Policy & Advocacy

Volume 24, Number 9: September 2023

IAHPC Marks Peace Day with Interfaith Webinar Open to All

Dr. Katherine I. Pettus, PhD
IAHPC Senior Advocacy & Partnerships Director

IAHPC will mark September 21, the United Nations' International Day of Peace, with an international, interfaith panel discussion on Zoom: Peace in Serious Illness and at the End of Life. Is it possible?

Dr. Dingle Spence, Caribbean palliative care pioneer and a former IAHPC board member, who identifies as Buddhist, will moderate the panel consisting of:

Panelists will discuss their ministries of patients and caregivers who identify with the world’s three largest faith affiliations: Christianity, Islam, and those with no affiliation. For those unable to attend, the webinar will be recorded. It is open to the public, so please share widely through your networks.

Taking stock 5 years after Astana...

Five years have passed since the landmark 2018 Astana Declaration on primary health care (PHC) that—after concerted advocacy among all the international palliative care associations—included our discipline as a component of PHC. I had the privilege of attending the Astana meeting and moderating a ministerial side event on the importance of integrating palliative care into primary health care (read my report). A high-level, in-person global event is planned for October 23, 2023, in Astana to take stock of how far the world has come in terms of realizing those visionary aspirations and commitments. IAHPC Board Member Dr. Gulnara Kunirova, founder of the Kazakhstan Palliative Care Association, will represent the IAHPC at the event.

... & WHO Europe regional meeting

The WHO regional meeting for Europe, to which IAHPC has been invited in our capacity as a nonstate actor in official relations, takes place in Astana from October 24 to 26 immediately following the five-year reassessment event. To that end, the Secretariat has launched an online platform whose purpose is to encourage the participation of health workers in the region “celebrate successes, talk about our challenges, and visualize the future.” European readers, please register for the platform, which went live on September 4 with a full agenda of virtual side events, access to country cases, and exhibitor booths. 

If the platform is as interactive as WHO intends, palliative care advocates all over the region will be able to join discussions about the challenges and joys of serving those most in need in their communities. We have learned that the European Association of Palliative Care is organizing a side event and will share details as soon as they are settled. Dr. Simone Cernesi, a primary care physician and geriatrician in Italy, will represent the IAHPC at the regional meeting.

The virtual roundtable takes place on September 20: all are welcome. Find details here.

3 European meetings on improving global access to medical opioids

Regular readers of this column will know that the Chair of last year’s Commission on Narcotic Drugs (CND), Ambassador Ghislain D’Hoop (Belgium), led a campaign hashtagged #NoPatientLeftBehind to raise awareness about the global lack of availability of medicines controlled by international drug conventions. Now preparing to take over the presidency of the Council of the European Union, Belgium has invited IAHPC to participate in a high-level event in November in Brussels to build upon the “Access and Availability” initiative launched at CND last year. The panel discussions will serve as a critical opportunity to convene policymakers and stakeholders to engage in a comprehensive dialogue to enhance collaboration, and increase political and financial support for this area of work. This is an in-person event only.

The United Nations Office on Drugs and Crime (UNODC) has invited IAHPC to participate in a technical briefing with member states on improving availability of and access to controlled medicines within the framework of the UNODC-WHO-UICC Joint Programme. The meeting aims to develop recommendations for future project implementation. It is scheduled to take place in a hybrid format from September 27 to 29, 2023. IAHPC member Dr. Odette Spruijt has been invited by the Australian government to attend as an expert, and Dr. Tania Pastrana and I will join virtually.

Advocacy opportunity: Those of you who wish to improve access and availability in your countries can write directly to your member state missions and/or health ministry contacts to urge them to accept the UNODC invitation to the consult. Please contact me if you have any questions.

Intersessional meetings of the Commission on Narcotic Drugs are scheduled in October to prepare for next year’s regular and Ministerial sessions. The Vienna NGO Committee on Drugs has put out a call for civil society speakers to address six different topics pertaining to international drug control treaties, one of which is treaty compliance. Since governments that do not ensure adequate availability and accessibility of controlled substances for medical purposes are technically noncompliant with the conventions, we have encouraged colleagues in Africa to respond to the call. Two that we know of have already applied.

Advocacy opportunity: Alert your health ministry and your permanent mission in Vienna to the fact that the topic will be discussed on October 25, and send them accurate information about your country's availability situation. This will give the delegation talking points for the general debate. Mission staff are often diplomats and foreign affairs civil servants who know little about health or palliative care issues and will appreciate the help.

Painkiller ignores the failure of governance

Most readers will be aware of the North American opioid crisis, or overdose "epidemic," reported extensively in the media and analyzed by the 2022 Stanford Lancet Commission. Global media attention to that crisis of excess (opioid availability) in the US, which dwarfs attention to the crisis of access in the 85% of the world's lower- and middle-income countries, has had a chilling effect on our advocacy efforts at the multilateral level. Bestselling books, the miniseries Dopesick, and now the Netflix series Painkiller provide standard bingeable entertainment, demonizing all classes of opioid medicines and casting the immensely wealthy pharmaceutical moguls as the villains.

As always, the real story is more complex.

It is unsurprising that the pharmaceutical industry, like all private industry, is profit-oriented rather than person-oriented. The key problem is the fact that the US government allowed the fraudulent marketing to the medical community in the first place. This constitutes a governance failure, not a problem with opioids in themselves, which are indispensable for the relief of suffering, as even international drug conventions stipulate.

The good news is that governance issues can be fixed by: having the right leadership, convening inter-ministerial conversations with prescribers, and mandating bureaucratic accountability by elected officials. All factors were lacking in the US when it came time to approve the Sackler family’s blockbuster painkiller Oxycontin. I discuss the issue in more depth in this blog. Governments looking to improve availability, which is needed in 85% of the world, must address governance as well as workforce training.

Lack of palliative care constitutes neglect

Finally, the IAHPC made a submission to the UN Office of Human Rights to contribute to an upcoming debate on a thematic report: the abuse and neglect of older persons worldwide. The debate is being hosted by the 54th Human Rights Council in Geneva; the report is by Dr. Claudia Mahler, UN Independent Expert on the Rights of Older Persons.

Dr. Mahler's report is based on the WHO definition of elder abuse as “[…] a single or repeated act, or lack of appropriate action, […] that includes […] abandonment; neglect; and serious loss of dignity and respect." The IAHPC submission states that lack of access to timely and affordable palliative care constitutes neglect and loss of dignity and respect. Advocacy focal points from Burkina Faso, Canada, Italy, the UK, the USA, and Zambia contributed to the report, which we hope to publish as a journal article.

Advocacy opportunity: Please let me know if you would like to contribute with evidence or testimony about palliative care availability for older persons in your country.

Do you have any comments or questions about this piece or our advocacy program?

Contact Dr. Katherine Pettus

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