Info Service on Health Issues (May13/09)
30 May 2013
Third World Network
friends and colleagues,
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:
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.
writer, Ms. Shila Kaur, is the Health Action International Asia Pacific
(HAIAP) and Health Consultant to Third World Network.
Third World Network
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
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
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.
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
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. +
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,
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
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
"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
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
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. +
crucial for increased access to treatment
(First published in SUNS #7592 Tuesday 28 May 2013)
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
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',"
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
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
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: http://apps.who.int/prequal/)
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,"