New listing for co-packaged ORS-zinc in the WHO essential medicines list could improve access and save lives
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Seattle, Washington, USA, July 9, 2019 – PATH applauds a landmark decision this week by the World Health Organization (WHO) to include a new listing for co-packaged oral rehydration salts (ORS) and zinc sulfate in its Model List of Essential Medicines (EML) and Model List of Essential Medicines for Children (EMLc), reinforcing the lifesaving benefits of using ORS and zinc together for pediatric diarrhea management, and achieving alignment with the long-standing recommendation for the use of both therapies as frontline practice. It is estimated that more than 60 percent of childhood diarrheal deaths could be prevented with full coverage of ORS and zinc alongside other community interventions.
This decision follows a global effort led by the Diarrhea Innovations Group (DIG)—a cross-sector coalition of innovators committed to reducing the global burden of enteric and diarrheal diseases—to make ORS and zinc more accessible in low-resource settings. In November 2018, initiated by a United Kingdom-based nonprofit ColaLife, DIG petitioned the WHO EML secretariat to include an additional listing of ORS-zinc as a composite pack. In all, 17 leading global health institutions joined the application by providing letters of support, including the Bill & Melinda Gates Foundation, the United Kingdom’s Department for International Development, the Ghana Health Service, Médicins Sans Frontières, the Ministry of Health and Social Action of Senegal, the United Nations Children’s Fund (UNICEF), the US Agency for International Development, and others.
“Children in some of the world’s most vulnerable communities still die from diarrhea every day,” said Dr. Andrew Murrison, the United Kingdom International Development Minister. “This ground-breaking decision from the WHO will save lives. I am proud that UK aid’s partnership with PATH has made this possible.”
The WHO EML and EMLc are highly influential normative standards that offer critical guidance for countries to adapt their national policy and prioritize health expenditures, procurement and supply, and health care provider training practices. Both ORS and zinc are already listed in the EML and EMLc as medicines used in diarrhea management, but as separate items, and up to this point, no formal guidance related to the use of co-packaged ORS and zinc existed. As a result, the two products are treated differently in national essential medicines lists, creating barriers to access to a proven, highly effective treatment.
“Co-packaged ORS and zinc can be delivered by community health workers everywhere and, therefore, reach the children most in need,” said Stefan Peterson, MD, chief of health at UNICEF. “It can and will save lives that are unnecessarily still lost to diarrhea.”
Administration of low-osmolarity ORS and zinc sulfate tablets for 10 to 14 days as an adjunct therapy has been demonstrated to significantly reduce the duration and severity of diarrheal episodes and prevent future episodes, and has been recommended by WHO and UNICEF since 2004. However, the percentage of children with diarrhea receiving the optimal co-administration of ORS and zinc remains unacceptably low, at less than 7 percent.
“Adding co-packaged ORS and zinc to the WHO EMLc could encourage national governments to align their policies and treatment guidelines with the WHO standard, ultimately increasing access to this lifesaving treatment and accelerating progress toward universal health coverage goals,” said Deborah Atherly, global head of Policy, Access, and Introduction for PATH’s Center for Vaccine Innovation and Access.
A number of countries, including Kenya, Nigeria, and Uganda, have already introduced co-packaged ORS and zinc through their public facilities as a successful strategy to rapidly improve coverage rates. Co-packaged ORS-zinc was added to UNICEF’s Supply Catalogue in 2014, and since then, 16 countries have introduced these products for public-sector distribution. There are an increasing number of co-packaged products available through private-sector markets, and five countries—Ghana, Kenya, Senegal, Vietnam, and Zambia—have added the co-pack to their national essential medicines lists.
About the Diarrhea Innovations Group
The Diarrhea Innovations Group is a global network of innovators committed to reducing child mortality and morbidity from enteric and diarrheal diseases through the advancement of appropriate diagnostic and therapeutic technologies and approaches. It is a voluntary association of academic, nonprofit, public, and private members. The group aims to accelerate progress by focusing on solutions with the greatest potential for positive health impact in countries that bear the highest disease burden. DIG is housed within and co-led by PATH. Learn more at https://pathwebprod.path.org/resources/diarrhea-innovations-group/.
PATH is a global organization that works to accelerate health equity by bringing together public institutions, businesses, social enterprises, and investors to solve the world’s most pressing health challenges. With expertise in science, health, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales solutions—including vaccines, drugs, devices, diagnostics, and innovative approaches to strengthening health systems worldwide. Learn more at http://www.path.org/.