The Pharmaceutical Journal
Vol 275 (Supplement) F04-F04
October 2005

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FIP Congress 2005

FIP organisations must co-ordinate medicines donations after disasters

The president of the International Pharmaceutical Federation, Jean Parrot, has called on the federation’s member organisations to create specialist pharmaceutical units capable of co-ordinating the management of medicines that are donated in the wake of disasters such as the Asian tsunami last December.

Speaking at the opening session of the FIP congress on 4 September, Mr Parrot said that, after the tsunami, there was an imperative need for safe, quality medicines and, in a surge of generosity, these medicines were forthcoming from the international community in great quantities. But, like many times before, medicines accumulated in airports. Compounding that problem was a lack of qualified people ready to receive containers of medicines in areas of need, which sometimes delayed the medicines indefinitely in customs zones. This happened in spite of previous experience. Six years ago, the World Health Organization published clear guidelines concerning the donation of medicines in order to reduce the inefficiency with which they are collected and distributed. Also, in 1997, FIP had published its own statement in this context.

“Our role as pharmacists,” said Mr Parrot, “demands that we do not accept this situation, and that we do not remain silent while medicines pass through uncertain channels, rarely reaching those who most desperately need them, while leaving already cash-strapped governments and non-governmental organisations obliged to finance the destruction of several tons of medicines meant for better use.”

Calling on FIP member organisations to create the specialist units, he said that trade globalisation has brought a new responsibility to all governments to define in advance plans for public health action in cases of emergency. “Whether it be an epidemic of avian influenza, bioterrorism or natural disaster, it should be possible to mobilise effective means of damage control as dictated by previously established guidelines, and these plans should be applicable on an international scale,” he said.

HIV/AIDS

Mr Parrot went on to talk about the HIV/AIDS pandemic, which continues to be a matter of concern. He said the procurement of care continues to depend on the solidarity of the better-equipped countries to aid in the development of prevention and treatment in those countries most lacking in resources, yet most affected by the disease.

We are nearing the time, he said, when all parties involved need to assess the outcomes of the “Three by Five” initiative launched by the WHO two years ago. Now, as 2005 draws to a close, it is necessary to reflect on the fact that the goal of treating three million individuals affected by HIV/AIDS by the end of 2005 has not been met, although much headway has been made.

For example:

· Several sustainable funds have been and continue to be mobilised in favour of countries where resources are scarce; what remains to be done is to use these funds efficiently

· Several countries in Africa and South America have achieved the WHO objective

· Although Africa remains an area of overwhelming concern, results in places like Botswana and Uganda, where the target has been met, are exemplary and most encouraging

But lack of health care professionals and insufficient management of medicinal supplies are still major obstacles, which is why the WHO launched its “Decade for human resources in the area of health 2006–15” initiative. The initiative concerns all health professionals, including pharmacists. “Therefore it is our duty as pharmacists to reinforce our own ranks and the numbers of our assistants as the contribution that pharmacy can make to the community. The development of quality pharmacy schools, promoting continuing professional development through professional life and trying to avoid an exodus of graduates to the industrialised nations are imperative,” Mr Parrot declared.

He told congress participants that within the framework of the FIP Working Group on Pharmacists and AIDS, an investigation had been carried out to try to assess the number of health professionals in Africa. The survey shed light on the serious lack of professionals on that continent and its consequences when it comes to taking care of HIV/AIDS patients. He said the recent G8 summit had committed to address the health situation in Africa. Leaders recognised the need to reinforce health care systems and underscored the importance of training and maintaining specialist personnel in their native regions. He hoped that, thanks to the alleviation of the debt burden on the poorest countries, resources might be allocated to the development of sufficient tools with which to combat HIV/AIDS.

Counterfeit medicines

Mr Parrot went on to discuss the difficult fight that the pharmaceutical industry and others in the medicines supply chain have in order to combat drug counterfeiting. It has become evident that all countries in the world are potentially threatened by parallel markets and the risk associated with substandard products, and the reputation of the entire medicines supply chain, from producer to pharmacist, is at stake. “It is imperative that its professionals and public authorities urgently adapt policies and procedures to address a scourge that is endangering years of research and is undermining health care systems,” he said.

He called for complete transparency of all parties involved in the manufacture of medicines and their wholesale and retail distribution. “The batches of medicines transferred from one firm to another should be associated with a roadmap identifying every stage of the process. This is, in fact, quite feasible if we have the political will to do it,” he said.

Some medicines are more at risk from counterfeiting than others. In developed countries, those with the highest added value, the highest market demand, or those with restricted access are the most affected, and systems intended to identify all who have taken part in the supply chain should focus first on those medicines most liable to be counterfeited.

