Striving for global drug availability

Abstract

Chifumbe Chintu (photo) is professor of paediatrics and child health, and director of HIV/AIDS and TB research and training. Peter Mwaba is a consultant physician at the University Teaching Hospital and the Ministry of Health, Zambia. The lack of resources with which to pay for treatment of patients with infectious and non-infectious diseases in resource-poor nations, despite the proven efficacy of available drugs, raises several major ethical issues. The right of all human beings to enjoy living standards conducive to good health is enshrined in Article 25 of the United Nations Universal Declaration of Human Rights, established just over 50 years ago. This declaration states that “everyone has the right to a standard of living adequate for the health and well-being of themselves and of their family—including food, clothing, housing, and medical care and necessary social services—and the right to security in the event of unemployment, sickness, disability, widowhood, old age, or their lack of livelihood in circumstances beyond their control”. WHO and UNICEF (the United Nations International Children's Emergency Fund) reaffirmed this statement in 1978 in a joint Alma-Ata declaration. In part, this declaration states that the gross inequality in the health of people, particularly that between more-developed and less-developed countries, is politically, socially, and economically unacceptable. WHO and UNICEF called for a new economic order to address this inequality. WHO then set the goal of achieving health for all by the year 2000. Perhaps not surprisingly, this objective has not been met. Some of the major hurdles associated with essential medicines being unavailable in resource-poor nations include: general poverty; poor prescribing habits, including polypharmacy, as a result of limited diagnostic facilities; lack of national drug policies in some less-developed countries; and limited research aimed at establishing the most appropriate drugs and therapeutics in most less- developed countries. In 1996, the United Nations, in partnership with the World Bank and the International Monetary Fund, embarked on a special initiative of debt relief for Africa. The Jubilee 2000 initiative, in which cancellation of debts owed by the poorer nations to the wealthier ones is called for, is generating wide support. However, critics of this initiative argue that the funds freed by such debt cancellation might not reach those in greatest need. The overwhelming tragedy is that the poor people of the world are unable to help themselves. Governments in the less-developed world are limited in their ability to provide basic health care, in part as a result of their huge debts and the requirement to pay interest on loans provided by wealthy nations. The net result is the deterioration of health-care delivery. While African governments battle with the repayment of multi-billion-dollar debts, there are signs of continued deterioration in the delivery of health care. The above factors, taken together with the exorbitant cost of many drugs and therapeutic agents, make them beyond the reach of many poor nations. Even if finances for the purchase of essential drugs were available, these drugs would not necessarily be used correctly. Some of the erratic drug supplies seen in most resource-poor countries could be attributed to poor prescribing habits. Inaccurate prescription of drugs is commonly a result of limited or absent diagnostic facilities. If the supply of essential drugs and therapeutics is to be improved, the capacity for doctors and health-care workers in these countries to diagnose common ailments should be strengthened, and training and retraining should be tied in with programmes aimed at an increase in the drug supply. The tendency, in light of limited diagnostic facilities, is to prescribe many drug combinations so that a wide range of potential diagnoses is covered. To improve the quality and quantity of existing stocks of drugs, national bodies should be formed to supervise the procurement, quality control, stock management, and distribution of essential drugs. These bodies should work hand in hand with established institutions within WHO and UNICEF. In turn, WHO and UNICEF could provide technical and logistical support. Such bodies should, from time to time, review national policies on essential drugs on the basis of available evidence. Such bodies could also help in the reduction of costs. Major pharmaceutical companies in the western world are reluctant to invest in research on new drugs in less-developed countries because of a general lack of protection for innovations in most resource-poor nations. The World Trade Organisation should address the rules governing the trade-related aspect of intellectual property rights so that drugs to treat diseases of public-health importance—eg, respiratory infections, malaria, tuberculosis, and HIV and AIDS—could be made accessible to resource-poor countries.