The Brazzaville Foundation, in partnership with the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine (LSHTM), held a highly successful conference on the issue of substandard and falsified medicines at the Wellcome Trust in London on 28 March.
35 international experts and practitioners took part, including academics and researchers from Harvard, Oxford and the LSHTM, representatives from the WHO, the Council of Europe, the British and French Health Ministries, leading NGOs, including the Institute for Research against Counterfeit Medicines and the Chirac Foundation, and specialists from Africa and the Middle East.
A call to action…
The conference agreed that now was a crucial moment to tackle this issue which affects every country around the world but which in many low-income countries has become a grave public health crisis. It is particularly acute in sub-Saharan Africa where between 30% and 60% of the medicines in circulation are believed to be substandard or falsified. It needs to be a new global priority.
Starting with the upcoming World Health Assembly in May 2018, but also the G20, the African Union, the Commonwealth and the UN General Assembly, we want to ensure that the drive to provide Universal Health Care (UHC) as a part of the 2030 Agenda for Sustainable Development means providing access to medicines but access to medicines that work. Failure to end the problem of substandard and falsified medicines will fatally undermine the goals of UHC .
Among the key conclusions were:
- The agreement on working definitions at the 2017 World Health Assembly represents an important step forward. Disagreement on definitions and terminology can no longer be an excuse for inaction.
- Because the issues of substandard and falsified medicines are complex, more research and data are still critical to define the precise scale and nature of the problem.
- This is a multi-faceted problem. The policy solutions, including, improved regulation, stronger legal frameworks, stricter enforcement and tougher penalties, need to reflect this reality. Therefore, these are issues that will require the engagement of not only health ministries but also justice and interior ministries.
- The Council of Europe’s Medicrime Convention provides a model for the introduction of a criminal legal framework. However, because criminal activity is transnational, this framework needs to be adopted world-wide to be effective. So far only 12 countries have ratified the Convention.
- The extent of criminal involvement, especially transnational criminal networks, is an important area which remains under-researched.
- Innovative technologies, particularly in the rapid detection of substandard and falsified medicines, are becoming available and are an important part of the solution. We need to ensure that successful experiments are evaluated quickly and rapidly scaled up.
- A vigorous and effective global surveillance system is essential to understand the full dimensions of the problem. The new WHO system is a valuable start, but it suffers from massive under-reporting. We need to find new approaches to ensure better data and more systematic reporting.
- International concern about the growth in Antimicrobial Resistance (AMR) is a further reason for increasing the focus on ending the traffic in substandard and falsified medicines.
- Research to date has tended to focus on the supply side; more is now needed on the demand side. This means not only better consumer information but improved access to quality medicines – “medicines that work”.
Lynda Scammell (UK MHRA); Oscar Alrcón Jiménez (Council of Europe - Medicrime); Ashish jha (Harvard)
Mick Deats (WHO), Irene Papanicolas (LSE)
Bernard Leroy (IRACM), Paul Newton (Oxford University), Harpakash Kaur (LHSTM), Ron Piervincenzi (USP), Sir David Richmond
Farid Bennis (Larophan, Friends of the Brazzaville Foundation); Nick Chance (Trustee of the Foundation)