|Press Release WHO/45
3 September 1999
WHO CALLS FOR GOOD DRUG DONATION PRACTICE DURING EMERGENCIES AS IT ISSUES NEW GUIDELINES
Good drug donations save lives and are very much needed, especially in times of emergencies. Sufficient essential drugs to meet the needs of 1.5 million people for three months were sent to Albania early on in the Southern Balkans crisis, for example.
However, a recent survey by the World Health Organization (WHO) of 108 drug donation lists submitted to the Albanian Ministry of Health during May 1999 found that: some 50% of these lists only mentioned trade names, many of which were unknown to local health professionals; only 56% included information on shelf-life, of which about 41% of the drugs had a remaining shelf-life of less than one year; and 18% of donations contained small packs of free samples or drugs returned to pharmacies. None of these practices are acceptable, WHO argues.
A similar picture also emerges elsewhere. A 1997 study by Epicentre and Pharmaciens Sans Frontières estimated that 50B 60% of drugs donated in Bosnia were inappropriate. Likewise, drug donation problems have been reported from Rwanda, Somalia and Honduras and could happen in the wake of the Turkish earthquake disaster because WHO principles on drug donations are not adhered to, said Dr Jonathan Quick, Director of WHO's Department of Essential Drugs and Other Medicines.
"As soon as any disaster reaches our television screens, many drugs, the great majority sent with the best of intentions, are dispatched to the scene of the emergency. However, there also have been problems with some drug donations. They fail to meet the most urgent real health needs and, once in the country, they clog up already overloaded distribution systems and become difficult to dispose of," said Dr Quick.
WHO urges: follow the Guidelines
"For this reason, WHO has for years promoted good drug donation practices. And on the basis of a recent global survey of experiences with the Interagency Guidelines for Drug Donations, issued by WHO in 1996, we have revised them to make them easier to follow," added Dr Quick. This survey showed that six donor countries and 13 recipient countries had developed their own drug donation guidelines. Forty per cent of all responding organizations had changed their donation practices to follow the guidelines. Forty-five per cent of recipients reported an improvement in drug donation quality, while 52% now find it easier to refuse unwanted donations. The revised Guidelines are based on consensus among 15 major United Nations and international agencies active in emergency humanitarian relief.
Improvements in drug donations have indeed been observed, but greater efforts are required if the situations seen in so many countries are to be avoided. "Put simply," reiterated Dr Quick, "more countries need to develop national guidelines for drug donations, and more donors will need to change their practices."
WHO is therefore repeating its plea to donors to ensure that their donations:
WHO is also broadening its partnership to promote good donation practices beyond the interagency group that developed the guidelines. Other non-governmental organizations, pharmaceutical industries and donor groups are being invited to adhere to the guidelines and WHO will continue to monitor donation practice in emergency situations.
The release of the revised Guidelines is particularly timely in light of the flux of drug donations into Turkey following the earthquake there. Large quantities of donated and unsolicited medical supplies are hampering the restocking or regular or emergency medical structures, according to a report from the International Federation of Red Cross and Red Crescent Societies.
Making a bad situation worse: having to dispose of unwanted drugs
Unwanted drug donations are bad enough, but if accumulated can become a major chemical waste problem. Disposal should be in purpose-built facilities to minimize potential environmental contamination. But such facilities are rare in low and middle-income countries. Pierre Chirac, pharmaceutical consultant to Médecins Sans Frontières, reports that it was necessary to send an incinerator to Mostar in 1996 and Armenia in 1988 to dispose of unsuitable donations.
The only other alternative is to ship such drugs to another country. But the price is high: it will cost US$ two to four million to ship 1000 metric tons of inappropriate pharmaceuticals and medical supplies from Croatia for appropriate disposal.
Responding to this situation, WHO has today also issued its interagency Guidelines for Safe Disposal of Unwanted Pharmaceuticals in and after Emergencies. Representing the combined efforts of 13 agencies, the guidelines are aimed at ministries, health authorities, environmental and waste management authorities, and experts at ministerial, regional and local levels. They describe a number of disposal methods involving minimal risks to public health and the environment. These include landfill, encapsulation, inertization (i.e., rendering the product as safe waste), discharge to a sewer and incineration, and can all be used by countries with limited resources and equipment.
Note to editors: Copies of the Revised Guidelines for Drug Donations (reference WHO/EDM/PAR/99.4) and Interagency Guidelines for Safe Disposal of Unwanted Pharmaceuticals in and after Emergencies (reference WHO/EDM/PAR/99.2) are available from the Documentation Centre, Department of Essential Drugs and Other Medicines, World Health Organization, 1211 Geneva 27, Switzerland. Both sets of WHO guidelines are available at the WHO website at: http://www.who.int/dap/edmguidelines.html
For further information please contact Gregory Hartl, Office of Press and Public Relations, WHO, Geneva, telephone: (41 22) 791 4458, fax: 41 22 791 4858. E-mail: firstname.lastname@example.org or Dr Jonathan Quick, Director, Department of Essential Drugs and Other Medicines, tel +41 22 791 4443, E-Mail: email@example.com; Hans Hogerzeil, tel: +41 22 791 3528/3893 E-Mail: firstname.lastname@example.org, or Dr Robin Gray, tel: +41 22 791 3522/3893. E-Mail: email@example.com All WHO Press Releases, Fact Sheets and Features can be obtained on Internet on the WHO home page http://www.who.ch