4-P-3
TWENTY-FIVE YEARS OF
ESSENTIAL DRUGS: REFLECTIONS ON ACHIEVEMENTS AND UNFINISHED AGENDA Jonathan D. Quick, MD, MPH, Director, Essential Drugs and Medicines Policy (EDM) World
Health Organization (WHO), Geneva Since
the concept of ¡°essential drugs¡± was first introduced to the world in 1975,
much has been achieved. By the
end of 1999, 156 countries had an essential drugs list (127, or 80%, of
which had been recently updated), 135 countries had developed national
treatment guidelines (83% of which had been recently updated), 88 countries
had introduced the essential drugs concept into curricula for medicine and
pharmacy students, and the WHO Guide to Good Prescribing had been
translated into 18 languages and adopted by teaching institutions in numerous
countries. Most importantly, the number of people estimated to have regular
access to essential drugs rose from 2.1 billion in 1977 to nearly 4 billion
in 1997. Despite
these achievements, it is estimated that one-third of the world¡¯s
population ¨C roughly two billion people ¨C lacks regular access to essential
drugs. Unsafe and wasteful
drug use persists: 25 to 75% of antibiotic prescriptions in teaching
hospitals studies from both developed and developing countries are
inappropriate, 30 to 60% of patients in primary health care centres
received antibiotics (perhaps twice what is clinically needed), high levels
of unnecessary and unsafe injections continue in many countries, and 50% of
patients worldwide fail to take medicines correctly. Finally, 10 to 20% of sampled drugs
in a survey of developing countries failed quality control tests. And in one large dataset of
reported counterfeit and substandard drugs, 60% had no active ingredient. Hence,
challenges include securing universal access to essential drugs, promoting
rational use of drugs by health professionals and the public, and ensuring
the quality and safety of all medicines. These challenges are especially great for the nearly 80
countries in which average income is less than $2 per capita per year. Key
actions include expanding access to essential drugs through improved drug
selection, equitable and sustainable drug financing mechanisms, affordable
drug prices, and reliable pharmaceutical supply systems. Countering continued irrational use
of drugs requires educational, managerial, and regulatory action for health
professional and consumers in both the public and private sectors. And improving drug quality and
safety requires not only appropriate standards, but also effective drug
regulation systems.