The Pharmaceutical Journal
Vol 277 (Supplement) F02-F04
October 2006

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FIP Congress 2006

Diseases know no boundaries; neither should medicine or pharmaceutical care

The International Pharmaceutical Federation has made significant progress in representing pharmacists worldwide, according to Jean Parrot.

Delivering his valedictory address as FIP’s president to the opening session of the congress, he said that new associations have joined and consequently reinforced the diverse representation of FIP’s council; FIP now has 120 member associations from more than 80 countries.

He said: “It is imperative to consult representatives from as many countries as possible with regards to the decisions we make as a federation in order to prepare our profession for future challenges on a global scale. Globalisation and the efficiency of communication have progressively erased boundaries; practice in any country could sooner or later influence practice in another. We should all acquire a true international culture in pharmacy so as to assimilate the evolution of our profession. Diseases know no boundaries; it should be the same with medicines and pharmaceutical care.”

Mr Parrot reminded the congress that FIP has the objective of representing and promoting pharmacy and pharmaceutical sciences worldwide. This means that it should demonstrate a vested interest in all that relates to medicines, from research to patients’ use, not forgetting any action relating to dispensing and wholesale distribution. In every instance, pharmacists should question the professional skills of those involved in guaranteeing safe procedures, ethics and the requirements they should impose upon themselves in order to assure the existence and delivery of high quality medicines everywhere in the world.

A goal of FIP as a non-governmental organisation is to expand the relationships it has with international institutions. He said it has been a priority to reinforce FIP’s collaboration with the WHO. This has been achieved by the integration of FIP members in many WHO working groups, where their presence is largely responsible for the inclusion of policies related to implementing pharmacy services in order to satisfy patients’ needs worldwide.

In particular, Mr Parrot said he had had the honour of organising the founding meeting of the African Pharmaceutical Forum, the sixth FIP/WHO forum. Now FIP is able to employ these integrated FIP/WHO initiatives on every continent, allowing the federation to position itself as a true WHO field partner. “Forums offer us valuable platforms from which to improve and focus attention on the value of pharmacists’ contributions in the implementation of co-ordinated health policies adapted to targeted communities,” he said.

“Pharmacists and members of the boards of directors of these forums should be aware of the potential this positioning represents; they must explore it for the benefit of local communities and our profession as a whole. These forums must not only reinforce their relationship with WHO offices, but must also become better integrated within FIP structures.”

What should be a priority for all health care professions is to create multidisciplinary initiatives and patient-centred protocols, where each profession’s expertise is used to give continuity to the other. Therefore, there is an essential need for connecting care provided in the hospital and that provided in the community. The lack of continuity that exists between community and hospital is a source of dysfunction and waste. This gap often compromises the quality of care, resulting in less likelihood of recovery for the patient.

Workforce issues

Regarding the global pharmacy workforce, FIP has spent much time and energy preparing an important study providing complementary data to that released by the WHO for World Health Day 2006. Both establishments point to a true demographic challenge, affecting both developing and developed countries. Developing countries are facing more dire circumstances as lack of health care providers and structures to employ them, as well as a lack of medicines themselves, result in the deaths of millions of patients from diseases that are largely treatable.

The “brain drain” from countries with scarce resources to those considered wealthy makes an already difficult situation all the worse. Students in the developing world go to developed countries looking for professional training and tend to remain. Motivational measures should be deployed in order to encourage professionals to return to their countries of origin in order that their communities can benefit from their knowledge acquired abroad. So the development of new schools of pharmacy in developing countries has become a must.

Industrialised countries could provide support to these schools by sending academic support. “This is one of the best ways to encourage students to establish their practice in their own countries.” Mr Parrot declared. Another solution might be to create new professions to address needs in terms of care, when these needs are extreme. “We must train intermediate level professionals able to solve simple health issues or to provide basic care under the supervision of a pharmacist or a physician,” he said.

Turning to training in developed countries, Mr Parrot said he believes that training systems for health professionals have also shown limitations. In many cases, the quota system at universities has resulted in a reduction in numbers of pharmacists, physicians and dentists. The elderly population, which is increasing in most developed countries, will certainly increase the need for professionals and health services. “We still have to develop preventive measures and the rational use of existing human resources. Government officials must recognise that the need for more professionals is a pressing and irreversible trend, and that communities should be prepared in time.”

International health

FIP has many battles to fight, said Mr Parrot, and international health is one of these that is causing concern. “We should continue to move forward in order to curb and reverse such pandemic situations as AIDS, malaria and other chronic diseases, as well as be prepared to fight against the dangers of newly emerging threats such as avian influenza.”

Twenty-five years after its appearance, the devastating AIDS epidemic is still present in frightening numbers. Sixty-five million people are infected, 25 million people have died and 40 million people are currently sick in the world. In addition to the lives of those suffering, AIDS also destroys the lives of families and communities, and hinders social and economic development. Life expectancy is shortened. What do we do, Mr Parrot asked. Initiatives arise year after year, but the magnitude of this terrible calamity still persists and defies health service providers. The WHO’s “3 by 5” programme has been only partially achieved. Why?

