Presentation on theme: "Dr Lembit Rägo Coordinator"— Presentation transcript:
1Introduction to regulation of medicines and health technologies: Global context of drug regulation Dr Lembit RägoCoordinatorQuality Assurance and Safety: Medicines Essential Medicines and Health ProductsWorld Health Organization
2ContentSetting the scene. What products we have? What is the situation with medicines quality and regulatory affairs Globally?3 case studiesAfrica - antimalarial medicines quality survey and falsified antimalrialsPakistan – two "killer" medicines casesCase study from NIS – a biosimilar caseWho is WHO?WHO activities to medicines quality assurance and regulationWhat is WHO doing to strengthen national regulatory authorities?Local production of Essential Medicines and its constraintsConcluding remarks
3What type of regulated products we have? Regulated health productsMedicines, including biological products:Medicines – originator and "generic" productsBiological medicinesVaccinesOther biologicals: Monoclonal antibodies, Interferons etc.Blood productsSimilar biotherapeutic products (biosimilars)Traditional/herbal medicines (complimentary medicines)Medical devices – in vitro diagnostics (IVDs)
4Medicines: originator vs generic medicines New medicines or originator productsNeed to prove safety, efficacy and qualityMultisourcse (generic) medicinesFocus on quality, safety and efficacy referred to originatorSafety and efficacy – bridging through bioequivalence studiesInterchangeabilityPharmaceuticalTherapeutic
5What is the situation with medicines quality (QSE) Globally What is the situation with medicines quality (QSE) Globally? 1st Case example. Antimalarials/AfricaCooperation with NDRAs in Cameroon, Ethiopia, Ghana, Kenya, Nigeria, TanzaniaACTs and sulfadoxine-pyrimethamine935 samples collected and screened by Minilab, 306 tested in laboratory5
6Falsified/Counterfeit antimalarials also common (1st Case example Falsified/Counterfeit antimalarials also common (1st Case example. Cont).Several notifications about falsified antimalarials – no active ingredient or … containing paracetamolWHO issues also public Drug Alerts/drugalerts/drugalertindex/en/index.html
7What is the situation with medicines quality (QSE) Globally What is the situation with medicines quality (QSE) Globally? 2nd Case example – Pakistan 1.More than 107 death case and 450 severe ADRs with isosorbide mononitrate manufactured in PakistanClinically resembled Dengue feverPassed quality control testing… forensic investigation – contained pyrimethamine in toxic quantitiesReason – totally ignoring GMP and negligence
8What is the situation with medicines quality (QSE) Globally What is the situation with medicines quality (QSE) Globally? 2nd Case example – Pakistan 2.Dextromethorphan killing more than 20 peopleAll death cases seemed to be linked to drug addiction… forensic analysis revealed that the medicine contained also high percentage of levomthorphan (potent opiate)API manufacturing quality failureSite in India closed
9What is the situation with medicines quality (QSE) Globally What is the situation with medicines quality (QSE) Globally? 3rd Case example – NIS biosimilarA biosimilar approved in a NIS country several years agoPatient complaints, MPs involved …Approval based on … regulations about chemical generic medicines!Company profile – not very credibleQuestion why it was authorized remains open.
