The role of international pharmacy organisations

When one contemplates developments in the 20th century, one can realistically only envisage the role of international pharmacy organisations in the first few decades of the next. I was in pharmacy administration for more than 35 years and encountered consistent cynicism about the relevance of international professional organisations. The suggestion was that those involved were there for the travel opportunities and the benefits of membership of a rather exclusive club.

If that was ever the case, it is certainly not so now. The governing bodies of professional associations should certainly ensure that those appointed to represent them on international organisations make a full contribution and report back. But the same governing bodies should be prepared to budget sufficient financial resources to make sure that international bodies representing the profession are strong in terms of expertise and have staff, however few in number, of the highest calibre. This is particularly important in relation to the European Union, to which I shall return later; but it is right to start with the voice of pharmacy world-wide – the International Pharmaceutical Federation.

International Pharmaceutical Federation

The FIP (Féderation Internationale Pharmaceutique) was originally very much a “European club”. Although it is still based in The Hague, it is nowadays truly international. It has made considerable strides under the stewardship of its past three presidents and there is every indication that more progress will be made with Peter Kielgast (Denmark) at the helm.

First, the decision was taken to generate sufficient resources to enable a full-time secretary general with the necessary experience and expertise to be engaged. Dr Joseph Oddis (United States) led that initiative. Very soon after, Dr Nippe Strandqvist (Sweden) was appointed president in 1990, he convened a meeting of pharmacists he considered to be leaders in their respective countries and from that initiative a first draft of a document on good pharmacy practice emerged. This was refined in various stages and the text was finally adopted at the FIP congress in Tokyo in 1993.

Dr Strandqvist also recognised the importance of close liaison with the World Health Organisation’s headquarters in Geneva and eventually, during the presidency of Dieter Steinbach (Germany), the good pharmacy practice document became a WHO text.

One cannot overestimate the importance of establishing, with the WHO, the credibility of an international professional organisation. The co-operation has led to a series of “consultations”, the most recent of which took place in The Hague just prior to the FIP congress in 1998 and resulted in the publication of a booklet in 1999 on “The role of the pharmacist in self care including self medication”.

We have also seen resolutions at the World Health Assembly relating not just to pharmaceuticals but to the importance of the pharmacist’s role. WHO pronouncements can be very influential when governments, particularly, those in developing countries, are evolving strategies for health services and pharmaceutical supplies.

During Dr Steinbach’s presidency, very close links were forged with the World Medical Association, the World Self Medication Industry and the International Federation of Pharmaceutical Manufacturers Associations. Joint statements with these bodies were prepared on a range of topics, again raising the profile of FIP internationally, and statements of policy and principle were developed, some of which effectively fleshed out individual sections in the good pharmacy practice text. This work is continuing under Peter Kielgast’s presidency, as witnessed by the adoption at the congress in Barcelona in 1999 of statements on counterfeit medicines and on medication error reporting.

What is likely to be achieved during the remaining years of Mr Kielgast’s presidency? No doubt, knowing of his energy, determination and persistency, he will achieve a good deal, but I suspect his greatest reward will be to see established in the other regions of the World Health Organisation, the equivalent of the Europharm Forum. That is another story.

Europharm Forum

The Europharm Forum is an association of pharmaceutical bodies in the countries of the European region of the World Health Organisation with the regional office of WHO, based in Copenhagen.

The forum was founded as a result of an initiative taken by Peter Kielgast when he was chief executive of the Danish pharmaceutical association. When the WHO published its “Health for all by the year 2000” programme, there was an impression in some minds that this related only to developing countries. Peter Kielgast persuaded the Danish pharmaceutical association to fund a seminar in Copenhagen to which he invited leading pharmacists from many European countries as well as from North America and the Antipodes. Also invited was Dr Jo Asvall, the regional director for the European region of the WHO.

The presentations made at the seminarm, and the subsequent discussions, convinced Dr Asvall that pharmacists, particularly community pharmacists, in countries with highly developed health services, had a considerable contribution to make in assisting their governments to achieve their “health for all” targets. A working group was established to prepare a constitution for the body that became the Europharm Forum and which now has in membership the pharmaceutical associations of more than 30 countries of the WHO region. The forum has made amazing progress in less than a decade.