At government level, new actions have been developed this year. The international community is engaged in providing universal access to anti-HIV treatments. It is about finding resources in order to combine the four elements needed to succeed. Those four elements are:

• Education for communities in order to combat risky behaviours

• Availability of adequate care

• Availability of safe medicines at reasonably low prices

• Dispensing of medicines in such ways as to ensure their proper use and efficacy

Pharmacists lie at the core of this issue, said Mr Parrot. In spite of that, access to medicines in many countries depends on the goodwill of officials, who need to fight corruption and counterfeiting and reorganise health infrastructures. A recent report delivered by the Independent Commission on Industrial Property, Innovation and Health Rights, created two years ago by the WHO, provides important hints on how to improve and evolve the situation in poor countries. Among the measures proposed the need for initiatives to train health practitioners and to retain them in their local jobs is emphasised.

International solidarity could also be used to search for ongoing financial sources in order to respond to the needs of those infected with HIV/AIDS, tuberculosis or malaria. One of the latest initiatives, the International Drug Purchase Facility, includes a tax on air travel tickets, which will bring some additional relief to existing financial systems. Brazil is one of the promoters of this action together with international and non-governmental organisations, Mr Parrot told the congress.

Fortunately, some countries have been able to reduce the prevalence of HIV/AIDS on their own. Private foundations have brought remarkable support to this battle against these and other chronic diseases. Tangible results are evident and are a considerable source of motivation to continue the fight. “However, it is necessary to admit that we have entered a new era of health risks, which progress in parallel with globalisation. In the case of bird flu, every country in the world should be able to co-ordinate its actions to avoid the dangers from a pandemic. This implies different action levels and, once again, pharmacists have a central role to play:

• In monitoring — surveillance of an endemic risk is based on reports provided by health professionals who are in contact with patients and this surveillance is imperative to allow immediate reactions to threats

• In primary prevention — through counselling on hygiene and diet

• In secondary prevention — through vaccination and detection

• In training different individuals in intervention schemes

The WHO has recently revised the International Health Regulations, which became immediately applicable in the case of bird flu.

Each country is invited to assess its needs and develop a national action plan. “Pharmacists should be associated with this process and should be used in these plans on account of the knowledge they possess,” said Mr Parrot. “This requires a proactive approach from their professional organisations towards the officials in charge.”

Mr Parrot went on to say that he had been surprised by the first schemes brought forward by French health authority agencies in their preparations for the fight against bird flu. These schemes showed no awareness of the proximity and availability of many categories of potential contributors, he said. They largely ignored the capabilities of pharmacists.

“But the intervention of pharmacist representatives has fortunately provided a possibility for restructuring these plans to better incorporate available resources.”

Counterfeit medicines

Turning to counterfeit medicines, Mr Parrot said that we are affected at the heart of our profession. One of the most recent reports published in the US estimated that sales of counterfeit medicines could reach $75bn by 2010. Many of the measures in the fight against counterfeiting directly involve pharmacists.

On the one hand, pharmacists could provide public education, so that everyone becomes vigilant, buying medicines only from pharmacies and alerting health authorities about any suspicious products; on the other, pharmacists could assure the integrity of the medicines distribution chain by respecting good supply and tracking practices.

To tackle the problem, an international working group gathering all stakeholders should be created by the WHO with haste, said Mr Parrot.

FIP is already an active member of the working group on counterfeit medicines set up by the Council of Europe. It has also established closer relationship with the commissioner in charge of the fight against counterfeiting in the EU.

Concluding, Mr Parrot said that the many FIP initiatives in this field have attempted to make government officials, in all countries of the world, aware of the fact that, with an adapted set of regulations, pharmacists possess the capabilities to protect public health and ensure integrity and, therefore, safety to the medicines supply chain.

“The evolution of the role of pharmacists within the health system has finally become whole,” he said.

Challenges to pharmacists all over the world

Pharmacists attending the World Congress of Pharmacy are ambassadors of goodwill, bravely struggling to find scientific answers to the diseases that affect human beings and constantly trying to overcome the challenges imposed by many of these illnesses.

So said Jaldo de Souza Santos, president of the Federal Council of Pharmacy of Brazil, when he addressed the congress opening session.

There are several challenges, he said, including HIV/AIDS, yellow fever, hepatitis C, a lack of access to basic and disease-specific medicines, a need for urgent progress in genomic therapy and the lack, in some countries, of pharmaceutical and public services in community pharmacies.

All of these are challenges to pharmacists all over the world, he said.

Nowadays, all pharmacists show a greater awareness of their social responsibilities as health care professionals. They are more technically and scientifically prepared for the job and are moved by a strong desire for knowledge.

Pharmacists are no longer professionals exclusively dedicated to the manufacturing of drugs; they are professionals who care about all human beings, regardless of whether they need to take medicines or not.

“We have improved ourselves,” said Dr de Souza Santos. “We have improved in terms of quality and quantity. We have enlarged the understanding of boundaries between patients as human beings and human beings as patients, and we have absorbed new missions and diversified our fields of practice.”

Pharmacy, he said, must be focused on educational health campaigns, including vaccination programmes, where the pharmacist works with patients to determine, first, their needs and, second, what care should be provided to meet those needs.

“We must not forget that the population considers the pharmacist a friend. Therefore, whenever seeking our services, the public should not need to make an appointment and should not have to pay for the care provided,” Dr de Souza Santos declared.

He quoted from the Brazilian writer Monteiro Labato: “The pharmacist’s motto is identical to the soldier’s — to serve.

One serves the homeland; the other serves humanity.”

Pharmacists, as soldiers on the front line, must always be ready to serve the collective community, he concluded.