International Conference Calls for Improved Use of Medicines

Issued by: Organizers of the International Conference on Improving Use of Medicines

About 450 leading multi-disciplinary researchers, national and international policy makers, patient advocates and clinicians representing nearly 80 countries, gathered in Chiang Mai, Thailand, for the second International Conference on Improving Use of Medicines (ICIUM 2004). Participants reported on the many advances made during the past years and, at the same time, expressed concern over the continued, widespread improper use of medicines. While agreeing that the unprecedented level of funding now available to increase availability of medicines in non-industrialized nations is essential, they cautioned that the increased access to quality drugs is beneficial only if the medicines are used properly.

“Improper use of medicines will lead to resistance making therapy more expensive in the future,” said Dr. Hans V. Hogerzeil, Interim Director of the World Health Organization's Department of Essential Drugs and Medicines Policy (WHO/EDM). “To save lives, increased availability of medicines and treatment must be accompanied by responsible use.”

Overuse, underuse, and misuse of medicines along with poor patient adherence to therapy are contributing to the emergence and rapid spread of disease strains that are resistant to currently available treatment. Resistance to conventional drugs has been observed in patients with respiratory infections, HIV/AIDS, diarrheal diseases, tuberculosis, and malaria along with other ailments. Once the ability to use important drugs is lost due to resistance, their effectiveness is lost to every patient, whether in Africa, Asia or anywhere else in the world.

Members of the international community who assembled for ICIUM 2004 reviewed impressive research generated since the first International Conference on Improving Use of Medicines in 1997. The previous conference was a milestone which resulted in unprecedented consensus on interventions to improve medicine use and a definitive global research agenda to increase understanding of issues that impact the appropriate use of medicines.

Since the 1997 meeting, “we now face a much more complex and challenging international health environment in which there is a potential for promoting improved use of medicines,” said Dr. Jonathan Quick, President-elect and CEO designate of Management Sciences for Health. A key participant in 1997, Dr. Quick, former head of WHO/EDM, stated that “measurable progress is possible. To achieve sustained long term impact, we must learn to use the levers of health insurance, public information and public opinion, and political leadership. We must also build strong fundamentals of technical, financial, and human resources, and focus on clear public health priorities.”

As one of the exciting new developments, emerging health insurance systems promise to be effective tools to improve access to and use of medicines. “The future of the concept of essential medicines lies with health insurance” said Dr. Hogerzeil. “Insurance systems can emerge in resource-deprived settings. Increasingly, reimbursement schemes will leverage programs of rational use, medicine pricing and pharmaceutical policies in general." He went on to suggest that the WHO could help countries by establishing practical guidelines for creating or strengthening health insurance systems.

In the struggle to combat increasing antimicrobial resistance, according to Dr. Hogerzeil, one of the most exciting things is the potential for 3-day therapy of childhood pneumonia, the major killer of under 5-year olds in developing countries. Short-course antibiotic therapy for non-severe pneumonia seems to be effective, lower treatment cost, increase adherence, cause less adverse effects, and decrease the emergence of resistant bacteria. If the evidence is really conclusive, this is not only important for Africa, but for Europe and the rest of the world as well.

Looking to the future, Eva Ombaka, who heads the Ecumenical Pharmaceutical Network in Kenya, strongly encouraged “harnessing the people’s power” to improve medicine use in the community. In the keynote address she said, “Community leaders, faith leaders, and the youth are untapped resources that should be used.”

ICIUM 2004 is part of a global effort to improve the use of medicines, particularly in non-industrialized countries. The ICIUM 2004 Conference was collaboratively organized by the Boston University School of Public Health Center for International Health, Harvard Medical School Department of Ambulatory Care & Prevention, International Network for Rational Use of Drugs, Management Sciences for Health through its Rational Pharmaceutical Management Plus (RPM Plus) and Strategies for Enhancing Access to Medicines (SEAM) Programs, the Thai Network for Rational Use of Drugs, and the World Health Organization Department of Essential Drugs and Medicines Policy.

Major support for the conference was provided by the Bill & Melinda Gates Foundation, Canadian International Development Agency, Swedish International Development Cooperation Agency, U.S. Agency for International Development, World Health Organization (WHO)-Geneva, WHO Country Office for Thailand, and WHO Regional Office for South-East Asia (SEARO). In addition, more than 20 other organizations contributed to the success of the conference by sponsoring attendance of multiple participants.

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