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[post_content] => Administered to the nasal mucosa, a spike-based formulation triggers rapid local defences that clear the COVID-19 virus where it enters.
In 2022, a year after Australia’s longest COVID-19 lockdowns, researchers from the Centenary Institute and the University of Sydney received a grant of almost $1 million from the NSW COVID-19 Vaccine Acceleration Research Grants Program to develop an intranasal COVID-19 vaccine.
Now, new research has been released by the team – finding that their formulation can stop infection in the nose before the virus spreads through the body, and to other people.
[caption id="attachment_30517" align="alignright" width="150"]
Dr Erica Stewart, Centenary Institute[/caption]
Australian Pharmacist sat down with Dr Erica Stewart, first author and researcher at the Centenary Institute when the work was undertaken, to discuss how the vaccine works, its applications and why it could be the key to stopping the spread.
What is the vaccine’s mechanism of action?
By acting where the virus first enters, the nasal vaccine prompts a rapid, effective immune response that eliminates the virus, Dr Stewart said.
‘The adjuvant we used was Pam2Cys, a Toll-like receptor 2 (TLR2), and we showed that it was able to stimulate the immune response in the nasal passages,’ she said.
‘We formulated the SARS-CoV-2 spike protein with this adjuvant, which emulates bacteria to alert the immune system that there is a danger and it should respond.’
When administered as a booster after a standard injection, the treatment also provided additional protection to vital organs, including the lungs and brain – pointing to the benefits of focusing immune responses within the upper airways.
Why target the nasal mucosa?
The nasal passage is an increasingly promising site for vaccine adjuvant formulation, Dr Stewart said.
‘It’s becoming more and more clear that the nasal passage is a very different immune environment to an injection in the muscle.’
Internationally, there are some other pre-clinical models of mucosal vaccines. ‘But most of those mucosal vaccines are viral vectors because there aren't a lot of vaccine adjuvants that have been found to be effective nasally, which is part of the novelty of this study,’ she said.
The team had previously looked at intranasal vaccination in mice, using a model where the vaccine entered both the lungs and the nose.
‘However, the main takeaway from this research was, when [administering] a very small volume to just the nose, we still got a really strong immune response in the blood,’ she said. ‘We also looked into the nose itself, and we could see that the immune cells were retained for long periods in the nasal passages, where they will be able to respond to infection quickly.’
There’s hope that these vaccines can potentially prevent infection and transmission by building immune defences directly in the upper airways where the virus first takes hold – a frontier that traditional vaccines have yet to reach.
‘We currently reduce disease severity really well, but we're still trying to block transmission,’ Dr Stewart said. ‘That's what nasal vaccines are aiming to address.’
Who would benefit most from a nasal COVID-19 vaccine?
Vulnerable populations who are more susceptible to severe disease, hospitalisations and death.
‘Sometimes you'll hear people say, “COVID-19 is over” – but people are still dying of it, including the elderly, immunocompromised people and those with other comorbidities,’ Dr Stewart said.
Similar to how younger, healthy patients are advised to get the flu vaccine to protect more vulnerable members of the community – this vaccine offers an additional layer of protection.
‘It would be the vulnerable people who are benefiting, but the vaccine would be for everyone to try to reduce the circulation of the virus in our community,’ she said.
How would the vaccine fit into the routine immunisation schedule?
With most people vaccinated against COVID-19 or exposed to the virus, the mucosal vaccines will likely be used as a booster.
‘In the mouse model, both the vaccine as a booster or as a primary vaccination induced nasal immunity,’ Dr Stewart said.
It’s assumed that the nasal vaccine will be used as an annual seasonal dose, similar to the flu vaccine or COVID-19 boosters for certain populations.
‘We do have some evidence that the vaccine can neutralise against other variants, but [we need to explore] how well it protects people and for how long, because that would indicate whether continuous boosters are needed,’ she said.
It’s also anticipated that the nasal vaccine will be self-administered.
‘There are studies looking into self-administration of nasal vaccines, which could really help with distribution and access to these vaccines in the community,’ she said.
This mode of administration could be particularly beneficial for those who are needlephobic, including children.
‘For people who cannot stand getting a needle, this is a less invasive method of vaccination,’ Dr Stewart said.
The researchers say that while more work is needed, the results show strong potential for nasal vaccines to complement existing COVID-19 vaccines and provide an extra layer of protection against the virus in the future.
[post_title] => Intranasal vaccine stops infection at the source
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[post_content] => For years it seemed impossible to achieve, but markedly reducing chemical restraint is on its way. AP meets guardians of medicine management who are highly involved.
Australian pharmacists are playing a vital role in one of the nation’s most important healthcare campaigns – the reduction and ultimate elimination of chemical restraint.
The final reports of the Royal Commission into Aged Care Quality and Safety1 (2021) and the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability2 (2023) made strong recommendations to reduce and ultimately eliminate the use of chemical restraint, sharing a commitment to upholding the rights and dignity of older people and people with disability.
In a joint statement in 2022, the Australian Commission on Safety and Quality in Health Care, the Aged Care Quality and Safety Commission and the NDIS Safety and Quality Commission acknowledged that psychotropic medicines were being overprescribed and overused for managing behaviours of concern. The disability royal commission final report went even further, says Advanced Practice Pharmacist and University of Western Australia Adjunct Professor Manya Angley FPS.
‘It called for a national approach to reducing and eliminating restrictive practices, including chemical restraint, and emphasised the need for a coordinated framework with targets, data collection, evaluation, performance indicators, timeframes and independent oversight. It also focused,’ she notes, ‘on supported decision-making and workforce training in trauma-informed, person-centred care.’
Annual Positive Behaviour Support progress reports were specifically recommended, she says, with an independent evaluation of measures to determine if the use of psychotropic medicines as chemical restraint in people with cognitive disability was reducing.
‘I have been working in aged care as an RMMR and QUM pharmacist since 2018,’ says Dr Angley. ‘Before the aged care royal commission interim report, risperidone as chemical restraint, and psychotropic medicines generally, were used less “mindfully”. If a doctor prescribed a psychotropic medication at usual doses as chemical restraint, it was considered acceptable. Since 2020, GPs, nurses and care staff have greater awareness of the risks of antipsychotics (including falls, stroke and death), the value of bespoke Positive Behaviour Support plans containing a suite of person-centred non-pharmacological strategies, and the need to gain informed consent before using chemical restraint.’
Dr Angley believes ‘everyone is getting better at identifying triggers for changed behaviours’. These can include constipation, urinary retention, pain, boredom, hunger or thirst, infection and medicines.
‘There is improved understanding that chemical restraint should only be used as a last resort, for the shortest possible time and at the lowest dose possible.’
Dr Angley also registered as an NDIS Positive Behaviour Support (PBS) practitioner in 2023. She uses her medicines expertise to identify and deprescribe chemical restraint in NDIS participants.
Pharmacists, as highly trained clinicians, are able to identify if health issues are contributing to changed behaviour. She believes credentialed pharmacists need to play a bigger role in the development of PBS plans for NDIS participants who are prescribed chemical restraint.
There are, however, limited funding options for medicines review services by credentialed pharmacists. Aside from registering as a PBS practitioner, remuneration for services provided to NDIS participants in the community is only available through Home Medicines Reviews, which require a doctor’s referral – a significant barrier.
AP asked two credentialed pharmacists about their experiences with the reduction of chemical restraint.
Case 1
[caption id="attachment_30506" align="alignright" width="148"]
Chelsea Felkai, MPS[/caption]
Chelsea Felkai MPS, Disability and ACOP Pharmacist, Maroba Aged Care Facility, Waratah, Newcastle, NSW
I typically generate reports on residents who use psychotropic medicines. I talk with the resident, their family members, the RACF staff who know the resident, and the resident’s prescriber, to look at whether the medicine is the best option for the person, or if we need to explore alternatives.
Once we have established a resident would benefit from reductions, I work with the prescriber to put deprescribing or tapering plans in place to reduce (or cease) less appropriate medicines. Because I am on site 3 days a week, I am able to monitor this closely to ensure the resident is supported and safe through the process.
In early wins, we have been able to replace mostly tricyclic antidepressants (TCAs) with high anticholinergic burden to newer agent antidepressants (I tend to call this low-hanging fruit) with a lot of success.
Though it’s not strictly chemical restraint, it has brought about a large reduction in adverse outcomes across the facility. We have seen a complete cessation of antipsychotic medicines in only two residents so far (the facility has 150, with approximately 25 in the memory support unit), but we have been able to reduce chemical restraint in all residents to the lowest effective maintenance dose.
We have seen an increase in selective serotonin reuptake inhibitor (SSRI) medicines, and a reduction in TCAs. We have also seen an increase in duloxetine and mirtazapine. I have tried to use some of the newer evidence of duloxetine’s efficacy for chronic pain management and mirtazapine’s for sleep support, as options when switching antidepressants.
There has been some discomfort from residents and staff while we have trialled reduction in psychotropic medicines, to ensure the resident is on the lowest possible dose. Because education was provided to staff at the start, it was met with little resistance. And it helped that I was on site to provide support and monitor the outcomes.
Working with the nursing staff to understand when PRN (as required) chemical restraint might be used, and ensuring other options have been exhausted first, has shown the most reduction in how much psychotropic medications have been used so far. The numbers are relatively small, but to be honest, this is largely because the facility had great protocols to begin with.
The impact has been noticeable. Staff members say they feel more confident in the care they provide and the non-pharmacological options they now have at their disposal.
When they do move to a chemical restraint option, it is because other options have been exhausted, and it is in the best interest of the resident.
Case 2
[caption id="attachment_26803" align="alignleft" width="144"]
Dr Natalie Soulsby FPS[/caption]
Dr Natalie Soulsby FPS, Credentialed Pharmacist, South Australia
My role is Head of Clinical Governance and Quality Assurance for Embedded Health Solutions, which provides clinical pharmacy services to about 600 residential aged care facilities (RACFs).
One of my roles is to attend national medication advisory committee (MAC) meetings to provide information to head office on medication management, including the psychotropic register. I analyse the information on the register and provide a clinical lens, which is used to support staff to understand where these medicines may be being used as restraints.
The Aged Care Quality and Safety Commission responded to the Royal Commission into Aged Care Quality and Safety by creating a psychotropic register that needs to be updated monthly, so they can keep track of how many patients were prescribed a medicine that was used as a chemical restraint and how they were being managed.
In 2021, when the National Aged Care Quality Indicator Program included the use of antipsychotic medicines, the quarterly numbers showed 21.6% of residents were administered antipsychotic medicines during a 7-day time frame. That figure is now down to 17.3%.
The registers have been a good trigger to remind doctors to review their patients’ treatments. When it began, doctors were concerned about prescribing antipsychotic medicines, and unfortunately some GPs stopped their patients’ medicines, which caused a return of their symptoms. These medicines must be weaned slowly.
There is still a stigma with these medicines, and our focus is always on appropriateness. All the new red tape means staff at the facilities spend a lot more time collecting data.
Initially it was overwhelming and confusing. GPs were concerned about the impact on their patients. There was also a lack of communication and understanding. The staff are more confident now, but there is still confusion as to what constitutes a chemical restraint.
Now everyone in the care team, including the staff in the home, the GP and the family, are involved in the process. Staff members encourage GPs to look at the psychotropic medicines regularly (at least every 3 months), and the staff assess the effectiveness or otherwise of the medications and consider any adverse effects and update the Behaviour Support Plan. This is considered best practice.
And one of the roles of the credentialed pharmacist is to support the home in filling out the register.
One impact has been a shift to more person-centred care.
The patient is seen as an active participant in their care, which lines up with the new Aged Care Act coming into effect in November this year. The concept is good, but we are still trying to work out how that will work in the long term.
Reviewing the psychotropic register allows us to support our facilities in ensuring appropriate treatments are prescribed and reviewed regularly for the residents.
We can use the register as part of our reviews and for follow-ups.
Nursing staff are more aware of the role of medicines in treating responsive behaviours, and having the register supports their conversations with the GPs. Our role is to be the continuity-of-care person and why we allocate pharmacists to specific aged care facilities, which allows them to become part of the team and provide appropriate advice and support.
