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Pharmacovigilance: challenges facing WHO . Shanthi Pal Leader, Medicines Safety Safety and Vigilance, WHO, Geneva. What is pharmacovigilance.
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Pharmacovigilance: challenges facing WHO Shanthi Pal Leader, Medicines Safety Safety and Vigilance, WHO, Geneva
What is pharmacovigilance • The science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problems. (The Importance of Pharmacovigilance, WHO 2002) • A tool for generating evidence to influence policies
WHO Global PV ProgrammeWhy?? World Health Assembly Resolution 16.36 INVITES Member States to arrange for a systematic collection of information on serious adverse drug reactions observed during the development of a drug and, in particular, after its release for general use.
Who? Capacity : Francophone & Arabic countries Capacity : Africa focused Public health focused WHO-CC Accra (2009) WHO-CC Rabat (2010) Technical support Capacity building Database, tools , Signals PV in academia Patient reporting UMC WHO-CC Uppsala > 40 years WHO-CC Oslo >30 years ATC DDD (2012) WHO-HQ Geneva > 50 years NationalCentres Policies, Norms, Guidance, Donor Liaison Resources Implement Collect ADRs Share with WHO database
Challenges to PV in low and middle income countries (LMIC) WHO survey of PV systems in 55 countries • Lack of political support • Lack of resources • Lack of competence • Lack of PV systems and/ or inadequate function • Lack of communication and information exchange Capacity to detect significant vaccine safety issue Europe North America
Why is this a problem? • More than 300 products in the pipeline for neglected diseases, HIV AIDS, TB and malaria • At least half of them will be launched in the coming years in those very settings where there is little or no capacity for post approval monitoring Developer Analysis, BVGH, 2012
Global TB Drug Pipeline Discovery1 Preclinical Development Clinical Development Diarylquinoline DprE Inhibitors GyrB inhibitors InhAInhibitors LeuRSInhibitors MGyrX1 inhibitors Mycobacterial Gyrase Inhibitors Pyrazinamide Analogs Riminophenazines Ruthenium (II) complexes Spectinamides Translocase-1 Inhibitors BTZ043 TBA-354 CPZEN-45 DC-159a Q201 SQ609 SQ641 AZD5847 Bedaquiline (TMC-207) Linezolid Novel Regimens2 PA-824 Rifapentine SQ-109 Sutezolid(PNU-100480) Delamanid (OPC-67683) Gatifloxacin Moxifloxacin Rifapentine 4 Repurposed Drugs 6 New Drugs 3 New Classes Drugs currently in the regulatory review process www.newtbdrugs.org Updated: June 18, 2012
http://www.who.int/medicines/areas/quality_safety/safety_efficacy/saf_pub/en/http://www.who.int/medicines/areas/quality_safety/safety_efficacy/saf_pub/en/ What can we do about it?
Innovative solutions to support those systems Network of WHO Collaborating Centres (CC) to support PV systems in countries • Uppsala Monitoring Centre, Sweden • WHO CC Accra, Ghana • WHO CC Rabat, Morocco • WHO CC Oslo, Norway • WHO CC Netherlands (Lareb) PV consultants in Africa, for Africa
Overcome technical barriers to PV in LMIC • for receiving and storing ADR reports. • The entered reports can be extracted as XML files • can be transferred to other (E2b)databases • A search and statistics module is built into the system • Easy to use and error-checking ensures accuracy. Vigiflow
Task shifting: patients as partners • Conventional models can't work in some settings • All hands on board • Task shifting • Patient reporting (more data, timely data, additional information)
Forward looking strategies through broad networks Expanding and implementing the full scope of PV Links with medication errors networks Links with SSFFC networks
Pharmacovigilance investments will yield multiple benefits • As an insurance for investments in public health interventions: • A comprehensive disease control approach must include quality and safety as a component. • By Investing in PV, countries will have data on medicines • To assist decision making by regulators, improve treatment strategies, health care practices, and treatment outcomes • Pharmacovigilance data can guide procurement of effective medicines and reduce wastage • Robust safety monitoring also provides a quality assurance mechanism and helps monitor programmatic implementation.