What the 72nd World Health Assembly means for access to essential palliative care medicines

Categories: Care, Featured, Leadership, People & Places, and Policy.

Dr Stephen Watiti, Uganda, patient, clinical provider and palliative care advocate with Hon Dr Dzulkefly Ahmad, Malaysia Minister of Health at the WHA side event on palliative care, cosponsored by the IAHPC, Ministry of Health of Malaysia and the Republic of Panama.

Last week, the World Health Assembly adopted a resolution to improve the transparency of markets, vaccines and other health products in an effort to expand access through Universal Health Coverage.

A corresponding zero draft of a 5-year roadmap for comprehensive support for access to medicines and vaccines included several mentions of palliative care.

The International Association for Hospice and Palliative Care has been engaging this issue, laying the groundwork for WHO’s engagement, delivering a range of interventions (statements) at the World Health Assembly, and cosponsoring a side event at the WHA with the Minister of Health of Malaysia and the Republic of Panama.

ehospice caught up with Katherine Pettus, Advocacy Officer for the IAHPC, to hear more about developments on this issue at the 72 World Health Assembly and implications for the UN High Level Meeting on Universal Health Coverage on 23rd September.

What does the passed resolution on improving transparency of markets for medicines mean for palliative care?

This mostly has to do with expensive medicines that are still under patent, and whose prices vary widely between countries. IAHPC advocates for increased availability of oral morphine, and for generic palliative care medicines on the WHO Model List.

Prices do vary widely, as we show in our Opioid Price Watch, but the reasons for unavailability and unaffordability of controlled medicines mostly have to do with supply chain issues, as well as  their being inexpensive, and unprofitable, which often leads to markups.

IAHPC has requested the WHA and the Secretariat to undertake a report on pricing and availability of controlled medicines similar to that produced last year on Cancer Medicines and pricing.

How did IAHPC get palliative care prominently into the Zero Draft Roadmap for Access 2019-2023?

We were involved in the consultations and the Secretariat was open to our suggestions to change some of the language that did not reflect the need to improve availability, but rather concentrated on “overstock” and prevention of “misuse.” IAHPC is a “non-state actor” in official relations with WHO, and our focal point is the Medicines Division, so we work closely with them on issues relating to availability of palliative care medicines.

What do you think the side event accomplished? Any outcomes to highlight? 

A key outcome from the side event was to increase visibility of the issue and the data that Dr. Knaul and colleagues are providing to take the Lancet Implementation project forward. It was very helpful that the WHPCA sponsored the presence of Dr. Stephen Watiti from Uganda, who gave the patient/stakeholder/provider voice, and talked about nurse prescribing of morphine in Uganda. Any airtime for palliative care is good at the World Health Assembly, especially when there is so much focus on prevention, treatment, “best buys”, for Non-communicable diseases, and the opioid overdose crisis in the US.

What’s next in terms of IAHPC’s advocacy efforts? Where do you go from here in the lead up to the UN High Level Meetings on Universal Health Coverage?

What is next is to explore the openness of the new Executive Board to consider approving a resolution to send to next years WHA on an official World Hospice and Palliative Care Day. This would boost the visibility of the October WHPC Day we already have, and lend communications and outreach support to all the partners working on the ground.

On the September High Level Meeting on UHC in New York, we are collaborating with WHPCA to disseminate some suggested text for the Political Declaration to raise the visibility of palliative care as an essential service. We are sending this to all our various members and partners so they can pass the suggested text along to contacts in the Ministries of Health and Foreign Affairs, since it is the missions in New York who will be doing the negotiating on the text.

We are aware that there is a crisis in the United States of non-medical use of opioids and therefore we consistently reinforce the message that governments’ efforts should focus on the availability for the medical and rational use of opioids. The lack of access to patients in the Lower and Middle Income Countries in particular is an area of focus, where access and affordability are still a public health scandal of global proportions.

Resolving this crisis merits much more inter-organisational technical and normative work to help governments  develop and implement balanced drug policies, train their workforce in basic palliative care, and strengthen their supply chains, among other things.

[1] World Health Organization. https://www.who.int/news-room/detail/28-05-2019-world-health-update-28-may-2019