The Erice Declaration on Communicating Drug Safety Information, first published in September 1997, provides a vision of vigorous, open, ethical, patient-centred communications in drug safety that the world has yet to achieve. The Declaration is reprinted here as a further stimulus to all parties to renew their commitment and to add new momentum to the improvements which have undoubtedly taken place in the past few years. The content of the Declaration is briefly reviewed, and some of the continuing communications challenges and problems are outlined.
Although the techniques involved in drug safety monitoring (pharmacovigilance) have dramatically improved in recent years, communication of these issues to health professionals and the public lags far behind. Several measures need to be taken in order to address this discrepancy. A climate of greater openness concerning the basis of merit assessments must be created. We need to develop merit-assessment formulations that are more accurate and helpful when treating individual patients in clinical situations. All of the involved groups must be educated about the nature of drugs and drug therapy, and the possibilities and limitations of such therapy. More effective techniques and systems have to be developed in order to stimulate higher rates of high quality spontaneous reporting of adverse effects. More conscientious and purposeful attention to the theory and practice of communications, in order to ensure the effective delivery of optimal benefits to patients, clinicians and society at large, would also be advantageous. We must ensure that where issues of public health and confidence in the medical profession are at stake, we employ the very best communications practices.
In this narrative review, a brief summary of theoretical approaches to risk perception is followed by an analysis of some of the special factors influencing risk perception and risk communication in sub-Saharan Africa. Examples of recent and emergent local medicines and vaccine controversies in several countries are given along with evidence and analysis of how they were managed. These demonstrate, among other things, the extent to which ethnic, religious and cultural issues influence popular perception, and the power of rumour and anecdote in shaping public opinion and official responses to events. Where safety monitoring systems exist, they are in their infancy, with limited capacity for data collection, credible scientific review, effective public communication and robust crisis management. Although increasing democratic freedoms, including less restricted media, and evolving health systems are addressing the challenges and give hope for further progress, there are still deep and intractable issues that inhibit transparent and effective risk communication and stand in the way of African populations comprehending medicines and their risks in safer and more balanced ways. Some proposals for future change and action are offered, including the pursuit of a deeper understanding of local and national values, assumptions and beliefs that drive risk perception; tailoring public health planning and communications to specifically-targeted regions and populations; strengthening of safety surveillance and data-collection systems; giving higher priority to medicines safety issues in healthcare training and public education.
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