We are the second set of eyes. We put a clinical lens over what has gone on and can help the nursing staff.
Pharmacists are the guardians of medicines management and the advocates for the nursing staff and residents. We help support the residents’ care.
References
- Royal Commission into Aged Care Quality and Safety. Final Report. 2021. At: www.royalcommission.gov.au/aged-care/final-report
- Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. Final Report. 2023. At: https://disability.royalcommission.gov.au/publications/final-report
[post_title] => How pharmacists are reducing chemical restraint
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[post_content] => Women of reproductive age using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) could be at risk of unintended pregnancy, and may be unaware of associated risks to pregnancy and unborn babies.
A new study by Flinders University, which examined records from more than 1.6 million women aged 18–49 who attended general practice between 2011 and 2022, found that only one in five (21%) of those with first prescribing of GLP-1 RAs had documented contraceptive use.
The study also found that most prescriptions for GLP-1 RAs are now issued to women without diabetes. In 2022 alone, more than 6,000 women began treatment on GLP-1 RAs, and over 90% of those did not have a type 2 diabetes diagnosis.
[caption id="attachment_30483" align="alignright" width="300"]
Associate Professor Luke Grzeskowiak[/caption]
Participants were tracked at the initial stages of GLP-1 RA therapy, with the research team looking at documented evidence of pregnancies over a 6-month period, said lead author and pharmacist, Associate Professor Luke Grzeskowiak.
‘[While] limited to data from GP records, one in 25 women aged 18 to 34 years had a documented pregnancy at the time of prescribing,’ he said.
‘There will also be pregnancies that the GP might not be aware of, so if anything, what we're expecting is that this is an underestimate of what's truly happening.’
Those who were prescribed concurrent contraception were 50% less likely to have a documented pregnancy.
‘So we've got clear evidence that contraceptive use at the time of initiating these medicines reduces the risk of pregnancies occurring,’ A/Prof Grzeskowiak said.
Why does GLP-1 RA use increase pregnancy risk?
There are two key reasons: first, it is ‘well established’ that weight loss can improve fertility.
‘Because we know these medicines are very effective at promoting weight loss, it's highly plausible that they could improve fertility through that mechanism,’ A/Prof Grzeskowiak said.
There have also been concerns that GLP-1 RAs might impact absorption of the oral contraceptive pill.
In June 2025, the UK’s Medicines and Healthcare products Regulatory Agency issued a regulatory warning following case reports of unexpected pregnancies associated with GLP-1 RA use.
‘A detailed review [revealed] that the strongest evidence was around potential interaction between tirzepatide and reduced effectiveness of oral contraception,’ A/Prof Grzeskowiak said.
To date, evidence regarding interactions between GLP-1 RAs and the oral contraceptive pill is limited.
‘So the general recommendations around that regulatory warning were for those relying on oral contraceptive methods to also consider using a barrier method,’ he said.
What are the congenital risk factors?
The research also considered potential harms associated with GLP-1 RAs in pregnancy. Key concerns were taken from a University of Amsterdam review of animal studies, cited in the Flinders University study.
‘In animals, use of GLP-1 RAs [in pregnancy] led to reductions in foetal growth, impairments in bone development and impaired maternal weight gain,’ A/Prof Grzeskowiak said.
At this stage, the human data are more reassuring.
‘The studies that have been done have not shown an increased risk of birth defects,’ he said. ‘But they are still relatively limited in terms of numbers, and we don't have an examination of the full range of pregnancy outcomes yet,’ he said.
Due to this uncertainty, an abundance of caution is advised.
‘The recommendations are to not use these medicines during pregnancy, and to avoid the potential for them to be used during pregnancy accidentally,’ A/Prof Grzeskowiak said. ‘So it’s important to have a plan around concurrent contraception use, high-quality pre-conception care, and ensure that where pregnancies are planned, everything has been done to optimise pregnancy outcomes.’
What should pharmacists advise patients?
Dispensing GLP-1 RAs provides important opportunities for pharmacists to talk to patients about reproductive health.
For example, when dispensing tirzepatide, access to dispensing data on contraceptive methods enables pharmacists to raise awareness of the potential interaction by initiating an open and unassuming conversation, A/Prof Grzeskowiak said.
‘Having a conversation about how that might be addressed means patients can make an informed decision,’ he said. ‘It might mean changing contraceptive methods or [referring] them back to the GP for a conversation. Or it may be that they're using contraceptives for non-contraceptive purposes such as acne [management], so there’s a low risk of pregnancy.’
The initiation of therapy is the ideal time to discuss potential risks.
‘That way people know what to expect in terms of the medicines,’ he said.
When commencing GLP-1 RAs, patients may also experience profound gastrointestinal adverse effects, including vomiting or diarrhoea.
‘That in itself can reduce the effectiveness of oral contraception, regardless of any other interactions,’ A/Prof Grzeskowiak said. ‘So people should be aware of the side effects of what to expect when starting this and how it might impact on other treatments that they're using.’
Pharmacists have an important role in engaging patients in conversations about reproductive health, particularly contraception.
‘Not everyone feels comfortable asking those questions, but there are good training resources, particularly through PSA, around improving pharmacists’ comfort with having those conversations, including around the different types of contraceptive methods,’ he said.
‘It's one thing to start the conversation, but you also need to be armed with various information to be able to continue it, or at least identify when to refer patients back to their medical practitioner or another [healthcare practitioner] to provide that detailed advice.’
[post_title] => GLP-1 RAs found to pose pregnancy risks
[post_excerpt] => Women of reproductive age using GLP-1 RAs could be at risk of unintended pregnancy, and unaware of the risks to pregnancy and unborn babies.
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[post_content] => In August 2025, I had the privilege of attending the International Pharmaceutical Students’ Federation (IPSF) World Congress in Nairobi, Kenya.
The theme of this year’s congress, Advancing Pharmacy Education and Practice for Global Health Impact, was reflected throughout the week in discussions, panels and workshops.
Thanks to the generous support of PSA and the National Australian Pharmacy Students’ Association (NAPSA), I was able to represent both Australia and New Zealand as the sole Official Delegate at the General Assembly. Without their support, our countries would not have had a voice.
Leaders in training
Before the official start of World Congress, I participated in the Leaders in Training (LiT) program, where I became an Alpha Trainer after reaching the required hours. I ran workshops focused on developing soft skills for future leaders, guiding students through sessions on motivation, feedback and evaluation.
This was a rewarding opportunity to share knowledge, strengthen my own skills, and witness the energy and passion of upcoming leaders.
Once the Congress began, much of my time was spent in the General Assembly, carrying the responsibility of casting votes and ensuring the perspectives of
students from both Australia and New Zealand were heard. Being the only delegate from our area made me realise just how vital the support of PSA and NAPSA was.
Technology and access
Among the many events I attended, one highlight was a panel discussion on the use of AI in healthcare. This session offered a fascinating look at both the opportunities and the challenges of integrating AI into healthcare delivery.
I also gained insight into the industrial pharmacy sector in Kenya, as well as the broader challenges faced by healthcare in Nairobi. These experiences expanded my understanding of the global landscape of pharmacy and reminded me of the inequities that continue to exist in access to medicines and resources.
The Congress also gave me the chance to reconnect with peers from around the world, including those I had previously worked with as NAPSA’s Contact Person. It was valuable to strengthen existing connections and build friendships with students who share the same interest in pharmacy.World Congress was a once-in-a-lifetime experience; one I hope more Australian pharmacy students will pursue in the future.
Start local, go global
IPSF represents over 500,000 pharmacy students worldwide, yet Australia’s presence remains small. I want to change that by encouraging more students to get involved and take advantage of the opportunities IPSF offers.
The first step is to become involved in your local student branch, which can then open doors to national opportunities through NAPSA and, eventually, to international representation.
I still remember attending my first IPSF conference alone and feeling nervous, only to be welcomed immediately by the IPSF Asia Pacific Regional Office (APRO), who embraced me as part of their community. The warmth and inclusivity I experienced then continues to inspire me, and I encourage others to take the same leap.
People want to connect with you, and IPSF provides a space where friendships, networks, and professional growth come naturally.
Looking ahead, the next IPSF events will be the Asia Pacific Pharmaceutical Symposium (APPS) in Indonesia and the World Congress in Thailand. I would strongly encourage pharmacy students to consider attending these future events, as they are transformative experiences that broaden horizons, deepen understanding and build lifelong networks.
Pathways Ahead
I am deeply grateful to PSA for their monumental support in making my attendance possible. With travel costs being high, it would have been impossible for me to attend without their sponsorship.
Because of their generosity, Australia and New Zealand were represented at the General Assembly, and our perspectives contributed to global discussions.
I also want to thank NAPSA for their support, which made it more feasible for me to attend in my role as Official Delegate. Their backing ensured that I was able to fulfil my duties and give our members a voice on the international stage.
Attending World Congress 2025 in Nairobi was an unforgettable experience that strengthened my leadership skills, broadened my understanding of global healthcare, and connected me with pharmacy students from across the world.
Most importantly, it reminded me of the importance of ensuring Australia and New Zealand are active participants in shaping the future of our profession.
To PSA and NAPSA, thank you once again for making this possible. To my fellow pharmacy students, I encourage you to take that first step, get involved, and see where it leads. You might just find yourself representing our country on the world stage one day.
[post_title] => A voice for Australia and New Zealand at IPSF 2025
[post_excerpt] => Australia and New Zealand had a voice at the IPSF World Congress, influencing discussions on education, practice and global health.
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[post_content] => A blistering opening plenary session at the FIP Congress last week has challenged policymakers and health professionals alike to act to slow the advance of antimicrobial resistance (AMR).
Mr Michele Cecchini, Head of Public Health, Organisation for Economic Co-operation and Development (OECD), worked through startling data showing the cost of AMR globally – in dollars, and in years of life lost.
The high price of insufficient action on AMR
The OECD has crunched the numbers, and the statistics are startling.
AMR is currently shortening life expectancy by an average of 1.8 years globally – 1.7 years for people in high-income countries, or 2.5 years for people in low-income countries.
This is represented in 79,000 people dying due to resistant infections across 34 OECD, European Union and European Economic Area counties – corresponding to 2.4 times the number of deaths due to tuberculosis, influenza and HIV/AIDS combined in 2020.
The financial burden on the health system is similarly staggering, with global annual costs totalling $US 412 billion.
Once lost productivity and loss of income costs are added in, this cost balloons to $US 850 billion annually – about the same size of Poland’s economy.
Bold action is required
Modelling by the OECD has shown that meaningful action is achievable – albeit with a substantial price tag.
To reduce AMR-related deaths by 10%, six actions are required:
- All countries need to have national AMR action plans and 60% of countries commit a budget
- 90% of countries should meet WHO’s minimum infection prevention and control programs at a national level
- All countries need to report surveillance data on AMR and antimicrobial use
- Meaningful reduction in antimicrobial use is taken in agrifood systems
- Strengthened actions to prevent and address the discharge of antimicrobials into the environment
- Mechanisms to support research and development to address AMR should be promoted.
The cost of these initiatives globally is estimated to be $US 52 billion annually – equivalent to 0.5% of the global health budget.
‘The World Bank told us this is a rounding error [in the context of health spending]. This is not an amount of money which cannot be mobilised,’ Mr Cecchini said.
These sentiments were echoed by the Danish Minister for the Interior and Health Sophie Løhde.
‘To tackle [AMR], we need to work much closer together, and your role as pharmacists and life science professionals is key,’ said Minister Løhde at the first plenary session of the 2025 FIP world congress last week. ‘We need your expertise to develop new antimicrobials in the most prudent and effective manner, and to inform and educate our citizens when you meet them in pharmacies all over the world.’
The FIP Copenhagen Declaration on Antimicrobial Resistance, signed by 79 organisations – including The Pharmaceutical Society of Australia – took place on 1 September 2025.
The FIP Declaration outlines clear priorities to address AMR, including global partnership building, promoting vaccination and rational antimicrobial use, protecting medicine supply chains, and advancing evidence on stewardship and outcomes.
[post_title] => OECD sounds the alarm on antimicrobial resistance
[post_excerpt] => A blistering session at the FIP Congress challenged policymakers and health professionals to slow the advance of antimicrobial resistance.
