Plan to boost access to essential medicines for children

The first international Expert Consultation on Paediatric Essential Medicines, jointly held by the World Health Organization (WHO) and the United Nation's Children's Fund (UNICEF), has delivered a plan to boost access to essential medicines for children.

"Children are often hailed as the hope and future of humanity, but they don't benefit enough from pharmaceutical research and technology," said Dr Howard Zucker, Assistant-Director General at WHO. "Too often, the right medicines for children, in the right dosages and formulations are missing from the spectrum of available treatment options. WHO and UNICEF will work quickly with partners to change this."

Ten million children die every year, many of them from diarrhoea, HIV/AIDS, malaria, respiratory tract infection or pneumonia. Effective interventions - classified on WHO's list of essential medicines - exist for these illnesses but there's a lack of knowledge of how best to use these medicines in children, and a lack of paediatric formulations of them.

During two days of intensive discussion held 9-10 August at WHO's headquarters in Geneva, a mix of more than 20 developed and developing countries, non-governmental organizations including Médecins Sans Frontières, regulatory agencies, UNICEF and WHO staff prioritized a long-needed approach to overall paediatric care.

A top priority resulting from the meeting is to dramatically expand access to much needed child-focused formulations such as fixed dose combinations (several pills in one), crucial for children's correct use of medicines and treatment adherence.

The plan also calls for the improvement of medicines and prescribing guidelines addressing the entire range of infant and child care needs. Priorities include respiratory infections, neonatal care, palliative care for end stage AIDS, for HIV/TB co-infection and for other opportunistic infections, and improved electronic access to the latest WHO drug information.

The WHO Expert Consultation warned that without a model of best practice guidelines and paediatric formulations, and a buy-in at national levels right down to local care centres, then children - who in many countries make up half of the population - will continue to be considered as therapeutic orphans.

"For example, it is worrying to see so very few medicines suitable for children in resource-poor settings where there is enormous need. For these children, we must address cost issues and ensure the right medicine formulations exist", said Dr Hans Hogerzeil, WHO's Director for Medicines Policy and Standards. "The expert consultation was unanimous in its support for urgent, specific actions, which will significantly improve the chances for children to access the right medicines."

According to Hanne Bak Pedersen, Senior Adviser Pharmaceutical Policy, UNICEF Supply Division, "UNICEF is concerned that children's access to medicines is very low in many resource limited settings. Furthermore, there is a lack of availability of several paediatric formulations. Based on the work of this new project and WHO clinical recommendations, UNICEF Supply Division will strengthen and expand the dialogue with industry on paediatric formulations for HIV/AIDS to promote the development of the missing medicines for children."

High priority will be placed on ensuring a holistic approach to child care and treatment, including addressing quality of life issues such as producing painless remedies over injections, better tasting medications and investigating new mini tablet presentations.

Emphasis will also be placed on considering the climate zone requirements linked to distribution and use whenever new product formulations are made. For example, chewable or soluble powders are preferred over syrups as they do not require refrigeration and are less bulky to transport.

The plan will immediately be sent to countries for feedback on how best to implement the recommendations at the local level. In addition, WHO will consider several children's medicines for inclusion in the WHO Essential Medicines List in March 2007.