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Fitsum Y, Werede A, Mahmud Saleh A, Tesfamariam EH, Magombo F, Misghina F, Yemane H, Bahta I, Abraham L, Bahta M, Debesai M, Tesfagaber M, Ghirmai M, Tesfamariam S, Russom M. Understanding, readiness, and response of healthcare professionals in combating falsified medical products in Eritrea: a population-based survey. Ther Adv Drug Saf 2023; 14:20420986231213713. [PMID: 38107771 PMCID: PMC10725142 DOI: 10.1177/20420986231213713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/17/2023] [Indexed: 12/19/2023] Open
Abstract
Background The circulation of falsified medical products is a global threat and is expected to be higher in low- and middle-income countries. Objective This study was conducted to assess the understanding, readiness, and response of Eritrea's healthcare professionals (HCPs), and identify potential areas of intervention to combat circulation of falsified medical products. Design This was a nationwide population-based cross-sectional survey, conducted in December 2021. Methods This study enrolled representative samples of HCPs working in public and private health facilities. Two-stage stratified cluster sampling was used to select study participants and data were collected through face-to-face interviews. Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test along with their post hoc tests, Jonckheere-Terpstra, and logistic regression analyses were performed as appropriate. Results The study enrolled 707 HCPs, and 96.6% were successfully surveyed. The majority of the participants (62.5%) encountered products with suspected quality defects and 63.8% claimed that they had reported the incident(s) at least once. About 85% reported that complaints should be submitted to the Eritrean Pharmacovigilance Centre and 74.0% indicated that it should be reported at the earliest time possible even if the reporter lacks details. The standard reporting form for suspected product quality issues was correctly recognized by 13.8%. Overall, the median knowledge and attitude scores were found to be 9 out of 17 (interquartile range, IQR: 4.0) and 30 out of 35 (IQR: 4.0), respectively. Not knowing how to report (55.6%) and what to report (34.9%), no/delayed feedback from the regulatory authority (30.0%), and unavailability of reporting forms (29.0%) were the frequently reported barriers to reporting. In addition, profession (p = 0.027), no/delayed feedback (adjusted odds ratio [AOR]: 4.70; 95% CI: 2.17-10.18; p < 0.001), and not knowing how to report (AOR: 0.12; 95% CI: 0.05-0.28; p < 0.001) were found to be determinants of reporting suspected product quality defects. Conclusion The readiness and response of Eritrea's HCPs in detecting and reporting falsified medical products seems promising, although a significant knowledge gap was observed.
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Affiliation(s)
- Yodit Fitsum
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Azania Werede
- Product Evaluation and Registration Unit, National Medicines and Food Administration, Ministry of Health, P.O.BOX 212 Asmara, Eritrea
| | | | | | | | - Freminatos Misghina
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Hermella Yemane
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Iyassu Bahta
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Liya Abraham
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Merhawi Bahta
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Merhawi Debesai
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Meron Tesfagaber
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Michael Ghirmai
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Sirak Tesfamariam
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Mulugeta Russom
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
- European Programme for Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
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Ncube BM, Dube A, Ward K. Medicines Regulatory Science Expertise in Africa: Workforce Capacity Development and Harmonisation Activities Towards the Establishment of the African Medicines Agency. Pharmaceut Med 2022; 36:83-97. [DOI: 10.1007/s40290-022-00425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 12/01/2022]
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Moshoeshoe RJ, Enslin GM, Katerere DR. An exploratory assessment of the legislative framework for combating counterfeit medicines in South Africa. J Pharm Policy Pract 2022; 15:3. [PMID: 34986899 PMCID: PMC8730303 DOI: 10.1186/s40545-021-00387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Substandard and Falsified (SF) medical products are a growing global concern. They harm the individual patient, the healthcare system and the economy. The World Health Organisation (WHO) has highlighted contributing factors globally: insufficient national medicine regulation, poor enforcement of existing legislation, weak stakeholder collaboration and the rise of novel viruses, such as the COVID-19. The study aimed to assess the legislative and policy framework and institutional relationships governing pharmaceuticals and anti-counterfeiting strategies. METHODS The study was explorative and consisted of two phases. The first phase was between 2016 and 2017. It looked at document analysis (annual reports and press releases from 2011 to 2016) from government institutions involved in medicines regulation and law enforcement for SF seizure reports between 2004 and 2017. The second phase was between 2016 and 2018 through in-depth semi-structured interviews (seven in total) with selected stakeholders. RESULTS First Phase-the data collected and reported by various departments was sporadic and did not always correlate for the same periods indicating, a lack of a central reporting system and stakeholder collaboration. In South Africa, counterfeiting of medicines mainly involves the smuggling of non-registered goods. The most common counterfeit items were painkillers, herbal teas, herbal ointments, while some were medical devices. Furthermore, Customs identified South Africa as a transhipment point for SF infiltration to neighbouring countries with less robust regulatory systems. Second phase-interview transcripts were analysed by thematic coding. These were identified as the adequacy of legislation, institutional capacity, enforcement and post-market surveillance, stakeholder collaboration and information sharing, and public education and awareness. CONCLUSION Document analysis and interviews indicate that South Africa already has a national drug policy and legislative framework consistent with international law. However, there is no specific pharmaceutical legislation addressing the counterfeiting of medicines. Law enforcement has also been complicated by poor stakeholder engagement and information sharing.