Some national health policy makers have chosen to remove certain medicines from the regular, secured pharmaceutical supply chain. They do so for the sake of free trade, said Mr Parrot, with a view to increasing access or cutting medicine prices. This, however, tends to reduce the respect with which medicines should be treated. In many countries medicines are accessible to the public without adequate precautions for ensuring their quality and proper use. This constitutes a security gap through which counterfeiting is expanding, and this is not to mention the risks of buying medicines on the internet.

Mr Parrot said: “Unfortunately, the growth of medicines trade worldwide also leads to an increase in counterfeit dissemination. That is why FIP, within the framework of its ongoing work with European authorities, is calling on all stakeholders to take action with both European and national authorities to make clear the importance of preserving the special status of medicines. The utmost goal should be to remove medicines from policies based solely on commercial criteria, open markets and excessive deregulation.”

Medicines are unique in that they carry with them both vast benefit and serious risk to public health. Consequently they must be the object of special care at every stage of their life. The expansion of the European internal market increases the risk of penetration by counterfeit medicines wherever measures for controlling imports are insufficient. Once admitted into the European Union, such medicines can circulate without further control, said Mr Parrot. “That is why we must promptly harmonise our procedures.”

Industrialised countries

Mr Parrot continued his address by talking about major trends affecting pharmacy practice in industrialised countries. He said it was no secret that health systems must improve the efficiency and security of all treatments given to patients. Most are facing similar challenges: an ageing population and the high cost of new therapeutic techniques. Health policies are thus called on to reconcile contradictory objectives, namely, to improve the quality and effectiveness of treatments while at the same time managing inevitable budget restrictions.

The pharmacist, in turn, is therefore subjected to increasingly difficult constraints. He or she must take into account the consequences of political reorientation of health systems and, in particular, a redistribution of roles among health professionals. Pharmacists are increasingly being called upon to contribute to prevention and detection of disease. To this end they must be able to adopt a clinical approach in their professional practice. “It goes without saying,” said Mr Parrot, “that we should not change pharmacists into second-rate physicians, asking them to undertake medical diagnoses. But they should be able to direct patients appropriately within the health care system.”

Such referral by pharmacists could take several forms. For example, a pharmacist could select patients’ profiles with regard to risk factors in order to guide them towards early detection. He or she could identify the effects of medicines on patients with chronic conditions in order to detect side effects and prevent iatrogenic effects. The possibilities are many, said Mr Parrot.

He added that the efficiency of health care systems largely depends on the ability of primary health care providers to take responsibility for the early detection of diseases. Where pharmacists are concerned this means taking action the better to identify risk factors for well-known patients. In fact, the pharmacist has many assets that would allow him or her to exercise pre-detection for a number of health problems, Mr Parrot said.

Pharmaceutical research

Finally, Mr Parrot turned to pharmaceutical research, which, he said, is at an important crossroads in terms of biotechnology. New approaches, which bear much hope for several unsatisfied needs in terms of disease treatments, cannot be developed without strong encouragement for governments and reinforced co-operation between public and private research, he said.

Within ongoing groundbreaking developments new players are making themselves known on the world scene. Stem cell research, for example, could revolutionise medicine in coming years by producing replacement tissues or body parts. “This prompts the need for our societies to open up ethical debates that transcend the borders of any one nation,” said Mr Parrot.

“Let me also add that it is important, more so than ever, for countries well advanced in these fields to take into consideration the needs of developing countries in their research programmes. Such orientation also depends on the political will of governments,” he concluded.

Top FIP awards go to British pharmacists

Two British pharmacists have been recognised by the International Pharmaceutical Federation for their contribution to international pharmacy.

John Ferguson, a former secretary and registrar of the Royal Pharmaceutical Society, was presented with an FIP Distinguished Service award during the opening session of the congress on 4 September.

At the same time, the Høst-Madsen medal, FIP’s highest scientific honour, was presented to Bob Davis, emeritus professor at the University of Nottingham.

Further awards were presented to João Silveira, of Portugal (Distinguished Practice award), to Hans-Günter Friese, of Germany (Lifetime Achievement in Pharmaceutical Practice award), and to Kal Chatto, of the United States (Distinguished Service award).

New fellows FIP established fellowships in September 2004 to recognise individual members of FIP who have exemplified, throughout their careers, strong international leadership and distinguished work in pharmaceutical practice or science. Jane Nicholson, of Bristol-Myers Squibb, UK, is one of the inaugural recipients. The others are Dominique Duchene (France), Keith Johnson (US), Hans Junginger (Germany) and Hiroshi Terada (Japan).