Since the start of the coronavirus pandemic (COVID-19), it has been affecting health, societies and economies (Zhou et al., 2020; Chen et al., 2021). Symptoms and manifestations of COVID-19 can be severe, with acute respiratory failure and sepsis that requires hospitalization, and sometimes even lead to death (Wiersinga et al., 2020). At the beginning of the pandemic, there was no FDA approved drug for the treatment of COVID-19, nor a vaccine to prevent and slow the spread of the disease.

Due to the lack of certainty regarding the treatment and prevention of the virus, and in order not to overwhelm the healthcare system, most countries imposed complete lockdowns. Other safety measures were also imposed, which included the enforcement of social distancing, such as curfews; working from home, reduced working hours for those who had to be at their place of work, reduced manpower, the closure of non-essential shops, and border closures along with the cancellation of non-essential travel. Applying these lockdowns and safety measures proved to be effective and resulted in the significant decline of the infection rate and the reduction in mortality, especially when such measures were applied early (Ghosal et al., 2020; Ji et al., 2020; Taghrir et al., 2020; Lau et al., 2021).

Although the FDA has approved the first drug, remdesivir, for certain patients (FDA, 2021) and several vaccines have also been approved for emergency use across the globe (WHO, 2021), many countries are still enforcing lockdowns and social distancing measures in order to alleviate the effect of the subsequent waves and the new variants of the virus.

Due to the lockdowns, many factories, including drug factories, were closed worldwide at the beginning of the pandemic or operated with a lower capacity (Bookwalter, 2021). China, which is considered the largest global supplier of active pharmaceutical ingredients (APIs), imposed a national lockdown in order to contain the virus. This was a significant concern for many countries, as China’s lockdown was thought to pose a risk to the supply chain of drugs and APIs, thereby resulting in a drug shortage (Chatterjee, 2020). Drug shortages are also a cause of reduced manpower, and other factors, such as factories being unable to work at maximum capacity and challenges to the importing of normal quantities due to transportation restrictions, and also the closure of ports, as well as increased demand due to panic buying.

Panic buying and stockpiling have affected many items, such as groceries, food, sanitisers, disinfectants and protective equipment, including face masks and gloves, around the world and have led to acute shortages for these items, leaving people in need with no means to obtain them. During this time, people might feel that the situation is out of their hands which generates many concerns, anxiety, and fear about resources insufficiency. Therefore, people act with their primitive instincts and tend to panic buy to mitigate this anxiety and fears (Arafat et al., 2020a). If such circumstances occur in regard to drugs, the consequences of drug shortages can be catastrophic for patient outcomes (Badreldin and Atallah, 2021). The balance between the drug supply and demand should always be maintained. This pandemic has already affected drug supplies due to the reduction of manufacturing. Therefore, an increase in the demand will exacerbate the problem, both in the short and the long term, and compromise the healthcare system’s ability to deal with this situation.

Patients, especially with chronic diseases, need to always have a supply of their respective drugs. Other drugs, such as pain killers and emergency drugs, also need to be available during lockdowns and curfews. People are encouraged to hold an adequate amount of essential drugs without buying excessively or stockpiling (American Pharmacists Association AS of H-SP and Foundation and NA of CDS, 2007). However, there is no clear guideline concerning how people should react during a pandemic in regard to keeping their supply of drugs without this affecting the volume of drugs in the supply chain and increasing the risk of stock-outs or keeping too many drugs at home.

Although the pharmaceutical industry in Jordan is considered to be one of the best in the region, Jordanian manufacturers export most of their production of drugs overseas and only a small percentage is left for the local market. This percentage is not sufficient for meeting the national demand, and therefore, most of the drugs that are used domestically in Jordan are still imported (Alomari et al., 2015; Jordan Chamber of Industry, 2021). The general population can obtain drugs depending on their medical and clinical needs, either as prescribed drugs through a prescription from healthcare providers, or through direct purchases of over-the-counter drugs from pharmacies. Despite the current national regulations that are stated in The Drug and Pharmacy Law No.12 which do not allow pharmacists to dispense prescription-only drugs without a prescription (Jordanian Ministry of Health, 2013), self-medication is a common practice (Yousef et al., 2008) and prescription-only drugs such as antibiotics can still be dispensed sometimes from pharmacies to patients who ask for them even without a prescription, which gives the general population open access to the majority of drugs classes, except controlled drugs (e.g., narcotics and psychotropic substances), with no limitations concerning the number of drugs that can be bought (Al-Husseini et al., 2018). Therefore, Jordan can be liable to drug shortages during crises such as wars, natural disasters, political conflicts and/or pandemics.

This study aims to assess the behaviour of the general population in Jordan in regard to the stockpiling and panic buying of drugs during the week before the full national lockdown due to the coronavirus pandemic, investigate the factors affecting it and measure their knowledge about the consequences of this behaviour.

