Access to and Barriers to Access for Essential Medicines in Nephrology and Related Non-Communicable Diseases: A Scoping Review Protocol

Objective: This scoping review aims to understand the extent of evidence regarding: 1) access to essential medicines, 2) barriers to access, and 3) interventions to improve access for chronic kidney disease (CKD) and related non-communicable diseases (NCDs). Introduction: Access to essential medicines for treatment of NCDs is lacking in low- and low-middle income countries. In nephrology, access to essential medicines is especially important to reduce risk of CKD progression, as kidney replacement therapy is unavailable or cost-prohibitive in many regions of the world. As part of the International Society of Nephrology Emerging Leaders Program’s mandate to improve health promotion and access to prevention and management of kidney diseases globally, this scoping review serves as an initial step towards designing implementation studies to improve access to essential medicines. Inclusion criteria: Articles of any study design involving populations with chronic kidney disease, cardiovascular disease, hypertension, and/or diabetes will be included. The core concept of essential medicines will encompass access to essential medicines, barriers to access, and interventions to improve access. All geographical regions and all World Bank Income categories will be considered. Methods: Methods for this scoping review are based on the Joanna Briggs Manual for Evidence Synthesis. MEDLINE, EMBASE, Web of Science, CENTRAL will be searched. Included studies will be restricted to English language. Screening of title/abstract of each article and subsequent review of retrieved full-text articles will be performed by one reviewer, followed by a second reviewer checking the excluded lists for accuracy. A data extraction tool will be customized using Covidence software. Data will be summarized narratively, and in tabular and diagrammatic format. Studies assessing barriers to access or interventions to improve access will be categorized by patient-level, provider-level, organization-level, community/regional-level, and national/health policy-level.

The People's Vaccine: Intellectual Property, Access to Essential Medicines, and the Coronavirus COVID-19

This paper explores intellectual property and access to essential medicines in the context of the coronavirus COVID-19 public health crisis. It considers policy solutions to counteract vaccine nationalism and profiteering by pharmaceutical companies and vaccine developers. This paper considers the campaign for the development of a People's Vaccine led by the People’s Vaccine Alliance, UNAIDS, Oxfam and Public Citizen. The WHO has established the ACT Accelerator in order to boost research, development, and deployment of COVID-19 technologies. However, the operation of COVAX thus far has been falling short of its original ambitions. The Medicines Patent Pool has expanded its jurisdiction to include the sharing of intellectual property related to COVID-19. Meanwhile, Costa Rica has proposed a COVID-19 Technology Access Pool – an idea for a new institutional structure which has been taken up by the WHO. In the context of the coronavirus public health crisis, there has also been discussion of the use of compulsory licensing and crown use to counteract profiteering and anti-competitive behavior. There has been a push by Universities Allied for Essential Medicines (UAEM) and others for the public licensing of COVID-19 technologies developed with government funding. The Open COVID Pledge has been taken by a number of intellectual property owners. In response to the assertion of proprietary rights in respect of COVID-19 technologies, the open movement has championed the development of Open Science models of science. India and South Africa have put forward a waiver proposal in the TRIPS Council to enable countries to take action in respect of COVID-19 without fear of retribution under trade laws. While the United States has been willing to support a TRIPS Waiver for vaccines, there remain a number of opponents to a TRIPS Waiver – including the European Union, Germany, Japan, and Switzerland. This paper makes the case that international intellectual property law should accommodate a People's Vaccine.

Impact of COVID-19 Pandemic on Palliative Care Workers: An International Cross-sectional Study

Objectives: The COVID-19 pandemic and the measures taken to mitigate spread have affected countries in different ways. Healthcare workers, in particular, have been impacted by the pandemic and by these measures. This study aims to explore how COVID-19 has impacted on palliative care (PC) workers around the world. Materials and Methods: Online survey to members of the International Association for Hospice and PC during the initial months of the COVID-19 pandemic. Convenience sampling was used. Statistical descriptive and contingency analyses and Chi-square tests with P < 0.05 were conducted. Results: Seventy-nine participants (RR = 16%) from 41 countries responded. Over 93% of those who provide direct patient care reported feeling very or somewhat competent in PC provision for patients with COVID-19. Eighty-four felt unsafe or somewhat safe when caring for patients with COVID-19. Level of safety was associated with competence (P ≤ 0.000). Over 80% reported being highly or somewhat affected in their ability to continue working in their PC job, providing care to non-COVID patients and in staff availability in their workplace. About 37% reported that availability and access to essential medicines for PC were highly or somewhat affected, more so in low-income countries (P = 0.003). Conclusion: The results from this study highlight the impact of COVID-19 on the provision of PC. It is incumbent on government officials, academia, providers and affected populations, to develop and implement strategies to integrate PC in pandemic response, and preparedness for any similar future events, by providing appropriate and comprehensive education, uninterrupted access to essential medicines and personal protective equipment and ensure access to treatment and care, working together with all levels of society that is invested in care of individuals and populations at large. The long-term effects of the pandemic are still unknown and future research is needed to monitor and report on the appropriateness of measures.