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Affiliation(s)
- R J Moshoeshoe
- Department of Pharmaceutical Sciences, Tshwane University of Technology, Private bag X640, Pretoria, 0001, South Africa
| | - G M Enslin
- Department of Pharmaceutical Sciences, Tshwane University of Technology, Private bag X640, Pretoria, 0001, South Africa
| | - D R Katerere
- Department of Pharmaceutical Sciences, Tshwane University of Technology, Private bag X640, Pretoria, 0001, South Africa.
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Strüver V, Ali S, Fneish F, Fortwengel G. Patient Benefit of Clinical Research in Diversely Advanced African Developing Countries. Curr Ther Res Clin Exp 2022; 96:100656. [PMID: 34976234 PMCID: PMC8688875 DOI: 10.1016/j.curtheres.2021.100656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background The globalization of clinical research should also benefit the population in developing markets. In this context, the approval of tested medicines and the associated expansion of medical care beyond clinical studies would be desirable as a possible long-term benefit. Objectives This study was designed to compare the development of the number of clinical trials with the number of marketing authorizations of medicines on the African continent. To contrast these 2 parameters, the data were analyzed using the model of an ecological study. Methods To reflect the broad spectrum of African developing countries with diverse levels of development, the data collection was based on 2 geographically selected sample countries each from Central, North, East, West, and Southern Africa. Based on the ClinicalTrials.gov registry, the first step was to collect trends data on the development of the clinical trials in the 10 selected countries of the country list of the African Region published by the World Health Organization for the period 2015 to 2018. Subsequently, data on the current number of marketing authorizations of medicines in the selected sample countries were identified using the online registries of the national authorities. The data were utilized in comparative analyses. Results Eight out of 10 model countries showed an increase in the number of clinical trials, with the exceptions of Cameroon and Libya, which showed an overall decline in research activity over the entire time. In direct comparison with drug registrations, the numbers indicate a similar development. The only exception here is Nigeria, a country with a solid performance in clinical research and yet a decrease in medicine registrations since 2015. Conclusions The expected increase in the development of clinical research as result of the globalization trend can basically be observed in most of the model countries. However, this increase does not guarantee an improvement in the number of medicine registrations. Although this is evident in some of the selected model countries, it cannot be projected to the entire African region. This may be linked to the diverse development of the individual countries due to the different political situations and the varying degrees of clinical research infrastructure. (Curr Ther Res Clin Exp. 2022; 82:XXX–XXX)
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Affiliation(s)
- Vanessa Strüver
- Department of Media, Information, and Design, Hochschule Hannover, University of Applied Sciences and Arts, Hannover, Germany
| | - Sheraz Ali
- School of Pharmacy and Pharmacology, College of Health and Medicine University of Tasmania, Sandy Bay, Tasmania, Australia
| | - Firas Fneish
- Biostatistics Department, Institute for Cell Biology and Biophysics, Leibniz University Hannover, Hannover, Germany
| | - Gerhard Fortwengel
- Department of Media, Information, and Design, Hochschule Hannover, University of Applied Sciences and Arts, Hannover, Germany
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Perehudoff K, Durán C, Demchenko I, Mazzanti V, Parwani P, Suleman F, de Ruijter A. Impact of the European Union on access to medicines in low- and middle-income countries: A scoping review. THE LANCET REGIONAL HEALTH. EUROPE 2021; 9:100219. [PMID: 34693391 PMCID: PMC8513155 DOI: 10.1016/j.lanepe.2021.100219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This Scoping Review synthesises evidence of the impacts of European Union (EU) law, regulation, and policy on access to medicines in in non-EU low- and middle-income countries (LMICs), and the mechanisms and nature of those impacts. We searched eight scholarly databases and grey literature published between 1995-2021 in four languages. The EU exerts global influence on pharmaceuticals in LMICs in three ways: explicit agreements between EU-LMICs (ex. accession, trade, and economic agreements); LMICs' reliance on EU internal regulation, standards, or methods (ex. market authorisation); 'soft' forms of EU influence (ex. research funding, capacity building). This study illustrates that EU policy makers adopt measures with the potential to influence medicines in LMICs despite limited evidence of their positive and/or negative impact(s). The EU's fragmented internal and external actions in fields related to pharmaceuticals reveal the need for principles for global equitable access to medicines to guide EU policy.
