By Katherine I. Pettus, PhD
IAHPC Senior Advocacy & Partnerships Director
I write this having just returned to Spain from Vienna, where I attended the weeklong 66th session of the Commission on Narcotic Drugs (CND). I have been coming to CND since 2012, even before working for IAHPC, because as an independent scholar I was curious about why the international drug policy narrative ignored the treaty obligation undertaken by all parties to the Single Convention on Narcotic Drugs to ensure adequate access to the essential medicines it has “controlled” internationally since 1961. At the time (and sadly still), very few diplomats or civil society organizations understood the legal and ethical dimensions of the issue, and the high-level documents and resolutions approved at CND only gave the issue a brief nod, if any. Attention was focused on controlling supply, eradicating “Illicit” crops, punishing people who use drugs (including with the death penalty), and building a “drug-free world.” Although dedicated physician activists, such as Dr. Jim Cleary from the Pain and Policy Studies Group, Dr. Kathleen Foley from Memorial Sloan Kettering Center, and other colleagues including policy expert Diederik Lohman from Human Rights Watch, had raised the issue of global lack of availability, high-level political attention remained stubbornly anemic.
This year’s session revealed the cumulative effect of almost two decades of relentless advocacy begun by those early pioneers. More member states than ever recognized the global inequity and pledged to improve availability. Three side events highlighted work being done on access to controlled medicines, and the United Nations Office of Drugs and Crime has hired a full-time staff person, Dr. Elizabeth Sáenz, to coordinate initiatives and maintain the momentum. They even produced a brochure and props, such as these dummy medicine vials filled with sweets.
A CND blog post describes the high-level side event on improving availability sponsored by the governments of Belgium, Australia, and many other member states. It features Dr. Emmanuel Luyirika, executive director of the African Palliative Care Association, and Dr. Anselme Kananga of the Democratic Republic of Congo. There is much to be hopeful about if these initiatives to provide palliative care in sub-Saharan Africa can be replicated.
Read the IAHPC statement I delivered to the plenary, available in all UN languages.
The International Narcotics Control Board (INCB) released a supplement to its 2022 Annual Report titled “No Patient Left Behind: Progress in Ensuring Adequate Access to Internationally Controlled Substances for Medical and Scientific Purposes,” which repeats the still dismal refrain concerning global inequity and imbalance in access to internationally controlled essential medicines. Find out what your country reports about its consumption of controlled medicines to INCB in the 2022 Narcotic Drugs Technical Report.
We are continuing our advocacy for inclusion of the words “suffering,” “palliative care,” and “rehabilitation” into the pandemic preparedness and response treaty currently under negotiation by the Intergovernmental Negotiating Body (INB) convened by the World Health Organization. Negotiations are ongoing, and IAHPC Advocacy Focal Points have been participating on calls and taking the floor to promote inclusion of the words whenever the modalities permit. For more information, see our dedicated webpage. Four international, four regional, and 56 national organizations and allied associations have endorsed our Advocacy Note to date. I sent the Advocacy Note with all the endorsements to the co-chairs of the INB and key Secretariat staff, and we will contribute to the relevant constituency statements on the topic for the World Health Assembly in May. The recently released WHO Report: Access to NCD Medicines: Emergent issues during the COVID-19 pandemic and key structural factors supports our request to include language about palliative care and internationally controlled medicines in the treaty.
In the May newsletter, I will report on the IAHPC’s virtual side event that took place in early April, “Older Persons’ Right to Palliative Care in Albania, the Philippines, the USA, and Zambia,” at the margins of the 13th Open-Ended Working Group on Ageing. The side event featured IAHPC LEAD (Leadership Development Program) grantee Dr. Irena Laska, executive director of the Mary Potter Center in Albania, and IAHPC Focal Points Dr. Rumalie Corvera, founder and CEO of the Ruth Foundation for Palliative and Hospice Care in the Philippines, Dr. Kristin Forner, palliative care physician at Medstar Southern Maryland Hospital Center in the United States, and Dr. Mataa Moses Mataa, palliative care physician and chair of Alzheimer’s Disease and Related Dementias in Zambia (ADDIZ).
IAHPC co-sponsored a virtual side event with Pallium India at the 67th Session of the Commission on the Status of Women in March. The event, moderated by IAHPC Board member Dr. Ebtesam Ahmed, featured the powerful testimony of patients and caregivers left to fend for themselves in the face of serious and chronic illness.
According to Pallium India’s concept note, “worldwide, more than 65 million women provide unpaid labor in the form of care for children, the elderly, and their families. Caregiving duties often preclude women from gaining employment and education and negatively contribute to the achievement of sustainable development goals. Gender inequality in caregiving has been a major unaddressed contributor to disparate labor and educational outcomes for women and girls. Pallium India is an NGO based in South India that provides community-level support to thousands of patients and caregivers with serious health-related suffering, including palliative care, volunteer services, and caregiver training. By highlighting the unique community-based model of palliative care that Pallium India has championed, we will also share victories and innovations in community-based palliative care programs that empower women as caregivers, and novel methods that support preventive health and societal progress." Through these kinds of collaborations, the IAHPC and our partners build a world free from health-related suffering.
In February, I was a keynote speaker at the 2023 Palliative Care Winter Conference in Ontario, Canada, that drew more than 850 participants. The annual conference is a collaboration between Northern Ontario School of Medicine University and Near North Palliative Care Network, an IAHPC institutional member whose executive director is Advocacy Focal Point Monica Do Coutto Monni. My topic was “Palliative Care for All Who Need it in a World Free from Health-Related Suffering.”
Audience reactions showed the need for ongoing advocacy.
“[M]any times our worldview is limited to the contexts in which we work, but she [Katherine] helped stretch our minds to the suffering of others as well. This creates a sense of gratitude for where we are at, even with our own shortcomings in health care."
"I was amazed that many countries could not access morphine for use in palliative care."
"I had no idea about the lack of palliative care and pain relief worldwide. This makes me value our system and encourages me to think more critically and more thankfully when I discuss pain relief with clients."
"It was perhaps my favourite session of the day... I feel I work sometimes at such a micro level, I have no understanding of what is happening at the macro/global level. HPC is truly a movement, having the ‘big picture’ awareness keeps my role in it real."
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