WHO Expert Committee On Specifications For Pharmaceutical Preparations

1033
W H O Te c h n i c a l R e p o r t S e r i e s
1033
WHO Expert Committee on Specifications for Pharmaceutical Preparations

The Expert Committee on Specifications for Pharmaceutical
Preparations works towards clear, independent and practical
WHO Expert Committee

standards and guidelines for the quality assurance of
medicines and provision of global regulatory tools. Standards
are developed by the Expert Committee through worldwide
consultation and an international consensus-building
process. The following new guidance texts were adopted and
recommended for use:
on Specifications
Guidelines and guidance texts adopted by the Expert Committee
on Specifications for Pharmaceutical Preparations; Points
for Pharmaceutical
to consider when including Health Based Exposure Limits
(HBELs) in cleaning validation; Good manufacturing practices:
water for pharmaceutical use; Guideline on data integrity;
Preparations
WHO/United Nations Population Fund recommendations
for condom storage and shipping temperatures; WHO/United
Nations Population Fund guidance on testing of male latex
condoms; WHO/United Nations Population Fund guidance Fifty-fifth report
on conducting post-market surveillance of condoms; WHO
“Biowaiver List”: proposal to waive in vivo bioequivalence
requirements for WHO Model List of Essential Medicines
immediate-release, solid oral dosage forms; WHO Certification
Scheme on the quality of pharmaceutical products moving
in international commerce; Good reliance practices in
the regulation of medical products: high-level principles WHO Technical Report Series
and considerations; and Good regulatory practices in the
regulations of medical products.
All of the above are included in this report and recommended
for implementation.
ISBN 9789240020900
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on Specifications
for Pharmaceutical
Preparations
Fifty-fifth report
This report contains the views of an international group of experts and

