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NEWS EXTRA: James Ciment Study finds that most drug donations to developing countries are appropriate BMJ 1999; 319: 942c [Full text]

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Harvard donations study

Mark Raijmakers   (8 October 1999)

Harvard donations study 8 October 1999
Mark Raijmakers, Programme coordinator Wemos Foundation, Amsterdam Send response to journal: Re: Harvard donations study	What about the inappropriate donations? Dear James Ciment, Reading your article one could ask him/herself is the bottle half empty or half full? Looking more closely at the results of Harvard Professor Reich's study(1) these reveal substantial different data than the news you publish in your contribution to the BMJ of 9 October. You state for example that "58-90 % of drugs donated were on the researched countries' essential drugs list or the WHO's model list". Interesting however are some precise data: 289 of 494 (59 %) of the different pharmaceutical products arriving in the three researched countries were not on the country's essential drugs list. Furthermore between 10 % and 42 % of the unique drug products shipped to these three countries were not on the countries' essential drugs list, neither were therapeutic alternatives or on the WHO model list. The study was unable to determine whether these products were requested. This seriously raises doubts on the relevance of these donations. You further state that "data from 129 countries show 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 WHO, however, as can be read in inter-agency guideline number six(2) says "after arrival in the recipient country all donated drugs should have a shelf life of at least one year". The Harvard study shows that, at the time of shipment, about 30 % of the shipment items had a year or less of shelf life remaining. For one of the two researched donor organisations, however, the median interval between the receipt of product and shipment to recipient countries was another 113 days. Also I read in your article that part of the study's results come from "examining data from 129 countries". The study however only examined three recipient countries but got data on pharmaceuticals that were going to be shipped to in total 129 different countries. Not the countries were researched but the drugs that were donated to these 129 countries. The Harvard study only considered two aspects of the twelve guidelines. No data is presented on dosage forms, presentation forms, language, presence of the generic name, package form. All contribute considerably to the quality of the donation. An American consortium of pharmaceutical companies and private voluntary associations sponsored the Harvard study. One could seriously question this. Especially since other studies also quoted in your news contribution reveal huge quantities of unwanted and thus inappropriate donations, especially in emergency situations. I appreciate your lines about the need for considering the problems of disposing inappropriately donated drugs, by quoting Reich, "No donation should be allowed without disposal insurance". What about not donating these drugs at all? Mark Raijmakers Coordinator programme on pharmaceuticals, Wemos Foundation Wemos coordinates the committee on drug donations in the Netherlands as well as the European NGO-consortium on 'appropriate drug donations'. Please access www.drugdonations.org for more information. (1) Also published in WHO's Bulletin of the World Health Organisation, 1999, 77 (8): 675-680. (2) Guidelines for drug donations, Revised 1999, WHO (also accessible at www.drugdonations.org)