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[post_content] => Administered to the nasal mucosa, a spike-based formulation triggers rapid local defences that clear the COVID-19 virus where it enters.
In 2022, a year after Australia’s longest COVID-19 lockdowns, researchers from the Centenary Institute and the University of Sydney received a grant of almost $1 million from the NSW COVID-19 Vaccine Acceleration Research Grants Program to develop an intranasal COVID-19 vaccine.
Now, new research has been released by the team – finding that their formulation can stop infection in the nose before the virus spreads through the body, and to other people.
[caption id="attachment_30517" align="alignright" width="150"] Dr Erica Stewart, Centenary Institute[/caption]
Australian Pharmacist sat down with Dr Erica Stewart, first author and researcher at the Centenary Institute when the work was undertaken, to discuss how the vaccine works, its applications and why it could be the key to stopping the spread.
What is the vaccine’s mechanism of action?
By acting where the virus first enters, the nasal vaccine prompts a rapid, effective immune response that eliminates the virus, Dr Stewart said.
‘The adjuvant we used was Pam2Cys, a Toll-like receptor 2 (TLR2), and we showed that it was able to stimulate the immune response in the nasal passages,’ she said.
‘We formulated the SARS-CoV-2 spike protein with this adjuvant, which emulates bacteria to alert the immune system that there is a danger and it should respond.’
When administered as a booster after a standard injection, the treatment also provided additional protection to vital organs, including the lungs and brain – pointing to the benefits of focusing immune responses within the upper airways.
Why target the nasal mucosa?
The nasal passage is an increasingly promising site for vaccine adjuvant formulation, Dr Stewart said.
‘It’s becoming more and more clear that the nasal passage is a very different immune environment to an injection in the muscle.’
Internationally, there are some other pre-clinical models of mucosal vaccines. ‘But most of those mucosal vaccines are viral vectors because there aren't a lot of vaccine adjuvants that have been found to be effective nasally, which is part of the novelty of this study,’ she said.
The team had previously looked at intranasal vaccination in mice, using a model where the vaccine entered both the lungs and the nose.
‘However, the main takeaway from this research was, when [administering] a very small volume to just the nose, we still got a really strong immune response in the blood,’ she said. ‘We also looked into the nose itself, and we could see that the immune cells were retained for long periods in the nasal passages, where they will be able to respond to infection quickly.’
There’s hope that these vaccines can potentially prevent infection and transmission by building immune defences directly in the upper airways where the virus first takes hold – a frontier that traditional vaccines have yet to reach.
‘We currently reduce disease severity really well, but we're still trying to block transmission,’ Dr Stewart said. ‘That's what nasal vaccines are aiming to address.’
Who would benefit most from a nasal COVID-19 vaccine?
Vulnerable populations who are more susceptible to severe disease, hospitalisations and death.
‘Sometimes you'll hear people say, “COVID-19 is over” – but people are still dying of it, including the elderly, immunocompromised people and those with other comorbidities,’ Dr Stewart said.
Similar to how younger, healthy patients are advised to get the flu vaccine to protect more vulnerable members of the community – this vaccine offers an additional layer of protection.
‘It would be the vulnerable people who are benefiting, but the vaccine would be for everyone to try to reduce the circulation of the virus in our community,’ she said.
How would the vaccine fit into the routine immunisation schedule?
With most people vaccinated against COVID-19 or exposed to the virus, the mucosal vaccines will likely be used as a booster.
‘In the mouse model, both the vaccine as a booster or as a primary vaccination induced nasal immunity,’ Dr Stewart said.
It’s assumed that the nasal vaccine will be used as an annual seasonal dose, similar to the flu vaccine or COVID-19 boosters for certain populations.
‘We do have some evidence that the vaccine can neutralise against other variants, but [we need to explore] how well it protects people and for how long, because that would indicate whether continuous boosters are needed,’ she said.
It’s also anticipated that the nasal vaccine will be self-administered.
‘There are studies looking into self-administration of nasal vaccines, which could really help with distribution and access to these vaccines in the community,’ she said.
This mode of administration could be particularly beneficial for those who are needlephobic, including children.
‘For people who cannot stand getting a needle, this is a less invasive method of vaccination,’ Dr Stewart said.
The researchers say that while more work is needed, the results show strong potential for nasal vaccines to complement existing COVID-19 vaccines and provide an extra layer of protection against the virus in the future.
[post_title] => Intranasal vaccine stops infection at the source
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[post_content] => For years it seemed impossible to achieve, but markedly reducing chemical restraint is on its way. AP meets guardians of medicine management who are highly involved.
Australian pharmacists are playing a vital role in one of the nation’s most important healthcare campaigns – the reduction and ultimate elimination of chemical restraint.
The final reports of the Royal Commission into Aged Care Quality and Safety1 (2021) and the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability2 (2023) made strong recommendations to reduce and ultimately eliminate the use of chemical restraint, sharing a commitment to upholding the rights and dignity of older people and people with disability.
In a joint statement in 2022, the Australian Commission on Safety and Quality in Health Care, the Aged Care Quality and Safety Commission and the NDIS Safety and Quality Commission acknowledged that psychotropic medicines were being overprescribed and overused for managing behaviours of concern. The disability royal commission final report went even further, says Advanced Practice Pharmacist and University of Western Australia Adjunct Professor Manya Angley FPS.
‘It called for a national approach to reducing and eliminating restrictive practices, including chemical restraint, and emphasised the need for a coordinated framework with targets, data collection, evaluation, performance indicators, timeframes and independent oversight. It also focused,’ she notes, ‘on supported decision-making and workforce training in trauma-informed, person-centred care.’
Annual Positive Behaviour Support progress reports were specifically recommended, she says, with an independent evaluation of measures to determine if the use of psychotropic medicines as chemical restraint in people with cognitive disability was reducing.
‘I have been working in aged care as an RMMR and QUM pharmacist since 2018,’ says Dr Angley. ‘Before the aged care royal commission interim report, risperidone as chemical restraint, and psychotropic medicines generally, were used less “mindfully”. If a doctor prescribed a psychotropic medication at usual doses as chemical restraint, it was considered acceptable. Since 2020, GPs, nurses and care staff have greater awareness of the risks of antipsychotics (including falls, stroke and death), the value of bespoke Positive Behaviour Support plans containing a suite of person-centred non-pharmacological strategies, and the need to gain informed consent before using chemical restraint.’
Dr Angley believes ‘everyone is getting better at identifying triggers for changed behaviours’. These can include constipation, urinary retention, pain, boredom, hunger or thirst, infection and medicines.
‘There is improved understanding that chemical restraint should only be used as a last resort, for the shortest possible time and at the lowest dose possible.’
Dr Angley also registered as an NDIS Positive Behaviour Support (PBS) practitioner in 2023. She uses her medicines expertise to identify and deprescribe chemical restraint in NDIS participants.
Pharmacists, as highly trained clinicians, are able to identify if health issues are contributing to changed behaviour. She believes credentialed pharmacists need to play a bigger role in the development of PBS plans for NDIS participants who are prescribed chemical restraint.
There are, however, limited funding options for medicines review services by credentialed pharmacists. Aside from registering as a PBS practitioner, remuneration for services provided to NDIS participants in the community is only available through Home Medicines Reviews, which require a doctor’s referral – a significant barrier.
AP asked two credentialed pharmacists about their experiences with the reduction of chemical restraint.
Case 1
[caption id="attachment_30506" align="alignright" width="148"] Chelsea Felkai, MPS[/caption]
Chelsea Felkai MPS, Disability and ACOP Pharmacist, Maroba Aged Care Facility, Waratah, Newcastle, NSW
I typically generate reports on residents who use psychotropic medicines. I talk with the resident, their family members, the RACF staff who know the resident, and the resident’s prescriber, to look at whether the medicine is the best option for the person, or if we need to explore alternatives.
Once we have established a resident would benefit from reductions, I work with the prescriber to put deprescribing or tapering plans in place to reduce (or cease) less appropriate medicines. Because I am on site 3 days a week, I am able to monitor this closely to ensure the resident is supported and safe through the process.
In early wins, we have been able to replace mostly tricyclic antidepressants (TCAs) with high anticholinergic burden to newer agent antidepressants (I tend to call this low-hanging fruit) with a lot of success.
Though it’s not strictly chemical restraint, it has brought about a large reduction in adverse outcomes across the facility. We have seen a complete cessation of antipsychotic medicines in only two residents so far (the facility has 150, with approximately 25 in the memory support unit), but we have been able to reduce chemical restraint in all residents to the lowest effective maintenance dose.
We have seen an increase in selective serotonin reuptake inhibitor (SSRI) medicines, and a reduction in TCAs. We have also seen an increase in duloxetine and mirtazapine. I have tried to use some of the newer evidence of duloxetine’s efficacy for chronic pain management and mirtazapine’s for sleep support, as options when switching antidepressants.
There has been some discomfort from residents and staff while we have trialled reduction in psychotropic medicines, to ensure the resident is on the lowest possible dose. Because education was provided to staff at the start, it was met with little resistance. And it helped that I was on site to provide support and monitor the outcomes.
Working with the nursing staff to understand when PRN (as required) chemical restraint might be used, and ensuring other options have been exhausted first, has shown the most reduction in how much psychotropic medications have been used so far. The numbers are relatively small, but to be honest, this is largely because the facility had great protocols to begin with.
The impact has been noticeable. Staff members say they feel more confident in the care they provide and the non-pharmacological options they now have at their disposal.
When they do move to a chemical restraint option, it is because other options have been exhausted, and it is in the best interest of the resident.
Case 2
[caption id="attachment_26803" align="alignleft" width="144"] Dr Natalie Soulsby FPS[/caption]
Dr Natalie Soulsby FPS, Credentialed Pharmacist, South Australia
My role is Head of Clinical Governance and Quality Assurance for Embedded Health Solutions, which provides clinical pharmacy services to about 600 residential aged care facilities (RACFs).
One of my roles is to attend national medication advisory committee (MAC) meetings to provide information to head office on medication management, including the psychotropic register. I analyse the information on the register and provide a clinical lens, which is used to support staff to understand where these medicines may be being used as restraints.
The Aged Care Quality and Safety Commission responded to the Royal Commission into Aged Care Quality and Safety by creating a psychotropic register that needs to be updated monthly, so they can keep track of how many patients were prescribed a medicine that was used as a chemical restraint and how they were being managed.
In 2021, when the National Aged Care Quality Indicator Program included the use of antipsychotic medicines, the quarterly numbers showed 21.6% of residents were administered antipsychotic medicines during a 7-day time frame. That figure is now down to 17.3%.
The registers have been a good trigger to remind doctors to review their patients’ treatments. When it began, doctors were concerned about prescribing antipsychotic medicines, and unfortunately some GPs stopped their patients’ medicines, which caused a return of their symptoms. These medicines must be weaned slowly.
There is still a stigma with these medicines, and our focus is always on appropriateness. All the new red tape means staff at the facilities spend a lot more time collecting data.
Initially it was overwhelming and confusing. GPs were concerned about the impact on their patients. There was also a lack of communication and understanding. The staff are more confident now, but there is still confusion as to what constitutes a chemical restraint.
Now everyone in the care team, including the staff in the home, the GP and the family, are involved in the process. Staff members encourage GPs to look at the psychotropic medicines regularly (at least every 3 months), and the staff assess the effectiveness or otherwise of the medications and consider any adverse effects and update the Behaviour Support Plan. This is considered best practice.
And one of the roles of the credentialed pharmacist is to support the home in filling out the register.
One impact has been a shift to more person-centred care.
The patient is seen as an active participant in their care, which lines up with the new Aged Care Act coming into effect in November this year. The concept is good, but we are still trying to work out how that will work in the long term.
Reviewing the psychotropic register allows us to support our facilities in ensuring appropriate treatments are prescribed and reviewed regularly for the residents.
We can use the register as part of our reviews and for follow-ups.
Nursing staff are more aware of the role of medicines in treating responsive behaviours, and having the register supports their conversations with the GPs. Our role is to be the continuity-of-care person and why we allocate pharmacists to specific aged care facilities, which allows them to become part of the team and provide appropriate advice and support.