The forum is project based. High quality publications have been produced for projects on the role of the pharmacist in smoking cessation, in the care of patients with asthma and in diabetes care, and there has been an effective project on “questions to ask about medicines”. More recently, through a WHO programme, a project on hypertension has been launched and at the annual meeting held in Lisbon towards the end of 1999, there was a commitment in principle to a project on the role of the pharmacist in HIV/AIDS.

The meeting also accepted a proposal for twinning of countries in the European Union with countries of central and eastern Europe or the newly independent states, which have emerged from the break-up of the Union of Soviet Socialist Republics, in the “questions about medicines” project.

Before the Europharm Forum was established, WHO Europe seemed to obtain virtually all of its advice about medicinal products from doctors. That is no longer the case.

The Europharm Forum has links with the Medical Forum of WHO Europe and the success of the Europharm Forum has stimulated the nursing organisations to establish a parallel forum for their profession.

Now to return to FIP and Peter Kielgast. His wish is to see the equivalent of the Europharm Forum established in each of the other WHO regions. In fact, through an initiative taken by a past president of Europharm Forum and the American Pharmaceutical Association, the first such development is likely to be with the Pan American Health Organisation, which pre-dates the World Health Organisation, although it is now an integral part of the world-wide body.

The links between FIP and WHO Geneva and between pharmaceutical forums and each of the WHO regional offices are vital for the future development of the profession of pharmacy. Even greater strength is gained when the pharmaceutical, medical and nursing professions express a joint view at WHO level, because that combined voice is very influential as governments struggle with the problems of providing effective and comprehensive health care from limited resources.

The establishment of the Europharm Forum was not initially welcomed by another important European organisation – the Pharmaceutical Group of the European Union, which, although operating in relation to the institutions of the European Union, saw the forum as a threat. This was a mistake. The PGEU’s raison d’?tre is as a body seeking to influence EU legislation by effective lobbying based on sound pharmaceutical and public health principles, whereas the Europharm Forum has its strength in practice projects. The two bodies now recognise that, although they have distinct functions, they can draw great strength from working together.

The PGEU has its office based in Brussels and is the voice of community pharmacy to the European institutions – the Commission, the Parliament and the Economic and Social Committee. The group was formed in 1959 and comprises representatives of pharmacy owners of the six countries that were the original signatories to the Treaty of Rome. The United Kingdom joined in 1973 when, with Denmark and Ireland, it became a member of the then European Community.

If there is doubt in anyone’s mind of the need to make adequate resources available to European associations such as the PGEU, it should quickly be banished when one remembers that there are more than 40 EU directives or regulations relating to medicinal products and every directive and regulation must be transposed into the laws of member states.

UK law relating to the prescription-only classification of medicines, marketing authorisations, wholesaling, advertising and promotion, and content of patient information leaflets is governed by European Union Directives, as also is the legislation relating to the free movement of pharmacists. Legislation such as that relating to electronic commerce, which is currently before the British Parliament, will have to comply with the European Union directive on e-commerce which was under consideration by the Single Market Council of Ministers when this article was being prepared.
At the same time, the Department of Trade and Industry was carrying out its second consultation on the implementation of the distance selling directive which, incidentally, contains a provision that permits member states to ban the sale of medicines by this method. The “tele-shopping directive” prohibits the use of this method of promotion and sale for all medicines throughout the member states of the European Union.
Both provisions resulted from the PGEU activity. Strong representations are currently being made on the e-commerce directive.

The PGEU must have adequate funding to ensure that it has within its permanent staff the necessary expertise not only on pharmaceutical topics but, even more importantly, on the way in which the institutions of the European Union work and how best they can be influenced at the very beginning of their process of developing policy.

The manufacturers of medicines, represented by their European associations, recognised this fact many years ago. Their representative organisations are funded at a level that ensures that the necessary expertise is available and, when necessary, additional funding and staff resources appear to be made available through individual members of the association.

