WHO perspective on preventing avoidable harm from medicines

Editor—The BMJ news item on adverse drug reactions is important.¹ The estimated annual expenditure of $870m towards issues related to such effects would be hard on any economy; such figures could seriously cripple countries with lesser resources.

The cost factor should then be at least one of the reasons for all developing countries to promote pharmacovigilance. Started in 1968, the World Health Organization's programme for international drug monitoring has, to date, 79 countries as full members; only six of them are from sub-Saharan Africa, where pharmacovigilance is often still seen as a luxury. Yet in many of these countries, treatment programmes are being expanded rapidly after substantial funding has been released for procuring medicines for treating malaria, tuberculosis, and HIV/AIDS.

Not uncommonly, several disease control initiatives, including the administration of several drugs, are carried out among the same population, with little or no understanding of how these various medicines could interact.² Moreover, the conditions and populations in which many of these medicines were tested often differ radically from the conditions and populations of large scale treatment programmes.³ WHO is now seeking to roll out a programme of disease driven pharmacovigilance; disease programme managers are being trained to monitor and manage adverse reactions to medicines in specific public health programmes as a first step towards introducing pharmacovigilance into countries.

WHO is also working with the Forum for Collaborative HIV Research to coordinate cohort studies throughout the developing world to collect data on adverse drug reactions resulting from antiretroviral treatment (www.hivforum.org). Another aspect of work in WHO is to help member states when there is a crisis, such as the recent cluster of adverse drug reactions to one of the antimalarials used in Ghana. No one can afford to ignore pharmacovigilance because, if access to medicines is a human right, then preventing avoidable harm from medicines is a professional and moral obligation.