We are the second set of eyes. We put a clinical lens over what has gone on and can help the nursing staff.
Pharmacists are the guardians of medicines management and the advocates for the nursing staff and residents. We help support the residents’ care.
References
- Royal Commission into Aged Care Quality and Safety. Final Report. 2021. At: www.royalcommission.gov.au/aged-care/final-report
- Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. Final Report. 2023. At: https://disability.royalcommission.gov.au/publications/final-report
[post_title] => How pharmacists are reducing chemical restraint
[post_excerpt] => For years it seemed impossible to achieve, but markedly reducing chemical restraint is on its way.
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[post_content] => Women of reproductive age using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) could be at risk of unintended pregnancy, and may be unaware of associated risks to pregnancy and unborn babies.
A new study by Flinders University, which examined records from more than 1.6 million women aged 18–49 who attended general practice between 2011 and 2022, found that only one in five (21%) of those with first prescribing of GLP-1 RAs had documented contraceptive use.
The study also found that most prescriptions for GLP-1 RAs are now issued to women without diabetes. In 2022 alone, more than 6,000 women began treatment on GLP-1 RAs, and over 90% of those did not have a type 2 diabetes diagnosis.
[caption id="attachment_30483" align="alignright" width="300"] Associate Professor Luke Grzeskowiak[/caption]
Participants were tracked at the initial stages of GLP-1 RA therapy, with the research team looking at documented evidence of pregnancies over a 6-month period, said lead author and pharmacist, Associate Professor Luke Grzeskowiak.
‘[While] limited to data from GP records, one in 25 women aged 18 to 34 years had a documented pregnancy at the time of prescribing,’ he said.
‘There will also be pregnancies that the GP might not be aware of, so if anything, what we're expecting is that this is an underestimate of what's truly happening.’
Those who were prescribed concurrent contraception were 50% less likely to have a documented pregnancy.
‘So we've got clear evidence that contraceptive use at the time of initiating these medicines reduces the risk of pregnancies occurring,’ A/Prof Grzeskowiak said.
Why does GLP-1 RA use increase pregnancy risk?
There are two key reasons: first, it is ‘well established’ that weight loss can improve fertility.
‘Because we know these medicines are very effective at promoting weight loss, it's highly plausible that they could improve fertility through that mechanism,’ A/Prof Grzeskowiak said.
There have also been concerns that GLP-1 RAs might impact absorption of the oral contraceptive pill.
In June 2025, the UK’s Medicines and Healthcare products Regulatory Agency issued a regulatory warning following case reports of unexpected pregnancies associated with GLP-1 RA use.
‘A detailed review [revealed] that the strongest evidence was around potential interaction between tirzepatide and reduced effectiveness of oral contraception,’ A/Prof Grzeskowiak said.
To date, evidence regarding interactions between GLP-1 RAs and the oral contraceptive pill is limited.
‘So the general recommendations around that regulatory warning were for those relying on oral contraceptive methods to also consider using a barrier method,’ he said.
What are the congenital risk factors?
The research also considered potential harms associated with GLP-1 RAs in pregnancy. Key concerns were taken from a University of Amsterdam review of animal studies, cited in the Flinders University study.
‘In animals, use of GLP-1 RAs [in pregnancy] led to reductions in foetal growth, impairments in bone development and impaired maternal weight gain,’ A/Prof Grzeskowiak said.
At this stage, the human data are more reassuring.
‘The studies that have been done have not shown an increased risk of birth defects,’ he said. ‘But they are still relatively limited in terms of numbers, and we don't have an examination of the full range of pregnancy outcomes yet,’ he said.
Due to this uncertainty, an abundance of caution is advised.
‘The recommendations are to not use these medicines during pregnancy, and to avoid the potential for them to be used during pregnancy accidentally,’ A/Prof Grzeskowiak said. ‘So it’s important to have a plan around concurrent contraception use, high-quality pre-conception care, and ensure that where pregnancies are planned, everything has been done to optimise pregnancy outcomes.’
What should pharmacists advise patients?
Dispensing GLP-1 RAs provides important opportunities for pharmacists to talk to patients about reproductive health.
For example, when dispensing tirzepatide, access to dispensing data on contraceptive methods enables pharmacists to raise awareness of the potential interaction by initiating an open and unassuming conversation, A/Prof Grzeskowiak said.
‘Having a conversation about how that might be addressed means patients can make an informed decision,’ he said. ‘It might mean changing contraceptive methods or [referring] them back to the GP for a conversation. Or it may be that they're using contraceptives for non-contraceptive purposes such as acne [management], so there’s a low risk of pregnancy.’
The initiation of therapy is the ideal time to discuss potential risks.
‘That way people know what to expect in terms of the medicines,’ he said.
When commencing GLP-1 RAs, patients may also experience profound gastrointestinal adverse effects, including vomiting or diarrhoea.
‘That in itself can reduce the effectiveness of oral contraception, regardless of any other interactions,’ A/Prof Grzeskowiak said. ‘So people should be aware of the side effects of what to expect when starting this and how it might impact on other treatments that they're using.’
Pharmacists have an important role in engaging patients in conversations about reproductive health, particularly contraception.
‘Not everyone feels comfortable asking those questions, but there are good training resources, particularly through PSA, around improving pharmacists’ comfort with having those conversations, including around the different types of contraceptive methods,’ he said.
‘It's one thing to start the conversation, but you also need to be armed with various information to be able to continue it, or at least identify when to refer patients back to their medical practitioner or another [healthcare practitioner] to provide that detailed advice.’
[post_title] => GLP-1 RAs found to pose pregnancy risks
[post_excerpt] => Women of reproductive age using GLP-1 RAs could be at risk of unintended pregnancy, and unaware of the risks to pregnancy and unborn babies.
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[post_content] => In August 2025, I had the privilege of attending the International Pharmaceutical Students’ Federation (IPSF) World Congress in Nairobi, Kenya.
The theme of this year’s congress, Advancing Pharmacy Education and Practice for Global Health Impact, was reflected throughout the week in discussions, panels and workshops.
Thanks to the generous support of PSA and the National Australian Pharmacy Students’ Association (NAPSA), I was able to represent both Australia and New Zealand as the sole Official Delegate at the General Assembly. Without their support, our countries would not have had a voice.
Leaders in training
Before the official start of World Congress, I participated in the Leaders in Training (LiT) program, where I became an Alpha Trainer after reaching the required hours. I ran workshops focused on developing soft skills for future leaders, guiding students through sessions on motivation, feedback and evaluation.
This was a rewarding opportunity to share knowledge, strengthen my own skills, and witness the energy and passion of upcoming leaders.
Once the Congress began, much of my time was spent in the General Assembly, carrying the responsibility of casting votes and ensuring the perspectives of
students from both Australia and New Zealand were heard. Being the only delegate from our area made me realise just how vital the support of PSA and NAPSA was.
Technology and access
Among the many events I attended, one highlight was a panel discussion on the use of AI in healthcare. This session offered a fascinating look at both the opportunities and the challenges of integrating AI into healthcare delivery.
I also gained insight into the industrial pharmacy sector in Kenya, as well as the broader challenges faced by healthcare in Nairobi. These experiences expanded my understanding of the global landscape of pharmacy and reminded me of the inequities that continue to exist in access to medicines and resources.
The Congress also gave me the chance to reconnect with peers from around the world, including those I had previously worked with as NAPSA’s Contact Person. It was valuable to strengthen existing connections and build friendships with students who share the same interest in pharmacy.World Congress was a once-in-a-lifetime experience; one I hope more Australian pharmacy students will pursue in the future.
Start local, go global
IPSF represents over 500,000 pharmacy students worldwide, yet Australia’s presence remains small. I want to change that by encouraging more students to get involved and take advantage of the opportunities IPSF offers.
The first step is to become involved in your local student branch, which can then open doors to national opportunities through NAPSA and, eventually, to international representation.
I still remember attending my first IPSF conference alone and feeling nervous, only to be welcomed immediately by the IPSF Asia Pacific Regional Office (APRO), who embraced me as part of their community. The warmth and inclusivity I experienced then continues to inspire me, and I encourage others to take the same leap.
People want to connect with you, and IPSF provides a space where friendships, networks, and professional growth come naturally.
Looking ahead, the next IPSF events will be the Asia Pacific Pharmaceutical Symposium (APPS) in Indonesia and the World Congress in Thailand. I would strongly encourage pharmacy students to consider attending these future events, as they are transformative experiences that broaden horizons, deepen understanding and build lifelong networks.
Pathways Ahead
I am deeply grateful to PSA for their monumental support in making my attendance possible. With travel costs being high, it would have been impossible for me to attend without their sponsorship.
Because of their generosity, Australia and New Zealand were represented at the General Assembly, and our perspectives contributed to global discussions.
I also want to thank NAPSA for their support, which made it more feasible for me to attend in my role as Official Delegate. Their backing ensured that I was able to fulfil my duties and give our members a voice on the international stage.
Attending World Congress 2025 in Nairobi was an unforgettable experience that strengthened my leadership skills, broadened my understanding of global healthcare, and connected me with pharmacy students from across the world.
Most importantly, it reminded me of the importance of ensuring Australia and New Zealand are active participants in shaping the future of our profession.
To PSA and NAPSA, thank you once again for making this possible. To my fellow pharmacy students, I encourage you to take that first step, get involved, and see where it leads. You might just find yourself representing our country on the world stage one day.
[post_title] => A voice for Australia and New Zealand at IPSF 2025
[post_excerpt] => Australia and New Zealand had a voice at the IPSF World Congress, influencing discussions on education, practice and global health.
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[post_content] => A blistering opening plenary session at the FIP Congress last week has challenged policymakers and health professionals alike to act to slow the advance of antimicrobial resistance (AMR).
Mr Michele Cecchini, Head of Public Health, Organisation for Economic Co-operation and Development (OECD), worked through startling data showing the cost of AMR globally – in dollars, and in years of life lost.
The high price of insufficient action on AMR
The OECD has crunched the numbers, and the statistics are startling.
AMR is currently shortening life expectancy by an average of 1.8 years globally – 1.7 years for people in high-income countries, or 2.5 years for people in low-income countries.
This is represented in 79,000 people dying due to resistant infections across 34 OECD, European Union and European Economic Area counties – corresponding to 2.4 times the number of deaths due to tuberculosis, influenza and HIV/AIDS combined in 2020.
The financial burden on the health system is similarly staggering, with global annual costs totalling $US 412 billion.
Once lost productivity and loss of income costs are added in, this cost balloons to $US 850 billion annually – about the same size of Poland’s economy.
Bold action is required
Modelling by the OECD has shown that meaningful action is achievable – albeit with a substantial price tag.
To reduce AMR-related deaths by 10%, six actions are required:
- All countries need to have national AMR action plans and 60% of countries commit a budget
- 90% of countries should meet WHO’s minimum infection prevention and control programs at a national level
- All countries need to report surveillance data on AMR and antimicrobial use
- Meaningful reduction in antimicrobial use is taken in agrifood systems
- Strengthened actions to prevent and address the discharge of antimicrobials into the environment
- Mechanisms to support research and development to address AMR should be promoted.
The cost of these initiatives globally is estimated to be $US 52 billion annually – equivalent to 0.5% of the global health budget.
‘The World Bank told us this is a rounding error [in the context of health spending]. This is not an amount of money which cannot be mobilised,’ Mr Cecchini said.
These sentiments were echoed by the Danish Minister for the Interior and Health Sophie Løhde.
‘To tackle [AMR], we need to work much closer together, and your role as pharmacists and life science professionals is key,’ said Minister Løhde at the first plenary session of the 2025 FIP world congress last week. ‘We need your expertise to develop new antimicrobials in the most prudent and effective manner, and to inform and educate our citizens when you meet them in pharmacies all over the world.’
The FIP Copenhagen Declaration on Antimicrobial Resistance, signed by 79 organisations – including The Pharmaceutical Society of Australia – took place on 1 September 2025.
The FIP Declaration outlines clear priorities to address AMR, including global partnership building, promoting vaccination and rational antimicrobial use, protecting medicine supply chains, and advancing evidence on stewardship and outcomes.
