Improving Access to Affordable Quality-Assured Inhaled Medicines in Low- and Middle-Income Countries

25 Pages Posted: 1 Jun 2022

See all articles by Marie Stolbrink

Marie Stolbrink

Liverpool School of Tropical Medicine - Department of Clinical Sciences

Martha J. Chinouya

Liverpool School of Tropical Medicine - Department of International Public Health

Shamanthi Jayasooria

University of Sheffield - British Thoracic Society Global Health Group

Rebecca Nightingale

Liverpool School of Tropical Medicine - Department of Clinical Sciences

Laura Evans-Hill

Nifty Fox Creative

Keith Allan

Independent

Haddijatou Allen

London School of Hygiene & Tropical Medicine

Julie Balen

University of Sheffield, UK

Tim Beacon

Medical Aid International

Karen Bissell

University of Auckland

Jeremiah Chakaya

Respiratory Society of Kenya (ReSok)

Chen-Yuan Chiang

Taipei Medical University

Mark Cohen

Asociación Latinoamericana del Tórax

Graham Devereux

Liverpool School of Tropical Medicine

Asma ElSony

EpiLab, Sudan

David Halpin

University of Exeter - Medical School

John R. Hurst

University College London, School of Life and Medical Sciences, Faculty of Medical Sciences, Division of Medicine, UCL Respiratory

Clement Kiprop

IcFEM Dreamland Mission Hospital

Anna Lawson

AstraZeneca Pharmaceuticals

Cécile Macé

Independent

Agnes Makhanu

IcFEM Dreamland Mission Hospital

Pancy Makokha

IcFEM Dreamland Mission Hospital

Refiloe Masekela

University of KwaZulu-Natal - Department of Paediatrics and Child Health

Hellen Meme

Kenya Medical Research Institute (KEMRI) - Centre for Respiratory Diseases Research

Ee Ming Khoo

University of Malaya (UM)

Rebecca Nantanda

Makerere University - College of Health Sciences

Sarah Pasternak

GlaxoSmithKline

Christophe Perrin

Independent

Helen Reddel

The Woolcock Institute of Medical Research and The University of Sydney; The University of Sydney

Sarah Rylance

World Health Organization (WHO) - Noncommunicable Disease Management Unit

Peter Schweikert

Independent

Christopher Were

GlaxoSmithKline

Sian Williams

International Primary Care Respiratory Group

Tonya Winders

Global Allergy & Airways Patient Platform

Arzu Yorgancioglu

Celal Bayar University - Department of Pulmonology

Guy Marks

International Union Against Tuberculosis and Lung Disease (The Union)

Kevin Mortimer

International Union Against Tuberculosis and Lung Disease (The Union)

Date Written: May 9, 2022

Abstract

Background: Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs) causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022.

Methods: Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs. The virtual meeting was moderated using a topic guide around barriers and solutions to improve access. The thematic framework approach was used for analysis.

Results: A total of 58 key stakeholders, including patients, healthcare practitioners, members of national and international organisations, industry, and the World Health Organization attended the meeting. 20 submitted pre-meeting materials. The main barriers identified were: (1) low awareness of CRDs; (2) limited data on CRD burden and treatments in LMICs; (3) ineffective procurement and distribution networks; (4) poor communication of the needs of people with CRDs. Solutions discussed were: (1) generation of data to inform policy and practice; (2) capacity building; (3) improved procurement mechanisms; (4) strengthening advocacy; and (5) a World Health Assembly Resolution.

Conclusion: There are opportunities to achieve improved access to affordable, quality-assured inhaled medicines in LMICs through coordinated, multi-stakeholder, collaborative efforts.

Note:
Funding Information: MS was funded by a Wellcome Trust Clinical PhD fellowship (Grant number 203919/Z/16/Z). The authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of the Wellcome Trust. SJ is funded by an NIHR Clinical Lectureship. BN was funded by the MRC DTP Programme at Liverpool School of Tropical Medicine.

Declaration of Interests: The authors report no conflicts of interest. KM reports advisory board fees from AstraZeneca. JRH has received personal payment and payment to his employer for educational and advisory work from pharmaceutical companies that make medicines to treat COPD. AY reports advisory board fees from AstraZeneca, Novartis, Abdi İbrahim, GSK, Bilim. DMGH has received personal payment for educational and advisory work from pharmaceutical companies that make medicines to treat COPD and is a member of the Board of Directors and Science Committee of the Global Initiative for Chronic Obstructive Lung Diseases (GOLD). MC has received personal payment for educational and advisory work from pharmaceutical companies that make medicines to treat Asthma and COPD. JC reports advisory board fees from AstraZeneca. EMK reports grants from the National Institute for Health Research Global Health Research Unit on Respiratory Health (RESPIRE) and Seqirus UK; personal fees from AstraZeneca and GlaxoSmithKline; and is board director of the International Primary Care Respiratory Group. TW reports advisory board/speaker fees from Amgen, AstraZeneca, GSK, Novartis, Sanofi/Regeneron. HKR reports research grants from AstraZeneca, GlaxoSmithKline and Novartis; honoraria for advisory boards for AstraZeneca, Chiesi, GlaxoSmithKline, Novartis and Sanofi-Genzyme; consulting from AstraZeneca and Novartis; and independent medical education presentations from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Sanofi-Genzyme and Teva. No other conflicts of interest were reported. RM has received grants and advisory board fees / speakers fees from Astrazeneca, GlaxoSmithKline (GSK) and Boehringer Ingelheim.

