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Chiku C, Maruta T, Mbiba F, Manasa J. Navigating regulatory landscape: A qualitative exploration of medical devices and in vitro diagnostic medical devices oversight in Zimbabwe through key stakeholder perspectives. PLoS One 2024; 19:e0287415. [PMID: 38753856 PMCID: PMC11098438 DOI: 10.1371/journal.pone.0287415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Medical devices and In Vitro Diagnostics (IVDs) are vital for public health and accessible healthcare. Still, there is an imbalance in high-quality products in Low and Middle-Income Countries (LMICs). Zimbabwe's regulatory framework for medical devices and IVDs is unclear, leading to ineffective compliance and surveillance. As a result, there are knowledge gaps regarding pre-market and post-market regulatory elements to ensure the safety, quality and performance of medical devices and IVDs used in Zimbabwe. Our study aimed to explore the current status of medical devices and IVD regulations in Zimbabwe. Semi-structured interviews were conducted with 12 regulators from the Medicines Control Authority of Zimbabwe (MCAZ) National Microbiology Reference Laboratory (NMRL), Medical Laboratory and Clinical Scientists Council (MLCScCZ) to understand the current status of medical devices and IVD regulations in Zimbabwe. Three participants completed a questionnaire to understand the regulatory landscape in Zimbabwe. Three key informant interviews were conducted with three regulators from the South African Health Products Regulatory Authority (SAHPRA), Tanzanian Medicines and Medical Devices Authority (TMDA), and World Health Organization Regulatory Systems Strengthening (WHO RSS) to learn best practices to create a roadmap for Zimbabwe. We analyzed qualitative data using a thematic analysis. The findings reveal significant deficiencies and gaps in the legal framework for regulating medical devices and IVDs, highlighting the need for a legal framework and the absence of more comprehensive regulations. Regulatory entities face capacity limitations, especially in regulating medical devices and IVDs. Conformity assessment processes, medical devices, IVD classification criteria, and post-market surveillance also represent challenges, highlighting the need for a well-defined framework and regulatory procedures. The Zimbabwean regulatory system pathway is reactive, prompting several regulatory initiatives to address needs. Despite facing challenges, there is recognition of the importance of collaboration among regulatory authorities, emphasizing a shared commitment to improving and strengthening medical devices and IVD regulations for improved patient safety. By advocating for a proactive, comprehensive, and legally sound approach, indicating the potential for collaboration and synergy, this study provides a foundation for well-informed policy recommendations to guide enhancements and build a framework for a resilient, efficient, and transparent regulatory environment in the Zimbabwe and African regions as a whole.
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Affiliation(s)
- Charles Chiku
- Regulation and Prequalification Department, World Health Organization, Geneva, Switzerland
| | - Talkmore Maruta
- Programs, African Society for Laboratory Medicine, Lusaka, Zambia
| | - Fredrick Mbiba
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Justen Manasa
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Shi J, Chen X, Hu H, Ung COL. The evolving regulatory system of advanced therapy medicinal products in China: a documentary analysis using the World Health Organization Global Benchmarking Tool standards. Cytotherapy 2024:S1465-3249(24)00682-0. [PMID: 38739075 DOI: 10.1016/j.jcyt.2024.04.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/12/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
Advanced therapy medicinal products (ATMPs) are rapidly evolving to offer new treatment options. The scientific, technical, and clinical complexities subject drug regulatory authorizes to regulatory challenges. To advance the regulatory capacity for ATMPs, the National Medical Products Administration in China made changes to the drug regulatory system and developed regulatory science with the goal of addressing patient needs and encouraging innovation. This study aimed to systematically identify the regulatory evidence on ATMPs in China under the guidance of an overarching framework from the World Health Organization Global Benchmarking Tool. It was found that China's administrative authorities at all levels have issued a number of policy documents to promote the development of ATMPs, covering biopharmaceutical products research and development (n = 14), biopharmaceutical industry development (n = 9), high-quality development of medical institutions (n = 1), specific development plans/projects (n = 6) and specific regional development (n = 4). The legal and regulatory framework of ATMPs in China has been established and is subject to continuous adjustment in various aspects including regulations (n = 3), departmental rules or administrative normative documents (n = 22), and technical guidance (n = 15). As the regulatory reform continues, the drug review processes have been revised, and various technical standards have been launched, which aim to establish a regulatory approach that oversees the full life-cycle development of ATMPs in the country. The limited number of investigational new drug applications and approved ATMPs suggests a lag remains between the translation of advanced therapeutic technologies into clinically available medical products. To accelerate the translational research of ATMP in countries such as China, developing and adopting real-world evidence generated from clinical use in designated healthcare facilities to support scientific decision-making in ATMP regulation is warranted. The enhancement of regulatory capacity building and multi-stakeholder collaborations should also be encouraged to facilitate the timely evaluation of promising ATMPs to meet more patient needs.
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Affiliation(s)
- Junnan Shi
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Xianwen Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China; Centre for Pharmaceutical Regulatory Sciences, University of Macau, Taipa, Macao SAR, China; Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China; Centre for Pharmaceutical Regulatory Sciences, University of Macau, Taipa, Macao SAR, China; Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China.
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Alfonso CP, N’Jambong GB, Magdy A, Di Trapani L, Kuwana R, Kahsay AG, Maïga D, Ossei-Agyeman-Yeboah SNA, Djitafo Fah AB, Ndomondo-Sigonda M. Identifying and costing common gaps in Central and West Africa pharmaceutical regulation. Front Med (Lausanne) 2024; 11:1362253. [PMID: 38660423 PMCID: PMC11042247 DOI: 10.3389/fmed.2024.1362253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/19/2024] [Indexed: 04/26/2024] Open
Abstract
Background Regulatory systems strengthening is crucial for catalyzing access to safe and effective medical products and health technologies (MPHT) for all. Identifying and addressing common regulatory gaps through regional approaches could be instrumental for the newly incepted African Medicine Agency. Aims This original study sheds light on common gaps among 10 national regulatory authorities (NRAs) and ways to address them regionally. Objectives The study used NRA self-assessment outcomes to identify common gaps in four critical regulatory pillars and estimate the cost of addressing them from regional perspectives that aimed at raising the maturity level of regulatory institutions. Methods A cross-sectional study, using the WHO Global Benchmarking Tool (GBT), was conducted between 2020 and 2021 with five NRAs from ECCAS and ECOWAS member states that use French and Spanish as lingua franca. Results The 10 NRAs operated in a non-formal-to-reactive approach (ML1-2), which hinders their ability to ensure the quality of MPHT and respond appropriately to public health emergencies. Common gaps were identified in four critical regulatory pillars-good regulatory practices, preparedness for public health emergencies, quality management systems, and substandard and falsified medical products-with overall cost to address gaps estimated at US$3.3 million. Contribution We elaborated a reproducible method to strengthen regulatory systems at a regional level to improve equitable access to assured-quality MPHT. Our bottom-up approach could be utilized by RECs to address common gaps through common efforts.
