April 7, 2011 is the traditional World Health Day to celebrate the founding of the WHO in 1948. This year’s theme is the fight against anti-microbial resistance and the slogan is “No action today, No cure tomorrow.” It is a legitimate call to order, but to whom is this cry of alarm addressed? To the planet’s entire population or just those with access to anti-microbials? For, though antibiotics are wasted, this does not mean they are shared!
After having saved so many lives, antibiotics have become dangerous due to misuse in rich countries. This leads to not only inefficiency, but also to the emergence of resistant strains.
So to whom is this message addressed? Only the most affluent 25% of the population, even though it can always be argued that strains of Mycobacterium tuberculosis resistant to anti-tuberculosis drugs already proliferate in poor countries and in areas of high insecurity in wealthy countries.
But we don’t always remember to state that drugs, antibiotics, antibacterials, or antivirals are often sold in deplorable conditions, in the streets or on the ground itself, in open air markets, with no control either over their production (falsified medicines) or their expiration date…
Next year, shall the 2012 World Health Day be universal
Key for effective and coherent global health, the WHO, “the World’s health beacon“, should have delivered a resolutely international annual message. This beacon however, functions oddly with occasional eclipses. The wave of epidemic influenza – the supposed health tsunami, which mobilized all the WHO’s forces around the H1N1 virus in 2009/2010 – was ultimately much ado about (a costly) nothing. There were no real objectives since the announced Apocalypse, fortunately, did not occur. This example is compounded by another one today: antimicrobial resistance. This issue also addresses industrialized countries whose populations are the least exposed to communicable diseases and yet, are nonetheless the best protected. Less disease and more medication, excessive consumption and waste, the path is well trodden and not confined to the medical world. It repeats itself in many other contexts.
Our wish for next year is that the theme for the 2012 World Health Day be universal, addressing patients from economically stable countries and those, in far greater numbers, from poorer countries.
It is not sordid realism to reiterate that the latter countries concentrate within their boundaries the billion starving human beings; a billion thirsty people; a billion and a half men, women, and children without access to sanitation; the eight hundred million illiterate individuals; and the two billion people without access to lifesaving surgery….
Perhaps this is an uncalled for controversy, a Manichean debate, but …
Blessed are those who are resistant to medicine,
for they at least have had access to them…
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The United Nations have declared 2011 the International Year of Forests, which we at the Fondation warmly welcome. The fight against deforestation and support of sustainable harvest of timber are amongst the Fondation’s primary objectives, particularly because we are conscience of the direct link that exists between forest preservation and the protection of the rights of indigenous peoples.
The future of these populations is intimately linked to their ecosystems, on which they are dependent for survival. Preserving their forest, allows them to continue to live their traditional lifestyle, to meet their needs by sustainably using the resources of their forest, and as well as preserving their culture and language, the forest protects them from the frenetic evolution of today’s world.
The deforestation of a zone inhabited by an indigenous population is all too often synonymous with the forced entry into the Western and globalized world and the loss of orientation for fragile populations. Here we are measuring a very important aspect of the strong interdependence that exists between the forest and human development.
The forest is more than just a bunch of trees and vegetation to be admired while strolling through the countryside. The forest is an immense sanctuary of biodiversity, it is the most important reserve of fresh water in the world, the best way to preserve our soils from erosion, to maintain high soil quality and thus to reap successful harvests and to preserve our climate.
100 square meters destroyed every second
The forest is the lung of the planet, a lung that is in a pitiful state and that we continue to destroy at the rate of 100 square meters every second…
We really hope that this year, 2011, is the starting point for a greater awareness on the importance of the forest and its multiple interdependencies with human development. To all, we wish you a wonderful year in 2011…. in the forest!!!
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On this World AIDS Day we can be proud.
Globally we have reduced the number of new HIV infections and deaths by nearly 20%.
This means less people are becoming infected with HIV and less people are dying from AIDS.
56 countries have either stabilized or significantly reduced the rate of new HIV infections.
For the first time, we have broken the trajectory of the AIDS epidemic and reached the first part of the Millennium Development Goal for HIV.
We have achieved this amazing milestone because families, communities, governments— and UNAIDS have united the world in an unprecedented movement.
We are prevailing…with political commitment, leadership from all sectors including leaders of faith…with science, with evidence, with human rights, and passion.
On this World AIDS Day we can remember.
Our successes have not come without sacrifice. Today we mourn friends and family— some 30 million people who have lost their lives to AIDS.
An estimated 10 million people are waiting for treatment.
We must remember that punitive laws and stigma still hurt too many people around the world.
On this World AIDS Day we can commit.
Our hard-won gains are fragile—so our commitment to the AIDS response must remain strong.
AIDS is a proven investment and must be a shared responsibility today and tomorrow.
On this World AIDS Day we can be hopeful.
With your commitment and that of UNAIDS and the UN family, we are changing the course of the AIDS epidemic. I have called for the virtual elimination of mother-to-child transmission by 2015. Nothing gives me more hope than knowing that an AIDS free generation is possible in our lifetime. So on this World AIDS Day, take action today—together we can reach Zero new infections. Zero discrimination. Zero AIDS-related deaths!
Executive Director of UNAIDS and
Under Secretary-General of the United Nations
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Medicines are an important factor in the management of the health of populations. The prescription and rational use of medicines ensure for patients a therapeutic outcome based primarily on the quality, effectiveness, and safety of the drugs themselves. In sum, results hinge on proper practices in terms of manufacturing, distribution, and dispensing. The effectiveness of medication depends on its traceability.
