Access to essential drugs in poor countries.

THE EFFECTIVENESS OF DRUGS DEpends on a long chain of factors: research and development (R&D) of an appropriate pharmaceutical agent, production, quality control, distribution, inventory control, reliable information for health care professionals and the general public, diagnosis, prescription, financial accessibility, drug dispensing, observance, and pharmacovigilance. At each level, those involved may have conflicting interests, and poor populations are the first to suffer the effects of frail links in this long chain. Today, entire populations lack access to essential quality drugs, and the situation appears to be deteriorating, further marginalizing much of the world’s population. Essential drugs are the foundation for nearly every public health program aimed at reducing morbidity and mortality in the developing world, and pharmaceutical expenditure can account for a high proportion of the total health expenditure of a country. Important health programs that rely on essential drugs include child survival programs, antenatal care, treatment of enteric and respiratory pathogens, and control of tuberculosis and malaria. Other major public health issues exist for which there is no effective pharmaceutical treatment. This article focuses on 4 main issues associated with the inaccessibility of drugs for populations in greatest need: (1) poor-quality and counterfeit drugs; (2) lack of availability of essential drugs due to fluctuating production or prohibitive cost; (3) need to develop field-based drug research to determine optimum utilization and remotivate R&D programs for new drugs for the developing world; and (4) potential consequences of the recent World Trade Organization (WTO) agreements on the availability of old and new drugs. For all these issues, practical recommendations to improve the situation are proposed. The lack of access to essential drugs or vaccines because of economic reasons raises new human rights issues in a world that remains divided among wealthy countries, developing countries, and the rest of the world. Yet, financial access to drugs does not necessarily mean correct use. Continuous training for health care professionals, dissemination of reliable pharmacological data, and improvement of the management of drugs are fundamental steps in improving the quality of care in the developing world. THE PROBLEMS Examples of problems related to development and access to drugs and the magnitude of the public health problems concerned are given in TABLE 1.