What’s New in Health Disparities?

By: Jovonni Spinner, MPH, CHES

In June 2015, I presented at the Health Disparities, Education, Awareness, Research, and Training (HDEART) workshop at Prairie View A&M University, near Houston. This annual workshop brought together nationally recognized leaders to discuss genomics, communications, bioethics, and other minority health issues, as well as disease-specific health programs, such as cancer, maternal health, and smoking cessation.

Jovonni SpinnerWe know health disparities exist and minorities fare worse for many health outcomes. That is old news. The workshop promoted an open discussion and offered fresh ideas on bio-psychosocial approaches to address health disparities that will improve health equity.

The FDA’s George Strait moderated my panel, “Health Inequities, Health Communication, and the Media.” I spoke with three other public health experts and researchers about how to use communication strategies and collaborative models to reduce health disparities.

We focused on implicit and explicit bias among physicians, developing and implementing public health programs, and building a diverse health care workforce. We also discussed how changes in the private-practice model affect African-American physicians and their efforts to reduce health disparities.

I specifically talked about how the FDA Office of Minority Health (OMH) is building a robust outreach and communications program. OMH partners with minority-serving institutions to better engage minority groups, raise awareness around specific diseases, and develop linguistically and culturally appropriate health educational materials.

The HDEART panel was an excellent platform to raise the visibility of FDA’s role in improving minority health because the audience was filled with health care practitioners, researchers, and social workers who are engaged in these issues and did not know about us.

Here are some salient action items that emerged from the workshop:

  • Support and increase funding for health disparities research;
  • Implement strategies to remove communication and structural barriers;
  • Improve literacy skills by investing in early childhood education;
  • Recognize that multiple factors influence health equity and access to health care, including individual health behaviors, and social and environmental factors;
  • Scale up innovative public health programs that have a positive effect on health outcomes in minority communities; and
  • Find creative ways to reach the underserved; for example, use telemedicine to reach vulnerable and rural populations who do not have medical providers easily accessible.

During the lectures, I thought about how to apply this newfound knowledge to the work we do in OMH. Two areas came to mind: we can work to remove communication barriers and we can support health disparities research.

Moving forward, we can come up with strategies to:

  • Build and strengthen our partnerships to reach a wider audience;
  • Support our extramural and intramural research programs and facilitate scaling up successful projects; and
  • Use innovative communication strategies to reach our audience.

We live in a global society where disease knows no borders. It is our job as a public health agency to employ a holistic approach to improving health equity. Diverse populations are not one dimensional, so one-dimensional solutions will not be enough. We need to identify factors that influence health and tackle the problem from all angles. Only then can we make progress in closing the disparity gap and improve health equity for all!

More information about FDA’s OMH can be found here: www.fda.gov/minorityhealth

Follow us on Twitter @FDAOMH

More information about the HDEART Workshop can be found here: http://www.pvamu.edu/nursing/hdeart/

Jovonni Spinner, M.P.H., C.H.E.S., is a Public Health Advisor in FDA’s Office of Minority Health

The Times They Are a Changin’ – And So is FDA

By: Luciana Borio, M.D.

Today, at a public meeting of the FDA Science Board, the agency is releasing our progress report, FDA Science Moving Forward, highlighting advances that FDA has made since the Science Board’s 2007 report FDA Science and Mission at Risk. Also at this meeting, a Science Board subcommittee will present its recommendations on FDA’s regulatory science programs, scientific workforce, and collaborations.

Dr. Lu BorioAs our report FDA Science Moving Forward illustrates, FDA regulatory science programs have made dramatic advances in the last eight years. These advances are critical because, as I’m always reminded, regulatory science underpins virtually every decision we make at FDA.

Some of our early efforts focused on establishing an organizational framework to foster FDA’s vibrant scientific culture, with increasing opportunities for scientific collaborations and training of our staff.

FDA created the Office of the Chief Scientist and appointed a Chief Scientist, who was charged with working internally and externally to provide strategic leadership and advocacy for regulatory science and FDA scientists. Today that office, which I currently lead, has grown to also encompass offices dedicated to scientific professional development, counterterrorism and emerging threats, scientific integrity, toxicological research, women and minority health, as well as regulatory science and innovation.