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Affiliation(s)
- Katrina Perehudoff
- Law Centre for Health & Life, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
- Amsterdam Centre for European Law and Governance, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- WHO Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector, University of Toronto, Canada
- Medicines Law & Policy, Amsterdam, the Netherlands
- Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
| | - Carlos Durán
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, Netherlands
| | - Ivan Demchenko
- Department of Forensic Medicine and Medical Law, Bogomolets National Medical University, st. Mechnikova, 5, Kyiv, 01133, Ukraine
| | - Valentina Mazzanti
- Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
| | - Pramiti Parwani
- Law Centre for Health & Life, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
- Amsterdam Centre for European Law and Governance, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Campus Westville, Durban, 4041, South Africa
- WHO Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice, University of KwaZulu-Natal, Campus Westville, Durban, 4041, South Africa
| | - Anniek de Ruijter
- Law Centre for Health & Life, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
- Amsterdam Centre for European Law and Governance, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
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Narsai K, Leufkens HGM, Mantel-Teeuwisse AK. Linking market authorizations of medicines with disease burden in South Africa. J Pharm Policy Pract 2021; 14:33. [PMID: 33795015 PMCID: PMC8017838 DOI: 10.1186/s40545-021-00314-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa is going through an epidemiological transition, including an impressive increase in non-communicable diseases. The introduction of medicines has not kept pace with the needs in developing countries. The objectives of this study were to (i) examine the correlation between the number of medicine approvals and disease burden and (ii) compare approval timelines of medicines with disease burden in South Africa in the period 2012-2017. METHODS The dataset was compiled from publicly available data on medicines registered in South Africa between 2012 and 2017. A correlation analysis was conducted to determine the level of alignment between the number and nature of medicines registered, as determined by the WHO ATC Classification and the Lancet Global Burden of Disease data. Median registration timelines were determined to assess whether medicines for diseases of higher burden were registered faster. RESULTS A total of 3059 registered medicines were included in the study, including 2779 generic medicines, 267 new chemical entities and 13 vaccines. There was a high level of alignment between the number of medicines registered to treat diseases with higher disease burden levels more effectively, except for lower respiratory tract infections and HIV/AIDS which showed less medicines registered as compared to expectations based on disease burden, respectively. HIV/AIDS showed a lower level of correlation with a much higher disease burden compared to number of medicines registered, but simultaneously also a much shorter median registration timeline (32 months) compared to the other disease areas. CONCLUSIONS There was generally a high level of alignment between disease burden and number of medicines authorised, except for HIV/AIDS and lower respiratory tract infections. Regulatory authorities should continue to consider burden of disease data to ensure that public health needs are met.
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Affiliation(s)
- K Narsai
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - H G M Leufkens
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - A K Mantel-Teeuwisse
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.
