This space is usually occupied by letters from our readers. Exceptionally, in this issue, the letter comes from your Editor. After 14 years in which the Monitor has been one of the most rewarding parts of my professional responsibilities I am moving to new pastures and putting down the editorial pen. But I could not leave without saying fare well to you our 50 000 plus subscribers in five language editions and our even greater number of actual readers throughout the world. You work in health centres, hospitals, government ministries, universities and other training institutions, multilateral agencies and NGOs, and include a very wide range of professional disciplines.

Daphne Fresle

It has been my great pleasure and privilege over the years to interact with you by letter, phone, and increasingly by e-mail, visits to WHO, and also very often in my professional travels and teaching. It has been stimulating and often moving to learn of the critical, frequently difficult work that you do to increase access to essential medicines and to ensure that they are used appropriately. It is not possible to publish all the articles, reports and letters we receive, but the information you send is never wasted.

I have been delighted and sometimes surprised by where the Monitor is to be found. Quite often, visiting a centre or office in a remote part of the world I spot that familiar green border sticking out of a bookshelf or papers on a desk. And the supportive comments from so many of you about how you value the Monitor and the creative ways in which you use it, have been tremendously heartening to me and my colleagues in the editorial and distribution team. They have kept us going through sometimes tough times. Just one use that my colleagues and I regularly make of the Monitor is when teaching EDM courses on rational drug use where we have a session on use of the media.

In the 14 years that I have worked on essential drugs as a WHO staff member I have seen some positive changes in the global drug situation although not as many as I would have hoped. Steps forward include an increased commitment to national drug policies, and the adoption of essential drugs lists in developed and developing countries throughout the world. The rationale for such strategies is compelling as the article on page 23 makes clear. However adopting a policy does not necessarily lead to action. Policy implementation can be foiled in many ways: lack of funding, political change, opposition by vested interests, all of which can close a window of opportunity. The study of Souly Phanouvong and colleagues reported on page 26 highlights some of the national pitfalls in policy implementation.

Sometimes important national pharmaceutical policies are undermined internationally by actors that can include multilateral agencies or countries which feel that they have commercial interests at stake. There is insufficient public debate and documentation of such influences, particularly by official bodies, although the increased sharing of information on the Internet is changing this situation. Of personal concern to me over the years has been 'behind the scenes' pressure on developing countries not to take advantage of the safeguards in the TRIPS Agreement (see last Monitor). It is difficult for some countries to talk of this openly in public fora, although they will do so privately.

We continue to live in a highly inegalitarian world, and nowhere more so than in access to treatment and medicines. Aid is all too frequently tied to trade, and international agreements tend to reflect voices of the powerful rather than the needy. I have to hope that this new century will bring change to a currently depressing scenario, and that the many committed people around the world struggling for such change will prevail.

Finally, I hope that you will continue to share your activities with EDM so that we can all learn from experience in different parts of the world. I send you my very best wishes for the continuation and success of your work. Goodbye and thank you for so many years of hugely rewarding interactions.

Daphne Fresle
Editor, Essential Drugs Monitor
(1988/2002)