The Graduate Institute’s Global Health Programme, in cooperation with the University of Ottawa, held a public seminar at the Institute last week to discuss the threat that fake and substandard medicines pose to public health and the potential role of the World Health Organization (WHO) in resolving this daunting health challenge. Fake and substandard medicines are said to cause nearly 700,000 deaths a year. Chaired by Professor Ilona Kickbusch, Director of the Global Health Programme, the panellists included leading experts in political economy, global health and legal research. The seminar provided an opportunity to engage the public and policy-making audiences on this issue ahead of negotiations at the 64th World Health Assembly, which takes place in Geneva from 16 to 24 May 2011.

The challenge of fake and substandard medicines stretches from the World Health Assembly to the corner pharmacy. It requires international agreements between countries as much as it requires closer collaboration between health professionals, regulatory and law enforcement agencies, as well as better informed and empowered citizens. It is an example of 21st century governance for health which necessitates more elaborate cross-sector and multi-level collaboration that can adapt to complex challenges as they emerge. This new adaptive approach to governance is a theme that the Global Health Programme is currently analysing in partnership with the WHO Regional Office for Europe and will remain a priority research area for the Programme.

Addressing Geneva-based health attachés, and public as well as private stakeholders from the health and pharmaceutical sectors present at the meeting, Professor Kickbusch described global health governance as a multi-stakeholder arena in which it is paramount to have all actors involved in promoting legal instruments to ensure access to quality medicines. The international community needs to establish strong institutions and support regulatory agencies at national level to stamp out fake and substandard medicines. The panellists agreed that this would require strong political will, multiple interventions, and a general focus on raising the quality of medicines.

A major theme running throughout the seminar was the need to redress the critical imbalance in the provision of international legal tools to tackle the illicit trade and criminal production of fake medicines. A complete legal system would address both the positive challenge, to promote greater access to safe, WHO-qualified treatments, as well as the negative challenge, to stop criminal activity and bogus treatments that are intentionally fraudulent, illicitly traded and sold. Currently, the global system lacks balance, with most legal tools addressing the issue of counterfeit medicines. In other words, the international system is currently more prepared to tackle this issue as a violation of intellectual property rights rather than as a significant danger to public health.

The WHO Expert Working Group of Member States on Substandard/Spurious/Falsely-Labelled/Falsified/Counterfeit Medical Products acknowledges this imbalance and has already incorporated both challenges in its ongoing deliberations. The panellists concluded that the 64th World Health Assembly will provide a window of opportunity to further discuss the future agenda of the working group, and the need to strengthen international legal cooperation and national enforcement to tackle the threat that fake and substandard medicines pose to public health.

The Graduate Institute’s Global Health Programme is a research endeavour which concentrates on examining links between health, foreign policy, trade and development.