Reflections from the WHO monitoring centre visit

Reflections from the WHO monitoring centre visit
Did you know that the cosy university city of Uppsala could be a centre of world importance? We, at SI NFGL Uppsala did. Our city just never stops surprising people.

Once, when shopping, I saw the WHO (World Health Organisation) logo on one of the buildings and became interested in it. After a while, I realised that this was the office of Uppsala Monitoring Centre (UMC) – WHO Collaborating Centre for International Drug Monitoring. As all WHO Programmes, International Drug Monitoring is dedicated to combatting crucial issues regarding global health.

We wanted to learn more about the centre and the subject itself, so after some negotiations we were lucky enough to secure a study visit. Together with the students of the Global Pharmacy Course at Uppsala University, we were invited on 24th March to explore the work of the centre.

Jennifer Wall, Pharmacovigilance Specialist at UMC from the section of Education & Training, was our host during the visit.  She gave us a detailed introduction about the centre. The Thalidomide tragedy, in the 1960s had prompted the WHO to initiate the International Drug Monitoring Programme, and later Sweden, in 1978, established the centre in Uppsala. Around 100 employees work there, for the betterment of the pharmacological world. A big part of their work is to collect detected adverse drug reactions (ADRs) from the world and then report that for the global community. The centres pharmacovigilance activities include not only ADRs discovery, but also medical errors, antibiotic resistance, poison abuse, immunisation, product quality and even public health problems. The centre expanded from 10 initial countries to 125, with a range of associate members, which all partake in global pharmacovigilance work too.

How does the ADR report work?

A patient with an adverse reaction reports it to the doctor, or if a doctor notices an ADR in a patient, they register it. Either way, the doctor creates a report about the reaction to the local monitoring centre, and the centre later sends this report to UMC (this step is optional – the investigation may be performed on a local level too). Patients can also report ADRs directly to the centres through mobile apps as Yellow Card in the UK or HALMED in Croatia.  

Pharmaceutical companies also report ADRs, which they observe, to local centres too.  Local centres can function as a part of ministries of health, some departments at the universities or sometimes could be organised as smaller separate institutions. UMC collects reports from the local centres, they revise them and put into a database – VigiBase that contains more than 14 million individual reports. It has several tools, such as VigiFlow, which adds information into the database or VigiLyse, which analyses the information from VigiBase. VigiFlow can be used also as a national database, if a country does not have its own. There is also a special tool – VigiAccess, made for the public, so they can search for ADRs by region, drug etc..

When an ADR is registered at UMC it is analysed so that we understand its origin, occurrence and potential mechanism. This analysis is done at the Research Department. Sarah Watson – a pharmacist from this department presented their work to us. To perform thorough and effective research on the case several specialists gather at one room and work solely on case analyses. Depending on the situation, there could be different specialist in medicine and pharmacy (for example, a paediatrician in case of ADRs in children), a nurse, and always one software specialist. This way of close collaboration is called “sprint” (borrowed from computer science field) and has turned out to be very effective.

When the case is solved, one of the “sprinters” hit a gong, which they have in the room, to let the whole centre know the goal has been reached. Following the conducted research, UMC produce a “Signal” document, which is spread worldwide to avoid whichever particular ADR going forward. The UMC Research Department collaborates closely with various EU projects on drug safety. Strama, a representation of authorities and expert bodies in Sweden for example, are involved in a project with the WHO collaborating centre in the Netherlands titled Re-Act, which focuses on antibiotic resistance. The UMC Research Department also have been working with EMA (European Medicines Agency) on pharmacovigilance – the practice of monitoring drugs after they’ve been approved for use. Social media is also analysed; researchers search for ADR mentions in posts and comments. A lot of their work aims at the creation of the most detailed information about existing medications for health care providers and patients.

Another database, which includes information about medications, their effects, ADRs, and names in different countries is WHO Drug. The Product and Services Department work on this project. WHO Drug is also a source to code medications, that are used in clinical products. Every drug has a unique code, however some chemical substances partially match, so one can group medications according to the active and additional ingredients, therapeutic classification and names. This information can be used on a daily basis by medical practitioners to reduce side effects, allergic reactions and so on.

One more exciting application is its usage in clinical trials, when a new drug is tested in patients taking other medications, known as the concomitant medication stage. In that case a researcher should know and take into account possible chemical interactions with active and additional components of concomitant drugs. Recently, it has become  a requirement to analyse during clinical trials, meaning in the future, all solid investigations will use information from WHO Drug. It is important to note here that even though one can search for a specific case of a certain drug in a single patient, the information about the person is under the Data Protection Act, therefore, private. To get the most out of the WHO Drug project, one can learn how to use it through a web-based course, provided by UMC. There are also user group meetings, organised on a regular basis for the different parts of the world.

UMC provides many more learning opportunities for the public, researchers, doctors, pharmacists and students. There are also regular webinars on different aspects of pharmacovigilance. UMC has a  Youtube Channel various social media accounts too. The centre communicates with the public a lot; it’s a huge part of their work! Their initiative Take and Tell, for people taking medications is commited to register as many side-effect worldwide as possible and UMC promotes this among patients.

UMC also collaborates with Uppsala University by providing joint online courses, inviting students for the lectures and study visits. We were happy to have had a joint visit with students of the Global Pharmacy course, so we could discuss issues with them and see their viewpoint on current drug safety issues.

Sarah Watson also told us about how she became an employee at UMC; she completed her Master thesis here and thereafter an internship. This opportunity still exists and students can join an extraordinary team of people, working for a world with safer medication.

This sunny day was a lot about motivating us and giving us hope for a better future in global healthcare.

Uppsala Swedish Institute Network for Future Global Leaders would like to thank Uppsala Monitoring Centre for this incredible study visit, and all the information we were given in the great atmosphere!