In October of 2010, we outlined our broad vision for advancing regulatory science, followed by a more specific strategic plan in 2011 for our work within eight regulatory science priorities. Guided by these changes, we have successfully recruited additional top scientific talent to FDA, while strengthening our training programs and professional development opportunities for current staff. Importantly, we have developed new mechanisms and programs to leverage external expertise through a number of new partnerships and collaborations with our stakeholders, including the Centers of Excellence in Regulatory Science and Innovation.

FDA continues to keep pace with new science and technology, found in a growing number of medical product applications submitted for our review. For example, applications involving 3-D printing, devices incorporating nanotechnology and wireless controls, targeted drug therapies, and next generation sequencing technology are now commonplace in our regulatory portfolio.

Who would have imagined more than a century ago when FDA occupied a small office in the Department of Agriculture’s Bureau of Chemistry, that it would become what it is today—a leading regulatory agency with a public health reach that extends across the globe? More inspiring still have been the extraordinary advances in science and technology that have enabled FDA researchers to continually improve our food safety systems and help bring life-saving medical products from bench to bedside.

Although many challenges lie ahead, the progress report we are releasing today shows unequivocally FDA’s strong commitment to letting science guide our work of protecting and promoting the public health.

Luciana Borio, M.D., is FDA’s Acting Chief Scientist

‘Quality Metrics’: FDA’s plan for a key set of measurements to help ensure manufacturers are producing quality medications

By: Ashley Boam, MSBE and Mary Malarkey

Yesterday, we took an important step in advancing the quality of medications with the release of draft guidance for the pharmaceutical industry called, “Request for Quality Metrics.”

Ashley Boam

Ashley Boam, FDA’s acting Director, Office of Policy for Pharmaceutical Quality, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research

In these technical terms, that may not sound like much. But – in plain language – this document describes a set of measurements to help the agency evaluate the quality of the facilities and the processes that manufacturers use to make FDA-regulated drugs and biologics. These include prescription drugs and certain biological products. The guidance also encourages these manufacturers to conduct robust quality measurements on their own products.

It’s critically important for patients, health care professionals, caregivers, payers, and others to have confidence in how medications are made. “Quality metrics,” or the measures used to assess the quality of drug and biologic manufacturing, can help us achieve this goal.

We expect that these measurements will strengthen our efforts to ensure that FDA-regulated medications are not only demonstrated to be safe and effective, but also continually manufactured under strict quality standards.

We believe a careful analysis of quality metrics can help FDA better identify which facilities are at the highest risk for quality problems. This will help us use our inspection resources most efficiently and effectively.

Mary Malarkey

Mary Malarkey, FDA’s Director, Office of Compliance and Biologics Quality, Center for Biologics Evaluation and Research

Quality is also directly connected to a consistent supply of needed medications. Over the years, there have been disruptions in the availability of some drug and biological products due to manufacturing production flaws. We believe that a company’s own robust quality measurement system, along with our quality measurements, can help manufacturers better identify factors that may predict manufacturing problems – and move us a step closer toward reducing and controlling these disruptions.

FDA has been working for many years on solutions to encourage and support the modernization of pharmaceutical manufacturing, such as the use of risk-based regulatory strategies for oversight. Our quality metrics initiative is one of several approaches we believe will further support this effort.

We encourage patients, prescribers, industry and others to submit comments regarding our Quality Metrics draft guidance. We’ll also be hosting a public meeting on August 24, 2015. We’ll use this input to help create a final guidance to support the reporting and calculation of quality measurements.

Yesterday’s draft guidance is an important step on a shared path toward improved drug quality throughout the pharmaceutical industry. We look forward to receiving comments, finalizing the guidance, and receiving the first set of reports.

In the meantime, we’ll be working with others to support industry’s use of robust quality metrics programs and to understand the best way to use quality metrics to improve manufacturing quality and FDA’s regulatory decision making.

We also will continue to emphasize the importance of quality in the pharmaceutical industry for companies that make medications and for the patients who receive them.

