Dr Brundtland was speaking following the passage of a resolution on WHO's Revised Drug Strategy. When originally proposed at last year's World Health Assembly the resolution caused considerable debate and was referred back to WHO's Executive Board. The final text was passed unanimously in today's Committee A meeting. It reflects a broad consensus which resulted from an Executive Board working group consisting of 59 countries.

Fighting inequity in health care

Despite improved global availability, at least one-third of the world's population still lacks access to essential drugs. In the most impoverished parts of Africa and Asia, this proportion rises to over half. "The inequities are striking", says Dr Jonathan Quick, Director of Essential Drugs and Other Medicines at WHO. "In developed countries a course of antibiotics can be bought for the equivalent of two or three hours' wages. One-year's treatment for HIV infection costs the equivalent of four to six months' salary. And the majority of drug costs are reimbursed. In developing countries, a full course of antibiotics to cure simple pneumonia may cost one month's wages. In many of these countries one year's HIV treatment – if it were purchased – would consume 30 years' income. And the majority of households must buy medicines with money from their own pockets."

Adoption of the resolution gives WHO the go-ahead to expand its work on a range of issues which affect access, quality, and rational use of drugs.

Health implications of new trade agreements

Many WHO Member States have expressed concern about the possible impact of the World Trade Organization (WTO) agreement on intellectual property rights (TRIPS – Agreement on Trade-Related Aspects of Intellectual Property Rights). Some fear that TRIPS requirements for intellectual property rights could lead to a higher cost burden for newer, patent-protected essential drugs, further reducing access to health care. Others emphasize that TRIPS will stimulate research for needed new drugs.

The resolution urges countries to, "explore and review their options under international agreements, including trade agreements, to safeguard access to essential drugs." It charges WHO with, "monitoring and analyzing the pharmaceutical and public health implications" of these agreements. WHO will carry out this work in a participatory manner, with its Member States and with WTO, the World Intellectual Property Organization (WIPO), the UN Conference on Trade and Development (UNCTAD), industry, public interest NGOs, and other interested partners. Work will include monitoring and research activities, regional and national consultations, collaboration through the Director-General's roundtable process, and cooperation with other organizations such as UNAIDS and the European Union.

Combating poor quality and counterfeit medicines

Sub-standard, expired and counterfeit drugs are increasingly found in international and local markets. Control of production, import and export of drugs vary greatly among countries. Hundreds of people have died as a result. Paradoxically, although global standards for drugs are becoming more demanding, 10 to 20% of sampled drugs in developing countries fail quality control tests. Only one-in-six countries have fully functional drug regulation systems.

The resolution calls on countries and WHO to expand their efforts to ensure effective drug regulation and to promote quality assurance for all pharmaceuticals, including vaccines. Existing standards for good manufacturing practices and for trade in pharmaceutical products will be strengthened and better enforced through direct support to countries, expanded training programmes, regional regulatory networks, and new partnerships.

Access and rational use of drugs