Keywords: asthma, COPD, non-communicable disease, chronic respiratory disease, inhalers, essential medicines

Suggested Citation

Stolbrink, Marie and Chinouya, Martha J. and Jayasooria, Shamanthi and Nightingale, Rebecca and Evans-Hill, Laura and Allan, Keith and Allen, Haddijatou and Balen, Julie and Beacon, Tim and Bissell, Karen and Chakaya, Jeremiah and Chiang, Chen-Yuan and Cohen, Mark and Devereux, Graham and ElSony, Asma and Halpin, David and Hurst, John R. and Kiprop, Clement and Lawson, Anna and Macé, Cécile and Makhanu, Agnes and Makokha, Pancy and Masekela, Refiloe and Meme, Hellen and Ming Khoo, Ee and Nantanda, Rebecca and Pasternak, Sarah and Perrin, Christophe and Reddel, Helen and Rylance, Sarah and Schweikert, Peter and Were, Christopher and Williams, Sian and Winders, Tonya and Yorgancioglu, Arzu and Marks, Guy and Mortimer, Kevin, Improving Access to Affordable Quality-Assured Inhaled Medicines in Low- and Middle-Income Countries (May 9, 2022). Available at SSRN: https://ssrn.com/abstract=4107776 or http://dx.doi.org/10.2139/ssrn.4107776

Marie Stolbrink

Liverpool School of Tropical Medicine - Department of Clinical Sciences ( email )

Liverpool
United Kingdom

Martha J. Chinouya

Liverpool School of Tropical Medicine - Department of International Public Health ( email )

Liverpool
United Kingdom

Shamanthi Jayasooria

University of Sheffield - British Thoracic Society Global Health Group ( email )

United Kingdom

Rebecca Nightingale

Liverpool School of Tropical Medicine - Department of Clinical Sciences ( email )

Liverpool
United Kingdom

Laura Evans-Hill

Nifty Fox Creative ( email )

United Kingdom

Keith Allan

Independent ( email )

Haddijatou Allen

London School of Hygiene & Tropical Medicine ( email )

United Kingdom

Julie Balen

University of Sheffield, UK ( email )

17 Mappin Street
Sheffield, Sheffield S1 4DT
United Kingdom

Tim Beacon

Medical Aid International ( email )

United Kingdom

Karen Bissell

University of Auckland ( email )

Private Bag 92019
Auckland Mail Centre
Auckland, 1142
New Zealand

Jeremiah Chakaya

Respiratory Society of Kenya (ReSok) ( email )

Chen-Yuan Chiang

Taipei Medical University ( email )

250 Wu-Hsing Street
Taipei
Taiwan

Mark Cohen

Asociación Latinoamericana del Tórax ( email )

Uruguay

Graham Devereux

Liverpool School of Tropical Medicine ( email )

Liverpool
United Kingdom

Asma ElSony

EpiLab, Sudan ( email )

David Halpin

University of Exeter - Medical School ( email )

Exeter
United Kingdom

John R. Hurst

University College London, School of Life and Medical Sciences, Faculty of Medical Sciences, Division of Medicine, UCL Respiratory ( email )

London
United Kingdom

Clement Kiprop

IcFEM Dreamland Mission Hospital ( email )

Kenya

Anna Lawson

AstraZeneca Pharmaceuticals ( email )

1800 Concord Pike
Wilmington, DE 19803
United States

Cécile Macé

Independent ( email )

Agnes Makhanu

IcFEM Dreamland Mission Hospital ( email )

Kenya

Pancy Makokha

IcFEM Dreamland Mission Hospital ( email )

Kenya

Refiloe Masekela

University of KwaZulu-Natal - Department of Paediatrics and Child Health ( email )

Hellen Meme

Kenya Medical Research Institute (KEMRI) - Centre for Respiratory Diseases Research ( email )

Kenya

Ee Ming Khoo

University of Malaya (UM) ( email )

Institute of Mathematical Sciences, Faculty of Sci
University of Malaya, Lembah Pantai
Kuala Lumpur, 50603
Malaysia

Rebecca Nantanda

Makerere University - College of Health Sciences ( email )

Kampala
Uganda

Sarah Pasternak

GlaxoSmithKline ( email )

5 Moore Drive
RTP, NC 27709
United States

Christophe Perrin

Independent ( email )

Helen Reddel

The Woolcock Institute of Medical Research and The University of Sydney ( email )

University of Sydney
Sydney, NSW 2006
Australia

The University of Sydney ( email )

University of Sydney
Sydney, NSW 2006
Australia

Sarah Rylance

World Health Organization (WHO) - Noncommunicable Disease Management Unit ( email )

Geneva
Switzerland

Peter Schweikert

Independent ( email )

Christopher Were

GlaxoSmithKline ( email )

5 Moore Drive
RTP, NC 27709
United States

Sian Williams

International Primary Care Respiratory Group ( email )

United Kingdom

Tonya Winders

Global Allergy & Airways Patient Platform ( email )

Austria

Arzu Yorgancioglu

Celal Bayar University - Department of Pulmonology ( email )

Guy Marks

International Union Against Tuberculosis and Lung Disease (The Union) ( email )

68 boulevard Saint Michel
Paris, 75006
France

Kevin Mortimer (Contact Author)

International Union Against Tuberculosis and Lung Disease (The Union) ( email )

68 boulevard Saint Michel
Paris, 75006
France

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