At a recent event on the margin of the United Nations General Assembly, a senior World Health Organization official gave an update on global efforts against substandard and falsified medicines in the context of the fight against antimicrobial resistance (AMR). And a key issue is that often after arriving safely in the capitals, something happens just before quality-assured medicines reach the patient, contributing to AMR.

Hajime Inoue, senior advisor to the director-general and special representative for antimicrobial resistance at the WHO, said more than 130 member states have completed a national action plan on AMR or in the process, covering more than 90 percent of the global population.

The panel, “Quality Medicines: Critical underpinnings of all AMR strategies,” was hosted by several organisations including USP, and held on 19 September at the Harvard Club in New York.

Inoue was asked by the panel moderator about the UN political declaration on AMR passed last year, and in 2015 WHO adopted a global action plan and World Health Assembly resolution on AMR. In one year, WHO and its partner group will have to report back the assembly on progress.

He said WHO and member states are moving from the plan to implementation in the field, which he said is “the real challenge.” WHO is providing support to every member state on this.

In the question and answer period, Inoue reported on WHO efforts, saying for instance that since WHO launched its global surveillance and monitoring system for substandard or falsified medicines in 2012, they have gathered more than 1,500 reports of such medicine from more than 100 countries. So there is now some data on clusters of medicines or categories of medicines most prone to such issues.

Based on data from the first 4 years of the database, about 40 percent of all reports came from antimicrobials, either anti-malarial medicine or antibiotics, said Inoue.

On another point, he said PEPFAR, the Global Fund for AIDS, Tuberculosis and Malaria, and GAVI are financing mechanisms for medicines and vaccines that have good systems for assurance and procurement. He also mentioned UNITAID.

By the time the medicine purchased by these agencies arrive into the capital city of lower middle-income countries they are “surely quality assured,” he said. But based on data they are getting on where the substandard and falsified medicines are penetrating the system, it is in “the last one mile before the patients.” This is still difficult for these agencies to address, and WHO is facing it.

In answer to another question, Inoue said they still do not have enough robust data compared to other areas. “We still do not know the actual prevalence of this issue of substandard and fake medicines issues or the actual real causes or what’s most popular or the affected areas of medicines and so on,” he said.

He said that “convincing” data could be published by the end of the year, which he believes could increase momentum from outside stakeholders, not necessarily money but also in champions among all stakeholders.

Quality of medicine relates to all five objectives of the global action plan, he said: awareness, surveillance, reducing infections, appropriate use of antimicrobials, and research and development or investment. They would like to better quantify the linkage of quality of medicines with each of the five objectives, he said.