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Affiliation(s)
- Claudia P. Alfonso
- Regulatory Systems Strengthening, World Health Organization, Geneva, Switzerland
| | - Guy B. N’Jambong
- Essential Drug and Medicines, World Health Organization, Dakar, Senegal
- ICN Business School, CEREFIGE, Université de Lorraine, Nancy, France
| | - Alaa Magdy
- Regulatory Systems Strengthening, World Health Organization, Geneva, Switzerland
| | - Laura Di Trapani
- Regulatory Systems Strengthening, World Health Organization, Geneva, Switzerland
| | - Rutendo Kuwana
- Incident and Substandard and Falsified, World Health Organization, Geneva, Switzerland
| | - Abraham G. Kahsay
- Regulatory Convergence and Networks, World Health Organization, Geneva, Switzerland
| | - Diadié Maïga
- Regulatory Systems Strengthening, World Health Organization, Geneva, Switzerland
| | | | - Aimé B. Djitafo Fah
- Sub-Regional Program for the Harmonization of National Pharmaceutical Policies in Central Africa, Coordination Organization for the Fight Against Endemic Diseases in Central Africa, Yaoundé, Cameroon
| | - Margareth Ndomondo-Sigonda
- African Medicines Regulatory Harmonization Initiative, African Union NEPAD Agency, Pretoria, South Africa
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Sorato MM, Davari M, Kebriaeezadeh A. Improving access to medicines to reduce marketing and use of substandard and falsified medicines in Africa: Scoping review. THE JOURNAL OF MEDICINE ACCESS 2024; 8:27550834241236598. [PMID: 38476401 PMCID: PMC10929061 DOI: 10.1177/27550834241236598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
Background Both constrained access to essential medicines and combatting marketing of substandard and falsified (SF) medicines are unmet health sector goals in Africa. Objective To answer the question of how improved access can reduce the continuous surge of SF medicines in Africa. Design We conducted a scoping review based on standard protocol. Methods We searched articles published in the English language from PubMed/Medline, Cochrane Library, Embase, Scopus, Web of Science, and Google Scholar by using a systematic search query. Results Seventy-one articles were included in this review. Access to quality essential medicines is still a major problem in developing countries in Africa and will continue as a threat for the next decade of health care. Ensuring access to quality medicines and preventing SF medicines in Africa need a systematic approach to address their underlying causes. Failure to ensure access to medicines is the major reason for the availability of SF medicines. Improving access to quality medicines can reduce SF medicine marketing and use. Manipulating the entire supply chain for efficiency, avoiding trade agreements that could reduce access, using compulsory licensing provisions, and pharmaceutical price control, providing incentives for drug development, and promoting rational use of medicines can improve access. Conclusion Ensuring access to medicines and preventing SF medicine marketing cannot be achieved in the planned period in developing countries in Africa unless a comprehensive strategy is used. Improving access to quality medicines can reduce SF medicine marketing and use, that is, ensuring access through uninterrupted supply, improved efficiency, enhanced local production, preventing SF medicine entry, improved medication use system, and improved affordability. Therefore, it is essential to improve supply chain capability, address challenges of the supply chain, improve leadership and governance, establish country-specific anti-counterfeiting and anti-substandardization committees, and collaborate with all relevant stakeholders.
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Affiliation(s)
- Mende Mensa Sorato
- Department of Pharmacy, College of Medicine, Komar University of Science and Technology, Sulaimaniyah, Iraq
| | - Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Mukonzo JK, Ndagije HB, Sabblah GT, Mathenge W, Price DA, Grasela TH. Expanding regulatory science: Regulatory complementarity and reliance. Clin Transl Sci 2024; 17:e13683. [PMID: 37957894 PMCID: PMC10766020 DOI: 10.1111/cts.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023] Open
Abstract
Drug regulatory institutions, infrastructures, and systems are becoming increasingly interconnected across national boundaries and increasingly global in outlook. This process is reflected in the broadening and deepening application of the principles and practice of Regulatory Reliance, and parallel initiatives to strengthen the capacities of regulatory institutions in low- and middle-income countries (LMICs). Although these developments are important and constructive, they have tended to be framed in terms of the transfer of systems, knowledge, and skills from relatively "mature" regulatory agencies in high-income countries (HICs) to less-well-resourced regulatory agencies in LMICs. This framing recognizes and foregrounds the considerable practical challenges that many LMIC regulatory agencies face, but in doing so, also backgrounds and underestimates the significance of the different contextual insights that LMIC health researchers and regulators can bring to the regulatory deliberations of their HIC counterparts. This position paper argues that the systematic pursuit, identification, and sharing of these different contextual insights-a dimension of regulatory science that we term "Regulatory Complementarity"-can augment the current practice and goals of Regulatory Reliance, and further invigorate the emerging global regulatory ecosystem.
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Affiliation(s)
- Jackson K. Mukonzo
- Department of Pharmacology & TherapeuticsMakerere University, College of Health ScienceKampalaUganda
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Modiba WK, Katerere DR, Mncwangi NP. A desktop review of evaluation of implementation of national medicines policies in SADC countries. Heliyon 2023; 9:e22218. [PMID: 38045165 PMCID: PMC10692818 DOI: 10.1016/j.heliyon.2023.e22218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
A national medicine policy (NMP), formerly referred to as a national drug policy (NDP) is a document that serves as a political commitment and guide for action by the government to provide safe, efficacious, quality assured, available, affordable and rationally used medicines. This is the first study to review the implemented components of the NMPs of the 16 South African Development Community (SADC) countries over the past ten years (2011-2021). Information published between 2011 and 2021 of each country such as pharmaceutical profiles, official government documents, WHO/HAI/World Bank datasets and research studies on the implemented components were appraised. Significant progress has been made by 16 SADC countries over the period 2011-2021 in implementing the NMP. The most commonly implemented components included the concept of essential medicines, pricing, and regulation. Though traditional and herbal medicines component is yet to be implemented by the majority. The pharmacist-patient ratio of 1:2300 was below the target for all countries, prompting the need to strengthen the pharmacy personnel in the healthcare systems. Medicine pricing, affordability, and availability studies are necessary to develop equitable pricing policies that will improve the accessibility of medicines in all countries and the SADC region. With the exception of the Republic of Tanzania, SADC countries need to urgently revise their NMPs, thus adopting progressive processes such as incorporating Health Technology Assessment (HTA) in the NMP. All SADC countries require a strong, internationalistic evaluation culture built-in their policy formulation. As the first study to investigate the implemented NMPs in the SADC region, it could serve as a springboard for the countries to address their common pharmaceutical challenges thus improving their readiness for universal health coverage (UHC). Future in-depth cross-country studies in the SADC region are necessary to comprehensively evaluate the implemented components of NMPs.
