Bulletin of the World Health Organization最新文献

Glenda Gray talks to Gary Humphreys about her life and career in HIV prevention and treatment and the ongoing struggle to develop an effective vaccine.

Health-care policies and initiatives are designed to save lives and enhance well-being, but they can also entrain unintended negative effects. Gary Humphreys reports.

Antibiotic resistance is one of the most urgent threats to public health. The development of antibiotic resistance can be reduced by the use of narrow-spectrum antibiotics that target specific bacteria, meaning that fewer non-harmful bacteria are killed and other harmful bacteria are not exposed to selection pressure. However, many narrow-spectrum antibiotics were introduced decades ago and therefore lack regulatory documentation in line with current standards. An additional problem for a reliable supply is that of market fragmentation, where countries with similar resistance patterns and prescribing cultures (e.g. Norway and Sweden) prioritize different formulations and strengths. For example, over half of Sweden's highest priority paediatric antibiotics are not marketed in Denmark or Norway in the same formulations or dosages. Such market fragmentation, which can result in the annual demand of a country being smaller than batch production sizes, means that specific strengths and formulations may no longer be economical to supply. Further, once an antibiotic has been withdrawn from the market, it is difficult to attract a new supplier because of the cost of the clinical trials required to update approval of the drug. However, as resistance to antibiotics increases among populations, clinicians need access to the maximum possible range of antibiotics. Regional collaboration, that is, the harmonization of essential medicines lists (including strengths and formulations for older antibiotics) between countries, is a recommended first step towards reliable access to the necessary range of antibiotics.

The World Bank's report, Open and inclusive: fair processes for financing universal health coverage, represents an important effort to specify the benefits and criteria of fair processes in health financing decisions. Here we argue that the report's justification for increasing public engagement in health financing decisions, one of its most novel contributions, rests on a widely shared but flawed assumption that public engagement will produce more equitable outcomes. Examining evidence from national-level public engagement initiatives cited in the report, we argue that there is no reason to assume that engaged publics will prioritize equity over other relevant values such as the maximization of population health. We conclude that instead of seeing public engagement as a tool for advancing particular values, policy-makers should view it as a neutral way of assessing what the public values and gathering insights that can inform the design of health benefits packages. If policy-makers wish to prioritize equity, they should do so directly through substantive policy choices regarding the design and financing of coverage schemes.

Objective: To evaluate trends in pharmaceutical research and development, and to correlate these trends with global medical need.

Methods: We obtained details of proposed pharmaceutical substances from 1953 to 2022 from the International Nonproprietary Names (INN) database. We used the DrugBank and Cortellis databases to obtain the INN included in approved medicines over the same period. To evaluate trends, we categorized INN into 12 therapeutic classes according to their stem classification, and compared these trends with actual global medical need by extracting the INN in medicines included in essential medicines lists.

Findings: Out of a total of 10 611 proposed INN within our 12 therapeutic groups, 2280 were included in approved or registered medicines. We observed a considerable decrease in the number of new INN for anti-infective and antiparasitic, central nervous system and cardiovascular system medicines over the study period. In contrast, the number of new substances in the fields of antineoplastic, immunomodulatory, blood and haemopoietic system, and cell and gene therapy medicines has been increasing. In terms of public health impact, only 17.3% (441/11 453) of all INN in approved medicines are included in the World Health Organization Model list of essential medicines, the highest proportion of which are anti-infective and antiparasitic medicines.

Conclusion: Despite a high demand from global health systems, medicine development for neglected tropical and other infectious diseases remains largely dependent on national policy, governmental and philanthropic funding, and partnerships. Better alignment of research and development strategy and investment in global medical needs is required.