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Brhlikova P, Maigetter K, Murison J, Agaba AG, Tusiimire J, Pollock AM. Registration and local production of essential medicines in Uganda. J Pharm Policy Pract 2020; 13:31. [PMID: 32793355 PMCID: PMC7419186 DOI: 10.1186/s40545-020-00234-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 05/31/2020] [Indexed: 11/20/2022] Open
Abstract
Background Universal access to high quality essential medicines is critical to sustainable development (SDG 3.8). However low- and middle-income countries struggle to ensure access to all medicines on their national essential medicines lists (EML). Market registration is the first step in determining both access and availability yet the extent to which essential medicines are registered for use at country level is not known. Companies apply for a marketing authorisation, however low price or lack of a market is a disincentive. Local production has been promoted to ensure availability of essential medicines but research in this area is also limited. Methods The study took place between 2011 and 2015. We systematically examined the registration status of medicines and vaccines listed in the Ugandan 2012 EML and conducted 20 interviews with regulators, ministry of health representatives, donors, and pharmaceutical producers and analysed quality assurance issues affecting registration, procurement, and local production of medicines in Uganda. In 2017 we conducted a further three interviews to clarify issues around non-registration of essential medicines highlighted by our analysis. Results Of the 566 essential medicines and vaccines nearly half (49%; 275/566) had no registered product in 2012. Of the 3130 registered products, just over a quarter (28%; 880/3130) were listed on the EML. Six local producers had registered 138 products of which 40 corresponded to 32 unique essential medicines. Interviews highlighted alternative routes to availability other than registration. Local producers faced considerable barriers to achieving international quality standards required for international procurement of medicines for the domestic market. Conclusions Monitoring and audit of the registration of essential and non-essential medicines should be a priority nationally and, regionally through harmonisation of registration requirements in the East African Community. National and regional manufacturing plans should consider local production of unregistered essential medicines.
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Affiliation(s)
- Petra Brhlikova
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Karen Maigetter
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Jude Murison
- Centre for Trust, Peace and Social Relations, Coventry University, Coventry, UK
| | - Amon G Agaba
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jonans Tusiimire
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Allyson M Pollock
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
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Ndomondo-Sigonda M, Miot J, Naidoo S, Ng’andu B, Ngum N, Masota NE, Kaale E. National medicines regulatory authorities financial sustainability in the East African Community. PLoS One 2020; 15:e0236332. [PMID: 32702048 PMCID: PMC7377437 DOI: 10.1371/journal.pone.0236332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 07/03/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Adequate and sustainable funding of national medicine regulatory agencies (NMRAs) is key for assurance of quality, safety and efficacy of medical products circulating in a market. The study aimed to determine factors affecting NMRAs funding in five East African Community (EAC) countries namely: Burundi, Kenya, Rwanda, Tanzania (Mainland and Zanzibar) and Uganda. METHODOLOGY An exploratory, mixed method design using both qualitative and quantitative data, was employed. Data from six NMRAs was collected through a combination of semi-structured interviews, questionnaires, and checklists for the period 2011/12-2014/15 while 2010/11 data served as baseline. Interviews were conducted with heads of NMRAs and monitoring and evaluation experts of the respective agencies. NMRA's financing was assessed using six indicators namely, funding policy, financial autonomy, the total annual budget, actual funding per annum, funds received from various sources, and the NMRA expenditure. RESULTS The average total annual budget for all the EAC countries during the study period 2011-2015 ranged from USD 824,328.67 to USD 10,724,536.50. The low budget in Zanzibar may be attributed to population and pharmaceutical market size. Uganda's attainment of 98.75% (USD 10,656,704) revenue from industry fees is a result of deliberate government policy change from 100% reliance on donor funding over a period of 10 years (1995-2015). On average, the proportion of revenue against budget per annum is 54.8% (USD 458,970.11), 98.7% (USD 10,302,295.25) and 100% (USD 7,375,802.08) for Zanzibar Food & Drugs Agency (ZFDA), Uganda National Drug Authority (NDA) and Tanzania Medicines and Medical Devices Authority (TMDA) respectively. Governments, industry fees and donors are the major sources of funding across all NMRAs in the EAC region, with TMDA and Uganda NDA relying more on industry fees by 73.20% (USD 4,664,777.59) and 98.25% (USD 8,077,238.20) respectively. While Burundi relies solely on government funding, ZFDA, on the other hand, received on average 50.40% (USD 252,557.22) from government and 40.60% (USD 165,303.34) from industry fees and the remaining 9% from donors and other sources. An overall contribution of funds received from donors by each NMRA was the least among other sources of financing. Observation of expenditure patterns indicated operational costs to be the major expense in the majority of the NMRAs, followed by salaries and infrastructure development. The Kenya NMRA has the highest degree of average expenditure across all three categories, with the least average expenditures being marked by Burundi NMRA. The operational costs on average increased considerably in all the NMRAs during the study period. CONCLUSION Evidence from the EAC suggests that government and industry fees are the main sources of funding while donor contributions vary from country to country. Government policy, legal framework, and fees structure are the key enablers of NMRAs funding sustainability.
