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Study finds that most drug donations to developing countries are appropriate

James Ciment, New York

In the most extensive study of drug donations to date, a team of American researchers has concluded that most drugs donated by US pharmaceutical companies and delivered by private voluntary organisations are appropriate for local medical needs and arrive well before their expiry dates.

The Harvard School of Public Health's study An Assessment of US Pharmaceutical Donations: Players, Processes, and Products noted that 58-90% of drugs donated in three sample countries—Armenia, Haiti, and Tanzania—were on either the respective countries' essential drugs list or the World Health Organisation's "model" list.

Examining data from 129 countries, the Harvard researchers also found that the median time to expiry date on the day of shipment was well within the one year buffer period recommended by the WHO.

The findings contrast with those of an audit of drug donations to Kosovo conducted by the WHO last May. At that time, the Geneva based organisation found that 65% of donated drugs were either due to expire in less than a year or had missing expiry dates. Indro Mattei, a Swiss pharmacist and disaster expert who codirected the audit, estimated that 50% of the donated drugs flowing into Albania by non-medical voluntary organisations were "inappropriate or useless and will have to be destroyed."

Kosovo was not unique. A study published in the New England Journal of Medicine in 1997 found that about half the drugs donated to Bosnia were of little or no use.

In the wake of these problems, the WHO has recently updated its 1996 guidelines for drug donations to read: "The first and paramount principle is that a drug donation should benefit the recipient to the maximum extent possible, and that unsolicited drug donations are to be discouraged."

But according to Professor Michael Reich, director of the Harvard study, new guidelines, while helpful, are not enough. "No donation should be allowed without disposal insurance," he argued. "This would create some additional costs for the donor but would greatly help out the recipient who is saddled with these costs."

And according to the New England Journal of Medicine story, disposal expenses can be substantial. In Bosnia, it cost an estimated $30m (£18.75m), or about $2000 a tonne, to dispose of unneeded, unwanted, or expired drugs.

As Professor Reich points out, many of these drugs have to be burned in high temperature incinerators to avoid environmental contamination, and "these are few and far between in most disaster areas."

Ultimately, most experts agree, the problem is a complex one, involving a world community eager to give in times of emergency, host countries whose capacity for coordinating aid has been compromised by disaster or political unrest, and, in some cases, pharmaceutical companies eager to earn tax write-offs by donating unwanted and inappropriate inventories.