10What these case stories are telling? Quality of medicines is still an issue in many jurisdictionsMany countries do not have functional regulatory systems in place for product approval (MA, registration)Dossier assessment weak or absentInspectorates do not function properlyMany de facto do not control their markets nor do they control the supply chainNo effective control of importsNo effective licensing of all the activities - manufacturing, retail- and whole sale, hospital pharmaciesNo traceability of products at any point of supply chainLack of capacity doing all the necessary and no system in place to rely on those who have the capacity
11WHO activities in the field of health products regulation (medicines incl. biologicals, medical devices)Setting policies, norms and standards – for access, rational use, quality, safety and efficacyAssessment of national regulatory systems, regulatory support and capacity buildingPromoting regulatory harmonization and information exchange – safety, quality, best practices etc.Assuring safety and quality of selected products for United Nations family through prequalification programme (medicines, vaccines, diagnostics)
12Standards and WHOWHO is mandated to “develop, establish and promote international standards with respect to food, biological, pharmaceutical and similar products” (Article 2, WHO Constitution);WHO Expert Committee on Specifications for Pharmaceutical PreparationsWHO Expert Committee on Biological StandardizationBoth complimentary to ICH activitiesJoint FAO/WHO Expert Committee on Food Additives
14International Conferences of Drug Regulatory Authorities (ICDRA) Biennial Global meetings bringing together regulators from around 100 nationsPromoting information and best practices exchange, cooperation, harmonization and convergenceSeveral initiatives started in ICDRA environmentICH initial discussionsAMRH initiative initial discussionsReports from various harmonization initiatives
15Prequalification programme – powerful engine for facilitating quality manufacture
16Prequalification of Medicines Programme Since 2001 the UN Prequalification Programme managed by WHO is ensuring that medicines procured with international funds are of assessed and inspected for quality, efficacy and safety, involvesPrequalification programme for medicines (finished dosage forms)Prequalification of active pharmaceutical ingredients (APIs)Prequalification of quality control (QC) laboratoriesThe Prequalification Programme is an action plan for expanding access to priority essential medicines in the following four areas:- HIV/AIDS- Tuberculosis- Malaria- Reproductive Health- Selected individual products for other diseases (Flu, Zinc sulphate)16
17Extensive collaboration: working with regulators … for regulators Not duplicating work done be stringent regulatory authoritiesSRA approval of new and generic products – abridged procedureUS FDA tentative approvals – based on confidentiality agreement including in the PQ products listEuropean Medicines Agency (EMA) – Art 58 … and beyondCollaboration with EDQM, in particular in the area of APIs (confidentiality agreements with US FDA, EDQM, EMA …)Active participation and involvement ofRegulatory authority experts from well resourced and less resourced settings17
20Key achievementsContribution to increased access to quality medicines, for example:in 2012, 8 million people living with HIV and in need of treatment were receiving treatment, around 6.5 million of whom were taking WHO-prequalified antiretrovirals (ARVs);and sales of WHO-prequalified artemisinin-based combination antimalarials exceeded 180 million individual treatment courses in 2010)UNAIDS. World AIDS Day Report Geneva, UNAIDS, 2012.WHO. World Malaria Report, Geneva, World Health Organization,20
21PQP achievements 2009‒2012: In addition: prequalification of 28 active pharmaceutical ingredients (APIs), all of which can be used for manufacturer of UNITAID priority productsprequalification of 19 medicines quality control laboratories (QCLs), so that prequalified QCLs can now be found in all six WHO regions21
22Capacity building provided a core value of the programme Capacity building provided a core value of the programme. Participants in various capacity building workshops organized or co-organized by PQP during 2007‒201222
23Access to essential medicines remains a problem* In spite of progress, especially with communicable diseases (HIV/AIDS, malaria and TB), the access to essential medicines remains a huge problemChronic diseases—mainly cardiovascular disease, cancer, chronic respiratory diseases, and diabetes—were estimated to cause more than 60% (35 million) of all deaths in 2005; more than 80% of these deaths occurred in low-income and middle-income countries.NCDs have negative impact on individuals, and family economic production and wellbeing. For example, estimated loss in national income from heart diseases, stroke and diabetes in 2005 were $18 billions in China, $11 billion in the Russian Federation, $9 billion in India and $43 billion in Brazil.Access to medicines for mental disorders remains poor – up 70% may not get treatment in low-income countries
24Concept of local production Concept of local production*: Specific to local production WHO activitiesProject: Improving access to medicines in developing countries through technology transfer related to medical products and local production.Implemented by the Department of Public Health Innovation and Intellectual Property of the World Health Organization (PHI/HIS/WHO) in partnership with the United Nations Conference on Trade and Development (UNCTAD) and the International Centre for Trade and Sustainable Development (ICTSD) with funding from the European Union (EU).Objective of the project: To increase access – especially for the poor in developing and least developed countries – to medicines, vaccines and diagnostics.