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Affiliation(s)
- William K. Modiba
- Tshwane University of Technology, Department of Pharmaceutical Sciences, Faculty of Science, Private Bag X680, Pretoria, 0001, South Africa
| | - David R. Katerere
- Tshwane University of Technology, Department of Pharmaceutical Sciences, Faculty of Science, Private Bag X680, Pretoria, 0001, South Africa
| | - Nontobeko P. Mncwangi
- Sefako Makgatho Health Sciences University, School of Pharmacy, Faculty of Medicine, Medunsa, 0204, South Africa
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Shi J, Chen X, Hu H, Ung COL. Benchmarking Drug Regulatory Systems for Capacity Building: An Integrative Review of Tools, Practice, and Recommendations. Int J Health Policy Manag 2023; 12:8100. [PMID: 38618782 PMCID: PMC10699822 DOI: 10.34172/ijhpm.2023.8100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Benchmarking has been increasingly used on drug regulatory systems to achieve sustainable pharmaceutical system strengthening. This study aimed to identify the scope, tools and benefits of benchmarking regulatory capacities and the most recent development in such phenomenon. Method: This study employed an integrative and critical review of the literature and documents on benchmarking drug regulatory capacities identified from 6 databases and 5 websites of related organizations and government agencies in compliance with the Preferred Reporting Items for Systematic Review (PRISMA) guidelines. RESULTS Forty-three studies and 6 documents about regulatory benchmarking published between 2005 and 2022 were included in this review. Five benchmarking assessment tools or programmes recommended or adopted by international organizations or government agencies had been identified, which collectively covered 12 major regulatory functions (4 at system level and 8 at operational level) involving 9 indicator categories and 382 sub-indicators. Benchmarking drug regulatory systems was reportedly employed at national, regional and international levels for either internal assessment (mostly on regulatory system establishment, drug review process and post marketing surveillance) or external evaluation (mostly on regulatory standards, drug review process and pharmacovigilance systems) to assess current status, monitor performance, determine major challenges and inform actions for capacity building. Priority of actions in areas such as regulatory process, resources allocation, cooperation and communication, and stakeholder engagement have been suggested for strengthening drug regulatory systems. Nevertheless, the evidence about benchmarking in optimizing regulatory capacities remained underreported. CONCLUSION This integrative review depicted a framework for decision-makers about why and how benchmarking drug regulatory systems should be undertaken. For effective benchmarking, well-informed decisions about the goals, the scope, the choice of reference points and benchmarking tools are essential to guide the implementation strategies. Further studies about the positive effects of regulatory benchmarking are warranted to engage continuous commitment to the practice.
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Affiliation(s)
- Junnan Shi
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Xianwen Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
- Centre for Pharmaceutical Regulatory Sciences, University of Macau, Macao SAR, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
- Centre for Pharmaceutical Regulatory Sciences, University of Macau, Macao SAR, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China
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Machado FLDS, Cañás M, Doubova SV, Urtasun MA, Marín GH, Osorio-de-Castro CGS, Albuquerque FC, Ribeiro TB, Pont L, Crisóstomo Landeros J, Roldán Saelzer J, Sepúlveda Viveros D, Acosta A, Machado Beltrán MA, Gordillo Alas LI, Orellana Tablas LA, Benko R, Convertino I, Bonaso M, Tuccori M, Kirchmayer U, Contreras Sánchez SE, Rodríguez-Tanta LY, Gutierrez Aures Y, Lin B, Alipour-Haris G, Eworuke E, Lopes LC. Biosimilars approvals by thirteen regulatory authorities: A cross-national comparison. Regul Toxicol Pharmacol 2023; 144:105485. [PMID: 37659711 DOI: 10.1016/j.yrtph.2023.105485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Abstract
Biosimilars are biological medicines highly similar to a previously licensed reference product and their licensing is expected to improve access to biological therapies. This study aims to present an overview of biosimilars approval by thirteen regulatory authorities (RA). The study is a cross-national comparison of regulatory decisions involving biosimilars in Argentina, Australia, Brazil, Chile, Canada, Colombia, Europe, Hungary, Guatemala, Italy, Mexico, Peru and United States. We examined publicly available documents containing information regarding the approval of biosimilars and investigated the publication of public assessment reports for registration applications, guidelines for biosimilars licensing, and products approved. Data extraction was conducted by a network of researchers and regulatory experts. All the RA had issued guidance documents establishing the requirements for the licensing of biosimilars. However, only three RA had published public assessment reports for registration applications. In total, the investigated jurisdictions had from 19 to 78 biosimilars approved, most of them licensed from 2018 to 2020. In spite of the advance in the number of products in recent years, some challenges still persist. Limited access to information regarding the assessment of biosimilars by RA can affect confidence, which may ultimately impact adoption of these products in practice.
