Strengthening rural pandemic preparedness: Lessons from Nova Scotia's COVID-19 response for pharmacy practice

The COVID-19 pandemic exposed longstanding structural inequities in rural healthcare systems, including shortages of primary care providers, transportation barriers, geographic isolation, workforce limitations, and unequal access to digital health technologies. Rather than creating these challenges, the pandemic magnified existing weaknesses that limited equitable access to testing, vaccination, chronic disease management, and preventive healthcare. Nova Scotia provides an informative Public Health Mobile Units (PHMU) implementation of how innovative, community-based models of care can mitigate these inequities. During the pandemic, the province deployed PHMUs to deliver testing, vaccination, and health promotion services directly within underserved communities while pharmacists assumed expanded responsibilities in immunization, point-of-care testing, medication management, prescribing for minor ailments, and public health education. The Nova Scotia experience demonstrates that decentralizing healthcare delivery and optimizing pharmacists' scope of practice can substantially improve healthcare access in rural communities. Beyond increasing service availability, pharmacists enhanced continuity of care, strengthened public trust, and alleviated pressure on overstretched primary care services. These innovations, however, were largely implemented as emergency measures rather than embedded within routine health system planning.