Intended for healthcare professionals

Feature International Aid

The cost of donated drugs

BMJ 2009; 339 doi: (Published 02 October 2009) Cite this as: BMJ 2009;339:b3830
  1. Elizabeth Sukkar, world editor
  1. 1Scrip World Pharmaceutical News, London EC2A 4LQ
  1. Elizabeth.Sukkar{at}

    With new WHO guidelines due out next year, Elizabeth Sukkar examines the problem of inappropriate drug donations

    More than 4000 tonnes of medicines were donated to people in the Aceh region of Indonesia after the December 2004 tsunami. Of these, 600 tonnes were out of date or about to expire and cost an estimated €2.4m (£1.5m; €1.6m) to destroy.1

    This is just one example of inappropriate drug donations that the World Health Organization has collated. Although WHO has had guidelines on drug donation for over a decade, with the last revision in 1999, adherence is often poor.2 It is currently revising the guidelines to try to improve the situation.2

    “Unfortunately, countries in crises are still suffering from bad donations. Roughly half of donations in emergencies that are evaluated are still reported as inappropriate. Although we have seen much improvement over the years, we still observe problems. Not all donations and relief efforts are evaluated or documented systematically,” says Helene Moller, technical officer in WHO’s department for essential medicines and pharmaceutical policies. Donors include individuals, governments, charities, humanitarian bodies, and drug companies.

    The WHO guidelines say all donated drugs should be based on the needs of the recipient country, should be approved for use in that country, should not include returned unused drugs, and have a remaining shelf life of at least one year on arrival (although exceptions are made for short shelf life drugs and agreed donations to specific health centres).

    To help prepare the new guidelines, WHO did a systematic review of drug donations during 1998 to 2008. It found that only 56% of donations were appropriate given the characteristics of the event and what the recipient needed, and only 12.5% of drugs requested by recipient countries were received.

    Of the inappropriate donations, 57% had improper …

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