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Vogler S, Haasis MA, van den Ham R, Humbert T, Garner S, Suleman F. European collaborations on medicine and vaccine procurement. Bull World Health Organ 2021; 99:715-721. [PMID: 34621089 PMCID: PMC8477421 DOI: 10.2471/blt.21.285761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 11/27/2022] Open
Abstract
To ensure equitable access to medicines and vaccines, organizational efforts and purchase volumes have been pooled in joint procurements and negotiations for decades in some regions of the world, as well as globally through supranational procurement mechanisms. In Europe, countries started to collaborate on procurement and negotiations recently when it became increasingly difficult to ensure access to high-priced medicines, even in high-income countries. Two European country collaborations (the Nordic Pharmaceutical Forum and the Baltic Procurement Initiative) have successfully concluded at least one joint tender process for medicines and vaccines and the Beneluxa Initiative has concluded its first successful joint price negotiation. This article describes the experiences of these country collaborations. Challenges observed included: legal barriers; institutional and organizational differences between health-care systems in member countries; and the risk that suppliers will be reluctant to cooperate with country collaborations. Although these collaborations helped improve access to medicines and vaccines for the countries involved, in situations such as a global health crisis, larger-scale, more-inclusive initiatives are needed. In the current coronavirus disease 2019 (COVID-19) pandemic, COVID-19 Vaccines Global Access (COVAX) initiative established a global procurement mechanism to ensure the equitable distribution of COVID-19 vaccines globally. Despite differences in organization and scale, the European country collaborations and COVAX have some similarities: (i) their success depends on the increased purchasing power associated with pooled order volumes; (ii) expert knowledge and previous procurement experience is pooled; (iii) they perform other collaborative activities that go beyond procurement alone; and (iv) they actively involve external partners and stakeholders.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Gesundheit Österreich GmbH, Stubenring 6, 1010 Vienna, Austria
| | - Manuel A Haasis
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Gesundheit Österreich GmbH, Stubenring 6, 1010 Vienna, Austria
| | - Rianne van den Ham
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, Netherlands
| | - Tifenn Humbert
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Sarah Garner
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Fatima Suleman
- WHO Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice, University of KwaZulu-Natal, Durban, South Africa
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Teh BP, Ahmad N, Ibnu Rasid EN, Zolkifli NA, Sastu@Zakaria UR, Mohamed Yusoff N, Zulkapli A, Japri N, Lee JC, Muhammad H. Herbal-Based Formulation Containing Eurycoma longifolia and Labisia pumila Aqueous Extracts: Safe for Consumption? Pharmaceuticals (Basel) 2021; 14:ph14020142. [PMID: 33579048 PMCID: PMC7916751 DOI: 10.3390/ph14020142] [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: 11/28/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/03/2022] Open
Abstract
A combined polyherbal formulation containing tongkat ali (Eurycoma longifolia) and kacip fatimah (Labisia pumila) aqueous extracts was evaluated for its safety aspect. A repeated dose 28-day toxicity study using Wistar rats was conducted where the polyherbal formulation was administered at doses 125, 500 and 2000 mg/kg body weight to male and female treatment groups daily via oral gavage, with rats receiving only water as the control group. In-life parameters measured include monitoring of food and water consumption and clinical and functional observations. On day 29, blood was collected for haematological and biochemical analysis. The rats were necropsied and the organs were collected for histopathological examination. This study showed that the combined formulation did not induce any significant toxicity effect at any dose level in terms of morbidity, mortality, behaviour, functional observation, body weight, food and water consumption, whole blood haematology and serum biochemistry. However, there were some microscopic changes in the histopathological examinations of some organs given 2000 mg/kg body weight, which may suggest an early response to the polyherbal formulation. From this study, the no observed adverse effect level is estimated to be more than 500 mg/kg body weight but not exceeding 2000 mg/kg body weight. The observed effects at the highest dose indicate the need for further study of longer dosing duration.
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Affiliation(s)
- Bee Ping Teh
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.A.); (E.N.I.R.); (N.A.Z.); (U.R.S.); (N.M.Y.); (N.J.); (J.C.L.); (H.M.)
- Correspondence: ; Tel.: +60-33362-7961
| | - Norzahirah Ahmad
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.A.); (E.N.I.R.); (N.A.Z.); (U.R.S.); (N.M.Y.); (N.J.); (J.C.L.); (H.M.)
| | - Elda Nurafnie Ibnu Rasid
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.A.); (E.N.I.R.); (N.A.Z.); (U.R.S.); (N.M.Y.); (N.J.); (J.C.L.); (H.M.)
| | - Nor Azlina Zolkifli
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.A.); (E.N.I.R.); (N.A.Z.); (U.R.S.); (N.M.Y.); (N.J.); (J.C.L.); (H.M.)
| | - Umi Rubiah Sastu@Zakaria
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.A.); (E.N.I.R.); (N.A.Z.); (U.R.S.); (N.M.Y.); (N.J.); (J.C.L.); (H.M.)
| | - Norliyana Mohamed Yusoff
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.A.); (E.N.I.R.); (N.A.Z.); (U.R.S.); (N.M.Y.); (N.J.); (J.C.L.); (H.M.)
| | - Azlina Zulkapli
- Medical Resource Research Centre, Institute for Medical Research, Jalan Pahang, Kuala Lumpur 50588, Wilayah Persekutuan Kuala Lumpur, Malaysia;
| | - Norfarahana Japri
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.A.); (E.N.I.R.); (N.A.Z.); (U.R.S.); (N.M.Y.); (N.J.); (J.C.L.); (H.M.)
| | - June Chelyn Lee
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.A.); (E.N.I.R.); (N.A.Z.); (U.R.S.); (N.M.Y.); (N.J.); (J.C.L.); (H.M.)
| | - Hussin Muhammad
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.A.); (E.N.I.R.); (N.A.Z.); (U.R.S.); (N.M.Y.); (N.J.); (J.C.L.); (H.M.)
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