"People don't want to hear how many meetings WHO has held. They want to know what difference it has made. Have medicine prices gone down? Has availability gone up? Are fewer unnecessary injections being given? Is generic substitution possible? Is drug promotion being monitored? Are safety mechanisms in place? Is quality improving?" Dr Jonathan Quick is direct and forthright. Now, after seven years as head of the Department of Essential Drugs and Medicines Policy at WHO Headquarters, he is returning to the USA-based Management Sciences for Health (MSH) - scene of his first-ever student research project.
Dr Quick leaves a legacy: the WHO Medicines Strategy, which won the endorsement of all WHO Member States; the successful merger of the former Action Programme on Essential Drugs and the Division of Drug Management and Policies; the prequalification project; and the establishment of the Global Medicines Council.
"I am happy to have had the opportunity to define a single WHO strategy for medicines activities. It provides a framework, with the core aims of affordability, accessibility, quality and safety and rational use. In addition, it incorporates a practical monitoring programme, with each aim underpinned by specific and measurable progress indicators," says Dr Quick.
Analysing finance and public- private roles in medicines supply, he has encouraged WHO medicines activities to focus on the balance between knowledge creation and implementation. He has also supported a modernizing approach to the WHO Model List of Essential Medicines, and believes that the Doha Declaration on the World Trade Organization's TRIPS 5 Agreement and Public Health has moved in the right direction, affirming most of the points WHO tried to make in the controversial discussions of 1998.
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"Implementation of sensible pro-health policies in countries is not happening anywhere to the extent it should. If we get it wrong now, it's not just wrong for us, but for our children, and our children's children", he adds.
Similar problems - diverse solutions
Dr Quick's career began in Boston, USA. As a young medical student in 1978 - with majors in sociology and psychology - he embarked on an essential medicines research thesis. It became an eight-month global survey for MSH and WHO - whose Model List of Essential Medicines was still in its infancy - and led to the definitive Managing Drug Supply, published in 1981.
"The focus then was very much on the nuts and bolts of procurement, distribution and use. I went to Peru, which had one of the earliest generics and rational use programmes, Guatemala because they had good management, Costa Rica for their social health insurance, and Norway, because of its tough logistics. Tanzania was on my list, also Sri Lanka, Malaysia and Papua New Guinea. I had two weeks in each country," says Dr Quick.
"What struck me then - and still strikes me now - is how similar the problems are and how creatively diverse the solutions. I think one of the biggest barriers to progress is just not learning from what others have achieved."
"Looking back, if you ask me where there has been significant and sustainable progress, it's where there is both strong political commitment and sound technical support. Although it is ironic that many people from the political culture and the technical culture seem to miss the fact that they need each other to succeed," he continues.
In terms of medicines, what will challenge WHO in the next decade? The loss of medical and pharmacy leadership in developing countries, unfair financing of medicines and failing management systems will all be critical issues according to Dr Quick.
Dr Jonathan Quick, who headed the Department of Essential Drugs and Medicines Policy at WHO Headquarters for seven years
PHOTO: WHO/Pierre Virot