In times of natural or man-made disasters, the world community is usually quick to send large and often unsolicited donations of drugs and medical supplies. Under these circumstances drug donations can be of great help and can save lives, but some drug donations can do more harm than good. Donated drugs may not be adequate for the emergency, their names may be unknown and their labels in the wrong language. They may arrive unsorted, without clear packing lists. They may be close to their expiry date, or consist of large boxes of drug samples and unused drugs that have been returned to the pharmacy.
Guidelines for drug donations
WHO has collaborated with most international humanitarian emergency relief agencies to obtain the maximum benefit from drug donations. They have developed interagency Guidelines for drug donations17, which are intended as a guide for donors and recipients. The 12 articles of the guidelines are based on the following four core principles:
1. Drug donations should provide for maximum benefit to recipients, and must be based on their needs.
2. Donors should respect the wishes and authority of the recipient country.
3. There should be no double standards in drug quality.
4. Maximum communication between donor and recipient is vital.
The most important practical aspects of the 12 articles are that, as far as possible, drug donations should be based on an expressed need, consist of drugs that are on the list of essential drugs of the recipient country, and have a remaining shelf-life of at least 12 months after arrival in the country.
As part of a national drug policy it is recommended that the government develops and issues national guidelines for drug donations, and communicates these to its main development partners. During an emergency, the government should immediately establish a coordinating body to assess and inform the donors about needs, approve donations, and coordinate their receipt and distribution.
Additional guidelines for donations of single-source (usually patented drugs) are in preparation.41
New Emergency Health Kit
Large population movements or a sudden influx of refugees may create an immediate need for basic health services. A large group of international agencies active in humanitarian emergency relief has developed a standard kit of essential drugs, supplies and basic equipment, the New Emergency Health Kit. 42 This kit contains all that is needed for basic health care in the first phase of an acute emergency, and is kept ready for dispatch within 24 hours by several international suppliers.
Safe disposal of unwanted pharmaceuticals
Some drug donations are never used and ultimately create an environmental problem. WHO, in collaboration with many other organizations, has issued interagency guidelines for the safe disposal of excess stock or unwanted pharmaceuticals in emergency situations.43 The document contains many practical recommendations that may also be useful in other situations.