26Relevant publications Local production for access to medical products: Developing a framework to improve public health, 2011Trends in local production of medicines and related technology transfer, 2011Pharmaceutical production and related technology transfer: Landscape report, 2011….
27Chances for Developing Countries and Least Developed Countries* Old concepts do not hold – three "power centres" for pharmaceutical manufacturing with different logic and interest but – convergence on goingNew emerging economise (BRICS)Lower-middle income and low income countries(including African countries)Old industrialised countries (EU, US, Japan, Canada etc.)
28Industrialised countries Substantial industrial capacityNot much dependent on local manufacture, less generic marketsBase for research based industries - consolidating into few giants with new functions – marketing powerhouses, contracting a lot outGeneric industries merging and going GlobalMachinery/lab equipment monopoly shifting away – China producing production and lab equipmentIncreasing Globalization and work sharing80 % APIs from India and China, also a lot of excipients and packing materialsContract manufacturing for FPPs (India)R&D – more and more in "developing world" – clinical trials, basic research slowly following
29New emerging economies Increasing industrial capacity in many areas with needs for new markets, still at large generic markets but with increasing share of originator productsIncreasingly part of work sharing and taking over certain functionsAPI, excipients, packaging materials, machinery production etc.Participating in Global R&DClinical trials increasing, CROs developing, basic researchDeveloping its own original R&D for new productsGeneric industries developing and consolidating, going Global reaching out to old industrialised country markets (India) and developing country markets (China)
30Lower-middle income and low income countries (including African countries) Local manufacture may (?) be more important, mostly generic marketsBigger dependence on outside country/region resources (almost 100% for APIs, excipients, packing materials machinery)Less part of Global R&D – less clinical trials, in many no CROs, no participation in basic researchGeneric companies small and not reaching further than country or sub- regionMany have either no or only limited industrial capacityRelative lack qualified human resources and knowledge baseLess business freedom and less attractive investment environmentLocal policies may disfavour local manufacturingMore problems with good governance in pharmaceutical sector
31Sustainable local production in Africa needs favourable environment and … collaboration between countries and access to marketsLocal production in Global contextStrong national regulatory authority (NRA)Knowledge base and skilled workforceInfrastructure (roads, electricity, water supply)Good governance in pharmaceutical sector, modern laws and regulationsFavouring environment (secure investment and business climate, taxes and customs)Favourable health and industrial policies
32WHO position and experiences (particularly in the light of improved access to essential medicines) Local manufacturing may facilitate access but is not a goal in its own rightDramatic quality problems have occurred (e.g.Pakistan examples)Locally produced essential medicines may be of lower quality and higher priceHealth care providers and patients do not care where the medicines come from provided they are safe, of good quality and affordableSome products likely more feasible for local production than others e.g. blood products, antivenom seraLocally produced medicines must meet international standards for Quality, Safety and EfficacyRisk-based step-by-step approach possible, but no compromise on final goal
33Concluding remarks (1)Governments' commitment to create enabling environment for access to quality medicines in all of its complexity is importantGood Governance principles implemented, especially in pharmaceutical sector, are one of the foundationEfficient highly qualified national regulatory authority is a mustSub-regional and regional collaboration between governments and regulators is vital to create a predictable harmonized "quality market for quality products"
34Concluding remarks (2)WHO has promoted regulatory capacity building, collaboration and harmonization long time and will continue to do so being open to new ideasMaking medicines is not any more a "local" business and the era of only locally operating regulators with different standards starts to endThrough its prequalification programme and other technical activities WHO has obtained unique experience and expertise about the problems existing.WHO has also given substantial technical help to local manufacturers including API manufacturers in China and FPP manufacturers in several regions including Africa.
35The time of poor quality medicines for poor people should be over Poor people also deserve good quality medicinesRegulators have important role to play to make it happen