Ashley Boam is FDA’s acting Director, Office of Policy for Pharmaceutical Quality, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research

Mary Malarkey is FDA’s Director, Office of Compliance and Biologics Quality, Center for Biologics Evaluation and Research

FDA Science Forum 2015: Views of FDA

FDA’s 2015 Science Forum attracted more than 800 people from the scientific community. Here’s what some attendees said about the innovative research going on at the agency and why FDA can be a valuable collaborator in research aimed at transforming food safety and medical product development. If you couldn’t attend the FDA science forum, you can still see all the presentations on our web site.

More Collaboration, Research Needed to Develop Cures

By: Robert Califf, M.D.

The U.S. Food and Drug Administration’s drug approval process—the final stage of drug development—is the fastest in the world, which means Americans typically have first access to new drugs when they are demonstrated to be safe and effective. But even as our agency has transformed the approval process—approving 51 new molecular entities and biological products last year alone, including more new orphan drugs for rare diseases than in any previous year—drug discovery and development is not keeping pace for many diseases.

Robert CaliffIn many cases, what’s holding back progress is a lack of understanding of the biology of disease, as we outline in a new report we are releasing today that compares diseases where there is a robust pipeline of new therapies with certain diseases that have few known treatments or cures.

For instance, when it comes to cancer, HIV/AIDS, and other viral infections, decades of intense research have given the scientific community and the FDA critical insight on how to develop effective treatments. Ongoing research has led to the discovery of biomarkers, which are characteristics that are objectively measured and evaluated as indicators of normal biological processes, pathogenic processes or response to a therapeutic intervention. Some types of biomarkers give insight on the genetic and metabolic characteristics that alter patients’ responsiveness to particular drugs, and others give insight into whether drugs in development are likely to work. This deep knowledge has resulted in important breakthroughs, rapid drug development and speedy FDA approvals.

While additional research is needed for all diseases, the paucity of reliable biomarkers in some diseases highlights the critical need for more research if we are to make much needed progress. Examples include Alzheimer’s and many rare diseases, as we outline in the new report released today. In these cases, the scientific community still lacks basic information about what causes these diseases and how they can be slowed and treated. When research does not offer answers to important scientific questions, cures cannot be developed. And when viable cures are not in the pipeline, focusing on regulation will not improve the situation, since FDA can only approve therapies with evidence for safety and effectiveness.

Once key scientific questions are answered, we can use a variety of tools to reduce the length and cost of initial clinical trials for drug approval for these disease areas, and we can provide guidance to industry including advice on how to develop additional reliable biomarkers. For instance, we’ve improved the efficiency and predictability of clinical drug development by developing tools such as biomarkers and surrogate endpoints—markers of drug effect that do not directly represent an improvement in how a patient feels or functions, but are reasonably likely to predict a clinical benefit. Thus, for example, lowering a patient’s blood pressure can be used as a surrogate for the clinical benefit of preventing heart attack. Such tools have modernized clinical trial designs and may dramatically reduce the length and cost of drug development. They also can help target drugs to specific patients who can benefit most, thereby limiting the number and size of clinical trials.

These are exciting times as we experience simultaneous revolutions in the biological and information sciences. We expect that the astounding increase in knowledge of biological systems enabled by whole genome sequencing, cloud computing, social media, and wearable devices to monitor physiology will create challenges to traditional thinking. And we are confident that this increased knowledge will continue to expand the pipeline of new therapies. This report emphasizes that we are prepared to deal with the product of this scientific investment by using regulatory paradigms that match the state of the science and by supporting dissemination of the latest knowledge applied to drug development.

In this paradigm that takes advantage of the depth of this new biomedical information, it will be critical to continue to support ongoing clinical trials and observational studies to ensure sufficient knowledge of the benefit-risk profile of therapies as they evolve into broad use. Even the best of the current surrogates such as systolic blood pressure cannot substitute for the entire cumulative effects of a drug on the intended biological target and for off-target effects.

We will continue to work to speed patient access to therapies shown to be safe and effective through our existing programs that allow for expedited review, development, and approval of certain medical products. To encourage innovation, we also will continue to work with other government agencies and the healthcare community, including members of patient groups, academia, and industry. It will take a collaborative effort to improve our nation’s understanding of certain diseases and to translate any resulting scientific discoveries into cures.

Robert Califf, M.D., is FDA’s Deputy Commissioner for Medical Products and Tobacco.

More information can be found at: Innovation at FDA.

Celebrating the 3rd Anniversary of the FDA Safety and Innovation Act

By: Stephen M. Ostroff, M.D.

