Addressing global inequities in access to essential medicines
The availability of basic pharmaceuticals has long been an issue for veterinarians around the globe, whether they treat livestock, dogs, cats, or other animal species.
“There are some medicines that are essential that are lacking in many, many parts of the world, especially in some regions,” said Dr. Rafael Laguens, president of the World Veterinary Association (WVA).
Now the WVA and the World Small Animal Veterinary Association (WSAVA) are taking steps to improve the global availability of basic veterinary pharmaceuticals. The first step has been developing lists outlining what these medicines are for various animal species—mirroring the World Health Organization’s (WHO) lists of essential medicines for human adults and children.
The WSAVA released the first version of its list of essential medicines for cats and dogs in 2020, and the association is currently updating that list. The WSAVA Congress, held Oct. 29-31, 2022, in Lima, Peru, featured a panel session and a stakeholder summit on access to basic veterinary pharmaceuticals. The summit resulted in formation of a task force to help develop solutions.
The World Veterinary Association is collaborating with Brooke, a group that seeks to improve the lives of working equids, to develop lists of essential medicines for livestock. The lists will cover aquaculture, bees, equids, large ruminants, porcine, poultry, rabbits, and small ruminants.
Providing proper care to cats and dogs
Dr. Paulo Steagall, co-chair of the WSAVA Therapeutics Guidelines Group and a professor at the City University of Hong Kong, said global inequities in accessing essential veterinary medicines are rooted in differing regulatory, government, and harmonization regimes; the cost of these pharmaceuticals; appropriate lobbying; and general bureaucracy.
“What is clear is that there is a fundamental lack of understanding that veterinarians require essential medicines to practice and provide proper preventive care to their patients and to treat the most common diseases, while supporting animal welfare,” Dr. Steagall said.
A study by the WSAVA and the University of London Royal Veterinary College (RVC) of a sample of countries found that each country investigated had substandard formulations of amoxicillin or clavulanic acid—or both. A survey by the WSAVA found that many anesthetics and analgesics are not available at all in some countries in Africa and Asia.
According to the WSAVA List of Essential Medicines for Cats and Dogs, “The purpose of the list is to improve and facilitate regulatory oversight for ensuring appropriate medicines availability, drug quality, use and pharmacovigilance, while mitigating the growing black/counterfeit market of pharmaceutical products.”
As with the WHO lists of essential medicines for humans, the WSAVA list offers a core list and a complementary list. The core list presents the most efficacious, safe, and cost-effective medicines for priority conditions.
The complementary list presents essential medicines for priority diseases for which specialized diagnostic or monitoring facilities, care, or training are needed. Medicines may also be listed as complementary because they consistently cost more or are less cost-effective.
Dr. Steagall said the WSAVA List of Essential Medicines for Cats and Dogs already is supporting regulatory decisions around licensing, registration, and approval, as well as assisting with pharmacovigilance. The WSAVA reports that of a couple of veterinary groups use the list to lobby for access to essential medicines, including opioids for appropriate management of acute pain.
The WSAVA also is establishing collaborations with the World Organization for Animal Health (WOAH, founded as OIE) and the WHO regarding drug accessibility.
Farm animals need essential medicines, too
“Veterinary pharmaceuticals are crucial for animal health and welfare,” according to a WVA position statement. “In turn, animal health and welfare impact human health and welfare, because humans rely on animals for food, fibre, work, entertainment, and companionship.”
Dr. Laguens, WVA president, began his veterinary career working with farm animals as well as dogs and cats in a rural area of Spain before moving into public health. He said the world needs well-functioning animal health systems that address issues such as antimicrobial resistance, food safety and security, emerging diseases, and biodiversity.
Dr. Laguens said some of the reasons for global inequities in accessing essential veterinary medicines have to do with the world being diverse in terms of economics, geography, and even infrastructure—such as a lack of a proper cold chain to maintain some medicines.
After the WSAVA created its List of Essential Medicines for Cats and Dogs, people approached the WVA saying that farm animals also need essential medicines. So the WVA teamed up with Brooke to create lists of these medicines for farm animals.
The process took some time to organize because of the number of species of farm animals, Dr. Laguens said, but the work has been progressing.
The WVA Pharmaceutical Stewardship Working Group, chaired by Dr. Olatunji Nasir of Nigeria, is leading the project, in collaboration with Brooke. Each member of the working group is in charge of one of eight species-specific working groups drafting the list in each category.
As with the WHO and WSAVA lists, the WVA lists cover core and complementary medicines. Some of the lists are up for approval by the WVA General Assembly during the WVA Congress, coming up April 26-29 in Taipei, Taiwan.
Dr. Laguens said he has learned along the way that it is more important to have a list than it is to have a perfect list. Then countries can adapt each list to fit their diverse situations.
A version of this article appears in the June 2023 print issue of JAVMA.