TWN Info Service on Health Issues (May13/09)
30 May 2013
Third World Network

Dear friends and colleagues,

We are pleased to share with you the following three articles from the 66th session of the World Health Assembly that took place on 20-28 May at the headquarters of the World Health Organization in Geneva:

1.  D-G addresses several key concerns at WHA opening
2.  Antibiotic resistance a threat to global health security
3.  Generics crucial for increased access to treatment.

The writer, Ms. Shila Kaur, is the Health Action International Asia Pacific (HAIAP) and Health Consultant to Third World Network.

With best wishes,
Third World Network

Item 1

D-G addresses several key concerns at WHA opening
(First published in SUNS #7588 Wednesday 22 May 2013)
Geneva, 21 May (Shila Kaur) -- In her opening address at the 66th World Health Assembly (WHA) taking place in Geneva this week, the Director-General of the World Health Organisation Dr Margaret Chan stated emphatically that "WHO will never be on speaking terms with the tobacco industry ..."
By saying this, Dr. Chan clearly struck a chord with her audience, judging from the resounding applause from the galleries where representatives of civil society and public interest organisations, media and interested observers gathered to listen to the proceedings of the first day of the Assembly, which is meeting from 20 to 28 May.
The applause was echoed by government health leaders from around the world seated in the main Assembly Hall.
In a no-holds barred and authoritative speaking style, Dr. Chan said: "There are no safe tobacco products. There is no safe level of tobacco consumption."
She went on to state that, "... at the same time I do not exclude cooperation with other industries which have a role to play tackling Non-Communicable Diseases (NCDs)".
(Observers note that clearly it is a balancing game that WHO must play, one that has its supporters and detractors from governments and civil society representatives alike.)
Every year in May, health ministers meet in Geneva for seven days to discuss pressing, immediate and long- standing health concerns, to achieve consensus and chart out resolutions and action plans to resolve some of these concerns.
In her opening address, Dr. Chan spoke about emerging infectious diseases such as SARS (Severe Acute Respiratory Syndrome) and more recent cases of Corona virus and H7N9 in the Eastern Mediterranean region and China respectively, which rang alarm bells in the public health community globally.
Within three weeks, by the end of March this year, H7N9 had spread alarmingly to infect 100 persons in China. The Chinese health authorities responded rapidly to this threat by instituting the immediate closure of live bird markets in the country thereby containing the spread of the virus.
"The direct intervention from Chinese health care providers ensured that the infections were controlled," commended Dr. Chan.
Just like the case of SARS which heralded the new age of severe emerging infectious diseases of the 21st century which spread easily and rapidly through the airwaves, health care providers, globally and nationally, managed to defuse these threats and control their spread, thanks to strict adherence to reporting and immediate response measures.
A more sinister scenario presents itself to the international public health community. The threat of antimicrobial resistance looms large, making antibiotics-of-last-resort virtually useless.
"Medicine is fast moving towards a post-antibiotic era and the international health community must recognise and respond to this very serious threat of antimicrobial resistance," stated Dr. Chan emphatically.
On the other hand, the scale-up in antiretroviral therapy, a lowering of prices of medicines and an integrated delivery system have jointly succeeded in bringing HIV rates down.
In June, WHO will issue revised consolidated guidelines for use of retroviral drugs. WHO is continuing to also expand access to existing vaccines for polio despite security threats that compromise polio eradication efforts.
The past two decades have seen improvements in the health of peoples in developing countries.
"We have the right to be proud of recent improvement. For example, the achievements from the Millennium Development Goals have brought out the best in terms of human ingenuity," said Dr. Chan.
In a broad-ranging address that covered concerns about immediate and emerging infectious diseases, NCDs, WHO reform, resource constraints, women and child health, MDGs (Millennium Development Goals), HIV and retroviral therapy, neglected tropical diseases and role of industry, Dr. Chan's underlying message was that WHO's leadership role was crucial and integral to their solution.
"Conflict of interest safeguards are in place in WHO and WHO will use these safeguards in the food, beverage and alcohol industries but it will never work with the tobacco industry," she reiterated. Hence, her statement that "WHO will continue to have no interactions whatsoever with the tobacco industry".
She also stressed that for good public health to prevail, there was a need for equity, an effective governance system, attention to social and environmental determinants of health, a national medicinal policy that emphasises generics, an educated health work force and a commitment to primary health care.
"We are living in troubled times, in a degraded environment; times of armed conflict and acts of terrorism where large numbers of people are living on edge. In these troubled times, public health is a safe refuge."
"We need to keep doing the right thing, keeping on the right track always," were Dr. Chan's concluding remarks. +