[post_title] => OECD sounds the alarm on antimicrobial resistance
[post_excerpt] => A blistering session at the FIP Congress challenged policymakers and health professionals to slow the advance of antimicrobial resistance.
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[post_content] => Administered to the nasal mucosa, a spike-based formulation triggers rapid local defences that clear the COVID-19 virus where it enters.
In 2022, a year after Australia’s longest COVID-19 lockdowns, researchers from the Centenary Institute and the University of Sydney received a grant of almost $1 million from the NSW COVID-19 Vaccine Acceleration Research Grants Program to develop an intranasal COVID-19 vaccine.
Now, new research has been released by the team – finding that their formulation can stop infection in the nose before the virus spreads through the body, and to other people.
[caption id="attachment_30517" align="alignright" width="150"] Dr Erica Stewart, Centenary Institute[/caption]
Australian Pharmacist sat down with Dr Erica Stewart, first author and researcher at the Centenary Institute when the work was undertaken, to discuss how the vaccine works, its applications and why it could be the key to stopping the spread.
What is the vaccine’s mechanism of action?
By acting where the virus first enters, the nasal vaccine prompts a rapid, effective immune response that eliminates the virus, Dr Stewart said.
‘The adjuvant we used was Pam2Cys, a Toll-like receptor 2 (TLR2), and we showed that it was able to stimulate the immune response in the nasal passages,’ she said.
‘We formulated the SARS-CoV-2 spike protein with this adjuvant, which emulates bacteria to alert the immune system that there is a danger and it should respond.’
When administered as a booster after a standard injection, the treatment also provided additional protection to vital organs, including the lungs and brain – pointing to the benefits of focusing immune responses within the upper airways.
Why target the nasal mucosa?
The nasal passage is an increasingly promising site for vaccine adjuvant formulation, Dr Stewart said.
‘It’s becoming more and more clear that the nasal passage is a very different immune environment to an injection in the muscle.’
Internationally, there are some other pre-clinical models of mucosal vaccines. ‘But most of those mucosal vaccines are viral vectors because there aren't a lot of vaccine adjuvants that have been found to be effective nasally, which is part of the novelty of this study,’ she said.
The team had previously looked at intranasal vaccination in mice, using a model where the vaccine entered both the lungs and the nose.
‘However, the main takeaway from this research was, when [administering] a very small volume to just the nose, we still got a really strong immune response in the blood,’ she said. ‘We also looked into the nose itself, and we could see that the immune cells were retained for long periods in the nasal passages, where they will be able to respond to infection quickly.’
There’s hope that these vaccines can potentially prevent infection and transmission by building immune defences directly in the upper airways where the virus first takes hold – a frontier that traditional vaccines have yet to reach.
‘We currently reduce disease severity really well, but we're still trying to block transmission,’ Dr Stewart said. ‘That's what nasal vaccines are aiming to address.’
Who would benefit most from a nasal COVID-19 vaccine?
Vulnerable populations who are more susceptible to severe disease, hospitalisations and death.
‘Sometimes you'll hear people say, “COVID-19 is over” – but people are still dying of it, including the elderly, immunocompromised people and those with other comorbidities,’ Dr Stewart said.
Similar to how younger, healthy patients are advised to get the flu vaccine to protect more vulnerable members of the community – this vaccine offers an additional layer of protection.
‘It would be the vulnerable people who are benefiting, but the vaccine would be for everyone to try to reduce the circulation of the virus in our community,’ she said.
How would the vaccine fit into the routine immunisation schedule?
With most people vaccinated against COVID-19 or exposed to the virus, the mucosal vaccines will likely be used as a booster.
‘In the mouse model, both the vaccine as a booster or as a primary vaccination induced nasal immunity,’ Dr Stewart said.
It’s assumed that the nasal vaccine will be used as an annual seasonal dose, similar to the flu vaccine or COVID-19 boosters for certain populations.
‘We do have some evidence that the vaccine can neutralise against other variants, but [we need to explore] how well it protects people and for how long, because that would indicate whether continuous boosters are needed,’ she said.
It’s also anticipated that the nasal vaccine will be self-administered.
‘There are studies looking into self-administration of nasal vaccines, which could really help with distribution and access to these vaccines in the community,’ she said.
This mode of administration could be particularly beneficial for those who are needlephobic, including children.
‘For people who cannot stand getting a needle, this is a less invasive method of vaccination,’ Dr Stewart said.
The researchers say that while more work is needed, the results show strong potential for nasal vaccines to complement existing COVID-19 vaccines and provide an extra layer of protection against the virus in the future.
[post_title] => Intranasal vaccine stops infection at the source
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[post_content] => For years it seemed impossible to achieve, but markedly reducing chemical restraint is on its way. AP meets guardians of medicine management who are highly involved.
Australian pharmacists are playing a vital role in one of the nation’s most important healthcare campaigns – the reduction and ultimate elimination of chemical restraint.
The final reports of the Royal Commission into Aged Care Quality and Safety1 (2021) and the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability2 (2023) made strong recommendations to reduce and ultimately eliminate the use of chemical restraint, sharing a commitment to upholding the rights and dignity of older people and people with disability.
In a joint statement in 2022, the Australian Commission on Safety and Quality in Health Care, the Aged Care Quality and Safety Commission and the NDIS Safety and Quality Commission acknowledged that psychotropic medicines were being overprescribed and overused for managing behaviours of concern. The disability royal commission final report went even further, says Advanced Practice Pharmacist and University of Western Australia Adjunct Professor Manya Angley FPS.
‘It called for a national approach to reducing and eliminating restrictive practices, including chemical restraint, and emphasised the need for a coordinated framework with targets, data collection, evaluation, performance indicators, timeframes and independent oversight. It also focused,’ she notes, ‘on supported decision-making and workforce training in trauma-informed, person-centred care.’
Annual Positive Behaviour Support progress reports were specifically recommended, she says, with an independent evaluation of measures to determine if the use of psychotropic medicines as chemical restraint in people with cognitive disability was reducing.
‘I have been working in aged care as an RMMR and QUM pharmacist since 2018,’ says Dr Angley. ‘Before the aged care royal commission interim report, risperidone as chemical restraint, and psychotropic medicines generally, were used less “mindfully”. If a doctor prescribed a psychotropic medication at usual doses as chemical restraint, it was considered acceptable. Since 2020, GPs, nurses and care staff have greater awareness of the risks of antipsychotics (including falls, stroke and death), the value of bespoke Positive Behaviour Support plans containing a suite of person-centred non-pharmacological strategies, and the need to gain informed consent before using chemical restraint.’
Dr Angley believes ‘everyone is getting better at identifying triggers for changed behaviours’. These can include constipation, urinary retention, pain, boredom, hunger or thirst, infection and medicines.
‘There is improved understanding that chemical restraint should only be used as a last resort, for the shortest possible time and at the lowest dose possible.’
Dr Angley also registered as an NDIS Positive Behaviour Support (PBS) practitioner in 2023. She uses her medicines expertise to identify and deprescribe chemical restraint in NDIS participants.
Pharmacists, as highly trained clinicians, are able to identify if health issues are contributing to changed behaviour. She believes credentialed pharmacists need to play a bigger role in the development of PBS plans for NDIS participants who are prescribed chemical restraint.
There are, however, limited funding options for medicines review services by credentialed pharmacists. Aside from registering as a PBS practitioner, remuneration for services provided to NDIS participants in the community is only available through Home Medicines Reviews, which require a doctor’s referral – a significant barrier.
AP asked two credentialed pharmacists about their experiences with the reduction of chemical restraint.
Case 1
[caption id="attachment_30506" align="alignright" width="148"] Chelsea Felkai, MPS[/caption]
Chelsea Felkai MPS, Disability and ACOP Pharmacist, Maroba Aged Care Facility, Waratah, Newcastle, NSW
I typically generate reports on residents who use psychotropic medicines. I talk with the resident, their family members, the RACF staff who know the resident, and the resident’s prescriber, to look at whether the medicine is the best option for the person, or if we need to explore alternatives.
Once we have established a resident would benefit from reductions, I work with the prescriber to put deprescribing or tapering plans in place to reduce (or cease) less appropriate medicines. Because I am on site 3 days a week, I am able to monitor this closely to ensure the resident is supported and safe through the process.
In early wins, we have been able to replace mostly tricyclic antidepressants (TCAs) with high anticholinergic burden to newer agent antidepressants (I tend to call this low-hanging fruit) with a lot of success.
Though it’s not strictly chemical restraint, it has brought about a large reduction in adverse outcomes across the facility. We have seen a complete cessation of antipsychotic medicines in only two residents so far (the facility has 150, with approximately 25 in the memory support unit), but we have been able to reduce chemical restraint in all residents to the lowest effective maintenance dose.
We have seen an increase in selective serotonin reuptake inhibitor (SSRI) medicines, and a reduction in TCAs. We have also seen an increase in duloxetine and mirtazapine. I have tried to use some of the newer evidence of duloxetine’s efficacy for chronic pain management and mirtazapine’s for sleep support, as options when switching antidepressants.
There has been some discomfort from residents and staff while we have trialled reduction in psychotropic medicines, to ensure the resident is on the lowest possible dose. Because education was provided to staff at the start, it was met with little resistance. And it helped that I was on site to provide support and monitor the outcomes.
Working with the nursing staff to understand when PRN (as required) chemical restraint might be used, and ensuring other options have been exhausted first, has shown the most reduction in how much psychotropic medications have been used so far. The numbers are relatively small, but to be honest, this is largely because the facility had great protocols to begin with.
The impact has been noticeable. Staff members say they feel more confident in the care they provide and the non-pharmacological options they now have at their disposal.
When they do move to a chemical restraint option, it is because other options have been exhausted, and it is in the best interest of the resident.
Case 2
[caption id="attachment_26803" align="alignleft" width="144"] Dr Natalie Soulsby FPS[/caption]
Dr Natalie Soulsby FPS, Credentialed Pharmacist, South Australia
My role is Head of Clinical Governance and Quality Assurance for Embedded Health Solutions, which provides clinical pharmacy services to about 600 residential aged care facilities (RACFs).
One of my roles is to attend national medication advisory committee (MAC) meetings to provide information to head office on medication management, including the psychotropic register. I analyse the information on the register and provide a clinical lens, which is used to support staff to understand where these medicines may be being used as restraints.
The Aged Care Quality and Safety Commission responded to the Royal Commission into Aged Care Quality and Safety by creating a psychotropic register that needs to be updated monthly, so they can keep track of how many patients were prescribed a medicine that was used as a chemical restraint and how they were being managed.
In 2021, when the National Aged Care Quality Indicator Program included the use of antipsychotic medicines, the quarterly numbers showed 21.6% of residents were administered antipsychotic medicines during a 7-day time frame. That figure is now down to 17.3%.
The registers have been a good trigger to remind doctors to review their patients’ treatments. When it began, doctors were concerned about prescribing antipsychotic medicines, and unfortunately some GPs stopped their patients’ medicines, which caused a return of their symptoms. These medicines must be weaned slowly.
There is still a stigma with these medicines, and our focus is always on appropriateness. All the new red tape means staff at the facilities spend a lot more time collecting data.
Initially it was overwhelming and confusing. GPs were concerned about the impact on their patients. There was also a lack of communication and understanding. The staff are more confident now, but there is still confusion as to what constitutes a chemical restraint.
Now everyone in the care team, including the staff in the home, the GP and the family, are involved in the process. Staff members encourage GPs to look at the psychotropic medicines regularly (at least every 3 months), and the staff assess the effectiveness or otherwise of the medications and consider any adverse effects and update the Behaviour Support Plan. This is considered best practice.
And one of the roles of the credentialed pharmacist is to support the home in filling out the register.
One impact has been a shift to more person-centred care.
The patient is seen as an active participant in their care, which lines up with the new Aged Care Act coming into effect in November this year. The concept is good, but we are still trying to work out how that will work in the long term.
Reviewing the psychotropic register allows us to support our facilities in ensuring appropriate treatments are prescribed and reviewed regularly for the residents.
We can use the register as part of our reviews and for follow-ups.
Nursing staff are more aware of the role of medicines in treating responsive behaviours, and having the register supports their conversations with the GPs. Our role is to be the continuity-of-care person and why we allocate pharmacists to specific aged care facilities, which allows them to become part of the team and provide appropriate advice and support.
