Poor quality medicines harm patients and impose higher costs on health systems. Their prevalence is higher in countries with under-resourced national regulatory authorities, which cannot provide effective oversight on medicines manufactured, distributed or imported in the country. In a thoughtful essay published in the British Medical Journal, Elizabeth Pisani warned against some possible unwanted consequences of the efforts to achieve universal health coverage, and in particular on the risk that it may result in an unconditional push for the lowest possible prices of essential medicines, without due consideration for adequate quality standards. In their reply, however, Raffaella Ravinetto and Catherine Dujardin make the point that quality and affordability can go together, and that incentives to invest in pharmaceutical quality assurance may even descend from the market. They call on all major purchasers, including major funding agencies and their implementers, to create the demand for quality assured essential drugs by setting stringent criteria as a prerequisite for purchase.
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