Anniversaries are celebrated for many different reasons. Sometimes it is to recognize the enduring strength of an institution. Other times it offers an opportunity to gauge success or progress.

Acting FDA Commissioner, Stephen Ostroff, M.D.One commemoration that falls into the latter category is today’s third anniversary of the signing of the landmark Food and Drug Administration Safety and Innovation Act or, as it is known in the world of Washington acronyms, FDASIA.

FDASIA gave FDA authority to collect user fees from industry over five years, beginning in 2012, to fund reviews of innovator drugs, medical devices, generic drugs, and biosimilar biological products.

It also promotes innovation to speed patient access to safe and effective products, increases stakeholder involvement in FDA processes, and enhances the safety of the drug supply chain. Just as important, FDASIA improves the agency’s ability to help prevent drug shortages.

FDA has made great strides to implement this important law since President Obama signed it, issuing more than 35 draft and final guidances, more than 10 proposed and final rules, three strategic plans, 14 reports to Congress, 18 public reports, and 13 public meetings designed to solicit input from a vast assortment of stakeholders.

All told, we have completed more than 70% of the law’s deliverables and we continue to maintain our commitment to a transparent and accessible implementation plan that allows the public to follow our progress.

Our work on additional action items continues.

Just two days ago we completed another task – issuing a final rule that requires all manufacturers of certain medically important drug and biologic products to give FDA early notification of potential drug shortages and to report the reasons for that potential shortage.

This step is the latest in a series of changes FDA has made to significantly reduce drug shortages. Those efforts have helped to prevent 282 shortages in 2012, 170 in 2013, and 101 in 2014.

This progress is but one example of how FDA’s work under FDASIA is making an important difference for patients and health care professionals who depend on these products.

One of the most significant provisions of FDASIA was the creation of a new Breakthrough Therapy designation for drugs and biologics intended for serious or life-threatening illnesses where preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over existing therapies.

As of last month, 315 requests for this special designation have been received and 93 drugs and biologics have been granted breakthrough status. Expedited development is underway for the majority of these breakthrough designated products, while 26 breakthrough therapy drug/indication combinations have already been approved and are now on the market for use by patients. This program, which, along with fast track, accelerated approval, and priority review, was the topic of FDA’s final guidance on our expedited review programs, also has helped facilitate earlier and continuing consultation and advice by FDA for industry researchers and product developers.

In large part, as a result of these expedited programs, we saw the approval of a record number of new drugs in 2014 for the treatment of both rare diseases and more common conditions like various forms of cancer and hepatitis C. We also saw the approval of a record number of biologics, including new vaccines for meningococcus type B.

Innovation is being promoted under FDASIA through greater patient engagement, including a five-year Patient Focused Drug Development program to learn from patients about the impact of their disease on their daily lives. Since its creation, we have held 14 meetings with patients on subjects such as chronic fatigue syndrome, lung cancer, HIV, and narcolepsy.

As this strategy makes clear, knowledge and understanding of a patient’s perspective on disease are critical. But equally significant is the importance of ensuring adequate data quality and transparency in research to develop new treatments. That brings up another area of great progress under FDASIA: addressing the longstanding concern about representation of women and minorities in clinical trials that support marketing applications for medical products.

In 2014, in response to Congress’s request in Section 907 of FDASIA, we produced an Action Plan to help close gaps in data quality, clinical trial participation, and data access. We have issued a guidance document on the “Evaluation of Sex-Specific Data in Medical Device Clinical Studies,” and we’re working to promote clinical trial participation by women and minorities. We also are posting on our website easy-to-understand Drug Trials Snapshots which provide the breakdown of clinical trial participants by age, race, and sex for newly-approved drugs and biologics. Snapshots also summarize whether there were differences in efficacy and safety among different subgroups.

Part of our efforts to implement and achieve the goals of FDASIA is helping us address the enormous global changes affecting FDA’s responsibilities.

With roughly 40 percent of finished drugs coming from outside our borders, and 80 percent of active ingredient manufacturers being located outside of the U.S., protecting the U.S. drug supply chain and making sure that patients have access to the drugs they need is a continuing priority for FDA.

