By Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Palliative Care Medicines
April advocacy news from lockdown in Spain is the COVID-catalyzed collaboration between IAHPC, the International Children’s Palliative Care Network, Palliative Care in Humanitarian Aid Situations (PalChase), and the Worldwide Hospice Palliative Care Alliance leadership to produce a Special Series on COVID-19 and Palliative Care. The series features webinars and companion briefing notes by palliative care experts all over the world, many of whom have never worked together before.
The first webinar, on April 17, discussed issues specific to low- and middle-income countries. It featured health systems experts Drs. Felicia Knaul and Liz Grant, and palliative care service providers Drs. Emmanuel Luyirika and Ednin Hamza from Uganda and Malaysia, respectively. The second webinar, on April 24, focused on ethical and legal aspects of access to palliative care during the pandemic, featuring human rights expert Diederik Lohman, palliative care ethicist Dr. Lisa Schwartz, and palliative care pharmacist Ebtesam Ahmed. A third webinar, Clinical and Prevention Aspects in COVID-19, that took place on May 1, was led by IAHPC Chair Dr. Lukas Radbruch, IAHPC Board Member Dr. Dingle Spence, and Dr. Carla Alexander (University of Maryland). Click here to access the briefing notes authored by all these global experts. Videos of the webinars are available here.
The schedule and topics of future webinars is the first item in the News section.
I was privileged to coordinate the team drafting the briefing note titled “Global Availability of Internationally Controlled Essential Medicines” with Drs. Ebtesam Ahmed (St. John’s University), Jim Cleary (Indiana University), M.R. Rajagopal (Pallium India), Lukas Radbruch (University of Bonn), Liliana de Lima (IAHPC), Elizabeth Mattfeld (United Nations Office on Drugs and Crime, UNODC), and Christophe Rerat (World Health Organization, WHO). Several important questions arose regarding stockouts and shortages of these essential medicines. UN agency representatives provided important new information on steps they were taking to enable improved access in COVID-affected countries. Dr. Rerat, Sub-regional advisor in Medicines, Vaccines and Health Technologies at the Pan-American Health Organization/WHO reported (surprisingly!) that there was no consolidated list of manufacturers and suppliers.
According to Dr. Rerat, although the majority of suppliers are based in Europe and produce injectable opioids, they depend on imported supplies from India where the lockdown has slowed production. His division speaks twice a week with the International Association of Generic & Innovative Drug Manufacturers to monitor production capacity and supply-chain bottlenecks. It would be useful to know more about how these are being addressed. Dr. Rerat told the audience that while WHO provides emergency kits of medicines and supplies, limited production capacity renders them incomplete. Moreover, receiving countries often remove the opioids as a drug-control-related “precaution.”
Ms. Mattfeld, of the UNODC Prevention and Treatment Division (@UNODC_PTRS), clarified that some countries’ regulatory frameworks allow for donations of internationally controlled essential medicines (among other supplies) during humanitarian emergencies. She recommended that palliative care associations review their regulations for such flexibilities, as UNODC and the UN Development Partnership are discussing inclusion of controlled medicines in emergency development aid.
IAHPC’s advocacy partnership with Ms. Mattfeld and Dr. Rerat are based on our status as a Non-state Actor (NSA) in official relations with the WHO, and a nongovernmental organization accredited by the UN Economic and Social Council.
IAHPC Board Member Dr. Steven Radwany coordinated the expert team that drafted the ethics briefing note titled “Bio-Ethical Principles, Practices, and Recommendations Relevant to the COVID-19 Pandemic.” Its authors were Drs. Suzanna Ciruzzi (Hospital de Pediatría Garrahan); Tina Comoretto (Pontifical Academy for Life & ATLANTES Research Program, University of Navarra); Richard Hain (Cardiff University); Bruce Jennings (Hastings Center); Liz Schwartz (McMaster University); and myself. See here for the full briefing note, which prioritizes the principle of patient non-abandonment and provides clear ground rules for ethical decision-making regarding treatment and palliative care in situations of scarce health system resources.
Diederik Lohman, formerly of Human Rights Watch, led the expert group that drafted the briefing note titled “The COVID-19 Pandemic, Palliative Care and Human Rights.” Other authors included Dr. Frank Brennan (University of New South Wales); Bethany Brown (Human Rights Watch); and Fatia Kyange (Center for Health, Human Rights & Development, Uganda). This briefing note recommends that all national responses to the COVID-19 pandemic be framed within a human rights perspective, which includes the now-recognized right to access palliative care as a component of the right to the highest attainable standard of mental and physical health.
In preparation for the 73rd World Health Assembly, IAHPC delegates contacted their governments to request that a proposed European Union resolution on COVID-19 national responses include palliative care language. We thank the Geneva permanent mission staff of Zambia and Bangladesh for insisting on this request, which succeeded, and look forward to the resolution being approved at the virtual World Health Assembly next week. This is the text of the final resolution, with the reference to palliative care on P.4 in OP6.7. The IAHPC written submission to WHA73 can be found here.
Our virtual delegation to the virtual WHA73 includes myself, Kate Reed-Cox from Australia, Dr. Zipporah Ali from Kenya, Drs. Rumana Dowla and Farzana Khan from Bangladesh, Dr. Marvin Colorado from El Salvador, Dr. Nisla Camaño from Panama, and Dr. Abidan Chansa from Zambia. Please write to me to find out how to join IAHPC delegations to UN meetings.
In the meantime, please make sure you are following us on Twitter @iahpc, Facebook, and Linked In. And consider joining or renewing your membership in IAHPC at the reduced rates introduced for May to support our critically important work to ensure availability of palliative care worldwide for all who need it.
Learn more about the International Children’s Palliative Care Network in the IAHPC Global Directory of Palliative Care Institutions and Organizations.
Learn more about the Worldwide Hospice Palliative Care Alliance in the IAHPC Global Directory of Palliative Care Institutions and Organizations.