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In disaster relief, inappropriate pharmaceutical donations and/or a disorganized receiving operation can mean that tons of medications go straight into the rubbish.
Immediately after earthquakes struck Haiti and Japan, vast amounts of medications were donated and shipped to these countries. While these nations were obviously in need of aid and relief, the massive influx of medications often became a logistical nightmare. Without appropriate guidelines and systems in place, many donated drugs were destined for disposal, creating more work and wasting important resources.
I touched upon this topic briefly during a previous article about pharmacist humanitarian efforts [“Issues in emergency pharmacy,” February 14, 2013; http://bit.ly/emergencypharm], but felt the need to revisit it. During the recent meeting of the International Pharmaceutical Federation (FIP) Congress in September 2013, I attended a session led by Alexandr Kosyak, a pharmacist from the United States, that enabled me to delve a little further into the issues surrounding medication donations.
Our speaker began by detailing initial donations received in Port-au-Prince Haiti. Within 10 days of the earthquake, more than 500 metric tons of pharmaceutical products were received at the airport. While guidelines were followed more than usual during this time, there was still a large amount of waste.
The World Health Organization (WHO) has established guidelines for drug donations. The elements required include the following: the generic or trade name of the product, the dose or strength per unit, the manufacturer’s name, and the product’s expiration date and batch number. Donation of pharmaceuticals with less than a year expiration remaining is generally discouraged. In addition, recipients must state that the donated medication will not be sold or used for commercial purposes and that the medication will not be sold or used for commercial purposes by the receiving party.
The reasons for donating medications vary, the most obvious being the desire to lend a hand. A somewhat more self-serving purpose for donation is to garner tax credits. Some individuals use the opportunity to get rid of excess or short-dated products. Regardless of motives and intentions, during the initial phases of the recovery process, literally tons of medications are donated.
When appropriate, donations are a valuable resource to the affected nation, providing much-needed therapy to patients, as well as taking the financial burden off patients and local healthcare providers. Issues arise when the donations are of poor quality, when the labels are wrong or in an unfamiliar language, or when the medications are just unnecessary. The processing of unusable medication can result in excess costs for sorting, storage, transportation, and destruction, not to mention the loss of precious worker hours.
Setting up a proper donation receiving location can make for a much more structured and efficient means of allocating medication where it is needed. As outlined by our speaker, an ideal receiving location would be close to an airport and accessible by road or rail. It would be in an area with adequate perimeter security, and it would be situated at a distance from the most devastated areas. In addition, a reliable power source and proper climate control are necessary to the establishment of a centralized receiving center. During this session, it was suggested that decommissioned military bases could serve as appropriate grounds.
Once established, the center would receive donations on an “around the clock” basis, even during periods of calm. Medications would be inventoried and inspected for quality and need. Medications would be distributed to clinics and relief hospitals on the basis of their requests and actual need, so that recipients don’t have to sort through huge quantities of stock. Also, any damaged, unidentified, or outdated products would be handled by the facility rather than by relief workers, giving them more time to care for patients.
There is always an initial rush to provide aid to a suffering populace following disaster. However, it should not be assumed that donations of medication are needed in these scenarios; rather, it should be up to the country in need to request aid from the international community first. And those providing donations should work with the affected nation’s health ministry in order to determine need.
When these guidelines are followed, more appropriate and effective care can be provided to those affected during times of disaster.
Joel Claycomb's first report from the 2013 FIP Congress was published in the October issue of Drug Topics. Contact him at firstname.lastname@example.org.