FDASIA includes a set of provisions, contained in Title VII of the statute, which gave FDA new authorities to address the challenges posed by an increasingly global drug supply chain.

Given the enormity of FDA’s responsibilities, including the many new responsibilities authorized by Congress, combined with the budgetary challenges we face in this time of fiscal limitations, user fee funds play a critical role in FDA’s continued progress and excellence, including providing critical support to our staff of experts and helping maintain the high quality of their work.

Looking ahead, we have begun to plan for the next reauthorization of our user fee programs, beginning with a series of stakeholder meetings that began last month.

And, some of the themes advanced in FDASIA – encouraging antibiotic drug development, patient engagement, and the importance of biomarkers – are being considered by Congress as part of the 21st Century Cures initiative now making its way through Congress.

FDASIA provided enormous new responsibilities but also presented many promising opportunities. As we continue our progress in implementing this landmark law, we anticipate that we will continue to meet – and even exceed – the goals of the law as we strive to fulfill our mission to protect and promote the health of the American public.

Stephen M. Ostroff, M.D., is Acting Commissioner of the Food and Drug Administration

A Global Fight Against Dangerous Counterfeit and Unapproved Medical Products: From Operation Pangea to FDA’s Global Strategic Framework

By: Howard Sklamberg, J.D., George Karavetsos, J.D., and Cynthia Schnedar, J.D.

Unfolding earlier this month was a global cooperative effort, which included the Food and Drug Administration, to combat the online sale and distribution of potentially counterfeit and illegal medical products. Operation Pangea VIII was a project of massive scope, a lightning move by 115 countries that resulted in more than 2,400 websites being taken offline and the seizure of $81 million worth of potential dangerous illegal medicines and medical devices worldwide.

Howard Sklamberg

Howard Sklamberg, FDA’s Deputy Commissioner for Global Regulatory Operations and Policy

It’s a sad and cruel fact that drug and device counterfeiting and adulteration pose serious threats to public health. Unapproved and misbranded prescription drug products and unapproved/uncleared medical devices offered for sale on the Internet are potentially dangerous. The illegal sale of these medicines and devices bypasses both the existing safety controls required by the FDA and the protections provided when these products are used under a licensed practitioner’s supervision.

FDA is dedicated to sustaining and expanding the fight against counterfeits as part of our global strategy that leverages resources and expertise, engages the private and public sectors, and is data-driven and risk-based.

We have developed a Global Strategic Framework for counterfeit and substandard medical products (sometimes known by the acronym SSFFC, for Substandard, Spurious, Falsely-Labeled, Falsified, Counterfeit) to help protect consumers by reducing their exposure to counterfeit and substandard medical products.

The framework is focused on three pillars: Prevention, Detection, and Response.

What’s needed is better prevention of market entry of counterfeit and substandard products. Better detection of these products. And, more efficient response when counterfeit and substandard products are found.

FDA developed this framework in order to lay out a strategic vision of what is needed and how these needs can be met globally. There are areas where our expertise can and does contribute to prevention, detection, and response, but there are other areas where other U.S. federal and local government agencies, foreign counterparts, industry, healthcare professionals, consumer and patients, non-governmental organizations, procurement and donor organizations, standards bodies, and others have a role.

George Karavetsos

George Karavetsos, J.D., FDA’s Director, Office of Criminal Investigations

It is important for all players fighting to combat counterfeit and substandard drugs and devices to understand exactly how to best use our resources, knowledge, and experience, and leverage the work of others. This framework helps shape what roles we can play, minimize duplication of effort, and strengthen our global might in this fight against the criminals.

FDA has many ongoing activities and initiatives that support the framework goals. To better prevent counterfeit and substandard products from entering the market, we are working on improving the transparency, accountability, and integrity of the supply chain. Specifically, we are focusing on good manufacturing, distribution, and pharmacy practices, and we’re working for a convergence of global standards to create a more level playing field for the legitimate supply chain.

We are also implementing the new track and trace law (the Drug Supply Chain Security Act), which outlines steps to build an electronic, interoperable system to identify and trace certain prescription drugs as they are distributed in the United States, no matter where they originate. This is a collaborative effort whereby FDA is working with drug manufacturers, wholesale drug distributors, repackagers and dispensers (primarily pharmacies) to implement the law and develop the new system over the next eight years. Some of the key goals of this system will be to trace the path of drugs at the package-level through the drug supply chain, help ensure they are legitimate products, and enhance the detection of illegitimate drugs.

