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Europe should lead in coordinated procurement of quality-assured medicines for programmes in low-income and middle-income countries
  1. Christophe Perrin1,
  2. Sandrine Cloez1,
  3. Catherine Dujardin2,
  4. Raffaella Ravinetto3
  1. 1Independent Expert, Paris, France
  2. 2Belgian Directorate-General for Development Cooperation & Humanitarian Aid (DGD), Brussels, Belgium
  3. 3Public Health Department, Institute of Tropical Medicine, Antwerp, Belgium
  1. Correspondence to Raffaella Ravinetto; rravinetto{at}

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Summary box

  • Thoughtful procurement policies in humanitarian and development medical programmes can mitigate the risk of purchasing poor-quality medicines, allowing to address fundamental moral obligation to equity, transparency and accountability.

  • European donors are aware of the quality problems in the global pharmaceutical market, and some are already translating awareness into explicit procurement and quality assurance policies. However, a joint position and coordinated action is lacking.

  • European donors should share existing knowledge and tools, seek the input of recipient countries, and develop a joint position on how the donor community can help to ensure access to affordable and quality-assured health products—also during public health emergencies such as the COVID-19 pandemic.

  • Applying stringent and harmonised quality assurance requirements, European donors and their implementing organisations can help shaping the global pharmaceutical market towards affordable, quality assured products.

A secured supply of quality-assured medicines and other medical products is an essential prerequisite for universal health coverage. Unfortunately, on average one in 10 medicines do not meet acceptable quality standards in low-income and middle-income countries (LMICs).1 2 The high prevalence of poor-quality medicines in LMICs greatly depends on the globalisation of pharmaceutical production and distribution, combined with the weakness of many national medicines regulatory authorities (NMRAs).3 4 The use of non-quality-assured medicines, often undetected, causes poor case management and unfavourable medical outcomes in individual patients, while at population level, it is translated in poor control of communicable diseases, emergence of resistance to medicines and loss of trust in health systems.2 4–6 Risks are magnified by the COVID-19 pandemic, which triggered disruption of supply chains, stockouts, substandard production, falsification of repurposed medicines and irrational use of medicines.7 8

European taxpayers’ money is used to fund medical programmes in LMICs in the context of humanitarian aid and development. Medicines for these programmes are purchased either …

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