By Katherine I. Pettus, PhD
IAHPC Senior Advocacy & Partnerships Director
In December 2021, at its second-ever special session, the World Health Assembly established an intergovernmental negotiating body (INB) to draft and negotiate a convention, agreement, or other international instrument under the constitution of the World Health Organization to strengthen pandemic prevention, preparedness, and response.
As a nonstate actor in official relations with the World Health Organization (WHO), I have participated in INB consultations since its first open call for stakeholder inputs in 2022. IAHPC has consistently urged governments involved in INB negotiations to include palliative care language in any pandemic and preparedness response treaty. Although the words “palliative care” did appear in an early draft text, they were excised from the Zero Draft that member states began negotiating on February 27.
The IAHPC and our partner global, national, and regional organizations feel strongly that any WHO pandemic preparedness and response treaty must explicitly include palliative care. Failure to include it will result in palliative care services being sidelined and unfunded in policy preparations and implementation.
Together with the Worldwide Hospice Palliative Care Alliance, our advocacy team has performed a line-by-line analysis of the text of the Zero Draft under negotiation. We have suggested changes to the text, bolstered with references to language agreed upon by the United Nations (precedent). This “Advocacy Note” was prepared for use by others, as civil society organizations such as IAHPC now have a very limited, indirect role. INB negotiations are now in the hands of delegations appointed by the governments of all WHO member states: in other words, government representatives.
“Advocacy Note: Textual Suggestions for Negotiations on Zero Draft of the INB WHO CA+” was written to guide your government negotiators regarding how and where palliative care can be inserted in the text. It has garnered multiple endorsements.
We urge our members and supporters to ask their governments to consider our suggestions at the negotiating table.
See the Advocacy Note, list of endorsements and invitation to endorse, plus a video of the IAHPC intervention at the INB4 hearing. You can also consult the INB web page for background information. Its February newsletter introduces the main member state players and gives some excellent background on the process.
I will attend the 66th session of the Commission on Narcotic Drugs (CND) in Vienna, March 13-18, and report back in detail in the April newsletter. Although the Secretariat accepted our submission for a side event on opioid governance, financial and personal constraints prevented our proposed panelists from traveling to Vienna on the scheduled day. We decided to cancel our event and support the three others on controlled medicines taking place during the week. These are sponsored by the Government of Belgium, the Union for International Cancer Control, and the Government of South Africa.
I have submitted a written statement on Agenda Item 5(d): International cooperation to ensure the availability of narcotic drugs and psychotropic substances for medical and scientific purposes while preventing their diversion. I will speak for IAHPC on the floor, describing the global situation regarding lack of availability and proposing best practices for course correction. You can review the agenda in all UN languages.
The official report of the October 2022 Thematic Session of CND shows the fruits of our advocacy over the past decade. We must continue to build on this until there is equitable global access and availability of controlled medicines in all member states.
“The subject of improving availability of and access to controlled substances for medical and scientific purposes, while preventing their diversion recurred throughout the thematic session. Many speakers acknowledged the importance of controlled medicines for a variety of purposes, including pain management, palliative care and the treatment of drug use diseases. Several speakers highlighted the significant global disparity in access to medicines containing controlled substances, and the disproportionate impact of shortages on low- and middle-income countries. A range of good practices in improving availability and access was shared, including streamlining the supply chain; easing regulatory restrictions; educating medical professionals on the rational use of controlled medicines; and raising public awareness. Several speakers also highlighted the importance of balanced evidence-based national drug policies, which ensured that patients could access controlled medicines, as well as prevention, treatment and care services, while preventing the diversion of controlled substances into illicit channels.”
—from the CND Chair’s summary on the thematic discussions on the implementation of all international drug policy commitments (September 21-22, 2022)
According to our sources on the ground, the INCB Learning workshop on improving availability of controlled medicines in Central America received outstanding support from the government of El Salvador and CICAD, the Inter-American Drug Abuse Control Commission. The International Narcotics Control Board (INCB) workshop provoked a flurry of official Twitter activity from the INCB, CICAD, and participating governments. An article was published in a Salvadorean newspaper, and the INCB posted a story online. All participating countries delivered presentations on adequate availability. The regional health branch of the UN Office of Drugs and Crime also participated and, very encouragingly, Honduras and Guatemala are interested in replicating the activity in their capital cities.
IAHPC member and palliative care pioneer in El Salvador, Dr. José Mario Lopez Saca, reported that:
“The INCB is very much in favor of making opioids and other medicines containing narcotic drugs more accessible to governments. It was very gratifying to learn that: in a way we got to know the human face of the INCB. We understood that the so-called ‘quota’ we understood exists for each country is not a fixed quantity. Indeed, it should not be called that—each country has the right to ask for what it needs.”
Hearing the experience of all the countries in the region was important to understand where needs exist. El Salvador and Costa Rica have the most adequate systems to facilitate the dispensing of controlled medicines to patients (both have electronic prescriptions), and there is good communication between their prescribers and regulators. One thing that became clear is the importance of keeping statistics on opioid consumption to better detect where and how much opioids are used.
INCB Learning will continue collaborating with CICAD, as will the IAHPC, with the help of the Latin American Palliative Care Association and María Adelaida Córdoba, president of the Colombia Palliative Care Association (ASOCUPAC).
I presented virtually at the high-level launch of the East and South Africa Commission on Drugs (ESACD) on February 11 in Pretoria along with former IAHPC board member Dr. Nahla Gafer, from Sudan. Dr. Gafer described the challenges of availability in the context of a strict drug-control regime and I summarized barriers to availability based on the recently published policy brief “Removing Barriers to Palliative Care Medicine: Rational use of essential controlled medicines in Africa” authored by myself and Dr. Eve Namisango, another former IAHPC board member and senior staffer at the African Palliative Care Association.
The ESACD currently has four commissioners: former presidents Kgalema Motlanthe and Joaquim Chissano of Mozambique, Cassam Uteem of Mauritius, and Professor Quarraisha Abdool Karim. The Hon. Helen Clark, former prime minister of New Zealand, gave an opening address.
Palliative care is (finally!) being included in the March meeting of the Committee on the Status of Women at the United Nations in New York. Ramya Sampath, member of Pallium India and the IAHPC, and IAHPC India Focal Point Smriti Rana—along with their team of doctors and medical students—have organized a virtual side event on female caregivers in Kerala. IAHPC Board member Dr. Ebtesam Ahmed will moderate the event. Register here.
Until next month! As always, I welcome your thoughts, comments, and questions on our work.