Cynthia Schnedar

Cynthia Schnedar, J.D., Director of the Office of Compliance at FDA’s Center for Drug Evaluation and Research

To better detect potentially harmful products before they enter the supply chain on their way to patients, we are focusing on improving information-sharing and communication. Also, as part of our effort for better detection, we are improving our surveillance through more efficient investigations of suspect incidents, and more quickly confirming that products are counterfeit. To this end, we have developed new detection technologies, specifically the handheld device, CD3, which uses wavelength detection to detect counterfeit drugs and packaging at our ports of entry.

Lastly, to better respond to incidents in the most efficient manner, FDA’s Center for Drug Evaluation and Research is developing more effective ways to notify the public of confirmed incidents and quicker removal of counterfeit products from the marketplace.

As for enforcement, we will continue to rely on our skilled professionals in FDA’s Office of Criminal Investigations (OCI) to lead domestic and global investigations to combat counterfeits. For example, OCI’s involvement in the past seven years of Operation Pangea has resulted in the seizure of more than $172 million in unlawful medical products — a real testament to effective international partnership.

We fully recognize that there are sophisticated, global criminal networks engaged in money laundering and the preparation and transportation of illegal products around the world. Importantly, we are meeting this global threat with international collaboration. FDA’s Office of International Programs has engaged with the World Health Organization’s Global Surveillance and Monitoring System, the World Bank, and the U.S. Agency for International Development in securing drug supply chains, reducing the threat of substandard drugs and strengthening regulatory systems.

We also collaborate with many foreign law enforcement organizations. For example, we have an OCI agent permanently assigned to Europol, based in The Hague, Netherlands. We also have a longstanding and solid partnership with the United Kingdom’s Medicines and Healthcare Products Regulatory Agency (MHRA). More recently, OCI signed with the French National Gendarmerie a Letter of Intent to increase law enforcement collaboration.

Moreover, the stakes have grown higher in the U.S. as judges around the country recognize the risks of unapproved drugs in the U.S. marketplace. In January 2015, for example, a Turkish exporter of illegal drugs was sentenced to 30 months in federal prison for his part in the scheme.

As underscored by Operation Pangea last week, our actions to protect the health of Americans from the online sale of potentially dangerous illegal medical products will continue. In the longer term, our focus will be prevention, detection and response. We will need a more coordinated, domestic and global approach that leverages resources, expertise, tools, and trainings, and engages stakeholders, other regulators, and law enforcement.

Through our framework for strategically safeguarding supply chain security and integrity and combatting counterfeit and substandard drugs and devices, we know we are on the right path with the right goal: Protecting public health by helping to ensure that the prescription medications and devices used by health care professionals and patients are safe, effective and of high quality.

Howard Sklamberg, J.D., is FDA’s Deputy Commissioner for Global Regulatory Operations and Policy

George Karavetsos, J.D., is FDA’s Director, Office of Criminal Investigations

Cynthia Schnedar, J.D., is FDA’s Director, Office of Compliance, Center for Drug Evaluation and Research

Naloxone – FDA hosts meeting to discuss expanded use of overdose medicine

By: Peter Lurie, M.D., M.P.H.

At the FDA, we’re proud of our work supporting the development of important and innovative medical products that address the critical needs of patients. Sometimes this means wholly new molecules to treat previously untreatable diseases; other times it simply requires the combination of more user-friendly formulations and enhanced efforts to get the drug to patients. The potentially life-saving drug naloxone, which can reverse opioid overdoses, is a poster child for the latter situation. The drug, which literally dislodges opioid drugs such as heroin or oxycodone from their receptors, thus reversing overdoses in minutes, has increasingly been administered outside of conventional medical settings by community and family members, as well as by first responders such as police and fire departments.

Dr. Peter LurieA little over three years ago, FDA partnered with other HHS agencies and laid out the pathway for the development and marketing of naloxone. It was the first public meeting on naloxone sponsored by the Federal government. A key development since that first meeting was FDA’s approval of Evzio, a prescription naloxone hydrochloride injection that can be used by family members or caregivers to treat a person known or suspected to have had an opioid overdose. Evzio rapidly delivers a single dose of the drug via a hand-held auto-injector. Now work is underway to administer naloxone through the nose.