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Affiliation(s)
- Margareth Ndomondo-Sigonda
- Pharmacology Division, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- African Union Development Agency -New Partnership for Africa’s Development (AUDA-NEPAD), Midrand, South Africa
- * E-mail:
| | - Jacqueline Miot
- Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Shan Naidoo
- Public Health Medicine Department, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Brian Ng’andu
- African Union Development Agency -New Partnership for Africa’s Development (AUDA-NEPAD), Midrand, South Africa
| | - Nancy Ngum
- African Union Development Agency -New Partnership for Africa’s Development (AUDA-NEPAD), Midrand, South Africa
| | - Nelson E. Masota
- Institute for Pharmacy and Food Chemistry, Julius-Maximilians- University of Wuerzburg, Würzburg, Germany
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eliangiringa Kaale
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Pelfrene E, Harvey Allchurch M, Ntamabyaliro N, Nambasa V, Ventura FV, Nagercoil N, Cavaleri M. The European Medicines Agency's scientific opinion on oral fexinidazole for human African trypanosomiasis. PLoS Negl Trop Dis 2019; 13:e0007381. [PMID: 31246956 PMCID: PMC6597029 DOI: 10.1371/journal.pntd.0007381] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Eric Pelfrene
- Office of Anti-infectives and Vaccines, Human Medicines Evaluation Division, European Medicines Agency (EMA), Amsterdam, The Netherlands
- * E-mail:
| | | | - Nsengi Ntamabyaliro
- Clinical Pharmacology Unit, University of Kinshasa, Democratic Republic of the Congo
| | | | - Fátima V. Ventura
- Medicines Evaluation Department, National Authority of Medicines and Health Products (INFARMED), Lisbon, Portugal
| | - Nithyanandan Nagercoil
- Licensing Division, Medicines and Healthcare products Regulatory Agency (MHRA), London, United Kingdom
| | - Marco Cavaleri
- Office of Anti-infectives and Vaccines, Human Medicines Evaluation Division, European Medicines Agency (EMA), Amsterdam, The Netherlands
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Liberti L, McAuslane N, Stolk P, Breckenridge A, Leufkens H. A Proposed Framework for a Globally Applicable Pragmatic Approach to Using Facilitated Regulatory Pathways. Ther Innov Regul Sci 2018. [DOI: 10.1177/2168479018813977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lawrence Liberti
- Centre for Innovation in Regulatory Science (CIRS), London, United Kingdom
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands
| | - Neil McAuslane
- Centre for Innovation in Regulatory Science (CIRS), London, United Kingdom
| | - Pieter Stolk
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands
| | | | - Hubert Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands
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Laustsen AH, Dorrestijn N. Integrating Engineering, Manufacturing, and Regulatory Considerations in the Development of Novel Antivenoms. Toxins (Basel) 2018; 10:E309. [PMID: 30065185 PMCID: PMC6115708 DOI: 10.3390/toxins10080309] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 07/23/2018] [Accepted: 07/27/2018] [Indexed: 12/20/2022] Open
Abstract
Snakebite envenoming is a neglected tropical disease that requires immediate attention. Conventional plasma-derived snakebite antivenoms have existed for more than 120 years and have been instrumental in saving thousands of lives. However, both a need and an opportunity exist for harnessing biotechnology and modern drug development approaches to develop novel snakebite antivenoms with better efficacy, safety, and affordability. For this to be realized, though, development approaches, clinical testing, and manufacturing must be feasible for any novel treatment modality to be brought to the clinic. Here, we present engineering, manufacturing, and regulatory considerations that need to be taken into account for any development process for a novel antivenom product, with a particular emphasis on novel antivenoms based on mixtures of monoclonal antibodies. We highlight key drug development challenges that must be addressed, and we attempt to outline some of the important shifts that may have to occur in the ways snakebite antivenoms are designed and evaluated.
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Affiliation(s)
- Andreas Hougaard Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark.
| | - Netty Dorrestijn
- Utrecht Center for Affordable Biotherapeutics, Department of Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands.
