[e-drug] WHO PQ now charging application fees (4)

E-DRUG: WHO PQ now charging application fees (4)
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[While there is perhaps some misunderstanding of the intentions of the WHO PQ program, Balkrishna raises some valid concerns about what an enlarged PQ program might mean for countries – that the emphasis should be more on strengthening existing regulatory authorities so as to obviate the need for prequalification. While that is a situation we would all like to see, the reality is not there yet and, contrary to Balkrishna's argument, perhaps this will act as an incentive to NRAs to become SRAs so that there is no need of PQ of medicines originating from their countries? Any thoughts from colleagues on either side of the debate?
Note: some editing of the submitted message to improve readability. DB]

Dear All

WHO prequalification of GFATM medicines and manufacturers followed on from
the UN prequalification (PQ) of vaccines / manufacturers. The idea was acceptable because it was intended for UN procurement and for similar organizations like GFATM. The scope was limited. But what is being raised now is something different.

WHO on one hand collaborates with member countries to enable them to
have effective regulatory capability and on the other is taking over part of regulator's scope. This represents duplication of effort as well as underestimation of regulators.

The PQ program as it is appears to be a vertical program of the essential medicine department in WHO HQ. While it invites [NRA] regulatory inspectors to join their inspection it is unlikely to have desired impact at organisational level of the NRA. The situation - NRAs are either not capable or creditable and the PQ program seems to re-enforce this message by entering into the NRA regular activities.

If the PQ program assumes the PQ activities at a global level as is being talked about the PQ team will need to be present in countries with a pharmaceutical manufacturing base just like one of the SRA (stringent regulatory authority), USFDA inspection team and USP does in India.

What if the WHO PQ team fails to handle every individual manufacturers request?
What if the country NRAs become less strict considering the takeover of inspection by WHO PQ team.

After all whatever manufacturers spend will be passed on to consumers. If PQ products are purchased by consumers on an out-of pocket basis, is it not going to mean expensive commodities particularly in low-income countries
like Nepal? What if the market has PQ and non-PQ products to offer to
consumers? What if the NRA does a similar PQ job at a lower cost? Is there
any limitation in the scope of PQ program? So there are many concerns.

I would appreciate if these concerns are clarified!

Balkrishna Khakurel
Senior Drug Administrator
Department of Plant Resurces
MoFSC/ GoN,
Kathmandu, Nepal.
bkhakurel@yahoo.com

E-DRUG: WHO PQ now charging application fees (5)
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Dear All,

A PQ meeting comes up on the 23rd of this month in Copenhagen and I
think it is just apt that this discussion is coming up.

Additional questions: Is it not more sustainable to work with NRAs and
develop them to SRA levels than the PQ? Is anyone thinking about
capacity building in those resource-challenged environments where we
actually need the stringent regulations?

I have always advocated that these NRAs be strengthened and not just
looking up to the WHO for PQ. How many commodities can be pre-qualified?
Does the WHO have the manpower to police the world? Can donors be
clearly informed that not all of those items are prequalified as such
the need to work with the WHO to strengthen these NRAs?

Just more and more questions.

Jiru Bako
Technical Manager (Health) - Crown Agents
"Bako, Jiru" <Jiru.Bako@ng.crownagents.com>

E-DRUG: WHO PQ now charging application fees (6)
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[There are small countries eg Pacific Island Countries, with small capacity who aim to REGISTER products that meet necessary standards so they can control import quality. However they rely on certificates of assessment from countries with strong regulatory capacity or WHO PQ or WHO Certification scheme certificates,
http://www.who.int/medicines/areas/quality_safety/regulation_legislation/certification/qas_certif_scheme_2011.pdf BS]

The idea that every country in the world must have its own self-standing
capacity to individually register every novel and generic medicines - in
essence that there should be 200+ parallel assessments of what is
essentially the same evidence seems wasteful of scare resources. There
are epidemiological and demographic differences between countries that
might require differential weighing of benefit/risk in particular
circumstances that might justify some additional review, but it seems like
those would be the exception rather than the rule. Given scarce economic
and human resources in most low- and middle-income countries why would we
want them to squander those resources on duplicative assessments.

Admittedly, there is some capture of drug regulatory authorities in rich
countries and drug companies currently cook the books in some of their
submissions. However, there is no evidence that drug regulators in low-
and middle-income countries will be any less susceptible to administrative
capture, outright corruption, or falsification of submissions.

I doubt that we can or should go to a single assessment - a global
registration system - in part because some double-checking is probably
desirable and we want to avoid imposition of platinum-level regulatory
standards that innovators will use to deter registration of generic
equivalents. But surely there is something to be said both for regional
harmonization/mutual recognition systems and for a strong role for WHO
prequalification while such regional systems are being established.

Things best done locally should be done locally and that probably includes
facility inspections and pharmacovigilance. If scarce administrative
resources were devoted to regulating and inspecting manufacturers and
distributers and if product integrity/safety were confirmed throughout the
supply chain, low- and middle-income countries would be getting the most
out of their investments.

It sometimes seems like a matter of pride to have independent capacity,
but it can come at a very high - even prohibitive - cost, and it can leave
countries with less to spend on what can only be done in country and on
health system strengthening and service delivery more broadly.

Professor Brook K. Baker
Northeastern U. School of Law
Affiliate, Program on Human Rights and the Global Economy
400 Huntington Ave.
Boston, MA 02115 USA
Honorary Research Fellow, University of KwaZulu Natal, Durban, S. Africa
Senior Policy Analyst Health GAP (Global Access Project)
Alternate NGOs Board Member UNITAID
b.baker@neu.edu

E-DRUG:WHO PQ now charging application fees (7)
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Actually PQ runs one of the best capacity building programmes for DRAs.
Perhaps PQ people on the list can enlighten us with a briefing on this
critical part of their work

Best wishes
Mohga

Dr. Mohga M Kamal-Yanni
Senior health & HIV policy advisor, Oxfam GB
John Smith Drive, Oxford, OX4 2JY, UK
Tel: + 44 (0) 1865 472290
UK Mobile + 44 (0)777 62 55 884
Mohga Kamal-Yanni <mkamalyanni@Oxfam.org.uk>

E-DRUG: WHO PQ now charging application fees (8)
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Dear All,

I agree with Mohga, but it would also be really helpful if possible uptake and eventual output/outlook from the DRAs/NRAs on the list could be assessed. Expectation is that some form of progress be demonstrated where these DRAs/NRAs would be trusted to genuinely 'run the show' on behalf of the millions they should be protecting with efficacious medicines and allied commodities.

Very best,

Jiru Bako
Technical Manager
Crown Agents
Jiru Bako <jirubako@gmail.com>