According to a survey just published in CDC’s medical journal, there also has been enormous growth in the number of programs in which naloxone kits, primarily for delivering naloxone through the nose, and the associated training have been provided to laypersons. That survey reveals that since 2010 there has been a 243% increase in the number of local sites providing naloxone, a 183% increase in the number of laypersons provided naloxone kits, and a 160% increase in the number of overdose reversals reported.

This week FDA is hosting a two-day public meeting, co-sponsored by the National Institutes of Health’s National Institute on Drug Abuse, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, and the Health Resources and Services Administration. It brings together members of the community-based organizations that first pioneered lay administration of naloxone, medical professionals, policy-makers, public health officials, first responders, product developers, researchers and, of course, patients and their families, to explore and discuss issues surrounding the use of naloxone. The group will address a wide range of topics from a review of current naloxone use in clinical and non-clinical settings to questions of access, state law, over-the-counter status, training and evaluation of effectiveness.

The meeting builds on the good work already done to examine “second generation” questions: growth and sustainability. Discussions will include ways to further involve police and fire departments, expand the range of new products, and address issues of cost, logistics, and supply.

Science doesn’t stand still. But, as this week’s meeting on Exploring Naloxone Uptake and Use demonstrates, neither does the FDA. We will continue to explore every opportunity to apply the best regulatory science to the technology of today in support of our work to protect and promote the health of all Americans.

Peter Lurie, M.D., M.P.H., is associate FDA commissioner for public health strategy and analysis.

FDA Engages Internationally to Promote Access to Safe, Effective Animal Medicines

By: Bettye Walters, D.V.M.

Regulators around the world are reaching across national borders as they work together to ensure the safety of veterinary medical products.

Bettye WaltersI am a veterinarian on the International Programs Team at the FDA’s Center for Veterinary Medicine (CVM). In this role, I attended the 4th Global Animal Health Conference in Tanzania on June 24 and 25 and participated in the global dialogue about the use and availability of high quality, safe and effective veterinary medical products in developing countries, especially in Africa. FDA embraces the One Health approach, which recognizes the connection between the health of people, animals and the environment.

I was accompanied by my colleague Steven Vaughn, D.V.M., who heads CVM’s Office of New Animal Drug Evaluation. Dr. Vaughn has years of experience exploring the most effective ways to regulate animal medications to ensure that they are high quality and safe.

The conference was attended by leading figures from the world’s governments, academia, industries, and international organizations and its focus was on the concept of “regulatory convergence,” a process that allows countries to bring their regulatory processes into closer alignment. We tackled important ideas related to promoting market control, including the surveillance of veterinary products on the market and improving access to effective animal drugs. We also discussed fostering systems for mutual recognition of regulatory oversight and standards, forming regional organizations, and implementing African regional harmonization initiatives to create a convergence of international guidelines.

If all countries can agree on the testing and safety of animal drugs, each country could have faster access to new medical products and be able to better leverage often-limited resources. While globalization provides many challenges, FDA believes it also offers opportunities for innovation if regulators, industry, and academia are working together for the benefit of all countries.

It’s a small world and solutions to public health problems, for both people and animals, are increasingly found on the world stage. FDA is committed to working with its global partners to promote cooperation in veterinary medicine.

Bettye Walters, D.V.M., is a veterinary medical officer on the International Programs Team at FDA’s Center for Veterinary Medicine.

China’s Pharmaceutical Future – Both Complex and Growing

By: Howard Sklamberg, Richard Moscicki, M.D., and Alonza Cruse

中文(Simplified Chinese)

A visit to any one of the cities we visited on this trip – Shanghai, Nanjing and Beijing – would leave anyone marveling at the scale and trajectory of modern China. But it’s not just the sheer size of the population we were struck by. Rather, it was the seemingly tireless dedication to modernity that provided an almost palpable affirmation of what we already knew: that China — its skylines dotted with construction cranes and landscapes crisscrossed by high speed bullet trains — is inextricably connected with our own country’s economy, and increasingly with our agency’s ever-expanding regulatory mission.