We are the second set of eyes. We put a clinical lens over what has gone on and can help the nursing staff.
Pharmacists are the guardians of medicines management and the advocates for the nursing staff and residents. We help support the residents’ care.
References
- Royal Commission into Aged Care Quality and Safety. Final Report. 2021. At: www.royalcommission.gov.au/aged-care/final-report
- Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. Final Report. 2023. At: https://disability.royalcommission.gov.au/publications/final-report
[post_title] => How pharmacists are reducing chemical restraint
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[post_content] => Women of reproductive age using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) could be at risk of unintended pregnancy, and may be unaware of associated risks to pregnancy and unborn babies.
A new study by Flinders University, which examined records from more than 1.6 million women aged 18–49 who attended general practice between 2011 and 2022, found that only one in five (21%) of those with first prescribing of GLP-1 RAs had documented contraceptive use.
The study also found that most prescriptions for GLP-1 RAs are now issued to women without diabetes. In 2022 alone, more than 6,000 women began treatment on GLP-1 RAs, and over 90% of those did not have a type 2 diabetes diagnosis.
[caption id="attachment_30483" align="alignright" width="300"] Associate Professor Luke Grzeskowiak[/caption]
Participants were tracked at the initial stages of GLP-1 RA therapy, with the research team looking at documented evidence of pregnancies over a 6-month period, said lead author and pharmacist, Associate Professor Luke Grzeskowiak.
‘[While] limited to data from GP records, one in 25 women aged 18 to 34 years had a documented pregnancy at the time of prescribing,’ he said.
‘There will also be pregnancies that the GP might not be aware of, so if anything, what we're expecting is that this is an underestimate of what's truly happening.’
Those who were prescribed concurrent contraception were 50% less likely to have a documented pregnancy.
‘So we've got clear evidence that contraceptive use at the time of initiating these medicines reduces the risk of pregnancies occurring,’ A/Prof Grzeskowiak said.
Why does GLP-1 RA use increase pregnancy risk?
There are two key reasons: first, it is ‘well established’ that weight loss can improve fertility.
‘Because we know these medicines are very effective at promoting weight loss, it's highly plausible that they could improve fertility through that mechanism,’ A/Prof Grzeskowiak said.
There have also been concerns that GLP-1 RAs might impact absorption of the oral contraceptive pill.
In June 2025, the UK’s Medicines and Healthcare products Regulatory Agency issued a regulatory warning following case reports of unexpected pregnancies associated with GLP-1 RA use.
‘A detailed review [revealed] that the strongest evidence was around potential interaction between tirzepatide and reduced effectiveness of oral contraception,’ A/Prof Grzeskowiak said.
To date, evidence regarding interactions between GLP-1 RAs and the oral contraceptive pill is limited.
‘So the general recommendations around that regulatory warning were for those relying on oral contraceptive methods to also consider using a barrier method,’ he said.
What are the congenital risk factors?
The research also considered potential harms associated with GLP-1 RAs in pregnancy. Key concerns were taken from a University of Amsterdam review of animal studies, cited in the Flinders University study.
‘In animals, use of GLP-1 RAs [in pregnancy] led to reductions in foetal growth, impairments in bone development and impaired maternal weight gain,’ A/Prof Grzeskowiak said.
At this stage, the human data are more reassuring.
‘The studies that have been done have not shown an increased risk of birth defects,’ he said. ‘But they are still relatively limited in terms of numbers, and we don't have an examination of the full range of pregnancy outcomes yet,’ he said.
Due to this uncertainty, an abundance of caution is advised.
‘The recommendations are to not use these medicines during pregnancy, and to avoid the potential for them to be used during pregnancy accidentally,’ A/Prof Grzeskowiak said. ‘So it’s important to have a plan around concurrent contraception use, high-quality pre-conception care, and ensure that where pregnancies are planned, everything has been done to optimise pregnancy outcomes.’
What should pharmacists advise patients?
Dispensing GLP-1 RAs provides important opportunities for pharmacists to talk to patients about reproductive health.
For example, when dispensing tirzepatide, access to dispensing data on contraceptive methods enables pharmacists to raise awareness of the potential interaction by initiating an open and unassuming conversation, A/Prof Grzeskowiak said.
‘Having a conversation about how that might be addressed means patients can make an informed decision,’ he said. ‘It might mean changing contraceptive methods or [referring] them back to the GP for a conversation. Or it may be that they're using contraceptives for non-contraceptive purposes such as acne [management], so there’s a low risk of pregnancy.’
The initiation of therapy is the ideal time to discuss potential risks.
‘That way people know what to expect in terms of the medicines,’ he said.
When commencing GLP-1 RAs, patients may also experience profound gastrointestinal adverse effects, including vomiting or diarrhoea.
‘That in itself can reduce the effectiveness of oral contraception, regardless of any other interactions,’ A/Prof Grzeskowiak said. ‘So people should be aware of the side effects of what to expect when starting this and how it might impact on other treatments that they're using.’
Pharmacists have an important role in engaging patients in conversations about reproductive health, particularly contraception.
‘Not everyone feels comfortable asking those questions, but there are good training resources, particularly through PSA, around improving pharmacists’ comfort with having those conversations, including around the different types of contraceptive methods,’ he said.
‘It's one thing to start the conversation, but you also need to be armed with various information to be able to continue it, or at least identify when to refer patients back to their medical practitioner or another [healthcare practitioner] to provide that detailed advice.’
[post_title] => GLP-1 RAs found to pose pregnancy risks
[post_excerpt] => Women of reproductive age using GLP-1 RAs could be at risk of unintended pregnancy, and unaware of the risks to pregnancy and unborn babies.
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[post_content] => In August 2025, I had the privilege of attending the International Pharmaceutical Students’ Federation (IPSF) World Congress in Nairobi, Kenya.
The theme of this year’s congress, Advancing Pharmacy Education and Practice for Global Health Impact, was reflected throughout the week in discussions, panels and workshops.
Thanks to the generous support of PSA and the National Australian Pharmacy Students’ Association (NAPSA), I was able to represent both Australia and New Zealand as the sole Official Delegate at the General Assembly. Without their support, our countries would not have had a voice.
Leaders in training
Before the official start of World Congress, I participated in the Leaders in Training (LiT) program, where I became an Alpha Trainer after reaching the required hours. I ran workshops focused on developing soft skills for future leaders, guiding students through sessions on motivation, feedback and evaluation.
This was a rewarding opportunity to share knowledge, strengthen my own skills, and witness the energy and passion of upcoming leaders.
Once the Congress began, much of my time was spent in the General Assembly, carrying the responsibility of casting votes and ensuring the perspectives of
students from both Australia and New Zealand were heard. Being the only delegate from our area made me realise just how vital the support of PSA and NAPSA was.
Technology and access
Among the many events I attended, one highlight was a panel discussion on the use of AI in healthcare. This session offered a fascinating look at both the opportunities and the challenges of integrating AI into healthcare delivery.
I also gained insight into the industrial pharmacy sector in Kenya, as well as the broader challenges faced by healthcare in Nairobi. These experiences expanded my understanding of the global landscape of pharmacy and reminded me of the inequities that continue to exist in access to medicines and resources.
The Congress also gave me the chance to reconnect with peers from around the world, including those I had previously worked with as NAPSA’s Contact Person. It was valuable to strengthen existing connections and build friendships with students who share the same interest in pharmacy.World Congress was a once-in-a-lifetime experience; one I hope more Australian pharmacy students will pursue in the future.
Start local, go global
IPSF represents over 500,000 pharmacy students worldwide, yet Australia’s presence remains small. I want to change that by encouraging more students to get involved and take advantage of the opportunities IPSF offers.
The first step is to become involved in your local student branch, which can then open doors to national opportunities through NAPSA and, eventually, to international representation.
I still remember attending my first IPSF conference alone and feeling nervous, only to be welcomed immediately by the IPSF Asia Pacific Regional Office (APRO), who embraced me as part of their community. The warmth and inclusivity I experienced then continues to inspire me, and I encourage others to take the same leap.
People want to connect with you, and IPSF provides a space where friendships, networks, and professional growth come naturally.
Looking ahead, the next IPSF events will be the Asia Pacific Pharmaceutical Symposium (APPS) in Indonesia and the World Congress in Thailand. I would strongly encourage pharmacy students to consider attending these future events, as they are transformative experiences that broaden horizons, deepen understanding and build lifelong networks.
Pathways Ahead
I am deeply grateful to PSA for their monumental support in making my attendance possible. With travel costs being high, it would have been impossible for me to attend without their sponsorship.
Because of their generosity, Australia and New Zealand were represented at the General Assembly, and our perspectives contributed to global discussions.
I also want to thank NAPSA for their support, which made it more feasible for me to attend in my role as Official Delegate. Their backing ensured that I was able to fulfil my duties and give our members a voice on the international stage.
Attending World Congress 2025 in Nairobi was an unforgettable experience that strengthened my leadership skills, broadened my understanding of global healthcare, and connected me with pharmacy students from across the world.
Most importantly, it reminded me of the importance of ensuring Australia and New Zealand are active participants in shaping the future of our profession.
To PSA and NAPSA, thank you once again for making this possible. To my fellow pharmacy students, I encourage you to take that first step, get involved, and see where it leads. You might just find yourself representing our country on the world stage one day.
[post_title] => A voice for Australia and New Zealand at IPSF 2025
[post_excerpt] => Australia and New Zealand had a voice at the IPSF World Congress, influencing discussions on education, practice and global health.
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[post_content] => A blistering opening plenary session at the FIP Congress last week has challenged policymakers and health professionals alike to act to slow the advance of antimicrobial resistance (AMR).
Mr Michele Cecchini, Head of Public Health, Organisation for Economic Co-operation and Development (OECD), worked through startling data showing the cost of AMR globally – in dollars, and in years of life lost.
The high price of insufficient action on AMR
The OECD has crunched the numbers, and the statistics are startling.
AMR is currently shortening life expectancy by an average of 1.8 years globally – 1.7 years for people in high-income countries, or 2.5 years for people in low-income countries.
This is represented in 79,000 people dying due to resistant infections across 34 OECD, European Union and European Economic Area counties – corresponding to 2.4 times the number of deaths due to tuberculosis, influenza and HIV/AIDS combined in 2020.
The financial burden on the health system is similarly staggering, with global annual costs totalling $US 412 billion.
Once lost productivity and loss of income costs are added in, this cost balloons to $US 850 billion annually – about the same size of Poland’s economy.
Bold action is required
Modelling by the OECD has shown that meaningful action is achievable – albeit with a substantial price tag.
To reduce AMR-related deaths by 10%, six actions are required:
- All countries need to have national AMR action plans and 60% of countries commit a budget
- 90% of countries should meet WHO’s minimum infection prevention and control programs at a national level
- All countries need to report surveillance data on AMR and antimicrobial use
- Meaningful reduction in antimicrobial use is taken in agrifood systems
- Strengthened actions to prevent and address the discharge of antimicrobials into the environment
- Mechanisms to support research and development to address AMR should be promoted.
The cost of these initiatives globally is estimated to be $US 52 billion annually – equivalent to 0.5% of the global health budget.
‘The World Bank told us this is a rounding error [in the context of health spending]. This is not an amount of money which cannot be mobilised,’ Mr Cecchini said.
These sentiments were echoed by the Danish Minister for the Interior and Health Sophie Løhde.
‘To tackle [AMR], we need to work much closer together, and your role as pharmacists and life science professionals is key,’ said Minister Løhde at the first plenary session of the 2025 FIP world congress last week. ‘We need your expertise to develop new antimicrobials in the most prudent and effective manner, and to inform and educate our citizens when you meet them in pharmacies all over the world.’
The FIP Copenhagen Declaration on Antimicrobial Resistance, signed by 79 organisations – including The Pharmaceutical Society of Australia – took place on 1 September 2025.
The FIP Declaration outlines clear priorities to address AMR, including global partnership building, promoting vaccination and rational antimicrobial use, protecting medicine supply chains, and advancing evidence on stewardship and outcomes.