Availability, pricing and affordability of essential medicines in Eastern Ethiopia: a comprehensive analysis using WHO/HAI methodology

Background Access to essential medicines is a universal human right and availability and affordability are the preconditions for it. In line with the sustainable development goals, World Health Organization (WHO) has outlined a framework that assists the policy makers to improve access to essential medicines for universal health coverage by 2030. However, the availability and affordability of essential medicines remains suboptimal in several low-income countries. Therefore, this study was designed to investigate the availability, pricing and affordability of essential medicines in eastern Ethiopia. Methods A cross-sectional study design was employed to conduct this study. Public and private health facilities found in Eastern Ethiopia and which fulfilled criteria set forth by WHO/Health Action International (HAI) guideline and essential medicines listed on WHO/HAI guideline and essential medicine list of Ethiopia were included. Accordingly, 60 medicine outlets were selected based on the WHO/HAI standardized sampling methodology. A standardized data collection tools developed by WHO/HAI, with necessary modifications, was employed to collect the data. Median Price Ratio (MPR) was computed as a ratio of median local buyers’ price to international buyers’ reference price. The Mann–Whitney U test was employed to compare the median buyers’ price between public and private health facilities. Kruskal–Wallis test was also run to explore the median price difference among all facilities. Treatment affordability was calculated based on the number of days of wage of the lowest-paid government employee of Ethiopia required to purchase the prescribed regimen. Results The overall percent availability of originator brand (OB) versions of essential medicines was found to be 3.6% (range: 0.0–31.7%), with the public and private sectors contributing 1.43% and 5.50%, respectively. The overall percent availability of lowest price generics (LPGs) was 46.97% (range: 1.7–93.3%) (Public: 42.5%; private: 50.8%). Only eight LPGs (16.0%) met the WHO target of 80%. The Mann–Whitney U test indicated that 64% drugs showed statistically significant median price difference between public and private settings (p < 0.05). The MPR value indicated that the median buyers’ price of drugs in private sector were more than four times the international reference price in 30% of drugs. The percentage of unaffordable medicine were 72.09 and 91.84% for public and private facilities, respectively, with 79.17% of the medicines were unaffordable when both settings were combined. Conclusion Only 16% of the surveyed medicines surpassed the WHO cut-off point of 80%. Nearly one-third of drugs in the private sector had a price of more than four times compared to the international reference prices. Moreover, four out of five drugs were found unaffordable when both settings were combined, demanded several days of wage of lowest paid government employee. This finding calls a prompt action from stakeholders to devise a strategy that help promote the access of essential medicines and rescue the struggling healthcare system of Ethiopia.

The Global Kidney Health Atlas: Burden and Opportunities to Improve Kidney Health Worldwide

CKD is a growing public health problem. The Global Kidney Health Atlas (GKHA) is an important initiative of the International Society of Nephrology. The GKHA aims to improve the understanding of inter- and intranational variability across the globe, focusing on capacity for kidney care delivery. The GKHA survey was launched in 2017 and then again in 2019, using the same core data, supplemented by information about dialysis access and conservative care. Based on a WHO framework of the 6 building blocks essential for health care, the GKHA assesses capacity in 6 domains: information systems, services delivery, workforce, financing, access to essential medicines, and leadership/governance. In addition, the GKHA assesses the capacity for research in all regions of the world, across all domains (basic, translational, clinical, and health system research). The results of the GKHA have informed policy and been used to enhance advocacy strategies in different regions. In addition, through documentation of the disparities within and between countries and regions, initiatives have been launched to foster change. Since the first survey, there has been an increase in the number of countries which have registries to document the burden of CKD or dialysis. For many, information about the burden of disease is the first step toward addressing care delivery issues, including prevention, delay of progression, and access to services. Worldwide collaboration in the documentation of kidney health and disease is an important step toward the goal of ensuring equitable access to kidney health worldwide.

The global procurement landscape of leishmaniasis medicines

Ensuring access to essential medicines for leishmaniasis control is challenging, as leishmaniasis is a very small and unattractive market for pharmaceutical industry. Furthermore, control programmes are severely underfunded. We conducted an analysis of global procurement of leishmaniasis medicines for the past 5 years in order to shed light on the current leishmaniasis market landscape and supply and demand dynamics. We estimated global demand of each leishmaniasis medicines, the amount of each medicine required to treat all reported cases, based on the number of cases reported to WHO and the first-line treatment regimen used in each country. Procurement data were obtained from procurement agencies, international organizations, WHO, national leishmaniasis programmes and manufacturers. Expert interviews were conducted to have a better understanding of how medicines were procured and used. The comparison of estimated need and procurement data indicated discrepancies in supply and demand at global level as well as in the most endemic countries. The extent of the gap in supply was up to 80% of the needs for one of the leishmaniasis medicines. Mismatch between supply and demand was much wider for cutaneous leishmaniasis than visceral leishmaniasis. This study presents a current picture of procurement patterns and imbalance in global supply and demand. Addressing improved access and supply barriers requires concerted and coordinated efforts at the global and national levels. Priority actions include setting up a procurement coordination mechanism among major procurers, partners and national programmes where forecasting and supply planning is jointly developed and communicated with manufacturers. In addition, continuous engagement of manufacturers and advocacy is critical to diversify the supplier base and ensure quality-assured and affordable generic medicines for leishmaniasis.

Strategies to improve the availability of medicines in primary health care in Brazil: findings and implications

Aim: Access to essential medicines is a key component of managing patients in ambulatory care. In 2008, the State of Minas Gerais, Brazil, created the Pharmacy Network of Minas (Rede Farmácia de Minas [RFM]) program to improve access to medicines, increasing availability and restructuring the infrastructures. The aim was to assess the current situation, comparing municipalities with and without RFM. Materials & methods: Descriptive survey study, data collected from 2014 July to May 2015. Availability was verified by stock levels. Results: The drug availability index was 61.0%, higher in municipalities with RFM. Most physicians considered the pharmaceutical services as good/very good. The main reasons for medicines shortage were ‘financial transference problems’, ‘insufficient financial resources’ and ‘budget’. Conclusion: Strategies, such as the RFM can promote improvements in medicine availability.