The current secretary general of the PGEU is a skilled lobbyist who is very much aware of the need to establish the right lines of communication with the new Commission and ever-closer links with the European associations representing the medical profession and consumers. There is also a need for co-operation with the associations representing the European self-medication industry and the wholesalers, provided that the PGEU ensures professional factors are given priority.

There are separate organisations representing industrial pharmacists and hospital pharmacists in the European Union. Representatives of these bodies are invited to attend one of the PGEU general assemblies each year, but there is much scope for strengthened links and more detailed discussions when there is a need to establish a common position on topics under consideration in Europe which affect the profession as a whole. This is particularly relevant on topics relating to the free movement of pharmacists within the countries of the European Union and specialisation in fields of practice, under the Directives which became official in 1985. At that time the Council of Ministers also established an advisory committee on pharmaceutical education and training with a remit of ensuring a consistently high standard of education and training for pharmacists in all the countries of the European Union.

Pharmacy is one of the relatively few professions that have what are termed sectoral directives – directives covering a single profession. The others cover doctors, dentists, veterinary surgeons, nurses and midwives, and architects.

Only the professions with sectoral directives have advisory committees on education and training. The others, provided that qualification is by a course spanning at least three years at university or an equivalent institution, are covered by what is known as the first general directive, and those who qualify by a course of education and training which is less than three academic years are covered by the second general directive. These professions do not have official advisory committees at EU level.

The advisory committees currently have three sections with representatives, respectively, from the practising profession, the academic institutions and the competent or regulatory authorities. This means that a committee currently comprises 45 representatives and, not surprisingly, with the forthcoming enlargement of the European Union, and the potential addition of three more representatives from each new member state, the constitution and functions of all the advisory committees are under scrutiny.

It is likely that committee size will be reduced, but it is extremely important that the profession should seek to secure the continued existence of a properly constituted advisory committee which has a positive role in ensuring that pharmaceutical education meets the needs of developing practice. Here again, there is a need for stronger links in some member states (as we already have in the UK) with the other health professions which have sectoral directives, to ensure that governments are made aware of the importance the professions attach to the continued operation of these committees. If the funding of meetings is a problem for the Commission then it is undoubtedly in the interests of the individual professions to make the necessary funding available to cover all the costs of meetings.

Commonwealth Pharmaceutical Association

The Commonwealth Pharmaceutical Association was founded in 1970 following an initiative taken by the Pharmaceutical Society after the Commonwealth prime ministers’ conference in 1965.

Since the CPA’s inception, the Royal Pharmaceutical Society has provided the secretariat and office facilities without charge. In spite of a lack of adequate funding, the CPA has contributed significantly to the development of pharmacist education, pharmacy legislation and pharmacy practice in the 32 of the 39 member countries of CPA which, according to United Nations classification, are least developed or developing.

Pharmaceutical companies have been twinned with schools of pharmacy in these countries, rational medicines policies and the importance of pharmacist input have been promoted, a distance learning course on management of medicine supplies has been produced with the Commonwealth of Learning and tens of thousands of copies of the British National Formulary have been distributed. In addition, very successful conferences and regional meetings have been held and strong links have been forged with the WHO.

The CPA is one of the best illustrations of what can be done with minimal resources but unlimited commitment. However, so much more could be achieved if thousands of British pharmacists became personal members of the CPA via the secretary at 1 Lambeth High Street on the “Kennedy principle” – think not what your profession can do for you but what you can do for your profession in developing countries of the Commonwealth.

The future

So it seems to me that international pharmaceutical organisations will have an ever more important role in ensuring that the profession has a strong, united voice – where possible in unison with consumers and other health professions – whenever any initiative which involves medicines or pharmaceutical care, be it in the field of science, education or practice, is being considered at an international level. Governments will certainly speak to each other on all aspects of health care, especially cost containment. The profession must contribute to that, while ensuring standards of quality and service are not undermined.

There must be ever stronger links with the World Health Organisation in Geneva and at regional level and with bodies representing other health professions. The means to achieve the necessary aims must be made available by national associations. And those representing the profession on international bodies must each contribute positively to the work, not just attend a meeting and sit back until the next one!