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Abstract
Sound regulatory systems are critical for protecting public health against use of medical products which do not meet international standards of quality, safety and efficacy. This review provides a summary of the current status of National Medicines Regulatory Authorities (NMRAs) in Africa, and various initiatives that have been established to improve their performance. All countries in Africa (except Sahrawi Republic), have NMRAs but their organizational set-up and functionality is variable. Some are located within Ministries of Health and others are semi-autonomous. There is progressive improvement in regulatory capacity, particularly in quality control and post-marketing surveillance, pharmacovigilance and clinical trials oversight. The African Vaccines Regulatory Forum, African Medicines Regulatory Harmonization Initiative, Network of Official Medicines Control Laboratories and WHO Prequalification Scheme have helped countries strengthen their regulatory capacities. The potential establishment of the African Medicines Agency (AMA) in 2018 is an opportunity to improve NMRAs’ capacity in Africa.
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Newton PN, Hanson K, Goodman C. Do anti-malarials in Africa meet quality standards? The market penetration of non quality-assured artemisinin combination therapy in eight African countries. Malar J 2017; 16:204. [PMID: 28539125 PMCID: PMC5444102 DOI: 10.1186/s12936-017-1818-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/11/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Quality of artemisinin-based combination therapy (ACT) is important for ensuring malaria parasite clearance and protecting the efficacy of artemisinin-based therapies. The extent to which non quality-assured ACT (non-QAACT), or those not granted global regulatory approval, are available and used to treat malaria in endemic countries is poorly documented. This paper uses national and sub-national medicine outlet surveys conducted in eight study countries (Benin, Kinshasa and Kantanga [Democratic Republic of the Congo, DRC], Kenya, Madagascar, Nigeria, Tanzania, Uganda and Zambia) between 2009 and 2015 to describe the non-QAACT market and to document trends in availability and distribution of non-QAACT in the public and private sector. RESULTS In 2014/15, non-QAACT were most commonly available in Kinshasa (83%), followed by Katanga (53%), Nigeria (48%), Kenya (42%), and Uganda (33%). Non-QAACT accounted for 20% of the market share in the private sector in Kenya, followed by Benin and Uganda (19%), Nigeria (12%) and Zambia (8%); this figure was 27% in Katanga and 40% in Kinshasa. Public sector non-QAACT availability and distribution was much lower, with the exception of Zambia (availability, 85%; market share, 32%). Diverse generics and formulations were available, but non-QAACT were most commonly artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHA PPQ), in tablet formulation, imported, and distributed in urban areas at either pharmacies or drug stores. The number of unique manufacturers supplying non-QAACT to each country ranged from 9 in Uganda to 92 in Nigeria. CONCLUSIONS Addressing the availability and distribution of non-QAACT will require effective private sector engagement and evidence-based strategies to address provider and consumer demand for these products. Given the variation in non-QAACT markets observed across the eight study countries, active efforts to limit registration, importation and distribution of non-QAACT must be tailored to the country context, and will involve addressing complex and challenging aspects of medicine registration, private sector pharmaceutical regulation, local manufacturing and drug importation. These efforts may be critical not only to patient health and safety, but also to effective malaria control and protection of artemisinin drug efficacy in the face of spreading resistance.
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Affiliation(s)
- Paul N. Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WCH 9SH UK
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WCH 9SH UK
| | - Catherine Goodman
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WCH 9SH UK
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Moscou K, Kohler JC. Matching safety to access: global actors and pharmacogovernance in Kenya- a case study. Global Health 2017; 13:20. [PMID: 28335786 PMCID: PMC5363016 DOI: 10.1186/s12992-017-0232-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/12/2017] [Indexed: 11/11/2022] Open
Abstract
Background The Kenyan government has sought to address inadequacies in its National Pharmaceutical Policy and the Pharmacy and Poisons Board’s (PPB) medicines governance by engaging with global actors (e.g. the World Health Organization). Policy actors have influenced the way pharmacovigilance is defined, how challenges are understood and which norms are requisite to address drug safety issues. In this paper, we investigate the relationship between specific modes of engagement among global (exogenous) and domestic actors at the national and sub-national level to identify the positive or negative effect on pharmacovigilance and pharmacogovernance in Kenya. Pharmacogovernance is defined as the manner in which governing structures; policy instruments; institutional authority (e.g., ability to act, implement and enforce norms, policies and processes) and resources are managed to promote societal interests for patient safety and protection from adverse drug reactions (ADRs). Qualitative research methods that included key informant interviews and document analysis, were employed to investigate the relationship between global actors’ patterns of engagement with national actors and pharmacogovernance in Kenya. Results Global actors’ influence on pharmacogovernance and pharmacovigilance priorities in Kenya (e.g., legislation and adverse drug reaction surveillance) was positively perceived by key informants. We found that global actors’ engagement with state actors produced positive and negative outcomes. Engagement with the PPB and Ministry of Health (MOH) that was characterized as dependent (advocacy, empowerment, delegated) or interdependent (collaborative, cooperative, consultative) was mostly associated with positive outcomes e.g., capacity building; strengthening legislation and stakeholder coordination. Fragmentation (independent engagement) hindered risk communication between public, private, and NGO health programs. Conclusion A framework for assessing pharmacogovernance would support policy makers’ evidence-based decision making regarding investments to strengthen capacity for pharmacovigilance and guide policies regarding the state and exogenous actor relationship pertaining to pharmacogovernance. Ideally, dependency on exogenous actors should be reduced while retaining consultative, collaborative, and cooperative engagement when inter-dependency is appropriate. The use of global actors to address Kenya’s pharmacovigilance inadequacies leaves the country vulnerable to 1) ad hoc drug surveillance; 2) pharmacovigilance fragmentation; 3) shifting priorities; and 4) cross purpose interests.
