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Third International Conference for Improving Use of Medicines (ICIUM 2011)
Executive summary report from AMASA participants

Conference rationale objectives, and content

Appropriately used medicines are key to the health and well-being of individuals and to the efficient use of scarce resources in health systems. Between November 14 and 18, 2011, the global medicines community gathered in Antalya, Turkey for the Third International Conference for Improving Use of Medicines (ICIUM 2011). Those who work in the medicines field will remember ICIUM 2011's predecessors in 1997 and 2004 which brought together leading international and national policy makers, program managers, researchers, clinicians and other stakeholders to produce state-of-the-art consensus on interventions to improve use of medicines and recommendations for policy change and for research to fill gaps in knowledge.

This year's ICIUM conference focused on « Informed Strategies, Effective Policies, Lasting Solutions ». Over 600 experts from over 70 countries participated and evaluated more than 500 research projects conducted since ICIUM 2004. Based on discussions of the latest evidence, participants again generated recommendations for policies and programs to improve access to and use of medicines. They defined a new global research agenda that is relevant to current conditions and unfolding developments in global health.

'In a time of unprecedented changes in the world's population, enormous economic pressures, and widening gaps in individuals'  access to limited resources, we must make sure that all stakeholders in health systems can base their decisions on the best available information,' Dr. Anita Wagner, Assistant Professor at the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute said. 'With a focus on vulnerable populations in low and middle income countries, the experts gathered in ICIUM 2011 generated recommendations, based on state-of-the-art evidence, to tackle current and evolving medicines challenges. Like its predecessors, we met our expectations of  ICIUM 2011 being another milestone event in global health.'

Summary of the Agenda

Opening day keynote presentations addressed current challenges and novel opportunities for improving the medicines situations in health systems. In each half-day conference session, internationally renowned experts discussed cutting-edge topics like the role of the pharmaceutical industry in improving medicines access and use; challenges in financing medicines at the health system and household levels; and system strategies to enable patients with chronic conditions adhere to life-long medicines therapies.

Following each plenary session, participants evaluated the latest research on interventions to improve medicines use in eight parallel topic track sessions. Track themes are access to medicines; policy, regulation, and governance; economics, financing, and insurance systems; child health; HIV/AIDS and tuberculosis; malaria; and drug resistance. Cross-cutting topics include gender and socioeconomic inequities and the uses of information technology in the medicines field.

News from the conference have been shared with the global community throughout the event and summaries will be available on the conference blog (http://icium2011.wordpress.com/).

And the Webcast: The conference plenary sessions were webcasted at http://www.zboxmedia.com/icium/. The full program schedule can be found here: http://bit.ly/uZPFJg.

Cross-cutting issue focal point : gender and socioeconomic inequities in access to medicines

The conference paid a particular attention to the gender and socio-economic enequities in access to medicines. On one side some scholarships were provided to the researchers presenting related research, and on the other hand dedicated track sessions were planned;

A dissemination plan have been scheduled as well;

Summarizing the discussions on the topic, it was clear that despite outstanding progress in the area of medicines, their access and use have not been equitable throughout the world [Baghdadi G., WHO 2005].  According to the same source, 15% of the world's population consumes 91% of the world's production of pharmaceuticals. Only one third of the world population has access to essential medicines. Additionally, studies carried out in developing countries reveal that gender-related barriers in access to health services and medicines are greater for women than men because of social and cultural factors. In high-income settings, women are reported to use more medicines than men. Moreover, the current devastating human immunodeficiency virus (HIV) epidemic impacts women disproportionately. Women are more vulnerable to HIV infection than men biologically but also because of gender inequalities. More social and statistical data, in both developing and developed countries, are needed to fully understand the impact of gender on access to and use of medicines. Improving access to essential medicines will be possible only if countries introduce a gender perspective in their medicine policies.

AMASA Contribution : Plenary session chairing, Track sessions chairing and facilitating, oral communications and poster communications.

Through other grants or partial AMASA participation grants, three members of AMASA project attended the ICIUM 2011 conference. In total related to AMASA research topic or not, 6 posters and one oral communications have been delivered by AMASA project researchers. [See appendix for details]

Conference recommendations and press release :

November 21, 2011 - Two billion men and women in developing countries cannot get essential medicines

Once Every Seven Years World Experts Meet to Discuss Misuse of Medicines in Low- and Middle Income Countries

  • High medicine costs push 150 million people below the poverty line each year
  • In many low- and middle income countries, one month of life-saving insulin treatment for diabetes may cost half a month’s salary
  • In one Asian country, 42% of medicine costs is spent on bribing the doctors
  • In Oman, misuse of antibiotic use has been reduced by half since 1995
  • Cell phone messages remind East-African AIDS patients to take their medicines

Over 600 world experts on essential medicines met in Antalya, Turkey for the Third International Conference on Improving the Use of Medicines (ICIUM). They heard several similar stories from developing countries from all over the world – how life-saving treatments for malaria are not available in private pharmacies of East Africa; how unscrupulous local manufacturers continue to produce and promote malaria drugs that the World Health Organization has recommended be taken off the market because they lead to resistance; and how 42% of the price of medicines in one Asian country is spent on bribing the doctors.

Delegates from over 80 countries who attended ICIUM also learned that more people in developing countries die from chronic diseases such as hypertension, asthma and diabetes, than from infectious diseases such as AIDS and tuberculosis. Unfortunately very few governments do anything about it.

But there was also good news. The medicines for a year of treatment of such chronic diseases cost less than $6 dollars – provided they are bought as generic (off-patent) medicines and provided the local distributor, the pharmacist and the doctor do not add another 10 or 20 dollars to the price. The Sultanate of Oman has succeeded in drastically reducing the use of antibiotics (from 60% of prescriptions in 1995 to 15% of prescriptions in 2010), thus reducing the chance that resistance develops. Specially trained drug sellers in Tanzania, called ADDOs (Accredited Drug Dispensing Outlets), supply essential medicines of good quality to patients in rural areas.

ICIUM Conferences are only held every seven years. Earlier conferences were in 1997 and 2004, both in Thailand. This time ICIUM was held in Turkey to allow for more delegates from the Middle East to participate. The conference was originally planned to take place in Alexandria (Egypt) but had to be relocated in view of the political unrest in the region.

However, over 250 Egyptian experts and students attended the conference through a live webcast. Special attention was given to the needs of the people in countries of the “Arab Spring” with examples of constitutional text from other countries reflecting access to essential medicines as part of human rights.

AIDS has become a chronic disease, for which life-long treatment in needed. There are now more cell-phones in Africa than in the USA and Canada together. A very promising development is the use of cell-phones and short text messages in several African countries to remind AIDS patients about their appointments to get their medicines.

Delegates also heard that in most countries, women did not have more difficulty than men in getting their medicines; but more such studies are needed in countries such as Yemen, Somalia, Pakistan and India. As Dr Anita Wagner of Harvard University, one of the organizers of the conference, put it: “In most developing countries, both men and women have equally bad access to essential medicines.”

The World Health Organization estimates that about one third of the world’s population - around 2 billion people - does not have regular access to essential medicines. Richard Laing, coordinator for medicine policy at WHO’s Essential Medicines Programme, adds “These estimates have recently been confirmed by household surveys in countries such as Uganda. And every year, about 150 million people sink below the poverty line because of the high cost of the medicines they have to buy.”

 

More information:

AMASA researchers communications at ICIUM 2011

AMASA poster

ICIUM website