does not necessarily represent the decisions or the stated policy of the World Health Organization
WHO Expert Committee on Specifications for Pharmaceutical Preparations: Fifty-fifth report
(WHO Technical Report Series, No. 1033)
ISBN 978-92-4-002090-0 (electronic version)
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Contents
Abbreviations vi
WHO Expert Committee on Specifications for Pharmaceutical Preparations x
Declarations of interest xvi
OPEN SESSION 1
Introduction and welcome 1
I. Expert Committee on Specifications for Pharmaceutical Preparations processes
and procedures 1
II. Update on new guidelines, norms and standards 2
III. Technical agenda topics of the Fifty-fifth Expert Committee on Specifications
for Pharmaceutical Preparations 2
IV. Points of discussion 3
PRIVATE AND CLOSED SESSIONS 5
Opening 5
1. General policy 7
1.1 Process for development of WHO norms and standards 7
2. Quality assurance: collaboration initiatives 8
2.1 International Meeting of World Pharmacopoeias 8
3. Nomenclature, terminology and databases 9
3.1 International nonproprietary names for pharmaceutical substances 9
3.2 Quality assurance terminology 10
3.3 Guidelines and guidance texts adopted by the Expert Committee on
Specifications for Pharmaceutical Preparations 10
4. Quality control – national laboratories 11
4.1 External Quality Assurance Assessment Scheme 11
4.1.1 Final report on phase 9 11
4.1.2 Update on phase 10 12
5. Quality control – specifications and tests 13
5.1 The International Pharmacopoeia 13
5.2 General chapters 13
5.2.1 Dissolution test for oral dosage forms 13
5.2.2 General identification tests 14
5.2.3 Test for histamine-like substances 14
5.3 General monographs for dosage forms 15
5.3.1 Powders for inhalation 15
5.3.2 Liquid preparations for oral use 15
5.4 Specifications and draft monographs for medicines, including paediatric
medicines, and candidate medicines for COVID-19 16
5.4.1 COVID-19 therapeutics 16
5.4.2 Antiviral medicines, including antiretrovirals 17
5.4.3 Medicines for tropical diseases 18
5.4.4 Medicines for maternal, newborn, child and adolescent health 19
5.4.5 Excipients 20
5.5 Update on the virtual informal consultation on Screening Technologies,
Laboratory Tools and Pharmacopoeial Specifications for Medicines 20
6. Quality control: international reference materials 22
6.1 Update on International Chemical Reference Substances 22
7. Quality assurance: good manufacturing practice and inspection 23
7.1 Inspection guidelines and good practices with partner organizations 23
7.1.1 Revision of good manufacturing practices for sterile products 23
7.1.2 Good manufacturing practices for radiopharmaceuticals for
investigational use 23
7.2 Approaches to carryover limits in cleaning validation 24
7.3 Water for pharmaceutical use 25
7.4 Guideline on data integrity 26
7.5 Points to consider for manufacturers and inspectors: environmental aspects of
manufacturing for the prevention of antimicrobial resistance 27
7.6 Recommendations from the virtual consultation on good practices for health
products and inspection 29
8. Quality assurance: distribution and supply chain 30
8.1 Shelf life for supply and procurement of medical products 30
8.1.1 Revision to the guideline on remaining shelf life 30
8.2 Updated and new WHO guidance, procedures and operational documents for
pharmaceutical procurement 31
8.2.1 World Health Organization/United Nations Population Fund
prequalification guidance on condoms 31
9. Regulatory guidance and model schemes 33
9.1 Proposal to waive in vivo bioequivalence requirements for medicines on the
WHO Model List of Essential Medicines 33
9.2 WHO Certification Scheme on the quality of pharmaceutical products moving in
international commerce 36
9.3 Good practices in regulatory decision-making 38
9.3.1 Good reliance practices in the regulation of medical products 38
9.3.2 Good regulatory practices in the regulation of medical products 39
9.4 Update on WHO-listed authorities 40
9.5 Recommendations from the virtual consultation on Regulatory Guidance for
Multisource Products 41
10. Miscellaneous: update on activities related to COVID-19 43
10.1 Oxygen specifications 43
10.2 Therapeutic specifications 43
10.3 Existing guidance 44
10.4 New activities 44
11. Closing remarks 45
iv
12. Summary and recommendations 46
12.1 Guidelines and decisions adopted and recommended for use 47
12.2 Texts adopted for inclusion in The International Pharmacopoeia 47
12.3 Recommendations 49
Acknowledgements 52
References 71
Annex 1
Guidelines and guidance texts adopted by the Expert Committee on Specifications
for Pharmaceutical Preparations 75
Annex 2
Points to consider when including Health-Based Exposure Limits (HBELs) in
cleaning validation 93
Annex 3
Good manufacturing practices: water for pharmaceutical use 111
Annex 4
Guideline on data integrity 135
Annex 5
World Health Organization/United Nations Population Fund Recommendations
for condom storage and shipping temperatures 161
Annex 6
World Health Organization/United Nations Population Fund Guidance on testing
of male latex condoms 167
Annex 7
World Health Organization/United Nations Population Fund guidance on
conducting post-market surveillance of condoms 189
Annex 8
WHO “Biowaiver List”: proposal to waive in vivo bioequivalence requirements for
WHO Model List of Essential Medicines immediate-release, solid oral dosage forms 197
Annex 9
Guidelines on the implementation of the WHO Certification Scheme on the quality
of pharmaceutical products moving in international commerce 205
Annex 10
Good reliance practices in the regulation of medical products: high level principles
and considerations 237
Annex 11
Good regulatory practices in the regulation of medical products 269
v
Abbreviations
ACT Access to COVID-19 Tools
ALCOA attributable, legible, contemporaneous, original and accurate
AMR antimicrobial resistance
API active pharmaceutical ingredient
AQL acceptance quality level
AUC area under the curve
BCS Biopharmaceutics Classification System
BE bioequivalence
BMDL benchmark dose level
BPW bulk purified water
BWFI bulk water for injection
CAPA corrective and preventive action
CpK process capability (also saved under P)
CPP certificate of a pharmaceutical product
DABT Diplomate of the American Board of Toxicology
DIRA data integrity risk assessment
EAP WHO Expert Advisory Panel on The International
Pharmacopoeia and Pharmaceutical Preparations
ECSPP Expert Committee on Specifications for Pharmaceutical
WHO Technical Report Series, No. 1033, 2021
Preparations
EDI electro-deionization
EDQM European Directorate for the Quality of Medicines &
HealthCare
ERT European Registered Toxicologist
EQAAS WHO External Quality Assurance Assessment Scheme
EMA European Medicines Agency
EML WHO Model List of Essential Medicines
EU European Union
FAT factory acceptance test
vi
Abbreviations
FEFO first expiry-first out