Item 2

Antibiotic resistance a threat to global health security
(First published in SUNS #7589 Thursday 23 May 2013)
Geneva, 22 May (Shila Kaur) -- Experts gathered at the 66th session of the World Health Assembly (WHA) expressed grave warnings on antibiotic resistance as a threat to global health security.
While the official plenary meetings of the WHA continue to unfold, there are also steady and outstanding attendances from delegates to side meetings taking place mainly during early mornings, lunchtime and evenings, and organised by country delegations, other UN agencies and civil society groups.
One such meeting on 21 May - "Antibiotic resistance: a threat to global health security" - was a crowd puller.
Organised by the delegations of the United Kingdom, Northern Ireland and Sweden, the attraction for this side meeting was obvious: a top-notch panel of high-level public health officials and leading world experts on antimicrobial resistance (AMR) and the urgency of the subject matter.
Delegates and observers heard presentations from Professor Otto Cars, leading expert on AMR and Global Coordinator of ReACT; Dr Keiji Fukuda, Assistant Director-General, Health Security and Environment, WHO; Prof Dame Sally Davies, Chief Medical Officer, UK; Mr Goran Hagglund, Minister of Health, Sweden; Dr Madeleine de Rosas Valero, Under Secretary of Health, the Philippines; Mr R. K Jain, Ministry of Health, India; and Prof Chris Baggely, Chief Medical Officer, Australia.
(ReACT is an independent global network for concerted action on antibiotic resistance with its international secretariat in Uppsala University, Sweden.)
The messages underpinning the presentations from all speakers were that a strategic approach was needed to manage the state of AMR globally. This strategic approach would involve increasing awareness around the topic of AMR at all levels and strengthening national capacity to handle AMR.
In addition, there was an urgent need for innovation on existing antibiotics, development of newer and better antimicrobials and therapeutic approaches, as well as new diagnostic tests.
Apart from these, old business models had to be discarded to make way for newer ones that promoted the longest possible use for any antibiotic. To this end, what was requisite was to reach out to business and economists.
Prof. Otto Cars urged national governments to consider putting in place antibiotic survival plans.
"The science with respect to antibiotics is difficult; in fact many scientists have left this area of study and work. To prevent misuse of newer antibiotics, new business models were imperative so that there is no misuse/abuse through rampant and unregulated marketing. Apart from this, a massive education campaign on AMR must take place concurrently," he said.
Dr. Keiji Fukuda drove the point home when he stated, "The impact and resolution of AMR is going to be measured in years and possibly decades. AMR has very concrete implications which will affect everybody. Everyday, common infections are going to become untreatable. Hospitals will begin to close down because of an inability to combat and control AMR. The HIV, TB and Malaria games are going to be lost."
Dr. Fukuda reiterated the need for global surveillance and reporting on AMR to establish baseline data on the state of AMR globally.
In her presentation, Dr. Madeleine de Rosas Valero informed that, "In our rush to focus on human health and AMR, we have forgotten the animals."
"Antibiotics are used like vitamins in animals. In the Philippines, cockfights are a national sport and Filipinos believe that antibiotics are necessary to enhance the performance of the cocks and protect them from harm. After the cockfight, the birds are cooked in a special dish and consumed, pesticides residues notwithstanding," she added.
The state of AMR in humans is exacerbated by the use of antibiotics in veterinary practice.
"The withdrawal period is not adhered to, and so antibiotic residues find their way into human food," she stated.
According to Dr. de Rosas Valero, there is a mandatory policy in the Philippines for a national health plan on AMR involving multi-stakeholder collaboration from the relevant government departments, including agriculture, health and local government, as well as the private/business sector.
Mr. R. K. Jain shared India's experience and informed that the country had launched several initiatives to combat AMR including the Jaipur Declaration and the New Delhi Call for Action.
India is currently embarking on a sentinel surveillance system to coordinate use of antibiotics in view of widespread use and easy availability of antibiotics in the country.
Prof. Chris Baggely of Australia said that when the country introduced its Antibiotics Stewardship Initiative, the result was a decrease in the incidence of resistance in hospitals. Australia's Hand Washing Hygiene Initiative has been emulated by other countries worldwide.
"Since 2007, the reducing pipeline for antibiotics has become increasingly clear. In view of this, the role of infection control cannot be de-emphasised or discounted," he stressed.
"By revamping the accreditation process, all hospitals (both public and private) must put in place antimicrobial stewardship programmes. This is a compulsory standard from January 2013. As a result of this, the interest in AMR by CEOs of all hospitals had skyrocketed," said Prof. Baggely.
Prof. Dame Sally Davies and Mr. Goran Hagglund, as co-chairs, were emphatic in their concluding remarks: political will was pivotal to push forward the AMR agenda nationally.
Health ministers present at the meeting were urged to immediately implement national health plans for AMR.
What was clear from the proceedings was that the nature of the debate around AMR was much more than just medical. The social, economic and political contexts could no longer be ignored nor dismissed.
The current WHA session runs from 20 to 28 May 2013. +