Nowadays, it is a truism to recognize the importance of counterfeit drugs commonly called falsified medicines. They represent roughly 10% of the world market; adding up to nearly 45 billion US dollars within a global pharmaceutical production that totals approximately 570 to 575 billion US Dollars. Predictions for 2020 foresee world production reaching a value of 1,200 to 1,300 billion US dollars. The tragic health, social, and economic consequences will certainly be considerable if we are not careful.
According to WHO, if counterfeit drugs in certain developed countries represent about 1% of their market, figures reach 30% in African markets (reaching as high as 50% of all available medicines in some countries).
Worse yet, in Africa, counterfeit medicines are likely to focus on products most in demand for the treatment of endemic diseases (malaria), chronic diseases (tuberculosis, diabetes, hypertension ….), and devastatingly lethal diseases (AIDS). For example, two thirds of all antimalarial drugs sold on the continent are falsified, for a disease that kills on average over one million people each year, 80% of them in Sub-Saharan Africa alone.
We must take into account that health policies, as are medicines, have always been a source of political competition worldwide, regardless of pharmaceutical or medical aspects. This principle is often used by industrialized countries to maintain their rank within the alliance of great nations. Nowadays, organizations (NGOs, IGOs,…) and institutions of defense and financing of human health such as the WHO, the Global Fund, the Fondation Chirac, the Bill & Melinda Gates Foundation, are mobilizing to improve access to safe medicines wherever they are lacking and in the exclusive interest of public health.
Moreover, the evolution and development of the pharmaceutical industry in emerging countries like China, India, Brazil, Russia, Turkey, South Africa, Nigeria, Indonesia, and Thailand have also contributed significantly to overcoming the challenges of global production, geographical accessibility, and affordability of essential medicines. However, it would be a shame to allow counterfeit medicines to increase exponentially at the hands of mafia networks, which often take advantage of the vulnerability of countries or emergency regulations and decisions at the international level (compulsory licensing, the Doha declaration, parallel imports … .. ) to accomplish their dirty work.
To fight falsified medicines at all levels (networks, channels, trafficking, local markets…), we need to mobilize global resources, with the support of national and international political will.
Such political will must first be nourished by strong and coordinated commitments. Then it must be rendered concrete through consistently consensual legal provisions, and finally be complemented by sustainable actions that are supported by all.
Dr. Aboubakrine CARS
Chairman of Private Pharmacists’ Union of Senegal
Secretary General of the Inter-African Association of Pharmacists (Ispharma)
SG of the Permanent Secretariat of the Pharmaceutical Forum International (FPI)
Priorities in the fight against falsified medicines:
On the African continent, throughout regional and subregional institutions, such as the African Union, the West African Economic and Monetary Union (UEMOA), the Economic and Monetary Community of Central Africa (CEMAC), The Customs and Economic Union of Central Africa (UDEAC), the cornerstones and priorities of the fight are threefold:
➢ At the Legislative and Regulatory level:
1 / the development of coordinated laws and regulations to streamline litigation (through the use of different emergency procedures), to assess damage in relation to the harm caused to the licensee or patent holder, and to make provisions for more deterrent and coercive fines and prison sentences.
2 / the development of new offenses in the Customs Code penalizing the importation, exportation, trading, and transit of counterfeit goods and giving Customs full jurisdiction over suspected counterfeit products and the capacity to appeal directly to the Public Prosecutor.
3 / drawing up and/or updating within the Health Code of legal, regulatory, and disciplinary measures that are context-specific, coordinated, and valid in all member countries of the sub-regional or regional institution.
➢ At the communicative, informational and educational level:
1 / the development and creation of tools adapted to informing and raising awareness of the different target audiences (government, national and/or community institutions, opinion leaders, public health officials, and even counterfeiters)
2 / organizing seminars and workshops and/or strengthening the capacity of institutional enforcement authorities (customs, police…) in terms of detection, quality control, and traceability of medicines.
➢ At the health and socio-economic level:
1 / encouraging local production of essential medicines that are geographically and financially accessible.
2 / harmonizing international financial and technical support for the implementation of horizontal projects and programs according to the principles of the 2005 Paris Declaration.
3 / the adoption in the different regional and sub-regional areas of principles harmonized according to GMPs, GPDs and Pharmacovigilance (currently part of the WAEMU since July 2010 with the development of the GMP Guide).
4 / The creation of national committees in all the countries of the different regional and sub-regional areas. This would include pharmacists, but also the various State departments and services involved in tracking and enforcing laws against counterfeiters and sellers of falsified medicines.
The African pharmacist has a major role to play in this great undertaking, through his continuing education and that of his agents; through information and awareness campaigns for his patients/clients on the complexity of drug stability, as well as the dangers of consuming counterfeit medicines including those purchased in illicit channels and on the Internet; and finally through the advice he offers his patients.
We have benefited, as others, from technical and financial support to strengthen our capabilities particularly in the field of drug quality control at the Central Humanitaire Medico-Pharmaceutique of Clermont-Ferrand. Today, our priority is on this area of control along with pharmacovigilance in order to ensure the quality of the pharmaceutical care offered to our population.
This is the moment to encourage and congratulate institutions such as the Fondation Chirac and the Council of Europe, which, with the Cotonou Declaration and MEDICRIME have finished bravely establishing the basis for this global desire to fight the perpetrators of the genocide of fake medicines.
“Fear has changed sides.”
Together, with ethics, equity, solidarity, and justice as their sole weapons, the determination of just men will soon overcome the greed of the merchants of death.