FPP finished pharmaceutical product
GBT Global Benchmarking Tool
GCP good clinical practice
GDP good distribution practices
GLP good laboratory practices
GMP good manufacturing practices
GRP good regulatory practices
GRelP good reliance practices
GTDP good trade and distribution practices
GVP good pharmacovigilance practices
GxP good practices
HBEL health-based exposure limit
HPLC high-performance liquid chromatography
HPS Health Products Policy and Standards (WHO department)
HVAC heating, ventilation and air-conditioning
IAEA International Atomic Energy Agency
ICH International Council for Harmonisation of Technical
Requirements for Pharmaceuticals for Human Use
ICRS International Chemical Reference Substances
IEC International Electrotechnical Commission
IMP investigational medical products
IMWP International Meeting of World Pharmacopoeias
INN International Nonproprietary Names
IQ installation qualification
ISO International Organization for Standardisation
LOAEL lowest observed adverse effect level
LOEL lowest observed effect level
MHRA Medicines & Healthcare Products Regulatory Agency
MKT mean kinetic temperature
vii
WHO Expert Committee on Specifications for Pharmaceutical Preparations Fifty-fifth report
MSC maximum safe carryover

MSSR maximum safe surface residue
NOAEL no observed adverse effect level
NOEL no observed effect level
NSP Norms and Standards for Pharmaceuticals (WHO team)
NRA national regulatory authority
OEL occupational exposure limit
OQ operational qualification
PDE permitted daily exposure
PDG Pharmacopoeial Discussion Group
PIC/S Pharmaceutical Inspection Co-operation Scheme
PDG Pharmacopoeial Discussion Group
PQ performance qualification
PQ WHO Prequalification (WHO team)
PQCL pharmaceutical quality control laboratory
PQTm Prequalification of Medicines Team (WHO team)
CpK process capability
PVDC polyvinylidene chloride
PVDF polyvinylidene difluoride
Q&A question and answer
QA quality assurance
QRM quality risk management

QSE quality, safety and efficacy
R&D research and development
RO reverse osmosis
RSS Regulatory System Strengthening (WHO team)
SAT site acceptance test
SOP standard operating procedure
SRA stringent regulatory authority
SPC statistical process control
viii
Abbreviations
SPC summary of product characteristics

TLC thin-layer chromatography
TOC total organic carbon
TRS Technical Report Series
UN United Nations
UNFPA United Nations Population Fund
URS user requirement specifications
VRL visible residue limit
WFI water for injection
WHO World Health Organization
WLA WHO-listed authorit
WPU water for pharmaceutical use
ix
WHO Expert Committee on Specifications
for Pharmaceutical Preparations
The open session of the Fifty-fifth Expert Committee on Specifications for
Pharmaceutical Preparations was coordinated from WHO headquarters,
Geneva, and took place virtually on 6 October 2020
Participants 1
Mr Baba Aye, Health and Social Sector Officer, Public Services International, Washington
DC, United States of America (USA)
Ms Jane Barratt, Secretary-General, International Federation on Ageing, Toronto, Canada
Ms Janis Bernat, Director, Biotherapeutics and Scientific Affairs, International Federation
of Pharmaceutical Manufacturers and Associations, Geneva, Switzerland
Ms Iris Blom, Liaison Officer to the World Trade Organization, International Federation of
Medical Students’ Associations, Copenhagen, Denmark
Dr Nick Cappuccino, Chair, Science Committee, International Generic and Biosimilar
Medicines Association, Geneva, Switzerland
Ms Kelly Catlin, Director, Quality, Sourcing, Cost Optimization and Process Chemistry,
Clinton Health Access Initiative, Boston (MA), USA
Professor Kostas Fountoulakis, World Psychiatric Association, Thessaloniki, Greece
Mr Shalini Jayasekar Zürn, Senior Advocacy Manager, Union for International Cancer
Control, Geneva, Switzerland
Ms Padma Kamath, Director, Regulatory and Scientific Affairs, Global Self-care Federation,
Nyon, Switzerland
Ms Marion Laumonier, Senior Advisor, Regulatory Affairs, Drugs for Neglected Diseases
Initiative, Geneva, Switzerland

