WHO Medicines Strategy Progress: Priorities: Dr Guitelle Baghdadi Essential Drugs and Medicines Policy World Health Organization November 2003

2 EDM MIP Nov03.ppt Health inequity Health inequity - ensuring access to existing medicines and vaccines could save millions of lives each year Potential annual lives saved by 2015 with scaling up = 10.5 million Source: Commission on Macroeconomics and Health, WHO, 2001 The access problem

3 EDM MIP Nov03.ppt WHO Medicines Strategy : 4 objectives guided country, regional and global work WHO’s vision: people everywhere have access to the essential medicines they need; that the medicines are safe, effective, and of good quality; and that the medicines are prescribed and used rationally. 1. National Drug Policy 2. Access 3. Quality and safety 4. Rational use

4 EDM MIP Nov03.ppt WHO Medicines Strategy : some examples of progress 1. National Drug Policy ä Operational package for monitoring policy impact – public sector, private sector, households ä Traditional medicine strategy launched – bridging the gap between sceptics and enthusiasts 2. Access ä Expanded price information and new survey methodology – helping health systems and consumers become informed buyers ä Comprehensive guidance on international trade agreements – implications of WTO, Doha declaration

5 EDM MIP Nov03.ppt WHO Medicines Strategy : some examples of progress 3. Quality and safety ä Good manufacturing practices training (GMP) participants from 50+ countries – 4 languages – 5,800+ copies CD-ROM/video ä Quality assessment for priority products (“prequalification”) – now antiretroviral list includes 44 single-drug & 6 combination products 4. Rational use ä Selection of essential medicines thoroughly revised – independent, open, evidence-based, expanded information ä Comprehensive training programmes – use in community prescribing, drugs & therapeutics committees Promoting Rational Use in the Community

6 EDM MIP Nov03.ppt In each WHO region, support is tailored to country needs countries supported in 2002

7 EDM MIP Nov03.ppt WHO Medicines Strategy monitored through 26 country progress indicators (preliminary analysis of 2003 survey*) * Source: World Pharmaceutical Situation survey (« Level I » indicators). Raw frequencies without adjustment for reporting differences between the two surveys.

8 EDM MIP Nov03.ppt WHO Medicines Strategy : 5 priorities Objectives: policy, access, quality & safety, rational use 1. National medicines policies that focus on human rights, need for innovation, health-oriented approach to trade agreements, stronger ethical dimension 2. Access to traditional medicine by protecting knowledge and access, expanding evidence base, ensuring safety, informing consumers 3. Access to essential medicines, with emphasis on HIV medicines for 3-by-5, medicines for malaria, tuberculosis, childhood illness, reproductive health 4. Safer medicines through expanded safety monitoring and continued strengthening of quality assurance 5. Rational use through continuing education, initiatives linked to health insurance

9 EDM MIP Nov03.ppt Two billion people still lack regular access to essential medicines n 6 million people in developing income countries lack ARVs n Medicines are the largest health expense for poorer households and second largest public health expenditure n Prices are high & vary greatly ä Margins (taxes, duties, retail, distributor): 20-80% of final price n Unreliable procurement and supply result in shortages ä 1/3 of poor households in some countries receive none of the prescribed medicines (low income, high prices, unavailable) n Poor quality is common and life-threatening ä 50 to 90% of “SP” anti-malaria combinations fail quality tests ä less than half of assessed ARVs meet international standards Example 1: Access to essential medicines

10 EDM MIP Nov03.ppt Improve access to medicines - MDG-8/Target 17. Support the 3-by-5 initiative – through assistance on: n Selection of core ARVs n Registration n Product specifications / pharmacopoeial standards n Prequalification of ARVs n Market intelligence on sources, prices, raw materials n Procurement of core ARVs and diagnostics n Supply management and monitoring n Import taxes and margins n Patent status and licensing n Quality assurance for local production Example 1: Access to essential medicines

11 EDM MIP Nov03.ppt Medicines safety is a universal problem that will only intensify with increased access to newer medicines n Clinical trials show a medicine is effective and relatively safe – but interactions with medicines, pregnancy, other illnesses are only really known with large-scale use n In one major high-income country: ä Adverse reactions are among the top 10 causes of death ä Annually deaths may be due to medicines effects n Over the next 3 years it is expected that: ä Over 3 million people may be on combination HIV/AIDS medicines ä Up to 4 million malaria cases per year may be treated with new arteminisin combinations n Most of these treatments will occur in countries with limited or no current capacity to monitor safety Pomeranz et al., JAMA, 1998;279: Example 2: Medicine safety

12 EDM MIP Nov03.ppt Strengthened post-marketing safety monitoring, especially for new medicines n Maintain Programme for International Drug Monitoring – Uppsala Monitoring Centre n Support national initiatives – eg, South Africa “Focused Surveillance on ARVs” n Strengthen safety monitoring for new combinations for HIV/AIDS, tuberculosis, malaria, etc. n Train regulators in safety monitoring and safety information for health care providers and patients Example 2: Medicine safety

13 EDM MIP Nov03.ppt WHO Medicines Strategy – vital for improved health outcomes, stronger health systems WHO medicines strategy 1. National drug policy 2. Access to essential medicines 3. Quality and safety 4. Rational use Health systems delivery systems financing stewardship creating resources Health outcomes HIV/AIDS malaria - tuberculosis childhood illnesses reproductive health

/ medicines Saving lives with the right medicines