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Affiliation(s)
- Kathy Moscou
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada. .,WHO Collaborating Centre for Governance, Accountability and Transparency for the Pharmaceutical Sector, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada. .,School of Health Policy and Management, Faculty of Health, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
| | - Jillian C Kohler
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.,Munk School of Global Affairs1 Devonshire Place (At Trinity College), Toronto, ON, M5S 3K7, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,WHO Collaborating Centre for Governance, Accountability and Transparency for the Pharmaceutical Sector, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada
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Ahonkhai V, Martins SF, Portet A, Lumpkin M, Hartman D. Speeding Access to Vaccines and Medicines in Low- and Middle-Income Countries: A Case for Change and a Framework for Optimized Product Market Authorization. PLoS One 2016; 11:e0166515. [PMID: 27851831 PMCID: PMC5112794 DOI: 10.1371/journal.pone.0166515] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/31/2016] [Indexed: 11/29/2022] Open
Abstract
Background The United Nations Millennium Development Goals galvanized global efforts to alleviate suffering of the world’s poorest people through unprecedented public-private partnerships. Donor aid agencies have demonstrably saved millions of lives that might otherwise have been lost to disease through increased access to quality-assured vaccines and medicines. Yet, the introduction of these health interventions in low- and middle-income countries (LMICs) continues to face a time lag due to factors which remain poorly understood. Methods and Findings A recurring theme from our partnership engagements was that an optimized regulatory process would contribute to improved access to quality health products. Therefore, we investigated the current system for medicine and vaccine registration in LMICs as part of our comprehensive regulatory strategy. Here, we report a fact base of the registration timelines for vaccines and drugs used to treat certain communicable diseases in LMICs. We worked with a broad set of stakeholders, including the World Health Organization’s prequalification team, national regulatory authorities, manufacturers, procurers, and other experts, and collected data on the timelines between first submission and last approval of applications for product registration sub-Saharan Africa. We focused on countries with the highest burden of communicable disease and the greatest need for the products studied. The data showed a typical lag of 4 to 7 years between the first regulatory submission which was usually to a regulatory agency in a high-income country, and the final approval in Sub-Saharan Africa. Two of the three typical registration steps which products undergo before delivery in the countries involve lengthy timelines. Failure to leverage or rely on the findings from reviews already performed by competent regulatory authorities, disparate requirements for product approval by the countries, and lengthy timelines by manufacturers to respond to regulatory queries were key underlying factors for the delays. Conclusions We propose a series of measures which we developed in close collaboration with key stakeholders that could be taken to reduce registration time and to make safe, effective medicines more quickly available in countries where they are most needed. Many of these recommendations are being implemented by the responsible stakeholders, including the WHO prequalification team and the national regulatory authorities in Sub-Saharan Africa. Those efforts will be the focus of subsequent publications by the pertinent groups.