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Affiliation(s)
- Fernanda Lacerda da Silva Machado
- Instituto de Ciências Farmacêuticas, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil; Sorocaba University, Sorocaba, São Paulo, Brazil
| | - Martín Cañás
- Universidad Nacional Arturo Jauretche-FEMEBA, La Plata, Argentina
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Mexico City, Mexico
| | - Martín A Urtasun
- Universidad Nacional Arturo Jauretche-FEMEBA, La Plata, Argentina
| | - Gustavo H Marín
- Universidad Nacional de La Plata-CONICET, La Plata, Argentina
| | | | | | - Tatiane Bonfim Ribeiro
- Post Graduate Program in Epidemiology, Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Lisa Pont
- University of Technology Sydney, Sydney, Australia
| | | | | | | | - Angela Acosta
- Facultad de Ciencias Naturales, Departamento de Ciencias Farmacéuticas, Universidad ICESI, Cali, Colombia
| | | | - Lily Iracema Gordillo Alas
- Department of Regulation and Control of Pharmaceutical and Related Products, Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Lourdes Abigail Orellana Tablas
- Department of Regulation and Control of Pharmaceutical and Related Products, Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Ria Benko
- Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | | | | | | | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Saúl E Contreras Sánchez
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Mexico City, Mexico
| | - L Yesenia Rodríguez-Tanta
- Carrera de Farmacia y Bioquímica, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Perú
| | | | - Boya Lin
- University of Florida, United States
| | | | - Efe Eworuke
- Epidemiology and Drug Safety Team, Real World Solutions, IQVIA, United States
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Waffo Tchounga CA, Sacré PY, Ravinetto R, Lieberman M, Hamuli Ciza P, Ngono Mballa R, Ziemons E, Hubert P, Djang’eing’a Marini R. Usefulness of medicine screening tools in the frame of pharmaceutical post-marketing surveillance. PLoS One 2023; 18:e0289865. [PMID: 37566594 PMCID: PMC10420354 DOI: 10.1371/journal.pone.0289865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The negative consequences of Substandard and falsified (SF) medicines are widely documented nowadays and there is still an urgent need to find them in more efficient ways. Several screening tools have been developed for this purpose recently. In this study, three screening tools were used on 292 samples of ciprofloxacin and metronidazole collected in Cameroon. Each sample was then analyzed by HPLC and disintegration tests. Seven additional samples from the nitro-imidazole (secnidazole, ornidazole, tinidazole) and the fluoroquinolone (levofloxacin, ofloxacin, norfloxacin, moxifloxacin) families were analyzed to mimic falsified medicines. Placebo samples that contained only inert excipients were also tested to mimic falsified samples without active pharmaceutical ingredient (API). The three screening tools implemented were: a simplified visual inspection checklist, a low-cost handheld near infrared (NIR) spectrophotometer and paper analytical devices (PADs). Overall, 61.1% of the samples that failed disintegration and assay tests also failed the visual inspection checklist test. For the handheld NIR, one-class classifier models were built to detect the presence of ciprofloxacin and metronidazole, respectively. The APIs were correctly identified in all the samples with sensitivities and specificities of 100%. However, the importance of a representative and up-to-date spectral database was underlined by comparing models built with different calibration set spanning different variability spaces. The PADs were used only on ciprofloxacin samples and detected the API in all samples in which the presence of ciprofloxacin was confirmed by HPLC. However, these PADs were not specific to ciprofloxacin since they reacted like ciprofloxacin to other fluoroquinolone compounds. The advantages and drawbacks of each screening tool were highlighted. They are promising means in the frame of early detection of SF medicines and they can increase the speed of decision about SF medicines in the context of pharmaceutical post-marketing surveillance.
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Affiliation(s)
- Christelle Ange Waffo Tchounga
- Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, University of Liege (ULiege), CIRM, Liège, Belgium
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Pierre-Yves Sacré
- Department of Pharmacy, University of Liege (ULiege), CIRM, Research Support Unit in Chemometrics, Liège, Belgium
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Marya Lieberman
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, United States of America
| | - Patient Hamuli Ciza
- Faculty of Pharmaceutical Sciences, University of Kinshasa, Lemba, Kinshasa, Democratic Republic of the Congo
| | - Rose Ngono Mballa
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Laboratoire National de Contrôle des Médicaments et Expertise (LANACOME), Yaoundé, Cameroon
| | - Eric Ziemons
- Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, University of Liege (ULiege), CIRM, Liège, Belgium
| | - Philippe Hubert
- Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, University of Liege (ULiege), CIRM, Liège, Belgium
| | - Roland Djang’eing’a Marini
- Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, University of Liege (ULiege), CIRM, Liège, Belgium
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Kingori P, Peeters Grietens K, Abimbola S, Ravinetto R. Uncertainties about the quality of medical products globally: lessons from multidisciplinary research. BMJ Glob Health 2023; 6:e012902. [PMID: 37344004 PMCID: PMC10367018 DOI: 10.1136/bmjgh-2023-012902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Patricia Kingori
- Wellcome Centre for Ethics and Humanities. Ethox Centre, University of Oxford, Nuffield Department of Population Health, University of Oxford, UK
| | | | - Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Ndomondo-Sigonda M, Azatyan S, Doerr P, Agaba C, Harper KN. Best practices in the African Medicines Regulatory Harmonization initiative: Perspectives of regulators and medicines manufacturers. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001651. [PMID: 37186241 PMCID: PMC10132525 DOI: 10.1371/journal.pgph.0001651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
In the African Medicines Regulatory Harmonization initiative, national regulatory authorities (NRAs) within each of Africa's regional economic communities coordinate their activities, rely on the work of one another and other trusted regulatory authorities, and apply other principles of smart regulation. The first regional medicines regulatory harmonization (MRH) initiative in Africa was launched in 2012, with the goal of accelerating access to quality, safe, effective medical products, and now five MRH initiatives are active on the continent. Thus, a wealth of knowledge regarding best practices and approaches to dealing with common challenges has accumulated. The goal of this qualitative study was to gather and share information on these best practices. To do this, we conducted interviews with key participants from four regional MRH initiatives-the East African Community (EAC), Southern African Development Community (SADC), Economic Community of West African States (ECOWAS), and Intergovernmental Authority on Development (IGAD)-as well as representatives from the pharmaceutical industry. Here we explore major themes that emerged from the interviews: 1. Transparency and reliability are critical; 2. Reliance is essential for smart regulation; 3. Multiple successful strategies for NRA capacity building have been identified; 4. Communication between heads of agencies is essential; 5. Cooperation at the regional level is not possible without leadership at the NRA level; 6. Sustainable funding remains challenging; and 7. Industry has important insights. We hope that the information on best practices shared in this article can benefit regional MRH initiatives inside and outside of Africa, ultimately helping them accelerate access to quality, safe, effective medical products.
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Affiliation(s)
| | - Samvel Azatyan
- Regulatory Convergence and Networks, World Health Organization, Geneva, Switzerland
| | - Petra Doerr
- European Directorate for the Quality of Medicines & Healthcare, Strasbourg, France
| | | | - Kristin N. Harper
- Harper Health & Science Communications, LLC, Seattle, Washington, United States of America
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12
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Oddleifson DA, Kayani J, Shrivastava R, Tan J, Winters M, Forman H, Omer SB. Assessment of the COVID-19 vaccine market landscape in 2021 relative to challenges in low- and middle-income countries. Hum Vaccin Immunother 2022; 18:2124781. [PMID: 36269944 PMCID: PMC9746604 DOI: 10.1080/21645515.2022.2124781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
To evaluate the early vaccine landscape relative to challenges faced by low- and middle-income countries (LMIC), we conducted a cross-sectional study of all COVID-19 vaccines in clinical trials in 2021 (n = 123) using a structured 13-point analytic framework. Supply sustainability was defined as a composite metric of four manufacturing and regulation variables. Vaccine desirability was defined as a composite metric of nine development and distribution variables. Ten vaccines in phases 2/3, 3, or 4 and five vaccines in phases 1 and 1/2 had a sustainability score equal to or above 0.5. Ten vaccines in phases 2/3, 3, or 4 and seven vaccines in phases 1 and 1/2 had a desirability score equal to or above 0.5. No vaccines in Phases 2/3, 3, or 4 met more than one distribution criterion. Structured assessment COVID-19 vaccine candidates in clinical trials in 2021 revealed numerous challenges to adequate access in LMICs. Key policy recommendations included increasing technology transfer to LMICs, developing international legal mechanisms to prevent export bans, and increasing investment in vaccine candidates with more favorable distribution profiles.
