Promoting Appropriate Use of Medicines Is Critical to an Effective COVID-19 Response
Pandemics challenge the efficacy and resiliency of many systems, including the pharmaceutical system—how medicines and other medical products are managed in health systems. That’s particularly true in low- and middle-income countries, which already face significant challenges in securing sustainable access to and appropriate use of quality-assured affordable medical products.
As governments, researchers, and health care workers work to develop and deliver medical products to adequately prevent, test for, and treat COVID-19, countries will benefit from a response that strengthens the pharmaceutical system to ensure that any medical product deployed in the pandemic protects and promotes public health as opposed to causing harm.
Key areas country governments and development partners should focus on include:
Strong governance and adequate regulatory systems
Randomized, controlled clinical trials are underway for COVID-19 vaccines and therapies in many countries. As the scientific community urgently seeks effective treatments and vaccines, regulatory authorities must have the ability to set research guidelines and monitor clinical trials as Kenya has done, for example. Doing so requires clear policies, robust legislation, and sound management practices supported by good governance.
As treatments and vaccines are rolled out during new outbreaks like the COVID-19 pandemic, pharmacovigilance systems are essential to keep patients safe from unknown adverse effects.
Already, unproven treatments for COVID-19 are being used off-label or as part of uncontrolled studies, despite known adverse effects. For example, a multicountry observational study on use of hydroxychloroquine recently found that there was no evidence of benefit with increased risks, such as drug-induced cardiac effects, which underscores the need for further studies.
Countries must have a means to adequately collect, store, access, and process real-time data about adverse events such as the system established by the Philippines FDA, which is linked to WHO’s global safety reporting database. Tools like PViMS, which is being implemented by MTaPS in Rwanda and Mozambique, offer an integrated approach to provide for both active surveillance and spontaneous reporting. Such a mechanism is essential not only to handling cases today but also in laying the foundation for protecting patient safety during testing and roll-out of any SARS-CoV-2 vaccine, new therapies, or repurposing of old medicines.
Strong regulatory agencies also help to make sure that medicines for all other diseases are safe, effective, and quality-ensured and are not diverted away from other health programs that need them, like malaria, TB, and HIV/AIDS.
Treatment guidelines and clear communication
Governments need support in handling disease containment and mitigation and in updating and promoting treatment guidelines. In all cases, they must be able to provide clear guidance and risk communication, particularly to alleviate misinformation about the causes of and cures for COVID-19. Alarmingly, some governments in Africa are promoting locally sourced medicines that have not been tested via clinical trials, despite a warning from the WHO regional office in the continent. For example, Nigeria’s drug regulatory agency published a position statement on claims for treatment from traditional healers and alternative medicine. Such timely issued information ensures that public health is protected.
Trust in medicine safety and clear information about risks and benefits, like trust in strong leadership, helps push people toward adopting treatments and behaviors.
Empowering stakeholders working in the last mile
Clinicians, pharmacists, dispensers, and community health workers are the most visible and accessible providers in the community and must have adequate training and support to deliver effective, quality-assured, and affordable care, including dispensing medical products safely and appropriately. This is particularly important in the case of antibiotics.
Despite only 1 in 10 patients having a bacterial or fungal infection, studies showed that about 7 in 10 COVID-19 patients receive antibiotics, emphasizing the need for data-driven antimicrobial stewardship.
Niranjan Konduri is a principal technical advisor for USAID’s MTaPS program
MTaPS’ Tailored Support to Countries Responds to COVID-19 and Beyond
MTaPS’ groundwork in enabling appropriate medicines use, including antibiotics, can help governments bridge the gap between evidence, policy, and action. Our tailored interventions on regulatory systems strengthening, pharmacovigilance/medicines safety, and antimicrobial stewardship will ensure that the tenets of patient safety and responsive pharmacy practices are incorporated, which is critical to effectively responding to COVID-19 and any future epidemics. As part of the COVID-19 response, our MTaPS technical teams will also support countries in their ongoing efforts to build sustainable, responsive pharmaceutical systems in their journey toward self-reliance and universal health coverage.