[post_title] => OECD sounds the alarm on antimicrobial resistance
[post_excerpt] => A blistering session at the FIP Congress challenged policymakers and health professionals to slow the advance of antimicrobial resistance.
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[post_content] => Administered to the nasal mucosa, a spike-based formulation triggers rapid local defences that clear the COVID-19 virus where it enters.
In 2022, a year after Australia’s longest COVID-19 lockdowns, researchers from the Centenary Institute and the University of Sydney received a grant of almost $1 million from the NSW COVID-19 Vaccine Acceleration Research Grants Program to develop an intranasal COVID-19 vaccine.
Now, new research has been released by the team – finding that their formulation can stop infection in the nose before the virus spreads through the body, and to other people.
[caption id="attachment_30517" align="alignright" width="150"] Dr Erica Stewart, Centenary Institute[/caption]
Australian Pharmacist sat down with Dr Erica Stewart, first author and researcher at the Centenary Institute when the work was undertaken, to discuss how the vaccine works, its applications and why it could be the key to stopping the spread.
What is the vaccine’s mechanism of action?
By acting where the virus first enters, the nasal vaccine prompts a rapid, effective immune response that eliminates the virus, Dr Stewart said.
‘The adjuvant we used was Pam2Cys, a Toll-like receptor 2 (TLR2), and we showed that it was able to stimulate the immune response in the nasal passages,’ she said.
‘We formulated the SARS-CoV-2 spike protein with this adjuvant, which emulates bacteria to alert the immune system that there is a danger and it should respond.’
When administered as a booster after a standard injection, the treatment also provided additional protection to vital organs, including the lungs and brain – pointing to the benefits of focusing immune responses within the upper airways.
Why target the nasal mucosa?
The nasal passage is an increasingly promising site for vaccine adjuvant formulation, Dr Stewart said.
‘It’s becoming more and more clear that the nasal passage is a very different immune environment to an injection in the muscle.’
Internationally, there are some other pre-clinical models of mucosal vaccines. ‘But most of those mucosal vaccines are viral vectors because there aren't a lot of vaccine adjuvants that have been found to be effective nasally, which is part of the novelty of this study,’ she said.
The team had previously looked at intranasal vaccination in mice, using a model where the vaccine entered both the lungs and the nose.
‘However, the main takeaway from this research was, when [administering] a very small volume to just the nose, we still got a really strong immune response in the blood,’ she said. ‘We also looked into the nose itself, and we could see that the immune cells were retained for long periods in the nasal passages, where they will be able to respond to infection quickly.’
There’s hope that these vaccines can potentially prevent infection and transmission by building immune defences directly in the upper airways where the virus first takes hold – a frontier that traditional vaccines have yet to reach.
‘We currently reduce disease severity really well, but we're still trying to block transmission,’ Dr Stewart said. ‘That's what nasal vaccines are aiming to address.’
Who would benefit most from a nasal COVID-19 vaccine?
Vulnerable populations who are more susceptible to severe disease, hospitalisations and death.
‘Sometimes you'll hear people say, “COVID-19 is over” – but people are still dying of it, including the elderly, immunocompromised people and those with other comorbidities,’ Dr Stewart said.
Similar to how younger, healthy patients are advised to get the flu vaccine to protect more vulnerable members of the community – this vaccine offers an additional layer of protection.
‘It would be the vulnerable people who are benefiting, but the vaccine would be for everyone to try to reduce the circulation of the virus in our community,’ she said.
How would the vaccine fit into the routine immunisation schedule?
With most people vaccinated against COVID-19 or exposed to the virus, the mucosal vaccines will likely be used as a booster.
‘In the mouse model, both the vaccine as a booster or as a primary vaccination induced nasal immunity,’ Dr Stewart said.
It’s assumed that the nasal vaccine will be used as an annual seasonal dose, similar to the flu vaccine or COVID-19 boosters for certain populations.
‘We do have some evidence that the vaccine can neutralise against other variants, but [we need to explore] how well it protects people and for how long, because that would indicate whether continuous boosters are needed,’ she said.
It’s also anticipated that the nasal vaccine will be self-administered.
‘There are studies looking into self-administration of nasal vaccines, which could really help with distribution and access to these vaccines in the community,’ she said.
This mode of administration could be particularly beneficial for those who are needlephobic, including children.
‘For people who cannot stand getting a needle, this is a less invasive method of vaccination,’ Dr Stewart said.
The researchers say that while more work is needed, the results show strong potential for nasal vaccines to complement existing COVID-19 vaccines and provide an extra layer of protection against the virus in the future.
[post_title] => Intranasal vaccine stops infection at the source
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[post_content] => For years it seemed impossible to achieve, but markedly reducing chemical restraint is on its way. AP meets guardians of medicine management who are highly involved.
Australian pharmacists are playing a vital role in one of the nation’s most important healthcare campaigns – the reduction and ultimate elimination of chemical restraint.
The final reports of the Royal Commission into Aged Care Quality and Safety1 (2021) and the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability2 (2023) made strong recommendations to reduce and ultimately eliminate the use of chemical restraint, sharing a commitment to upholding the rights and dignity of older people and people with disability.
In a joint statement in 2022, the Australian Commission on Safety and Quality in Health Care, the Aged Care Quality and Safety Commission and the NDIS Safety and Quality Commission acknowledged that psychotropic medicines were being overprescribed and overused for managing behaviours of concern. The disability royal commission final report went even further, says Advanced Practice Pharmacist and University of Western Australia Adjunct Professor Manya Angley FPS.
‘It called for a national approach to reducing and eliminating restrictive practices, including chemical restraint, and emphasised the need for a coordinated framework with targets, data collection, evaluation, performance indicators, timeframes and independent oversight. It also focused,’ she notes, ‘on supported decision-making and workforce training in trauma-informed, person-centred care.’
Annual Positive Behaviour Support progress reports were specifically recommended, she says, with an independent evaluation of measures to determine if the use of psychotropic medicines as chemical restraint in people with cognitive disability was reducing.
‘I have been working in aged care as an RMMR and QUM pharmacist since 2018,’ says Dr Angley. ‘Before the aged care royal commission interim report, risperidone as chemical restraint, and psychotropic medicines generally, were used less “mindfully”. If a doctor prescribed a psychotropic medication at usual doses as chemical restraint, it was considered acceptable. Since 2020, GPs, nurses and care staff have greater awareness of the risks of antipsychotics (including falls, stroke and death), the value of bespoke Positive Behaviour Support plans containing a suite of person-centred non-pharmacological strategies, and the need to gain informed consent before using chemical restraint.’
Dr Angley believes ‘everyone is getting better at identifying triggers for changed behaviours’. These can include constipation, urinary retention, pain, boredom, hunger or thirst, infection and medicines.
‘There is improved understanding that chemical restraint should only be used as a last resort, for the shortest possible time and at the lowest dose possible.’
Dr Angley also registered as an NDIS Positive Behaviour Support (PBS) practitioner in 2023. She uses her medicines expertise to identify and deprescribe chemical restraint in NDIS participants.
Pharmacists, as highly trained clinicians, are able to identify if health issues are contributing to changed behaviour. She believes credentialed pharmacists need to play a bigger role in the development of PBS plans for NDIS participants who are prescribed chemical restraint.
There are, however, limited funding options for medicines review services by credentialed pharmacists. Aside from registering as a PBS practitioner, remuneration for services provided to NDIS participants in the community is only available through Home Medicines Reviews, which require a doctor’s referral – a significant barrier.
AP asked two credentialed pharmacists about their experiences with the reduction of chemical restraint.
Case 1
[caption id="attachment_30506" align="alignright" width="148"] Chelsea Felkai, MPS[/caption]
Chelsea Felkai MPS, Disability and ACOP Pharmacist, Maroba Aged Care Facility, Waratah, Newcastle, NSW
I typically generate reports on residents who use psychotropic medicines. I talk with the resident, their family members, the RACF staff who know the resident, and the resident’s prescriber, to look at whether the medicine is the best option for the person, or if we need to explore alternatives.
Once we have established a resident would benefit from reductions, I work with the prescriber to put deprescribing or tapering plans in place to reduce (or cease) less appropriate medicines. Because I am on site 3 days a week, I am able to monitor this closely to ensure the resident is supported and safe through the process.
In early wins, we have been able to replace mostly tricyclic antidepressants (TCAs) with high anticholinergic burden to newer agent antidepressants (I tend to call this low-hanging fruit) with a lot of success.
Though it’s not strictly chemical restraint, it has brought about a large reduction in adverse outcomes across the facility. We have seen a complete cessation of antipsychotic medicines in only two residents so far (the facility has 150, with approximately 25 in the memory support unit), but we have been able to reduce chemical restraint in all residents to the lowest effective maintenance dose.
We have seen an increase in selective serotonin reuptake inhibitor (SSRI) medicines, and a reduction in TCAs. We have also seen an increase in duloxetine and mirtazapine. I have tried to use some of the newer evidence of duloxetine’s efficacy for chronic pain management and mirtazapine’s for sleep support, as options when switching antidepressants.
There has been some discomfort from residents and staff while we have trialled reduction in psychotropic medicines, to ensure the resident is on the lowest possible dose. Because education was provided to staff at the start, it was met with little resistance. And it helped that I was on site to provide support and monitor the outcomes.
Working with the nursing staff to understand when PRN (as required) chemical restraint might be used, and ensuring other options have been exhausted first, has shown the most reduction in how much psychotropic medications have been used so far. The numbers are relatively small, but to be honest, this is largely because the facility had great protocols to begin with.
The impact has been noticeable. Staff members say they feel more confident in the care they provide and the non-pharmacological options they now have at their disposal.
When they do move to a chemical restraint option, it is because other options have been exhausted, and it is in the best interest of the resident.
Case 2
[caption id="attachment_26803" align="alignleft" width="144"] Dr Natalie Soulsby FPS[/caption]
Dr Natalie Soulsby FPS, Credentialed Pharmacist, South Australia
My role is Head of Clinical Governance and Quality Assurance for Embedded Health Solutions, which provides clinical pharmacy services to about 600 residential aged care facilities (RACFs).
One of my roles is to attend national medication advisory committee (MAC) meetings to provide information to head office on medication management, including the psychotropic register. I analyse the information on the register and provide a clinical lens, which is used to support staff to understand where these medicines may be being used as restraints.
The Aged Care Quality and Safety Commission responded to the Royal Commission into Aged Care Quality and Safety by creating a psychotropic register that needs to be updated monthly, so they can keep track of how many patients were prescribed a medicine that was used as a chemical restraint and how they were being managed.
In 2021, when the National Aged Care Quality Indicator Program included the use of antipsychotic medicines, the quarterly numbers showed 21.6% of residents were administered antipsychotic medicines during a 7-day time frame. That figure is now down to 17.3%.
The registers have been a good trigger to remind doctors to review their patients’ treatments. When it began, doctors were concerned about prescribing antipsychotic medicines, and unfortunately some GPs stopped their patients’ medicines, which caused a return of their symptoms. These medicines must be weaned slowly.
There is still a stigma with these medicines, and our focus is always on appropriateness. All the new red tape means staff at the facilities spend a lot more time collecting data.
Initially it was overwhelming and confusing. GPs were concerned about the impact on their patients. There was also a lack of communication and understanding. The staff are more confident now, but there is still confusion as to what constitutes a chemical restraint.
Now everyone in the care team, including the staff in the home, the GP and the family, are involved in the process. Staff members encourage GPs to look at the psychotropic medicines regularly (at least every 3 months), and the staff assess the effectiveness or otherwise of the medications and consider any adverse effects and update the Behaviour Support Plan. This is considered best practice.
And one of the roles of the credentialed pharmacist is to support the home in filling out the register.
One impact has been a shift to more person-centred care.
The patient is seen as an active participant in their care, which lines up with the new Aged Care Act coming into effect in November this year. The concept is good, but we are still trying to work out how that will work in the long term.
Reviewing the psychotropic register allows us to support our facilities in ensuring appropriate treatments are prescribed and reviewed regularly for the residents.
We can use the register as part of our reviews and for follow-ups.
Nursing staff are more aware of the role of medicines in treating responsive behaviours, and having the register supports their conversations with the GPs. Our role is to be the continuity-of-care person and why we allocate pharmacists to specific aged care facilities, which allows them to become part of the team and provide appropriate advice and support.
