Drug distribution developing countries

The current counterfeit drugs market is estimated to be about US 40 billion and is expected to increase to almost US 80 billion by 2010. Most of the counterfeit drugs are found in developing countries, where the enforcement of the regulatory authorities is weak or ineffective. In general, the distribution of counterfeit drugs as a proportion of the total market is as follows ... 

Reduction or elimination of duties and taxes for both generic and patented essential medicines contribute to price reduction. In developing countries, the final price of a medicines may be two five times the producer or importer price. This reflects the effects of multiple middlemen, taxes of over 20% in some countries, pharmaceutical import duties up to 65%, high distribution costs, and pharmacy and drug seller charges. 

In severe malnutrition where circulating protein concentrations are very low, in uraemia and in pregnancy, the distribution of the drug (e.g., anticonvulsants) between bound and free forms may alter, and when monitoring treatment it may be necessary to get the laboratory to measure free concentrations of the drug. However this can only be done in specialised centres, even in developed countries, and is not usually available elsewhere. 

Despite mission statements to the contrary, it often appears that the goal of the pharmaceutical industry is to protect its interests and exploit the incentives embedded in the framework that governs and supports it. It often develops in conjunction with other research establishments, manufactures, markets, and distributes drugs that may benefit most those suffering in the developed world - not necessarily those in developing countries. 

At that time there was the need to align with the worldwide movement regarding the issue of quality for pharmaceutical products. The World Health Assembly (WHA) discussed the issue of quality of drugs on many occcisions as the distribution of substandard products continued to increase significantly in developing countries. 

These regions are also different from, for example, the ICH territories, in that the economic resources that can be deployed to healthcare and drug purchases are limited. Factors which commonly encourage investment in the West (availability of skilled manpower, strong patent protections, highly developed drug distribution systems, socialized medical systems, private medical systems and affluent populations) are typically absent here. Yet, there are many physicians in these countries who may fairly be described as being pharmaceutical physicians. How does their envir-... 

On the basis of current research it may be possible to speculate about future directions for vaccine development. For example, controlled-release drug systems are well recognized and have appeared in clinical practice. It seems reasonable to ask if the same technology could be applied to vaccines. What would be ideal is a vaccine that only required a single dose which incorporated that booster dose so often necessary for complete effectiveness. If this in turn was combined with heat stability to overcome the problem of maintaining an effective cold chain for distribution in tropical countries we would be well on the way to providing an ideal product. 

In line with reasons developed by Baker and Carapinha, Kinsley Wilson and colleagues also accept the premise that the state is primarily responsible for ensuring access to essential medicines. They suggest that countries should develop a National Drug Policy (NDP) and accompanying implementation plans. Countries need to establish adequate processes as far as the registration, selection, procurement, and distribution of drugs are concerned. 

But the evolution of the industry, the decisions it has made, and the consequences of these decisions have not always produced desirable results, especially in regard to developing nations and their health needs. These needs include the development and distribution of drugs specifically targeted at the diseases affecting those countries, the pricing of those drugs, and access to them. 

Although folate is widely distributed in foods, dietary deficiency is not uncommon, and a number of commonly used drugs can cause folate depletion. Marginal folate status is a factor in the development of neural tube defects and supplements of 400 fj,g per day periconceptually reduce the incidence of neural tube defects significantly. High intakes of folate lower the plasma concentration of homocysteine in people genetically at risk of hyperhomo-cysteinemia and may reduce the risk of cardiovascular disease, although as yet there is no evidence from intervention studies. There is also evidence that low folate status is associated with increased risk of colorectal and other cancers and that folate may be protective. Mandatory enrichment of cereal products with folic acid has been introduced in the United States and other countries, and considered in others. 

The development, testing, and distribution of psychotherapeutic drugs, as described in Chapter 5, arc a major worldwide industry. Fewer than a dozen countries (predominantly the United States, Italy, Japan, Germany, France, the United Kingdom, Brazil, Spain, and Canada) account for approximately 75% of the world s... 

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