Dr Wilbert Bannenberg
World Health Organization, South Africa

The current problem is that Internet pharmacies exist but the control is only on the physical movement of products. Another problem is that there are port health officials at main post offices and airports, but they are able to check only 5% of incoming parcels. There are counterfeit drugs, and 10% - 25% of the drugs are stolen. The private sector is where the expensive drugs are found. There are large differences between rich and poor countries and within countries, between urban and rural areas, between hospitals and clinics, white and black segments of the population, and men and women.

A consultation on drugs and the Internet was held by the Medicines Control Council of South Africa (MCC),* and all stakeholders were invited. The conclusions were that more information is needed. What can be done to improve the situation? What are the priorities? What is the impact of code-of-conduct and quality seals?

* The health sectors in South Africa cover 42 million people, 5.2 million (12%) of whom are HIV positive.

The Medicines Control Council is the DRA for South Africa. It has 24 members and is chaired by Professor Peter Eagles.

Much of the information available to consumers is misleading promotional material. The recommendations, therefore, were that information that is unbiased, objective, evidence-based, and comparative should be provided. Consumers have the right to such information, and e-mail and web sites are good communication tools. MCC has to set a good example.

Both good-quality and biased information is spreading fast through the Internet, which is why DRAs should treat dispensing good-quality information as an urgent priority.

Medicine is a combination of product, information, and context:

• The product is the chemical substance, the form and dosage, the packaging, the distribution system, and the brand name.

• Information is an essential part of a medicine and should be objective. The following questions concerning information may be asked: Is the information objective? How should the product be used? How should it be prescribed? When should it be stopped?

• The context is culture, beliefs, attitude, perception, demand, use, and commercial pressures. The regulatory controls on medicines should focus more on the context, which plays an important role.

There are significant HIV/AIDS-related problems, but there is no advice from the government on how to provide information about HIV care, drugs and treatment guidelines, availability of drugs in the country, etc.