2018; Volume 19, No 11, November
Message from the Chair and Executive Director
Dear Readers,
Last month was extremely busy!
Panel members in WHO side event (L-R): Dr. Katherine Pettus (USA), Minister of Health of the Russian Federation Dr. Veroníka Skortsóva, Dr. Eric Krakauer (USA), Minister of Health of Uzbekistan Dr. Alisher Shadmanov, Deputy Secretary of Health of Singapore Dr. Benjamin Koh, and Dr. Sébastien Moine (France). (Photo: Dr. Eric Krakauer)
The most important event impacting global health policy this year happened last month, when on October 25 in Kazakhstan, the world’s Heads of State and Ministers of Health adopted the Declaration of Astana during the Global Conference on Primary Health Care. The Declaration commits to the proposition that ‘Promotive, preventive, curative, rehabilitative services and palliative care must be accessible to all.’ This important document was drafted through a series of consultations with the WHO, UNICEF, governments, and civil society. The initial drafts did not include palliative care, but thanks to advocacy by IAHPC and other palliative care organizations, the final approved document includes palliative care in two places.
We are very proud of and grateful to Katherine Pettus, our IAHPC advocacy officer, for her work both prior to and in Astana, representing IAHPC and raising the palliative care flag. Katherine also served as the moderator in a side event planned by the WHO in which Drs. Erik Krakauer (IAHPC board member) and Sébastien Moine (primary care physician and IAHPC member) along with the Ministers of Health from Uzbekistan and the Russian Federation and a Deputy Secretary of Health from Singapore, presented on the advances of palliative care in primary health care in their countries.
We are also very proud of and grateful to the members of the IAHPC delegation to Astana, for their efforts, commitment, and work with patients in their communities — and for making sure that palliative care is provided in primary health care.
International Congress in Peru
Liliana presenting on ‘Access to Essential Medicines in Palliative Care’ in Lima, Peru.
In October we both attended an international congress of palliative care in Lima, Peru, sponsored by the Latin American Association for Palliative Care (ALCP for its Spanish acronym) and the Peruvian Society of Palliative Care. The day before the congress, the ALCP, in collaboration with the IAHPC and FEDELAT (the Latin American Federation of IASP Chapters) organized a high-level meeting to present the findings and recommendations of the Lancet Commission on Palliative Care and Pain Relief as well as advances in palliative care throughout the region.
Participants included: Uruguay Minister of Public Health Dr. Jorge Basso; Guatemala Minister of Health Dr. Carlos Enrique Soto Menegazo; Panama Health Minister Advisor Dr. Temístocles Díaz; Dr. Tania Pastrana, president of the ALCP; Dr. João Batista García, President of FEDELAT; Liliana as well as Dr. Felicia Knaul, leader of the Lancet Commission; representatives of the ministries of health from Argentina, Bolivia, Brazil, Chile, El Salvador, Paraguay, Peru, Venezuela; lawmakers from Chile and Peru; and representatives of national palliative care associations.
At the end of the meeting, participants adopted a compromise and call for action to advance palliative care in the region. Additional information about the event can be found here.
Ministers of health, deputies, lawmakers, palliative care experts, and presidents of civil society organizations at the high level meeting in Lima, Peru.
WHO tramadol discussion is worrying
Later this month, the 41st WHO Expert Committee on Drug Dependence (ECDD) will be meeting in Geneva, to consider, among other things, whether to recommend to the Commission on Narcotic Drugs in Vienna to put tramadol (an opioid for moderate pain) under international control, in the same manner that potent opioids are now regulated.
The IAHPC has sent a letter to the WHO ECDD highlighting the current use of tramadol for analgesic purposes and the potential impact that the proposed scheduling may have regarding access for legitimate medical needs in pain treatment and palliative care. You can read the letter here. At IAHPC we think that this would hinder access to pain treatment to many patients around the globe. Based on this, the IAHCP recently conducted a survey among its members, asking what the impact of such scheduling could have on their patients who are experiencing pain and the results of the survey were astonishing: 41% prescribe tramadol daily or at least once a week, and although most use it for the treatment of mild to moderate pain and moderate to severe pain, participants from nine countries use it for all levels of pain, having no other analgesic available.
According to survey participants, placing tramadol under international control would have a very negative impact on access to pain treatment. The survey concluded that a greater negative effect would be borne by low-income and low-middle-income countries when compared to high-income countries. Based on these findings, the IAHPC submitted a letter to the WHO ECDD asking it to consider the ethical and public health implications of placing such a widely used pain medication under international control in the already acute global context of severe health-related suffering. Placing it under international control would limit the access of millions of patients to pain treatment, especially in countries where there is limited or no access to other strong analgesics, such as morphine. The letter we submitted can be found here.
We suggest that the ECDD recommends that tramadol not be placed under international control, and that Member States experiencing public health problems with non-medical use enhance surveillance and monitoring at the national and regional levels, as per the specifics of their particular context.
And, last but not least, this month we are launching a fundraising campaign to support the work of IAHPC and our mission drive programs. We hope that you can contribute, and invite your colleagues and friends to do so! Any amount helps and counts in our efforts to continue the work that we do.
Until next month,
Lukas Radbruch, MD
Chair, Board of Directors
Liliana De Lima, MHA
Executive Director