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Affiliation(s)
- D. August Oddleifson
- Yale School of Medicine, New Haven, CT, USA
- Yale School of Management, New Haven, CT, USA
- CONTACT D. August Oddleifson Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Howard Forman
- Yale School of Management, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Saad B. Omer
- Yale School of Medicine, New Haven, CT, USA
- Yale Institute of Global Health, New Haven, CT, USA
- Yale School of Nursing, New Haven, CT, USA
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13
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Nyika A, Ngara B, Mutingwende I, Gwaza L. Importation and distribution of unregistered medicines in the public sector: similarities, differences, and shared challenges among Southern African Development Community (SADC) countries. BMC Health Serv Res 2022; 22:570. [PMID: 35484525 PMCID: PMC9047363 DOI: 10.1186/s12913-022-07995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background The purpose of the study was to assess the requirements for approval of the importation of unregistered medicines for use in the public sector in the Southern African Development Community (SADC) countries. Methods The study reviewed the legal provisions and requirements to be fulfilled when importing unregistered medicines for the public sector in SADC countries relative to two comparators drawn from countries with stringent regulatory systems through extant document analysis. The relative implementation index score was calculated and used to measure the level of implementing legal provisions and requirements to be fulfilled. Analysis was performed using the STATA software package. Results Approximately 13 out of 16 SADC countries had a relative implementation index below 50%. The aggregated implementation index across all SADC countries was 44%, ranging from 4 to 54%, while the two comparators had a relative implementation index of 81% and 85%, respectively. Conclusion Implementing the minimum requirements for importing unregistered medicines for the public sector was deficient compared to the jurisdictions with stringent regulatory systems, and wide implementation gaps also existed within the SADC region.
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Affiliation(s)
- Admire Nyika
- Department of Pharmacy & Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Mazowe Street, Parirenyatwa Complex, P.O Box A178, Avondale, Harare, Zimbabwe.
| | - Bernard Ngara
- Department of Pharmacy & Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Mazowe Street, Parirenyatwa Complex, P.O Box A178, Avondale, Harare, Zimbabwe
| | - Isaac Mutingwende
- Department of Pharmacy & Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Mazowe Street, Parirenyatwa Complex, P.O Box A178, Avondale, Harare, Zimbabwe
| | - Luther Gwaza
- World Health Organization, Health Products Policy and Standards, Access to Medicines and Health Products Division, 20 Appia Avenue, Geneva, Switzerland
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14
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Ncube BM, Dube A, Ward K. Medicines Regulatory Science Expertise in Africa: Workforce Capacity Development and Harmonisation Activities Towards the Establishment of the African Medicines Agency. Pharmaceut Med 2022; 36:83-97. [DOI: 10.1007/s40290-022-00425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 12/01/2022]
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15
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Tefera B, Bacha B, Belew S, Raffaella R, Andualem T, Abegaz Z, Zelelew A, Uma G, Setegn T, Hunduma A, Jemal D, Daba D, Belete B. Study on identification, assay and organoleptic quality of veterinary medicines in Ethiopia. J Pharm Policy Pract 2022; 15:17. [PMID: 35241169 PMCID: PMC8892721 DOI: 10.1186/s40545-022-00410-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medicines of poor quality are currently prevailing problems undermining the quality of health care services in veterinary and human medicine. In this study, physico-chemical quality of veterinary medicines was evaluated. METHODS A total of 959 veterinary medicines samples were collected during routine regulatory activities, i.e. pre-registration, re-registration, consignment checking and post-marketing surveillance, in Ethiopia. The samples were transported to Animal Products, Veterinary Drug and Feed Quality Assessment Centre (APVD-FQAC), which is the quality control laboratory of the Veterinary Drug and Feed Administration and Control Authority (VDFACA) and stored until analysis. The samples were subjected to visual inspection and chemical analysis following the United States, European or British Pharmacopoeias, or manufacturer's methods. RESULTS The findings revealed that 12 (1.3%) of tested products showed defects in physical characteristics, packaging, or labelling information, while a total of 66 (6.9%) samples of the investigated products failed to comply with the Pharmacopoeias and supplier's specification limit set for assay. Of these, 60 samples did not comply with the minimum assay specification limit. CONCLUSION Overall, 8.2% of the investigated veterinary medicine samples did not comply with the specification set for the investigated quality attributes and thus were categorized as of poor quality. This indicates the need for continued strengthening of regulatory functions.
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Affiliation(s)
- Belachew Tefera
- Veterinary Drug and Feed Administration and Control Authority (VDFACA), Animal Products, Veterinary Drug and Feed Quality Assessment Centre, P.O. Box 31303, Addis Ababa, Ethiopia.
