- Email: [email protected]
WHO Regional Office for Europe
1030
THE LANCET
WHO
Regional Office for Europe
SIR,-As director of the department in which the pharmaceuticals programme referred to by Dr Herxheimer (Feb 13, p 427) has been located for almost two years, I am concerned that the reader may be left with the impression that the Regional Office for Europe of the World Health Organization (WHO) in Copenhagen has had little activity in the pharmaceutical field since 1991. The contrary is the case as illustrated by the following examples. We set up the Forum of European National Pharmaceutical Associations and WHO and two major meetings were held in January, 1992, and February, 1993. This forum aims to take the challenge of "Health for All" in Europe to the field of pharmaceuticals, to pharmacies, and to the door of every national pharmaceutical association in our 48 member states. Three pilot studies were carried out in 1992 and were discussed at the 1993 meeting. We also give continous assistance to the Drug Utilisation Research Group, which includes planning for its major meeting in 1993. We have also developed a new Special Action Programme for Pharmaceuticals for countries of central and eastern Europe, including the newly independent states. This programme has its own staff and is supported by voluntary contributions raised by the Regional Office. It complements the Special Action Programme on Vaccines, which the Regional Office also developed in 1992. In addition, we assess the needs of eleven of the countries in central and eastern Europe, including the newly independent states, with regard to essential drugs and related matters. We also produce various publications, such as Drug Utilization Studies: Methods and Uses, Drug Information, and Clinical Pharmacological Evaluation in
Drug Control. The WHO Regional Office for Europe has a policy of openness. We always extend a warm welcome to anyone interested in visiting us to learn about our activities. Regional Office for Europe, World Health Organization, DK-2100 Copenhagen, Denmark
MARK TSECHKOVSKI
Outbreak of yellow fever in Kenya: how doctors got the news SIR,-Kenya is the most popular African country for Swiss tourists, with an annual average of 30 000 travellers. Vaccination against yellow fever for travellers to this country has long been recommended by the Federal Office of Public Health. This February an epidemic (Professor Okello and colleagues, Feb 20, p 489, and ref 1) prompted us to survey the 62 travel clinics (vaccination centres and doctors) authorised to vaccinate against yellow fever in Switzerland, to establish when and how they learned of the epidemic. From Feb 22 to March 3, 60 of these were contacted successfully by telephone. 6 (10%) had not yet been informed, and 27 (45%) had learned of the outbreak from daily newspapers. Of the 54 doctors who knew of the epidemic, 39 practise in the German-speaking part of Switzerland (group A), where major newspapers reported the outbreak, and 15 work in the French-speaking and Italian-speaking regions (group B), where newspapers did not report the event. In group A, 69-2% (27) were informed by the press whereas none were in group B. The sources of information for group B were medical publications (333%), colleagues (33-3%), and travellers (26-7%). These sources and proportions were similar in the remaining 31 % of group A, who had their information from sources other than newspapers. 2 doctors learned of the epidemic while travelling in Kenya and Tanzania at the end of January, but neither reported the news on their return. Several doctors were informed early but did not transmit the news,
.
assuming, wrongly, that their colleagues were already aware of the epidemic. Five days after the initial WHO press release of Feb 5,1993, 83% of group A were informed, compared with 28% of group B (figure). The mean delays were 4-8 days (SD 3-8) and 8-4 days (4°7), respectively (p < 0-001). When reported in major newspapers medical news quickly reaches doctors. However, the random way in which doctors learned of the epidemic underlines the need for rapid and
uays
Trom wnu
press reiease
Time for information to reach travel clinics since WHO press release. Cum=cumulative.
standardised channels of communication, especially for travel clinics. This need was also expressed by vaccination centres questioned in neighbouring France and Germany. A good case is thus made for establishing an efficient information system at a European level. We thank our colleagues who participated in this survey, and Prof H. Stalder and Mrs C. White for their advice.
Community Medicine Unit, Policlinic of Medicine, Hôpital Cantonal Universitaire, 1211 Geneva, Switzerland
LOUIS LOUTAN
Federal Office of Public Health
PIERRE-ALAIN RAEBER
1. World Health Organization. Yellow fever
CLAUDE-FRANÇOIS ROBERT
m
Kenya. Wkly Epid Rec 1993; 38.
Palestinian deportees SIR,—On Jan 9 (p 110) The Lancet carried an appeal in which doctors were asked to write to the ambassador at the Israel Embassy requesting the release of deported Palestinians. The embassy has chosen to respond with a standard letter without any reference to points that may have been brought up in the original letter. The Palestinians have now been in exile for 4 months but their case is receiving little or no media coverage. In addition to the obvious breach of human rights, the deportation should also be a cause of great concern to the medical profession. They are living in horrific conditions, with dysentery a common problem. Furthermore, twelve of the deportees are members of the medical profession: one is an otorhinolaryngologist, one, Dr Mahmood al Zahar, is a general surgeon and acting dean of the Nursing School and Islamic University in Gaza, and the other ten are general practitioners. Their exile will have a deleterious effect on the quality of medical care for the inhabitants of the Gaza strip, where conditions are already poor. Among the other deportees there are individuals with nephrotic syndrome, diabetes mellitus, and peptic ulcer disease. As members of a caring profession we should try to contact either our own politicians or fellow professionals in Israel requesting them to intercede urgently on behalf of these Palestinians. 33 Great Western Square, Dublin 7, Ireland
BRIAN MCLAUGHLIN
Efficiency of medical journals for pharmacovigilance SIR,-Around 25 000 medical journals are currently available,! and doctors and scientists have to be selective about which ones they read.2 Our specialty, pharmacovigilance, is an example in which published data are used for routine as well as for research purposes. We have assessed the efficiency and performance of various medical journals with respect to pharmacovigilance.
