Utilization and Performance

By: Muhammad H. Zaman, Ph.D.

Department of Biomedical Engineering, Boston University 

The recently established UN commission on life saving commodities has a simple mission. It aims to save the lives of mothers and children by utilizing resources that are already available in the marketplace but are severely underutilized. This simple yet profound initiative appeals equally to economists and public health professionals. It also excites the engineers and innovators as an immense opportunity to accelerate our march towards achieving the Millennium Development Goals (MDGs) in maternal and child health.

Despite the resources and commodities being already available and the goals well defined, there is little doubt that the commission has ambitious tasks in front of it. For someone involved in engineering and design of robust and affordable technologies, I am particularly excited to see the emphasis on innovation, scale up and availability of these essential technologies to serve those who are most vulnerable and most deserving. Yet, there is also an elephant in this room of great ideas, high passion and transformative steps. It is important to note that the goal is not just to get essential life saving medicines to moms and children, the real target is to get them quality medicines. Just because a drug is available or accessible does not mean that it meets the quality standards needed to make a difference between life and death. The issue of quality control continues to plague countless medicines, including the ones listed by the commission. There are numerous studies documenting widespread availability of poor quality, substandard and counterfeit drugs. Substandard and poor quality medicines lead to mortality, morbidity, financial burden and long-term drug resistance that affects generations across the globe. The real goal of the commission, in my opinion, is not just to increase access, it is to increase access of the right product.

So what should the commission do? I believe that the focus on innovation in saving lives at birth should not just be limited to scale up, rapid production, commercialization and availability, but also ensuring quality without compromising the rate of production or access. This is a tough balance to strike, given that the landscape in developing countries is compounded by poor regulation and weak supply chains. In this regard, the importance of developing and scaling new technologies that not only test for counterfeit drugs but also emphasize testing of quality and drug performance cannot be emphasized enough. The loss of quality does not only come from malicious intent and corruption, it also comes from lack of resources to store appropriately, perform routine tests and lack of adherence to good manufacturing practices. The technologies to test drug quality have to be affordable, accessible and robust. These solutions also need to provide all stakeholders across the supply chain rapid and quantitative results to ensure that the quality of the drug reaching a sick mother or a child is never compromised. Here, the commission can benefit tremendously from the role innovators play in creating sustainable technologies optimized for the challenges in resource limited settings.

While the problem of drug quality is complex and multi-faceted, I believe that recent innovations using microfluidic systems, cell phones and handheld technologies have the potential to ensure that all essential medicines are of the desired quality. It is therefore important to build on recent successes for drug quality testing for the long-term success of the UN commission on essential commodities. Let there be no doubt that there can be no compromise on quality of medicines. The real success can only be guaranteed when we ensure that underutilized commodities do not underperform.