| | - Belachew Bacha
- Veterinary Drug and Feed Administration and Control Authority (VDFACA), Animal Products, Veterinary Drug and Feed Quality Assessment Centre, P.O. Box 31303, Addis Ababa, Ethiopia
| | - Sileshi Belew
- Jimma University Laboratory of Drug Quality (JuLaDQ) and School of Pharmacy, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | | | - Tenaw Andualem
- Food and Agriculture Organization of the Untied Nation (FAO), P.O. Box 5536, Addis Ababa, Ethiopia
| | - Zerihun Abegaz
- Veterinary Drug and Feed Administration and Control Authority (VDFACA), Animal Products, Veterinary Drug and Feed Quality Assessment Centre, P.O. Box 31303, Addis Ababa, Ethiopia
| | - Ayalew Zelelew
- Veterinary Drug and Feed Administration and Control Authority (VDFACA), Animal Products, Veterinary Drug and Feed Quality Assessment Centre, P.O. Box 31303, Addis Ababa, Ethiopia
| | - Gudeta Uma
- Veterinary Drug and Feed Administration and Control Authority (VDFACA), Animal Products, Veterinary Drug and Feed Quality Assessment Centre, P.O. Box 31303, Addis Ababa, Ethiopia
| | - Tadese Setegn
- Veterinary Drug and Feed Administration and Control Authority (VDFACA), Animal Products, Veterinary Drug and Feed Quality Assessment Centre, P.O. Box 31303, Addis Ababa, Ethiopia
| | - Abdisa Hunduma
- Veterinary Drug and Feed Administration and Control Authority (VDFACA), Animal Products, Veterinary Drug and Feed Quality Assessment Centre, P.O. Box 31303, Addis Ababa, Ethiopia
| | - Dinsefa Jemal
- Veterinary Drug and Feed Administration and Control Authority (VDFACA), Animal Products, Veterinary Drug and Feed Quality Assessment Centre, P.O. Box 31303, Addis Ababa, Ethiopia
| | - Diriba Daba
- Veterinary Drug and Feed Administration and Control Authority (VDFACA), Animal Products, Veterinary Drug and Feed Quality Assessment Centre, P.O. Box 31303, Addis Ababa, Ethiopia
| | - Bizuayehu Belete
- Veterinary Drug and Feed Administration and Control Authority (VDFACA), Animal Products, Veterinary Drug and Feed Quality Assessment Centre, P.O. Box 31303, Addis Ababa, Ethiopia
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Masini T, Macé C, Heide L, Hamill H, Hampshire K, Newton PN, Ravinetto R. Out of the boxes, out of the silos: The need of interdisciplinary collaboration to reduce poor-quality medical products in the supply chain. Res Social Adm Pharm 2022; 18:3694-3698. [DOI: 10.1016/j.sapharm.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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Macé C, Rägo L, Ravinetto R. How the concept of WHO-listed authorities will change international procurement policies for medicines. BMJ Glob Health 2022; 6:bmjgh-2021-008109. [PMID: 35144982 PMCID: PMC8883025 DOI: 10.1136/bmjgh-2021-008109] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/26/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Lembit Rägo
- Secretary-General, Council for International Organisations of Medical Sciences, Geneva, Switzerland
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
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18
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Van De Pas R, Widdowson MA, Ravinetto R, N Srinivas P, Ochoa TJ, Fofana TO, Van Damme W. COVID-19 vaccine equity: a health systems and policy perspective. Expert Rev Vaccines 2021; 21:25-36. [PMID: 34758678 PMCID: PMC8631691 DOI: 10.1080/14760584.2022.2004125] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction The global COVID-19 vaccine rollout has highlighted inequities in the accessibility of countries to COVID-19 vaccines. Populations in low- and middle-income countries have found it difficult to have access to COVID-19 vaccines. Areas covered This perspective provides analyses on historical and contemporary policy trends of vaccine development and immunization programs, including the current COVID-19 vaccination drive, and governance challenges. Moreover, we also provide a comparative health system analysis of the COVID-19 vaccine deployment in some countries from different continents. It recommends that the international Access to COVID-19 Tools Accelerator (ACT-A) partnership requires a strong governance mechanism and urgent financial investment. Expert opinion All WHO member states should agree on technology transfer and voluntary license-sharing via a commonly governed technology access pool and supported by a just Intellectual Property regime. Contextualized, dynamic understandings and country-specific versions of health systems strengthening are needed to improve vaccine equity in a sustainable matter.
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Affiliation(s)
- Remco Van De Pas
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Theresa J Ochoa
- Instituto De Medicina Tropical Alexander Von Humboldt Universidad Peruana Cayetano Heredia (Upch) Av. Honorio Delgado 430, Perú
| | - Thierno Oumar Fofana
- African Center of Excellence for the Prevention and Control of Communicable Diseases (CEA-PCMT), University Gamal Abdel Nasser Dixinn, Conakry, Guinea
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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19
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Samukange WT, Kluempers V, Porwal M, Mudyiwenyama L, Mutoti K, Aineplan N, Gardarsdottir H, Mantel-Teeuwisse AK, Nuebling CM. Implementation and performance of haemovigilance systems in 10 sub-saharan African countries is sub-optimal. BMC Health Serv Res 2021; 21:1258. [PMID: 34801022 PMCID: PMC8605544 DOI: 10.1186/s12913-021-07235-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background Haemovigilance is an important element of blood regulation. It includes collecting and evaluating the information on adverse events resulting from the use of blood and blood components with the aim to improve donor and patient safety. We describe the results of the pilot of the integrated GBT+ Blood for the haemovigilance function in 10 sub-Saharan African countries. Methods We piloted the integrated WHO Global Benchmarking Tool plus Blood (GBT+ Blood) to assess the haemovigilance function of national regulatory authorities (NRAs) in Ethiopia, Kenya, Malawi, Nigeria, Liberia, Rwanda, South Africa, Tanzania, Uganda, and Zimbabwe. Data obtained from documents and face to face interviews were used to determine the status of implementation and performance of the following six indicators; legal provisions regulations and guidelines, organisation and governance, human resources, regulatory processes, transparency and accountability and finally, monitoring progress and assessing impact, by estimating median scores across 20 sub-indicators. In addition, a cluster analysis was performed. Results The countries showed inter-organisation variability in implementation and performance of the haemovigilance function. The overall median score (all sub-indicators) was 44 % (range: 7.5 % - 70 %). The lowest average performance scores were for the arrangement for effective organisation and coordination (35 %) and human resources (35 %) indicators. The highest average scores were observed for the mechanism to promote transparency and mechanism to monitor regulatory performance indicators (50 % and 60 %, respectively). We identified clusters of best-implemented sub-indicators from the procedures for haemovigilance and poorly implemented sub-indicators from the legal provisions, regulations and guidelines for haemovigilance and human resources. Conclusions Implementation of sub-indicators and performance of haemovigilance systems varied greatly for all countries with a few countries performing reasonably well in the implementation of some sub-indicators under procedures for haemovigilance. Most countries were poorly implementing sub-indicators in the legal provisions, arrangement for effective organisation and human resources indicators. The legislative provisions in most countries were at a nascent stage. There is a need to set up targeted and customised technical support coupled with prioritised interventions to strengthen the capacities of NRAs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07235-0.
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Affiliation(s)
- Washington T Samukange
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.,Paul Ehrlich Institut, Langen, Germany
| | | | | | | | - Khamusi Mutoti
- South African Health Products Regulatory Authority (SAHPRA), Pretoria, South Africa
| | | | - Helga Gardarsdottir
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - C Micha Nuebling
- Paul Ehrlich Institut, Langen, Germany. .,Major Policy and International Relations, Paul Ehrlich Institut, Langen, Germany.