THE LANCET
WHO
Regional Office for Europe
SIR,-As director of the department in which the pharmaceuticals programme referred to by Dr Herxheimer (Feb 13, p 427) has been located for almost two years, I am concerned that the reader may be left with the impression that the Regional Office for Europe of the World Health Organization (WHO) in Copenhagen has had little activity in the pharmaceutical field since 1991. The contrary is the case as illustrated by the following examples. We set up the Forum of European National Pharmaceutical Associations and WHO and two major meetings were held in January, 1992, and February, 1993. This forum aims to take the challenge of "Health for All" in Europe to the field of pharmaceuticals, to pharmacies, and to the door of every national pharmaceutical association in our 48 member states. Three pilot studies were carried out in 1992 and were discussed at the 1993 meeting. We also give continous assistance to the Drug Utilisation Research Group, which includes planning for its major meeting in 1993. We have also developed a new Special Action Programme for Pharmaceuticals for countries of central and eastern Europe, including the newly independent states. This programme has its own staff and is supported by voluntary contributions raised by the Regional Office. It complements the Special Action Programme on Vaccines, which the Regional Office also developed in 1992. In addition, we assess the needs of eleven of the countries in central and eastern Europe, including the newly independent states, with regard to essential drugs and related matters. We also produce various publications, such as Drug Utilization Studies: Methods and Uses, Drug Information, and Clinical Pharmacological Evaluation in
Drug Control. The WHO Regional Office for Europe has a policy of openness. We always extend a warm welcome to anyone interested in visiting us to learn about our activities. Regional Office for Europe, World Health Organization, DK-2100 Copenhagen, Denmark
MARK TSECHKOVSKI
Outbreak of yellow fever in Kenya: how doctors got the news SIR,-Kenya is the most popular African country for Swiss tourists, with an annual average of 30 000 travellers. Vaccination against yellow fever for travellers to this country has long been recommended by the Federal Office of Public Health. This February an epidemic (Professor Okello and colleagues, Feb 20, p 489, and ref 1) prompted us to survey the 62 travel clinics (vaccination centres and doctors) authorised to vaccinate against yellow fever in Switzerland, to establish when and how they learned of the epidemic. From Feb 22 to March 3, 60 of these were contacted successfully by telephone. 6 (10%) had not yet been informed, and 27 (45%) had learned of the outbreak from daily newspapers. Of the 54 doctors who knew of the epidemic, 39 practise in the German-speaking part of Switzerland (group A), where major newspapers reported the outbreak, and 15 work in the French-speaking and Italian-speaking regions (group B), where newspapers did not report the event. In group A, 69-2% (27) were informed by the press whereas none were in group B. The sources of information for group B were medical publications (333%), colleagues (33-3%), and travellers (26-7%). These sources and proportions were similar in the remaining 31 % of group A, who had their information from sources other than newspapers. 2 doctors learned of the epidemic while travelling in Kenya and Tanzania at the end of January, but neither reported the news on their return. Several doctors were informed early but did not transmit the news,
.
assuming, wrongly, that their colleagues were already aware of the epidemic. Five days after the initial WHO press release of Feb 5,1993, 83% of group A were informed, compared with 28% of group B (figure). The mean delays were 4-8 days (SD 3-8) and 8-4 days (4°7), respectively (p < 0-001). When reported in major newspapers medical news quickly reaches doctors. However, the random way in which doctors learned of the epidemic underlines the need for rapid and
uays
Trom wnu
press reiease
Time for information to reach travel clinics since WHO press release. Cum=cumulative.
standardised channels of communication, especially for travel clinics. This need was also expressed by vaccination centres questioned in neighbouring France and Germany. A good case is thus made for establishing an efficient information system at a European level. We thank our colleagues who participated in this survey, and Prof H. Stalder and Mrs C. White for their advice.
Community Medicine Unit, Policlinic of Medicine, Hôpital Cantonal Universitaire, 1211 Geneva, Switzerland
LOUIS LOUTAN
Federal Office of Public Health
PIERRE-ALAIN RAEBER
1. World Health Organization. Yellow fever
CLAUDE-FRANÇOIS ROBERT
m
Kenya. Wkly Epid Rec 1993; 38.
Palestinian deportees SIR,—On Jan 9 (p 110) The Lancet carried an appeal in which doctors were asked to write to the ambassador at the Israel Embassy requesting the release of deported Palestinians. The embassy has chosen to respond with a standard letter without any reference to points that may have been brought up in the original letter. The Palestinians have now been in exile for 4 months but their case is receiving little or no media coverage. In addition to the obvious breach of human rights, the deportation should also be a cause of great concern to the medical profession. They are living in horrific conditions, with dysentery a common problem. Furthermore, twelve of the deportees are members of the medical profession: one is an otorhinolaryngologist, one, Dr Mahmood al Zahar, is a general surgeon and acting dean of the Nursing School and Islamic University in Gaza, and the other ten are general practitioners. Their exile will have a deleterious effect on the quality of medical care for the inhabitants of the Gaza strip, where conditions are already poor. Among the other deportees there are individuals with nephrotic syndrome, diabetes mellitus, and peptic ulcer disease. As members of a caring profession we should try to contact either our own politicians or fellow professionals in Israel requesting them to intercede urgently on behalf of these Palestinians. 33 Great Western Square, Dublin 7, Ireland
BRIAN MCLAUGHLIN
Efficiency of medical journals for pharmacovigilance SIR,-Around 25 000 medical journals are currently available,! and doctors and scientists have to be selective about which ones they read.2 Our specialty, pharmacovigilance, is an example in which published data are used for routine as well as for research purposes. We have assessed the efficiency and performance of various medical journals with respect to pharmacovigilance.