Howard Sklamberg

Howard Sklamberg, FDA’s Deputy Commissioner for Global Regulatory Operations and Policy

We traveled to China for a few reasons. First, we wanted to gain more on-the-ground insight into how its drug industry works. We also wanted to offer some helpful perspective to Chinese regulators and drug companies about the Food and Drug Administration Safety and Innovation Act (FDASIA), which passed three years ago and is in the process of being fully implemented. In part, the law gave the FDA new authorities to ensure the safety of the global drug supply chain, in which China plays an enormous part. How enormous? After the United States, China ranks second for the number of FDA-registered drug establishments that the agency regulates, and is the sixth largest provider of drugs and biologics to the U.S.

Our itinerary also included a meeting with the Chinese Food and Drug Administration (CFDA) and a tour of a Chinese pharmaceutical manufacturing plant. And if you asked us what the most important by-product of our trip has been, it was these face-to-face conversations with our Chinese counterparts.

Specifically, we discussed the responsibilities of firms in the global drug supply chain. These days, the drugs we have in our medicine chests may seemingly come from one company, but the ingredients in them may actually come from numerous companies and countries. China is a major provider of many of the active ingredients in finished drug products Americans rely on every day.

Dr. Richard Moscicki

Richard Moscicki, M.D., FDA’s Deputy Director, Center for Drug Evaluation and Research

We had productive discussions with the Chinese about how seriously we are committed to making sure that everyone in the drug supply chain – from the companies that make the active ingredients to those that provide the packaging –shares in this collective commitment to quality. As we did when we spoke with our counterparts in India, we stressed that we apply the same quality and data integrity standards to all countries shipping drug ingredients into the United States.

We delivered the same message to a huge crowd of students at an event hosted by China’s Pharmaceutical University in Nanjing. In our remarks, we set forth our expectations for the delivery of drug quality, saying: “…ideally, our approach will complement the baseline, legal requirement of compliance with the higher bar of firms’ self-interest in being recognized for providing quality products and engaging in a different way with FDA.

While in Nanjing, we had productive discussions with students and stakeholders about FDASIA, quality in contract manufacturing, inspections, regulatory science, and expedited approval pathways that FDA is using to accelerate the process for making novel drugs available to patients.

Additionally, we toured a Chinese pharmaceutical facility and met with CFDA to discuss the revision of China’s Drug Administration Law, our own FDASIA implementation, regulatory science matters, as well as continued collaborative activities. We also had a productive roundtable discussion with leaders from 17 prominent Chinese pharmaceutical companies. We addressed pharmaceutical quality, data integrity, and the approval process for generic and innovator drugs.

Alonza Cruse

Alonza Cruse, FDA’s Acting Director, Pharmaceutical Quality Program, Office of Regulatory Affairs

As China’s role on the global stage expands, FDA has significantly increased drug and medical device inspections there, but we need to continue to strengthen our efforts. The Office of Regulatory Affairs and our China office have managed a large number of pharmaceutical inspections. The FDA’s office in China has also strengthened relationships with regulators and helped expand the country’s expertise in regulatory operations. And we have worked with industry and academia to explain our regulations and analyze trends and events that might affect the safety of FDA-regulated products exported from China to the U.S.

Given the volume of U.S. trade with China, we are working to expand our presence there to significantly increase the number of inspections we conduct. Staffing increases will allow FDA to enhance its training efforts and technical collaboration with Chinese regulators, industry and others. In fact, in November 2014, we signed a Memorandum of Understanding with the Chinese government that expands our cooperation and will facilitate those staffing increases.

FDA’s priorities in China match its global priorities: we work to ensure the safety and efficacy of FDA-regulated products. China’s size and relentlessly expanding economy have an increasingly significant impact on the products that Americans consume, particularly pharmaceuticals.

We trust our trip to China added to the growing collaboration between FDA and our counterpart agencies there, ensuring the safety of the pharmaceutical products exchanged between our two nations.

Howard Sklamberg is FDA’s Deputy Commissioner, Global Regulatory Operations and Policy
Richard Moscicki, M.D., is FDA’s Deputy Director, Center for Drug Evaluation and Research
Alonza Cruse is FDA’s Acting Director, Pharmaceutical Quality Program, Office of Regulatory Affairs