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20
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Sithole T, Salek S, Mahlangu G, Walker S. Comparison of the registration process of the medicines control authority of Zimbabwe with Australia, Canada, Singapore, and Switzerland: benchmarking best practices. Expert Rev Clin Pharmacol 2021; 15:109-119. [PMID: 34645359 DOI: 10.1080/17512433.2022.1987883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Benchmarking regulatory systems of low- and middle-income countries with mature systems provides an opportunity to identify gaps, enhance review quality, and reduce registration timelines, thereby improving patients' access to medicines. The aim of this study was to compare the medicines registration process of the Medicines Control Authority of Zimbabwe (MCAZ) with the regulatory processes in Australia, Canada, Singapore, and Switzerland. METHODS A questionnaire that standardizes the review process, allowing key milestones, activities and practices of the five regulatory authorities was completed by a senior member of the divisions responsible for issuing marketing authorizations. RESULTS The MCAZ has far fewer resources than the regulatory authorities in the comparator countries, but employs three review models, which is in line with international best practice. The MCAZ registration process is similar to the comparator countries in key milestones monitored, but differs in the target timelines for these milestones. The MCAZ is comparable to the comparator authorities in implementing the majority of good review practices, although it significantly lags behind in transparency and communication. CONCLUSION This study identified the MCAZ strengths and opportunities for improvement, which if implemented, will enable the achievement of its vision to be a leading regulatory authority in Africa.
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Affiliation(s)
- Tariro Sithole
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Medicines Control Authority of Zimbabwe, Zimbabwe
| | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Institute for Medicines Development, Cardiff, UK
| | | | - Stuart Walker
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Centre for Innovation in Regulatory Science (Cirs), London, UK
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21
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Khadem Broojerdi A, Alfonso C, Ostad Ali Dehaghi R, Refaat M, Sillo HB. Worldwide Assessment of Low- and Middle-Income Countries' Regulatory Preparedness to Approve Medical Products During Public Health Emergencies. Front Med (Lausanne) 2021; 8:722872. [PMID: 34485350 PMCID: PMC8414408 DOI: 10.3389/fmed.2021.722872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Regulatory preparedness for public health emergencies is critical. However, responses to past emergencies, such as the 2009 H1N1 influenza pandemic and medical product shortages, have revealed sizable gaps in countries' regulatory capacity and preparedness. A systematic analysis of the regulatory preparedness of countries around the world has not yet been performed. The purpose of this study was to analyze and document the current regulatory preparedness status, highlight the related gaps and challenges in order to propose strategic, harmonized, and sustainable regulatory solutions to improve future responses to public health emergencies. Methods: From 2016 to 2020, we used the World Health Organization (WHO)'s Global Benchmarking Tool (GBT), a standardized instrument for identifying national regulatory authorities' strengths and gaps, to analyze the regulatory preparedness of 84 Member States, 95% of which were low- or middle-income countries. We analyzed whether participating Member States had not implemented, displayed ongoing implementation, had partially implemented, or had fully implemented 10 of the GBT's 268 sub-indicators most relevant to regulatory preparedness for public health emergencies. Findings: Only 10 Member States (12%) that underwent benchmarking had fully implemented all 10 sub-indicators related to regulatory preparedness for public health emergencies; 34 (40%) had fully implemented ≥50% of the emergency sub-indicators, and 20 (24%) had not fully implemented any of the sub-indicators. With regard to individual sub-indicators, regulatory preparedness ranged from 19 Member States (23%) fully implementing reliance on clinical trial decisions of others to 45 (59%) fully implementing legal provisions to fast-track (or expedite) marketing authorization applications. Interpretation: Many WHO Member States have limited regulatory preparedness for a public health emergency. Strengthening regulatory systems and promoting Good Regulatory Practices and reliance in these countries, to enable efficient response to emergencies, should be a global health priority.
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Affiliation(s)
- Alireza Khadem Broojerdi
- Regulatory Systems Strengthening Team, Regulation and Safety Unit, World Health Organization, Geneva, Switzerland
| | - Claudia Alfonso
- Regulatory Systems Strengthening Team, Regulation and Safety Unit, World Health Organization, Geneva, Switzerland
| | - Razieh Ostad Ali Dehaghi
- Regulatory Systems Strengthening Team, Regulation and Safety Unit, World Health Organization, Geneva, Switzerland
| | - Mohamed Refaat
- Regulatory Systems Strengthening Team, Regulation and Safety Unit, World Health Organization, Geneva, Switzerland
| | - Hiiti Baran Sillo
- Regulatory Systems Strengthening Team, Regulation and Safety Unit, World Health Organization, Geneva, Switzerland
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22
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Iessa N, Macolic Sarinic V, Ghazaryan L, Romanova N, Alemu A, Rungapiromnan W, Jiamsuchon P, Pokhagul P, Castro JL, Macias Saint-Gerons D, Ghukasyan G, Teferi M, Gupta M, Pal SN. Smart Safety Surveillance (3S): Multi-Country Experience of Implementing the 3S Concepts and Principles. Drug Saf 2021; 44:1085-1098. [PMID: 34331675 PMCID: PMC8325038 DOI: 10.1007/s40264-021-01100-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
Introduction The Smart Safety Surveillance (3S) concept is based on the understanding that, when faced with competing pharmacovigilance priorities, countries will have to invest judiciously, by focusing on new priority products, sharing work and resources with other countries when possible and building national competence for those activities that cannot be delegated. Method The 3S principles were applied to Armenia, Brazil, Ethiopia, India, Peru and Thailand using three priority products: bedaquiline, rotavirus vaccine and tafenoquine. A baseline assessment of pharmacovigilance preparedness was used to identify gaps and establish a work plan. The impact was measured by comparing pre and post 3S-intervention outcomes, which included the number and quality of reports (completeness scores) in the WHO global database of Individual Case Safety Reports, VigiBase, and number of structural indicators met. The implementation period was 9–18 months, ranging from March 2018 (earliest started) until May 2020 (latest). Result An increase in adverse drug reaction (ADR) reporting was demonstrated in Armenia (bedaquiline), Brazil (TB and malaria medicines), India (rotavirus vaccine) and Ethiopia (TB medicines). Completeness scores were above 0.5 at baseline in all countries, and reports improved in quality for Brazil (TB), Peru (malaria), Thailand (malaria) and India (immunization). The number of structural indicators met increased by more than double for Ethiopia. Ethiopia and India demonstrated an increased capacity for signal detection and signal evaluation. Armenia, Brazil, Peru and Thailand showed increased capacity to assess risk management plans following the implementation of 3S principles. Conclusion The 3S concept has demonstrated success in different ways across the six countries. Activities focused on three products for a proof of concept of the 3S principles, with the expectation that the project impact will be sustained through strengthened systems, to guide pharmacovigilance activities of other products in the future. It is important to continue monitoring the countries to understand if the gains and successes of the current 3S project are sustainable. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01100-z.
