By Katherine Pettus
Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Palliative Care Medicines, brings the latest roundup of advocacy news.
In December I returned to Europe from the US to attend the Reconvened Meeting of the Commission on Narcotic Drugs (CND) in Vienna.
The CND — a United Nations treaty body that oversees “drug control” conventions — holds its regular, week-long meeting in March, and a reconvened meeting in December to elect a Bureau, prepare the organization’s meetings for the following year, and take care of unfinished business. The purpose of my attendance at the reconvened session was to coordinate with colleagues at the United Nations’ Office of Drugs and Crime (UNODC), as well as diplomats from the missions of Belgium and Australia. We needed to discuss our advocacy strategy for a proposed resolution on the imperative of improving access to controlled medicines in more than 60% of the world, and to plan our now regular high-level side events on the same topic, to be held in March 2020. The Russian Federation has already requested to join the list of cosponsors of the side event, which will undoubtedly grow as we move toward March.
The sponsoring countries will present the draft resolution on controlled medicines to the delegations of state parties at CND’s 2020 regular meeting. To date we know the identity of at least two of the sponsors: Belgium and Australia. I will share details of the final draft of the resolution with advocacy partners and on social media as soon as I have permission from colleagues in the sponsoring countries.
Once the draft text is released, we urge you to encourage your country’s palliative care association to help garner the support of the government ministry that advises your country’s Vienna mission and sends delegates to CND. That ministry may be “drug control,” Interior, Foreign Affairs, or Justice, depending on how your government organizes “drug” control. Health ministries will only be indirectly involved, depending on your country’s civil service protocols. Since most focal points will circulate to relevant ministries, it will be important to keep yours health ministry in the loop.
Once approved through the CND consensus process next March, this resolution, with its “agreed language,” will form part of the global legal and normative framework that supports and protects your bedside practice with patients. I think of this framework as the narrative pallium. You can use the resolution’s words as leverage to advocate with your government, which will probably have approved it at CND and may even have cosponsored it.
While in Vienna, I also met with the UNODC staff person overseeing the ostensibly “comprehensive” Opioid Strategy, one of whose five pillars is to improve access to controlled medicines. Unfortunately, the staffer has not been able to secure even minimal funding for the project from CND member states with representation in Vienna.
This is very unfortunate, and shows a lack of political will to improve access to opioids for legitimate medical use, despite the narrative pallium of resolutions, high-level political declarations, and reports from UN Special Rapporteurs for human rights. Advocates need to make the case that including palliative care as an essential part of Universal Health Coverage entails adequate access to controlled medicines. This, in turn, requires compliance with international regulations, including technical (as well as clinical) expertise at the multilateral and national levels. IAHPC is collaborating by sharing web-based resources with UNODC.
I am also preparing our advocacy partners for the upcoming World Health Executive Board meeting that takes place in Geneva the first week of February. We will be asking you to prepare your national delegations to comment on palliative care progress in their countries under two EB146 agenda items: Universal Health Coverage (UHC) and Primary Health Care (PHC). The text of our Briefing Note can be found here.
We encourage you to familiarize your Ministry of Health contacts with the contents of our Briefing Note, and urge them to include at least one sentence in their statements on the floor (all delegations give statements on most agenda items regarding progress in primary care and movement toward Universal Coverage!) about ongoing efforts and challenges to integrate palliative care into UHC and PHC. It will be important to identify who, in the health ministry, will be attending the World Health Organization meeting in Geneva from February 3-7. The words “palliative care” are almost never vocalized by Member State delegations at WHO, a trend you can help us change.
Until delegations speak up about their progress and form partnerships with civil society organizations such as palliative care associations, palliative care will stay hidden in the global health shadows.
Please remember that I am here to answer whatever questions you may have about the IAHPC Advocacy Program and how you can participate. I am also available for lectures and information sessions via Zoom, Skype, or whatever web interface you use for meetings: I recently lectured remotely at both a National Palliative Care Conference in Peru (in Spanish) and in Malaysia (in English). Just because IAHPC’s travel budget has been deeply cut doesn’t mean we have to forego our interactions and advancement of knowledge regarding palliative care policy and advocacy.
We just need techies on each end!
If you don’t quite understand all the vocabulary and technical details of these advocacy reports, please consider reviewing IAHPC’s new basic advocacy course, “Advocating for Palliative Care in the Multilateral System.” Available online and free to members, the course explains the terms, texts, and process of the IAHPC Advocacy Program and invites you to be involved at whatever level you are comfortable.
I wish all of you a happy and fruitful New Year and look forward to supporting your work in 2020, along with the terrific IAHPC team.