements, we can ensure that the future of pharmacy practice not only meets the needs of our communities but also acknowledges the full scope of our profession’s impact.What are some of the most significant challenges you have faced in your advocacy efforts, and how have you overcome them?One of the most significant challenges I’ve faced in my advocacy efforts is bringing stakeholders along with me, particularly the pharmacists on whose behalf I advocate. Change is inherently difficult, and our profession, despite being pragmatic, is highly diverse, often leading to different, sometimes conflicting, points of view. This diversity is both a strength and a challenge when trying to chart a path forward and agree on a shared vision.A concrete example of both success and valuable learning is the role pharmacists played during the pandemic. The crisis highlighted something we’ve long known: pharmacists are among the most accessible health professionals. In fact, many healthcare systems recognized this and expanded the scope of services for pharmacists. We recently celebrated the milestone of 56 countries where pharmacists are now authorized to provide vaccination services. However, we must also acknowledge the flip side of this success. There are countries, where despite similar requests from health authorities, colleagues did not step up to provide COVID-19 vaccinations. This reluctance, driven by concerns over legal ambiguity, logistical challenges, orsimply vaccine hesitancy, represented a painful missed opportunity. It indicated that not everywhere were our constituencies ready to be active participants in the transformation of our profession, showing that we as leaders need to do a lot more. To address these challenges, continuous education and credentialing are essential to establish the legal basis for colleagues to provide expanded services. However, overcoming the lack of willingness to embrace change in part of the profession is much more difficult. As a section, we implemented several educational programs focusing on vaccine hesitancy. Additionally, a colleague delivered a lecture at the Model UN meeting for young leaders, though education alone has its limits.To further support our efforts, FIP has moved to provide evidence and share experiences between countries. The vaccination summit held in April in the Netherlands allowed for a direct exchange of experiences between countries that have embraced such services and those that have not. I am optimistic that this approach will help colleagues be more open to expanding the scope of pharmacy services globally and will assist them in their conversations with national regulators to make this possible.What strategies do you find most effective in engaging government and policy makers in discussions about pharmacy-related issues?Engaging government and policymakers in discussions about pharmacy-related issues has evolved significantly. Traditionally, these conversations focused on cost-benefit analysis and the strength of available evidence. While these aspects remain crucial, I've noticed a shift in recent years towards a more conceptual agreement on our proposals. This change is likely due to our improved ability to develop well-argued positions and the increasing burden on healthcare systems, which has made it clear that we need all hands on deck.These days, discussions often move beyond simply debating what needs to be done to addressing how to implement it effectively and efficiently. Policymakers and regulators have learned that implementation is often where good ideas falter. As a result, I now focus on not just advocating for a measure but also on presenting a clear strategy for achieving it. This includes demonstrating how the project will be scalable and how it will be accepted and integrated into existing systems. By addressing these practical considerations, we can better align our proposals with the realities of policy and regulatory environments, increasing the likelihood of successful implementation.Can you highlight any current or upcoming initiatives that you are particularly excited about in your advocacy work?There are so many initiatives I’m excited about in my advocacy work. One example is the work we've done this year with the policy committee to develop an FIP Statement of Policy on access to essential medicines and devices, which will be presented to the FIP Council for ratification later this year. Another key effort is our ongoing work in the Health and Medicines Information Section of FIP to address medical information needs at crucial points in the patient journey. For instance, we’re developing tools for healthcare practitioners to provide written discharge information to culturally and linguistically diverse communities in Australia, facilitating the critical transition from hospital to community care. We’ve also recently established a group focusing on another critical point of care–pregnancy, maternal health, and newborns.However, I’m particularly excited about our work on health literacy. In the Health and Medicines Information Section, we’re focusing on the pharmacist's role in developing their communities and providing accessible, accurate health information. Health literacy is one of the greatest tools we possess to build stronger, healthier communities where patients can effectively use their medicines, be well-informed about their health, and truly be active agents in their own care. This initiative aims to equip pharmacists with the knowledge, advocacy skills, and tools to improve their educator roles in the communities we serve. We are already recognized as the most accessible healthcare professionals; let’s build on that and become real health information resources for the communities we serve, educating patients and helping them reduce medication errors, recognize diseases early, and improve compliance with therapy. It’s a cost-effective measure that can bring significant benefits to both the community and health professionals.Last year, I had the opportunity to represent FIP at a meeting of the Council of Europe and the UN Refugee Agency, where a health literacy guidebook was launched. This event emphasized the importance of community health education in reducing health inequity and bridging gaps between different groups. We’re now working on a reference paper on the issue, collecting evidence from different countries about the roles of pharmacists in this area, and we’re planning a symposium next year at the FIP Congress in Copenhagen on the topic. These efforts will help our colleagues become agents of change, engaging in actions that improve health literacy in their communities.What advice would you give to young pharmacy professionals who are passionate about advocacy and want to make a difference in the field?My advice for colleagues interested in advocacy efforts is to take the initiative and not wait for an invitation or an official request. Remember, you don’t need to wait for someone who appears to be better prepared; often, the person best suited for the role is you, provided you have the time and energy to commit.Effective advocacy requires a blend of vision and perseverance. Be prepared to dream big and maintain your resolve, even when faced with challenges. It’s essential to keep the support and consensus of those you are advocating for; if you lose that backing, you might be heading in the wrong direction.In essence, start where you are, utilize your current strengths, and stay committed to your cause. Advocacy is as much about dedication and persistence as it is about strategy and preparation. Your passion and commitment can make a significant impact, so don’t hesitate to step forward and make a difference.Sherif Guorgui - FIP-Community Pharmacy Section | LinkedIn

Advocacy Leader in Pharmacy Dr. Boyan Todorov: ‘Advocacy … is a skill that anyone can learn.’

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