Drugs For Children: The World Situation
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0092-8615/2000 Copyright 8 2000 Drug Information Association Inc.
DRUGS FOR CHILDREN: THE WORLD SITUATION JANE G . SCHALLER, MD Professor of Pediatrics, Floating Hospital for Children, Chief of the Division of Pediatric Rheumatology, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, and Presidentelect. International Pediatric Association
Much of the global burden of death and disease is concentrated in the world’s developing countries. There is a core group of prophylactic and therapeutic substances capable of meeting the vast majority of health needs in these countries. Yet, the cost of purchasing pharmaceuticals can account for a high proportion of the total health expenditure of a developing nation. The World Health Organization initiated the Action Program of Essential Drugs to ensure worldwide access to affordable drugs of high quality as well as their rational and appropriate use. The world’s children too, by right and by necessity, deserve access to essential drugs that have been tested and formulated for pediatric populations and accompanied by information for their appropriate use in children. The off-label use of drugs in children is common and additional problems of access to health care, and availability and cost of drugs, are even greater for children in poor countries. A first step in addressing these problems would be an international collaborative effort to compile a prioritized list of essential drugs for the world’s children. Key Words: Essential drugs list for world’s children; Internationalcollaboration for pediatric research; Children’s rights; World Health Organization
INTRODUCTION POVERTY AND THE POOR health that it occasions, fueled by lack of basic disease control measures and access to basic means of treatment, are continuing causes of social discontent and unrest in our world today. Three-quarters of the planet’s population live in less developed countries where 86% of all children are born and 97% of all infant and childhood deaths occur (1). Therapeutic drugs are an important aspect of measures to reduce morbidity and mortality in the developing world, yet the cost of purchasing
Presented at the 35th DIA Annual Meeting, June 27July 1, 1999, Baltimore., Maryland. Reprint address: Dr. Jane G . Schaller, Floating Hospital, NEMC, 750 Washington Street, Box 8683, Boston, MA 021 1 1 .
pharmaceuticals can account for a high proportion of the total health expenditure of a nation (2). While Nicaragua points to lack of funds for medicine and disease-prevention programs as among the primary reasons for the decline of its children’s health (3), widespread availability of antibiotics, antimalarials, and vaccines have been identified as critical factors in the substantial decline in childhood mortality in The Gambia, in subSaharan Africa (4). Similarly, availability of appropriate drugs is considered one of the essential ingredients of a successful drug program against tuberculosis, a disease which may be responsible for infecting close to 40% of the populat
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