We are the second set of eyes. We put a clinical lens over what has gone on and can help the nursing staff.
Pharmacists are the guardians of medicines management and the advocates for the nursing staff and residents. We help support the residents’ care.
References
- Royal Commission into Aged Care Quality and Safety. Final Report. 2021. At: www.royalcommission.gov.au/aged-care/final-report
- Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. Final Report. 2023. At: https://disability.royalcommission.gov.au/publications/final-report
[post_title] => How pharmacists are reducing chemical restraint
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[post_content] => Women of reproductive age using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) could be at risk of unintended pregnancy, and may be unaware of associated risks to pregnancy and unborn babies.
A new study by Flinders University, which examined records from more than 1.6 million women aged 18–49 who attended general practice between 2011 and 2022, found that only one in five (21%) of those with first prescribing of GLP-1 RAs had documented contraceptive use.
The study also found that most prescriptions for GLP-1 RAs are now issued to women without diabetes. In 2022 alone, more than 6,000 women began treatment on GLP-1 RAs, and over 90% of those did not have a type 2 diabetes diagnosis.
[caption id="attachment_30483" align="alignright" width="300"] Associate Professor Luke Grzeskowiak[/caption]
Participants were tracked at the initial stages of GLP-1 RA therapy, with the research team looking at documented evidence of pregnancies over a 6-month period, said lead author and pharmacist, Associate Professor Luke Grzeskowiak.
‘[While] limited to data from GP records, one in 25 women aged 18 to 34 years had a documented pregnancy at the time of prescribing,’ he said.
‘There will also be pregnancies that the GP might not be aware of, so if anything, what we're expecting is that this is an underestimate of what's truly happening.’
Those who were prescribed concurrent contraception were 50% less likely to have a documented pregnancy.
‘So we've got clear evidence that contraceptive use at the time of initiating these medicines reduces the risk of pregnancies occurring,’ A/Prof Grzeskowiak said.
Why does GLP-1 RA use increase pregnancy risk?
There are two key reasons: first, it is ‘well established’ that weight loss can improve fertility.
‘Because we know these medicines are very effective at promoting weight loss, it's highly plausible that they could improve fertility through that mechanism,’ A/Prof Grzeskowiak said.
There have also been concerns that GLP-1 RAs might impact absorption of the oral contraceptive pill.
In June 2025, the UK’s Medicines and Healthcare products Regulatory Agency issued a regulatory warning following case reports of unexpected pregnancies associated with GLP-1 RA use.
‘A detailed review [revealed] that the strongest evidence was around potential interaction between tirzepatide and reduced effectiveness of oral contraception,’ A/Prof Grzeskowiak said.
To date, evidence regarding interactions between GLP-1 RAs and the oral contraceptive pill is limited.
‘So the general recommendations around that regulatory warning were for those relying on oral contraceptive methods to also consider using a barrier method,’ he said.
What are the congenital risk factors?
The research also considered potential harms associated with GLP-1 RAs in pregnancy. Key concerns were taken from a University of Amsterdam review of animal studies, cited in the Flinders University study.
‘In animals, use of GLP-1 RAs [in pregnancy] led to reductions in foetal growth, impairments in bone development and impaired maternal weight gain,’ A/Prof Grzeskowiak said.
At this stage, the human data are more reassuring.
‘The studies that have been done have not shown an increased risk of birth defects,’ he said. ‘But they are still relatively limited in terms of numbers, and we don't have an examination of the full range of pregnancy outcomes yet,’ he said.
Due to this uncertainty, an abundance of caution is advised.
‘The recommendations are to not use these medicines during pregnancy, and to avoid the potential for them to be used during pregnancy accidentally,’ A/Prof Grzeskowiak said. ‘So it’s important to have a plan around concurrent contraception use, high-quality pre-conception care, and ensure that where pregnancies are planned, everything has been done to optimise pregnancy outcomes.’
What should pharmacists advise patients?
Dispensing GLP-1 RAs provides important opportunities for pharmacists to talk to patients about reproductive health.
For example, when dispensing tirzepatide, access to dispensing data on contraceptive methods enables pharmacists to raise awareness of the potential interaction by initiating an open and unassuming conversation, A/Prof Grzeskowiak said.
‘Having a conversation about how that might be addressed means patients can make an informed decision,’ he said. ‘It might mean changing contraceptive methods or [referring] them back to the GP for a conversation. Or it may be that they're using contraceptives for non-contraceptive purposes such as acne [management], so there’s a low risk of pregnancy.’
The initiation of therapy is the ideal time to discuss potential risks.
‘That way people know what to expect in terms of the medicines,’ he said.
When commencing GLP-1 RAs, patients may also experience profound gastrointestinal adverse effects, including vomiting or diarrhoea.
‘That in itself can reduce the effectiveness of oral contraception, regardless of any other interactions,’ A/Prof Grzeskowiak said. ‘So people should be aware of the side effects of what to expect when starting this and how it might impact on other treatments that they're using.’
Pharmacists have an important role in engaging patients in conversations about reproductive health, particularly contraception.
‘Not everyone feels comfortable asking those questions, but there are good training resources, particularly through PSA, around improving pharmacists’ comfort with having those conversations, including around the different types of contraceptive methods,’ he said.
‘It's one thing to start the conversation, but you also need to be armed with various information to be able to continue it, or at least identify when to refer patients back to their medical practitioner or another [healthcare practitioner] to provide that detailed advice.’
[post_title] => GLP-1 RAs found to pose pregnancy risks
[post_excerpt] => Women of reproductive age using GLP-1 RAs could be at risk of unintended pregnancy, and unaware of the risks to pregnancy and unborn babies.
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[post_content] => In August 2025, I had the privilege of attending the International Pharmaceutical Students’ Federation (IPSF) World Congress in Nairobi, Kenya.
The theme of this year’s congress, Advancing Pharmacy Education and Practice for Global Health Impact, was reflected throughout the week in discussions, panels and workshops.
Thanks to the generous support of PSA and the National Australian Pharmacy Students’ Association (NAPSA), I was able to represent both Australia and New Zealand as the sole Official Delegate at the General Assembly. Without their support, our countries would not have had a voice.
Leaders in training
Before the official start of World Congress, I participated in the Leaders in Training (LiT) program, where I became an Alpha Trainer after reaching the required hours. I ran workshops focused on developing soft skills for future leaders, guiding students through sessions on motivation, feedback and evaluation.
This was a rewarding opportunity to share knowledge, strengthen my own skills, and witness the energy and passion of upcoming leaders.
Once the Congress began, much of my time was spent in the General Assembly, carrying the responsibility of casting votes and ensuring the perspectives of
students from both Australia and New Zealand were heard. Being the only delegate from our area made me realise just how vital the support of PSA and NAPSA was.
Technology and access
Among the many events I attended, one highlight was a panel discussion on the use of AI in healthcare. This session offered a fascinating look at both the opportunities and the challenges of integrating AI into healthcare delivery.
I also gained insight into the industrial pharmacy sector in Kenya, as well as the broader challenges faced by healthcare in Nairobi. These experiences expanded my understanding of the global landscape of pharmacy and reminded me of the inequities that continue to exist in access to medicines and resources.
The Congress also gave me the chance to reconnect with peers from around the world, including those I had previously worked with as NAPSA’s Contact Person. It was valuable to strengthen existing connections and build friendships with students who share the same interest in pharmacy.World Congress was a once-in-a-lifetime experience; one I hope more Australian pharmacy students will pursue in the future.
Start local, go global
IPSF represents over 500,000 pharmacy students worldwide, yet Australia’s presence remains small. I want to change that by encouraging more students to get involved and take advantage of the opportunities IPSF offers.
The first step is to become involved in your local student branch, which can then open doors to national opportunities through NAPSA and, eventually, to international representation.
I still remember attending my first IPSF conference alone and feeling nervous, only to be welcomed immediately by the IPSF Asia Pacific Regional Office (APRO), who embraced me as part of their community. The warmth and inclusivity I experienced then continues to inspire me, and I encourage others to take the same leap.
People want to connect with you, and IPSF provides a space where friendships, networks, and professional growth come naturally.
Looking ahead, the next IPSF events will be the Asia Pacific Pharmaceutical Symposium (APPS) in Indonesia and the World Congress in Thailand. I would strongly encourage pharmacy students to consider attending these future events, as they are transformative experiences that broaden horizons, deepen understanding and build lifelong networks.
Pathways Ahead
I am deeply grateful to PSA for their monumental support in making my attendance possible. With travel costs being high, it would have been impossible for me to attend without their sponsorship.
Because of their generosity, Australia and New Zealand were represented at the General Assembly, and our perspectives contributed to global discussions.
I also want to thank NAPSA for their support, which made it more feasible for me to attend in my role as Official Delegate. Their backing ensured that I was able to fulfil my duties and give our members a voice on the international stage.
Attending World Congress 2025 in Nairobi was an unforgettable experience that strengthened my leadership skills, broadened my understanding of global healthcare, and connected me with pharmacy students from across the world.
Most importantly, it reminded me of the importance of ensuring Australia and New Zealand are active participants in shaping the future of our profession.
To PSA and NAPSA, thank you once again for making this possible. To my fellow pharmacy students, I encourage you to take that first step, get involved, and see where it leads. You might just find yourself representing our country on the world stage one day.
[post_title] => A voice for Australia and New Zealand at IPSF 2025
[post_excerpt] => Australia and New Zealand had a voice at the IPSF World Congress, influencing discussions on education, practice and global health.
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[post_content] => A blistering opening plenary session at the FIP Congress last week has challenged policymakers and health professionals alike to act to slow the advance of antimicrobial resistance (AMR).
Mr Michele Cecchini, Head of Public Health, Organisation for Economic Co-operation and Development (OECD), worked through startling data showing the cost of AMR globally – in dollars, and in years of life lost.
The high price of insufficient action on AMR
The OECD has crunched the numbers, and the statistics are startling.
AMR is currently shortening life expectancy by an average of 1.8 years globally – 1.7 years for people in high-income countries, or 2.5 years for people in low-income countries.
This is represented in 79,000 people dying due to resistant infections across 34 OECD, European Union and European Economic Area counties – corresponding to 2.4 times the number of deaths due to tuberculosis, influenza and HIV/AIDS combined in 2020.
The financial burden on the health system is similarly staggering, with global annual costs totalling $US 412 billion.
Once lost productivity and loss of income costs are added in, this cost balloons to $US 850 billion annually – about the same size of Poland’s economy.
Bold action is required
Modelling by the OECD has shown that meaningful action is achievable – albeit with a substantial price tag.
To reduce AMR-related deaths by 10%, six actions are required:
- All countries need to have national AMR action plans and 60% of countries commit a budget
- 90% of countries should meet WHO’s minimum infection prevention and control programs at a national level
- All countries need to report surveillance data on AMR and antimicrobial use
- Meaningful reduction in antimicrobial use is taken in agrifood systems
- Strengthened actions to prevent and address the discharge of antimicrobials into the environment
- Mechanisms to support research and development to address AMR should be promoted.
The cost of these initiatives globally is estimated to be $US 52 billion annually – equivalent to 0.5% of the global health budget.
‘The World Bank told us this is a rounding error [in the context of health spending]. This is not an amount of money which cannot be mobilised,’ Mr Cecchini said.
These sentiments were echoed by the Danish Minister for the Interior and Health Sophie Løhde.
‘To tackle [AMR], we need to work much closer together, and your role as pharmacists and life science professionals is key,’ said Minister Løhde at the first plenary session of the 2025 FIP world congress last week. ‘We need your expertise to develop new antimicrobials in the most prudent and effective manner, and to inform and educate our citizens when you meet them in pharmacies all over the world.’
The FIP Copenhagen Declaration on Antimicrobial Resistance, signed by 79 organisations – including The Pharmaceutical Society of Australia – took place on 1 September 2025.
The FIP Declaration outlines clear priorities to address AMR, including global partnership building, promoting vaccination and rational antimicrobial use, protecting medicine supply chains, and advancing evidence on stewardship and outcomes.
[post_title] => OECD sounds the alarm on antimicrobial resistance
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