Almost half of the participants in our study stockpiled drugs just prior to the lockdown. In such cases, the drugs were mainly used for the management of chronic conditions, supplements, antibiotics, analgesics. In a country such as Jordan, with limited resources and a high dependence on other countries for the supply of generic drugs or raw materials, a sudden increase in demand within the local market amid international restrictions on trade will jeopardize the availability of drugs. This behaviour was irrelevant to participants’ age, gender, living area or educational level. However, in a study conducted in Brazil, male gender, higher socioeconomic status and younger age were correlated with a higher prevalence of panic buying (Lins and Aquino, 2020). The effect of socio-economic status on the patterns of pharmaceutical panic buying was also revealed in a study that was conducted by Elek et al. in Hungary. The findings of the study showed that socioeconomic status affected the patterns of pharmaceutical panic buying. People with limited income were much less likely to stockpile pharmaceutical products, which was a result of having modest and/or inadequate finances and reduced access to pharmacies and physicians (Elek et al., 2021).

Findings from our study show a higher percentage of people from non-medical backgrounds rarely stockpile drugs in normal conditions compared to people from a medical background. However, the percentage of buyers was significantly higher than non-buyers for participants with a non-medical background. This implies that these drugs were not part of the health care plan for people from non-medical backgrounds, though they were purchased during the pandemic. This, therefore, suggests the importance of medical knowledge in determining the behaviour of consumers during a crisis. In Indonesia, a study conducted on people who practised panic buying during COVID-19 concluded that knowledge is a key factor affecting this behaviour (Wijaya, 2020). Results from this study along with our results suggest that educating the population could attenuate this phenomenon.

Consumers from non-medical backgrounds are easily influenced by traditional and/or social media, concerns from being infected with the coronavirus, or rumours of the possible efficacy of certain drugs/supplements, and the possibility of lockdowns. In a study, Arafat and others collected information from traditional media reports about panic buying during the early stages of COVID-19 and showed that there was a high abundance of reports that mentioned panic buying and showed photos of empty shelves (Arafat et al., 2020b). Such anxieties disseminate via media and stimulate consumers from non-medical backgrounds to stockpile drugs, which subsequently cause them to be more positive to the idea of self-medication with COVID-19 drugs and supplements if they could acquire them as shown in our results. A similar case was reported in China where a woman who did not have COVID-19 self-medicated with hydroxychloroquine sulfate and was admitted to the intensive care unit suffering from cardiac arrhythmias (Liu et al., 2020). Therefore, during the pandemic, people required accurate, reliable information from trusted organizations that can be easily accessed (Aslani, 2020). Pharmacists can serve as educators concerning public health issues and serve as impeccable sources of knowledge. Moreover, they can provide remote pharmaceutical care services for patients that can reassure patients, reduce their risk of being infected with the disease, and monitor and report drug shortages (Liu et al., 2020).

The most purchased drugs were analgesics and antipyretics, followed by chronic medications, and vitamins and supplements. However, in Germany, the surge in purchasing drugs during the pandemic was highest for anti-Parkinson’s disease drugs and tranquillizers (Kostev and Lauterbach, 2020). In Australia, several reports showed that pharmacists observed increased purchases of thyroxine, paracetamol and hydroxychloroquine among other drugs (Bell et al., 2020). Similarly, a study from Hungary showed that at the beginning of the pandemic there was an increase in demand on almost all drugs classes especially gastrointestinal drugs (Elek et al., 2021).

Our study revealed that 81% of the consumers paid themselves for the drugs, though most of them were covered by medical insurance. This demonstrates a high degree of willingness to purchase drugs even during an economically challenging condition. This behaviour can be interpreted as a coping mechanism during stressful conditions in order to maintain the health of one’s family or to act in a fashion similar to other members of the community (Kostev and Lauterbach, 2020; Yuen et al., 2020; Chua et al., 2021).

An important finding from our study is that 73.7% of the buyers stated that they will keep unused drugs in the household until the expiry date passes, despite their knowledge of the safety concerns that this might pose if drugs were not stored or disposed of properly. A cross-sectional study from Jordan by Naser et al. shows that most households in Jordan inappropriately deal with the drugs in their household in terms of storage or disposal (Naser et al., 2021).

The major strength of our study is its originality. Due to the lack of similar studies, this research would be a backbone for future studies that highlight such important issues in such challenging times. On the other hand, our study has certain limitations including the small number of participants and the fact that panic purchasing of drugs was studied from the patients’ perspective only. With this in mind, future studies must be carried out with a larger sample size and from the pharmacists’ perspective, too. In addition, investigation of drug shortages during the pandemic will shed more light on the different aspects of the problem and possibly establish a clear connection to the panic buying of drugs during the same period.

The coronavirus pandemic has been a unique experience that revealed the vulnerability of humans in front of this dangerous and universal threat. The desire to secure drugs in case of a lockdown, the prospect of drug shortages and possible infection of COVID-19, caused consumers to buy excess amounts of drugs in order to feel secure, which served as a coping mechanism during the stressful conditions emanating from the pandemic. Pharmacists must play a role in providing alternatives for patients in case of drug shortages, which should comprise remote pharmaceutical care services and the provision of correct information and knowledge concerning the circulated material available via social media. National guidelines for drug management, drug security and rational drug use during crises that target both consumers and pharmacists, are urgently needed and should be available for future needs. Additionally, it is necessary to impose stricter measures to increase compliance with The Drug and Pharmacy Law that controls the drug dispensing from pharmacies to promote rational drug use.