In Practice

Essential medicine selection during the COVID-19 pandemic: Enabling access in uncharted territory

T D Leong, S M McGee, A L Gray, R de Waal, T Kredo, K Cohen, G Reubenson, M Blockman, J Nel, G Maartens, H Rees, R Wiseman, K Jamaloodien, A G Parrish

Abstract


The COVID-19 pandemic requires urgent decisions regarding treatment policy in the face of rapidly evolving evidence. In response, the South African Essential Medicines List Committee established a subcommittee to systematically review and appraise emerging evidence, within very short timelines, in order to inform the National Department of Health COVID-19 treatment guidelines. To date, the subcommittee has reviewed 14 potential treatments, and made recommendations based on local context, feasibility, resource requirements and equity. Here we describe the rapid review and evidence-to-decision process, using remdesivir and dexamethasone as examples. Our experience is that conducting rapid reviews is a practical and efficient way to address medicine policy questions under pandemic conditions.


Authors' affiliations

T D Leong, Essential Drugs Programme, Affordable Medicines Directorate, National Department of Health, Pretoria, South Africa

S M McGee, South African Medical Association, Pretoria, South Africa

A L Gray, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Division of Pharmacology, Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

R de Waal, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

T Kredo, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

K Cohen, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

G Reubenson, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa

M Blockman, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

J Nel, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

G Maartens, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

H Rees, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

R Wiseman, Liberty Health (Pty) Ltd, Cape Town, South Africa

K Jamaloodien, Essential Drugs Programme, Affordable Medicines Directorate, National Department of Health, Pretoria, South Africa

A G Parrish, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Department of Internal Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa; Frere and Cecilia Makiwane hospitals, East London, South Africa

Full Text

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Keywords

Decision framework; Remdesivir; Dexamethasone; Evidence review; Essential medicines; SARS-CoV-2

Cite this article

South African Medical Journal 0;0(0):.

Article History

Date submitted: 2020-09-29
Date published: 2020-09-29

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