Item 3

Generics crucial for increased access to treatment
(First published in SUNS #7592 Tuesday 28 May 2013)

Geneva, 27 May (Shila Kaur) -- United Nations agencies have stressed the pivotal role of generic medicines for access to affordable medicines, particularly in developing countries.
The World Health Organisation's Department of Essential Medicines and Health Products (EMP) and UNITAID jointly organised a side meeting on 22 May alongside the ongoing 66th World Health Assembly.
It was titled "The Current and Future Role of Generic Medicines in Increasing Access to Treatment" and was held at the WHO headquarters to full capacity with multiagency participation.
In welcoming participants to the meeting, Dr. Lembit Rago, EMP's Coordinator for Quality and Safety in Medicines, stated that generic medicines have a very important role to play in the future. Austerity measures in European countries have led to increased reliance and use of generics in view of their cost-saving potential.
"The role of generic medicines will continue to be very important for years to come," he emphasised.
In his introductory remarks, Dr. Philippe Duneton, Deputy Executive Director of UNITAID, explained how UNITAID's business model is providing access to generic medicines by focusing on generics manufacturers to lower prices and thereby increase access to treatment.
He reiterated, "Without the WHO Programme, there will be limited capacity for work. The programme has, in fact driven the harmonisation process."
He further stated that there were many challenges ahead. "Generic formulations, for example, may be difficult to assess and challenge," he warned. "Today is a good opportunity to prepare a ‘To-do List'," he stated.
Following Dr. Duneton's introduction, Dr Rago's presentation focused on the WHO's Prequalification of Medicines Programme (WHO-PQP) in which he described new aspirations given to the Health For All and the Non-Communicable Diseases agenda.
"Both of these," he emphasised, "depend heavily on availability and accessibility of good quality essential medicines".
In his slide entitled "Is quality of medicines still a big problem?", he showcased recent unnecessary deaths related to the use of poor quality medicines.
WHO has an extensive collaborative network which includes working with regulators. Some of the key achievements of these collaborations include increased access to quality medicines. For example, in 2012, eight million people received HIV retroviral treatments of which 6.5 million were for women using prequalified medicines.
Dr. Lembit also explained the benefits of prequalification to both regulators and industries in the region. "PQP is a powerful and effective mechanism to promote access to quality medicine," he said.
In his concluding remarks, Dr. Lembit was emphatic: "PQP saves lives. PQP is not a replacement for national regulatory systems but a mechanism to promote access to quality medicines. The time of poor quality medicines for poor people should be over. Poor people deserve good quality medicine."
Robert Matiru, Porfolio Manager at the Prequalification and Tuberculosis Projects, spoke on the role of WHO's PQP in establishing healthy markets, while Greg Perry, Executive Director at the Medicines Patent Pool, gave an overiew on The Medicines Patent Pool and WHO-PQP: expanding access to quality, generic antiretroviral medicines.
(For details on slide presentations and additional supporting documents, please see:
Hiiti B. Sillo, Director-General of the Tanzania Food and Drugs Authority, spoke about the challenges in national regulation of critically needed medicines in Tanzania. These included: Adequacy of legislation to address regulation requirements and mandates; management structures and processes; human resources capacity and resources; lack of a harmonised GMP requirement and inspection procedure amongst regulators in importing and exporting countries and within the same region; market control which includes inspecting all assignments/imported batches.
In his presentation on "The need for generic policies as part of health reform", Dr. Richard Laing, Medical Officer of the Medicine Programme, EMP, indicated that every country has a different generics market, and that no two countries are the same. Even after a patent expires, branded medications retain a sizeable volume of shares in some countries. What is critical is that all of the drugs, whether generics or branded, must be of the same quality.
Countries vary in their generics uptake. For example, in the US, generics capture more than 80 per cent of a brand's volume within six months.
(In Germany, brand erosion is not so obvious, somewhere between 15-16% over a 4-5 year period whereas in Austria, it is estimated that erosion is between 4-5% over a 4-5 year period.)
In conclusion, in all except high-income countries, out-of-pocket payment is the most frequent mode of payment for medicines. In those countries that have/or are in the process of introducing health insurance coverage which extends to medicines, clearly generic medicines' policies have an important role to play.
"Where people have to pay out-of-pocket, generics policies will allow individual patients to reduce costs by up to 60% and this could make the difference between death or impoverishment and survival," said Laing.