By Katherine I. Pettus, PhD
IAHPC Senior Advocacy and Partnerships Director
Greetings from sunny San Diego, where I am working for the summer! The global palliative care community has often converged here, thanks to the former Institute of Palliative Medicine Leadership Development Initiative. I had the unexpected pleasure in May of seeing (in person!) my mentor and friend from India, Dr. M.R. Rajagopal, in Laguna Beach as he was visiting family in California while on a book tour to promote Walk with the Weary: Lessons in humanity in health care.
IAHPC has two Advocacy Focal Points in India, Dr. Sushma Bhatnagar, president of the Indian Association of Palliative Care, and Ms. Smriti Rana, consulting psychologist and program director at Pallium India.
The theme of the 75th World Health Assembly, held May 22-28 in Geneva, was “Health for Peace and Peace for Health.” For the first time in two years the event was in-person only, a requirement that severely curtailed our ability to register an international delegation and participate virtually. IAHPC’s research advisor, Dr. Tania Pastrana, traveled from Aachen, Germany, to attend, having prerecorded our three one-minute statements in Spanish. These were broadcast in all UN languages at the assembly, reaching member state delegates and Secretariat staff as well as other nonstate actors.
A lot of airtime and debate was given to the health effects and politics of the war in Ukraine and the new threat of the monkeypox virus. I was able to catch some excellent side events and discussions, both livestreamed and recorded, on agenda items relating to global surgery and noncommunicable diseases. Many delegations identified social and economic determinants of health, including the influence of private industry on the public health crises of obesity, diabetes, and diseases caused by harmful use of tobacco and alcohol. There was a discussion on cervical cancer prevention and treatment, which allowed for the mention of palliative care. Sadly, few member states included palliative care in their official statements, focusing as usual on prevention, diagnosis, therapeutics, and control.
The World Health Organization has been trying different methods to meaningfully incorporate substantive statements of nonstate actors in “official relations,” a WHO designation accorded to the IAHPC and other qualifying NGOs working on public health. One Secretariat initiative entails the ad hoc formation of “constituencies" of NGOs that share an interest in specific agenda items. The IAHPC and our partners were able to ensure the inclusion of palliative care in several constituency statements, including these presented on the floor:
We thanked all organizations and member states that mentioned palliative care on Twitter in hopes of building stronger coalitions and partnerships.
An unintended consequence of controlling substances such as opioid analgesics and benzodiazepines is overly stringent regulation of those with a variety of medical uses, including pain relief, opioid overdose reversal, and epilepsy control. WHO estimates that 5,500 million people (83% of the world population) live in countries with low or nonexistent access to controlled medicines for the treatment of moderate to severe pain. It is estimated that of the 20 million people requiring palliative care, only 3 million (15%) receive the care they need.
—World Health Organization
The IAHPC has been engaged with the issue of global drug policy for more than a decade. We consistently highlight the negative effects of unduly restrictive policies encoded in national laws and regulations that are rooted in historical prejudice and thereby prevent adequate access to medical opioids for the treatment of pain, palliative care, obstetrics, mental health, and substance use disorder. The WHO Secretariat prepared a report, the The Public Health Dimension of the World Drug Problem, that discusses this issue.
Ms. Smriti Rana, one of our Advocacy Focal Points from India, represented the IAHPC in a pre-World Health Assembly event in May hosted by G2H2 on “The Public Health Dimension of the World Drug Problem: Promoting evidence-based health responses to drugs.” View the video recording of the event, or Ms. Rana’s slide presentation.
Dr. Pastrana prepared a concept note for a webinar on “Protecting Public Health and Welfare through Balanced Opioid Governance." You can view the entire webinar on YouTube. Since the World Health Assembly decided to “request the Director-General to continue to report to the Health Assembly every two years until 2030 on WHO’s activities to address the public health dimensions of the world drug problem,” IAHPC will continue to engage on the issue both in Geneva and Vienna.
Palliative care organizations and institutions have a new opportunity to contribute to the forthcoming 2023 report of the International Narcotics Control Board (INCB) on access to controlled medicines. The deadline for completing the survey is June 10.
In 2015 the INCB launched the report “Availability of Internationally Controlled Drugs: Ensuring adequate access for medical and scientific purposes,” followed in 2018 with a report on “Progress in Ensuring Adequate Access to Internationally Controlled Substances for Medical and Scientiﬁc Purposes.” The objective of these two reports was to analyze the global, regional, and national situations regarding the consumption of internationally controlled substances. See the two reports in all UN languages.
INCB is preparing another progress report to be published in early 2023. With a view to including the widest possible amount of reliable data, INCB has asked civil society organizations to provide national statistics about the consumption of, and access to, internationally controlled substances for medical and scientific purposes. For the palliative care community, this means access to, and availability of, the essential palliative care medicines identified in Section 2 of the World Health Organization Model List of Essential Medicines.
We invite representatives of palliative care organizations, associations, and institutions (including academic institutions) to fill out the survey and share it with your networks. Contact your national competent authority or health ministry, or review the INCB data to find out more. I am happy to provide guidance and help you find information: contact me with any questions about the survey.
The 2021-2022 IAHPC Advocacy Course, free to members, provides accessible background information on the topic of access to essential medicines, as well as lists of essential resources for palliative care advocates.
The introductory module of the course, which is open access, gives an overview that includes the “drug control system” and INCB. Modules 2 and 3 specifically address issues of access to palliative care medicines. If you are not a member, join in order to access IAHPC’s many educational benefits. Those who complete the course and its quizzes will receive a Certificate of Completion.
Last but not least, the theme for World Hospice and Palliative Care Day on October 8 is “Healing Hearts and Communities,” a timely topic if there ever was one! Stay tuned for more information as the day approaches, and sign up for the WHPCA newsletter here.