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Affiliation(s)
- Vincent Ahonkhai
- Integrated Development – Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
- * E-mail:
| | - Samuel F. Martins
- Integrated Development – Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Alexandre Portet
- Integrated Development – Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Murray Lumpkin
- Integrated Development – Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Dan Hartman
- Integrated Development – Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
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16
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Jensen DM, Sebhatu P, Reau NS. Generic medications for hepatitis C. Liver Int 2016; 36:925-8. [PMID: 27306302 DOI: 10.1111/liv.13120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 02/13/2023]
Abstract
The recent development and approval of expensive but highly effective oral agents against hepatitis C has led to restrictions and access limitations in many countries with limited healthcare budgets. Generic formulations of many of these agents are available at a fraction of the retail price in several countries because of generic licensure agreements. The discounted alternatives are only accessible in developing countries and require manufacturing and distribution regulations to ensure the quality and bioequivalence of the new drug formulations. The continued medication access limitations have driven great interest in the practice of personal drug importation of the generic formulations. This review and debate will address the medical and legal issues involved in the purchase and importation of these medicines.
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Affiliation(s)
- Donald M Jensen
- Section of Hepatology, Department of Medicine, RUSH Medical Center, Chicago, IL, USA
| | - Phoebe Sebhatu
- Section of Hepatology, Department of Medicine, RUSH Medical Center, Chicago, IL, USA
| | - Nancy S Reau
- Section of Hepatology, Department of Medicine, RUSH Medical Center, Chicago, IL, USA
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Pelfrene E, Pinheiro MH, Cavaleri M. Artemisinin-based combination therapy in the treatment of uncomplicated malaria: review of recent regulatory experience at the European Medicines Agency. Int Health 2015; 7:239-46. [PMID: 25855638 PMCID: PMC4492341 DOI: 10.1093/inthealth/ihv017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 11/03/2014] [Accepted: 12/12/2014] [Indexed: 11/13/2022] Open
Abstract
Malaria remains a major public health challenge with almost half of the world's population exposed to the risk of contracting the illness. Prompt, effective and well tolerated treatment remains one of the cornerstones in the disease management, with artemisinin-based combination therapy the recommended option for non-severe malaria in endemic areas with predominant Plasmodium falciparum infections.Recent experience has been obtained at the European Medicines Agency with regulatory approval of two such antimalarial fixed combination products. For these cases, two different regulatory pathways were applied. As such, the present contribution describes this experience, emphasising main differences and applicability offered by these regulatory choices.
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Affiliation(s)
- Eric Pelfrene
- Office of Anti-infectives and Vaccines, Human Medicines Evaluation Division
| | - Marie-Hélène Pinheiro
- Office of Regulatory Affairs, Human Medicines Research and Development Support Division; European Medicines Agency, 30 Churchill Place, Canary Wharf, London, E14 5EU, UK
| | - Marco Cavaleri
- Office of Anti-infectives and Vaccines, Human Medicines Evaluation Division
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Schroll JB, Abdel-Sattar M, Bero L. The Food and Drug Administration reports provided more data but were more difficult to use than the European Medicines Agency reports. J Clin Epidemiol 2014; 68:102-7. [PMID: 25150193 DOI: 10.1016/j.jclinepi.2014.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 06/18/2014] [Accepted: 06/30/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare the accessibility, comprehensiveness, and usefulness of data available from the European Medicines Agency (EMA) and the Food and Drug Administration (FDA) drug reports. STUDY DESIGN AND SETTING This is a cross-sectional study. All new molecular drugs approved between January 1, 2011 and December 31, 2012 from the FDA and EMA Web sites were eligible. RESULTS We included 27 drug reports. Most were searchable, but the FDA table of contents did not match the file's page numbers. Several FDA documents must be searched compared with a single EMA document, but the FDA reports contain more summary data on harms. Detailed information about harms was reported for 93% of the FDA reports (25 of 27 reports) and 26% of the EMA reports (7 of 27 reports). The reports contained information about trial methodology but did not include trial registry IDs or investigator names. All reports but one contained sufficient information to be used in a meta-analysis. CONCLUSION Detailed data on efficacy and harms are available at the two agencies. The FDA has more summary data on harms, but the documents are harder to navigate.
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Affiliation(s)
- Jeppe Bennekou Schroll
- The Nordic Cochrane Centre, Rigshospitalet, Dept 7810, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark.
| | - Maher Abdel-Sattar
- Department of Clinical Pharmacy, University of California, San Francisco, Suite 420, Box 0613, 3333 California Street, San Francisco, CA 94118 USA
| | - Lisa Bero
- Department of Clinical Pharmacy, University of California, San Francisco, Suite 420, Box 0613, 3333 California Street, San Francisco, CA 94118 USA; Institute for Health Policy Studies, University of California, San Francisco, Suite 420, Box 0613, 3333 California Street, San Francisco, CA 94118 USA
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