By Charlotte Greenhill
On June 25th, the Medicines in Health Systems Thematic Working Group continued its exploration of health systems challenges during the COVID-19 pandemic with a panel of public health professionals from South Africa, Bolivia, and Nigeria. The webinar focused on the quality and accessibility of medicines within the context of local and global disruption.
Dr. Andy Gray is a pharmacist and senior lecturer of pharmacology at the University of KwaZulu-Natal in South Africa, which is a WHO Collaborating Centre on Pharmaceutical Policy and Evidence-Based Practice. Gray remarked that South African HIV/AIDS patients are avoiding clinics out of fear of interaction with others and getting infected due to the pandemic. This severely hampers continuous access to anti-retroviral medicine since patients must frequently pick up their medication at such clinics. Luckily, South Africa does not have a law that limits larger volume pickups, so clinics have transitioned to offer higher quantities of anti-retrovirals (up to a three-month supply) to patients and thereby reduce the daily density of patrons. The downside of this is that less frequent visits limit the main method by which pharmacists track patient adherence to their medication: coming back for refills.
Dr. Rene Soria-Saucedo is a medical doctor and public health professor at Universidad Mayor de San Andres in Bolivia, as well as a member of Bolivia’s presidential committee for COVID-19 response. Lockdown efforts in Santa Cruz and beyond have managed to decrease the velocity of COVID-19 transmission but not stop it. Saucedo spoke on his country’s struggle to procure sufficient medical supplies. Gaps remain in the country’s testing capacity and ability to isolate and prevent cases; the health “system is overrun.” Since Bolivia does not produce domestically any of the necessary medical supplies, it must join the worldwide competition for importation and procurement of items such as PPE.
In addition, the Bolivian government has failed to publish important messaging fast enough. The government’s underdeveloped communication systems cannot keep up with supposed “treatments” perpetuated on social media. Bolivians are purchasing medicines in mass quantities (such as hydroxychloroquine) that were popularized on social networks but are ineffective against COVID-19, depleting the supply for patients that truly need these medications. Saucedo noted that the Ministry of Health takes too long to validate and release information on emerging COVID-19 therapies that would combat rampant misinformation. According to Saucedo, this “timing issue” is a direct result of insufficient investment in prevention capacity training.
Dr Monica Eimunjeze, the Director of Registration at NAFDAC, described Nigeria’s efforts to limit sub-standard pharmaceutical products from entering the market through regional and global collaborations. With the rise of e-commerce in pharmaceuticals, regulating the source and quality of medicines has become more difficult. During the pandemic, restrictions on international trade have impacted imported medicines and made it hard for Nigeria to meet its needs. The national regulatory system is working to accelerate approval for essential medicines sourced closer to home while still monitoring for falsified or poor quality medical supplies. Fortunately, Nigeria has “robust plans in place” for emergency preparedness that have helped the nation respond to the COVID-19 pandemic.
The webinar closed with the panelists’ reflections on securing future COVID-19 vaccines. Dr. Gray commented on the trend towards “vaccine nationalism” and the importance of technology transfer to the Global South to facilitate large-scale production of a more equitable “people’s vaccine.” Dr. Saucedo acknowledged the difficulty of predicting which clinical trials will produce a viable vaccine (like trials in China, at Oxford, or elsewhere) and where to focus the government’s limited political capital in the hopes of procuring vaccines for the country.
The pandemic has exposed both strengths and weaknesses in health systems across the globe and the lessons learned in South Africa, Bolivia, and Nigeria have relevance to COVID-19 response worldwide. With a long road ahead, Dr. Gray, Dr. Saucedo, and Dr. Eimunjeze consider access to medicines a crucial component of strong health systems that is worth protecting amidst this global crisis.