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Affiliation(s)
- Noha Iessa
- World Health Organization Headquarters, Geneva, Switzerland
| | | | - Lilit Ghazaryan
- Scientific Centre of Drug and Medical Technology Expertise of MoH, Yerevan, Armenia
| | - Naira Romanova
- Scientific Centre of Drug and Medical Technology Expertise of MoH, Yerevan, Armenia
| | - Asnakech Alemu
- Ethiopian Food and Drug Administration, Addis Ababa, Ethiopia
| | | | - Porntip Jiamsuchon
- Ministry of Public Health, Thai Food and Drug Administration, Nonthaburi, Thailand
| | - Pattreya Pokhagul
- Ministry of Public Health, Thai Food and Drug Administration, Nonthaburi, Thailand
| | | | | | | | | | | | - Shanthi Narayan Pal
- World Health Organization Headquarters, 20 Avenue Appia, 1202, Geneva, Switzerland.
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Durán CE, Cañás M, Urtasun M, Elseviers M, Vander Stichele R, Christiaens T. Potential negative impact of reputed regulators' decisions on the approval status of new cancer drugs in Latin American countries: A descriptive analysis. PLoS One 2021; 16:e0254585. [PMID: 34255795 PMCID: PMC8277058 DOI: 10.1371/journal.pone.0254585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/29/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Many new cancer drugs are being approved by reputed regulatory authorities without evidence of overall survival benefit, quality of life improvement, and often based on clinical trials at high risk of bias. In recent years, most Latin American (LA) countries have reformed their marketing authorization (MA) rules to directly accept or abbreviate the approval process in case of earlier authorization by the European Medicines Agency (EMA) and the US Food and Drug Administration, mainly. This study assessed the potential impact of decisions taken by EMA regarding the approval of new cancer drugs based on no evidence of overall survival or in potentially biased clinical trials in LA countries. DESIGN Descriptive analysis. SETTING Publicly accessible marketing authorization databases from LA regulators, European Public Assessment Report by EMA, and previous studies accessing EMA approvals of new cancer drugs 2009-2016. MAIN OUTCOME AND MEASURES Number of new cancer drugs approved by LA countries without evidence of overall survival (2009-2013), and without at least one clinical trial scored at low risk of bias, or with no trial supporting the marketing authorization at all (2014-2016). RESULTS Argentina, Brazil, Chile, Colombia, Ecuador, Panama and Peru have publicly accessible and trustful MA databases and were included. Of the 17 cancer drugs approved by EMA (2009-2013) without evidence of OS benefit after a postmarketing median time of 5.4 years, 6 LA regulators approved more than 70% of them. Of the 13 drugs approved by EMA (2014-2016), either without supporting trial or with no trial at low risk of bias, Brazil approved 11, Chile 10, Peru 10, Argentina 10, Colombia 9, Ecuador 9, and Panama 8. CONCLUSIONS LA countries keep approving new cancer drugs often based on poorly performed clinical trials measuring surrogate endpoints. EMA and other reputed regulators must be aware that their regulatory decisions might directly influence decisions regarding MA, health budgets and patient's care elsewhere.
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Affiliation(s)
- Carlos E. Durán
- Clinical Pharmacology Research Group, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Martín Cañás
- Federación Médica de la Provincia de Buenos Aires, La Plata, Argentina
- Instituto de Ciencias de la Salud, Universidad Nacional Arturo Jauretche, Florencio Varela, Argentina
| | - Martín Urtasun
- Federación Médica de la Provincia de Buenos Aires, La Plata, Argentina
- Instituto de Ciencias de la Salud, Universidad Nacional Arturo Jauretche, Florencio Varela, Argentina
| | - Monique Elseviers
- Clinical Pharmacology Research Group, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Robert Vander Stichele
- Clinical Pharmacology Research Group, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Thierry Christiaens
- Clinical Pharmacology Research Group, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
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Bourasseau A, Lavergne L, Ravinetto R. Assessments of the quality systems of pharmaceutical distributors: a remote approach to be applied in times of COVID-19 and beyond. J Pharm Policy Pract 2021; 14:43. [PMID: 33971973 PMCID: PMC8107414 DOI: 10.1186/s40545-021-00323-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background Adequate quality systems throughout pharmaceutical supply chains are crucial to protect individuals and communities from substandard and falsified medical products. Thus, pharmaceutical distributors are regularly assessed by qualified experts. Since the COVID-19 pandemic has forced a suspension of normal activities, remote assessments via videoconferencing may represent a temporary alternative to on-site audits. We exploratorily evaluated the feasibility of remote assessments of pharmaceutical distributors, located in a low- or middle-income country hard-to reach during the COVID-19 pandemic. Methods We conducted pilot remote assessments of four conveniently selected distributors. The expert was remotely connected via videoconference, and supported by an in-country assessment facilitator (ICAF), who had received ad hoc training and was present at the assessed facility. First, the remote expert assessed the quality assurance (QA) activities and rated their compliance with the standards of the World Health Organization Good Storage & Distribution Practices (GSDP), as per routine practice. Second, s/he assessed the completeness, clarity and accuracy of data collected remotely, first per distributor, and then in aggregated form. Results Data completeness was assessed by the expert as excellent, while clarity and accuracy were good. Overall data quality (a combination of completeness, clarity and accuracy) was good, with no major differences across QA activities, nor across distributors. Contextual limitations included poor internet connection, language barriers, and distributors’ lack of familiarity with QA terminology. Conclusions Our findings are exploratory and cannot be extrapolated to other contexts, nor to other types of audits. Nonetheless, this pilot experience suggests that a well-planned remote assessment of pharmaceutical distributors, conducted with the support of a well-trained onsite ICAF, can provide data of acceptable quality, allowing to assess GSDP-compliance and to make temporary decisions about licensing or purchasing. Purchasers and policy makers should read the results of remote assessments in light of their intrinsic limitations. At the moment, onsite assessments remain the gold standards, but this could change in the longer term, with improved information technology and in light of the need to avoid unnecessary travels. Furthermore, remote assessments could be considered for routine pre-screening candidates for on-site assessments, and for targeted follow-up of on-site assessment. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-021-00323-w.
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Affiliation(s)
| | | | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
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O'Brien J, Lumsden R, Macdonald J. Strengthening regulatory systems for medicines in a changed world: where do we go from here? BMJ Glob Health 2021; 6:bmjgh-2020-004680. [PMID: 33495287 PMCID: PMC7839853 DOI: 10.1136/bmjgh-2020-004680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Julie O'Brien
- Global Regulatory Policy and Intelligence, Global Regulatory Affairs, Pfizer Healthcare Ireland, Dublin, Ireland
| | - Rebecca Lumsden
- Global Regulatory Policy and Intelligence, Global Regulatory Affairs, Pfizer Ltd, Tadworth, Surrey, UK
| | - Judith Macdonald
- Global Regulatory Policy and Intelligence, Global Regulatory Affairs, Pfizer Ltd, Tadworth, Surrey, UK
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