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Pharmacist Fiona Marra was described as “a colossus in the world of blood borne viruses”, according to the person who nominated her, but she is someone with little recognition from within her own profession. Until now.
Marra is the lead clinician at the Scottish Paediatric and Adolescent Infection and Immunology Network – an NHS scheme to ensure all children and young people with a compromised immune system have access to the right care – a post usually held by a doctor.
She also works as an advanced pharmacist in hepatitis C virus (HCV) and HIV, covering adult and paediatrics in Glasgow.
She is respected globally for her knowledge and expertise in HIV and hepatitis. With 22 publications to her name, Marra travels the world to deliver talks on how to control infectious diseases.
“I get to travel a lot – Russia, Canada, Europe – and talk about clinical pharmacology,” she says, pointing out that she is often the only pharmacist and among few women at those meetings.
It was her three years volunteering in Ghana providing female education that piqued Marra’s interest in infectious diseases. When she returned to Glasgow in 2007, she completed a postgraduate diploma in travel medicine and an advanced pharmacy Masters.
Now, in 2020, she is completing a PhD in clinical pharmacology.
A particular passion is the eradication of hepatitis C. “My goal is to make sure there are no children with hepatitis C in Scotland,” she says. “Children rarely have symptoms so if it’s not flagged up you could progress to adulthood, and all the time it is chipping away at the liver, so there are big implications.”
But Marra believes that with better case-finding and newer treatments, these problems can be tackled. She is a co-author (and only pharmacist member) of the European Guidelines for Hepatitis C, published in 2018, which recommended countries adopt universal screening in pregnancy, and she is pushing for its adoption in Scotland.
“Most transmission is vertical (from mother to baby) and there’s potentially children who slipped through the gap so universal testing would make that easier,” she explains.
A few years ago, Marra found herself playing a role in a major health emergency. She was the pharmacist responsible for the distribution and dosing of drugs to treat a nurse who fell ill with Ebola in Glasgow. Her expertise put her in a good position to help infectious disease clinicians look at dosing and evidence for remdesivir and other experimental drugs.
“With the Royal Free [Hospital] and Gilead, we had to get access and sort all the legal requirements of bringing an unlicensed drug into the UK,” Marra says.
And, as well as being on the front line, Marra also has a role in disseminating important information regarding infectious diseases. Since 2013, she has been an honorary research associate at the University of Liverpool where she writes the content for the HIV and hepatitis C pages of their drug interactions websites – an essential resource used by clinicians and pharmacists, as well as other researchers. The HIV and hepatitis C pages are featured in more than 50 international guidelines for HCV and HIV as recommended practice, including in the UK, Europe and the United States.
More recently, she was involved in helping research and set up a new website on COVID drug interactions for use by healthcare professionals and researchers, looking at the drugs that had been repurposed to treat the disease. She explains that, at the start, “we had two professors of infectious disease and three pharmacists doing a lot of research and building up the tool — there were a lot of evenings and weekends”.
They have now had more than 210,000 views on the website, from nearly every country in the world: “We have been adding new drugs to it and [we] update [it] as new clinical trial data comes in.”
Marra finishes her role as lead clinician in March 2022, but says she will continue with her advanced pharmacist HCV/HIV role, which involves working towards government hepatitis C eradication targets. There is scope for further pharmacist-run clinics to achieve this, she adds.
There is plenty to keep her busy. “I am hoping my PhD will be completed in 2021–2022 and my aim for the next year is to start working towards an RPS [Royal Pharmaceutical Society] consultant pharmacist accreditation.”
“Fiona is an inspiration to all clinical pharmacists in showing what is possible in working towards international-level practice”
“Her depth of knowledge and influence is immense, and her networking, collaborative working and teaching is an inspiration”
Meet the rest of The Pharmaceutical Journal’s Women to Watch 2020 here.