Dr Joanna Laurson-Doube, International Consultant, Access to Treatment, Multiple
Sclerosis International Federation, London, United Kingdom of Great Britain and
Northern Ireland (United Kingdom)
Dr Dong Soo Lee, President, World Federation of Nuclear Medicine and Biology, Vienna,
Austria
Ms Isabel Lucas-Manzano, International Pharmacist Coordinator, Médecins Sans
Frontières, Geneva, Switzerland
Unable to connect: Mr Herbert Beck, Senior Advisor, Public Services International, Washington DC, USA;
1
and Professor William Carroll, Strategy and Programme Director, World Federation of Neurology, London,
(United Kingdom).
x
Mr Andrew Majewski, Senior Associate Director, Task Force for Global Health, Decatur
(GA), USA
Mr Marco Marchetti, Health Technology Assessment International, Alberta, Canada
Dr Kevin Moore, Senior Manager, Pharmacopoeial Collaboration, US Pharmacopeia,
Rockville (MD), USA
Dr Rui Nakamura, World Medical Association Inc., Ferney-Voltaire, France
Dr Lila Raj Puri, Medical Advisor – Asia, The Fred Hollows Foundation, Sydney, Australia
Dr Roxana Rustomjee, Senior Vice-President, Research and Development, Sabin Vaccine
Institute, Washington DC, USA
Mr Paul L. Smock, Senior Quality, QA and CMC Oversight, Sabin Vaccine Institute,
Washington DC, USA
Dr Valérie Solbes, Pharmacy Quality Advisor, Médecins du Monde, Paris, France
Ms Judy Stenmark, Director-General, Global Self-Care Federation, Nyon, Switzerland
Ms Malyika Vyas, Head of Public Policy, European Society for Medical Oncology, Lugano,
Switzerland
The main session of the Fifty-fifth Expert Committee on Specifications for

Pharmaceutical Preparations was coordinated from WHO headquarters,
Geneva, and took place virtually from 12-19 October 2020
Members
Dr Habib Abboud, Damascus, Syrian Arab Republic
Dr Varley Dias Sousa, Brasília, Brazil
Dr Petra Dörr, Bern, Switzerland (Chair)
Professor Ines Fradi Dridi, Monastir, Tunisia
Mr Johannes Gaeseb, Windhoek, Namibia
Ms Mónica Hirschhorn, Montevideo, Uruguay
Professor Eliangiringa Amos Kaale, Dar es Salaam, United Republic of Tanzania (Rapporteur)
Dr Adrian Krauss, Canberra, Australia (Co-Chair)
Dr Min Yong Low, Singapore
Dr Justina Molzon, Bethesda (MD), USA
Mrs Lynda M. Paleshnuik, Ottawa, Canada
Dr Lembit Rägo, Tartu, Estonia
Dr Budiono Santoso, Yogyakarta, Indonesia
xi
Dr Daisaku Sato, Tokyo, Japan

Dr G.N. Singh, Ghaziabad, India
Dr Luisa Stoppa, Rome, Italy (Rapporteur)
Dr Jinglin Sun, Beijing, China
Dr Adriaan J. Van Zyl, George, South Africa
Technical advisers 2
Professor Erwin Adams, Leuven, Belgium
Professor Maria Del Val Bermejo Sanz, Valencia, Spain
Dr Rubina Bose, New Delhi, India
Dr Marius Brits, Potchefstroom, South Africa
Dr Theo G. Dekker, Potchefstroom, South Africa
Dr Dimitrios Dimas, Athens, Greece
Dr Alfredo Garcia-Arieta, Madrid, Spain
Dr Sunday Kisoma, Dar es Salaam, United Republic of Tanzania
Ms Heeyoung Park, Chungcheongbuk-do, Republic of Korea
Ms Gugu Nolwandle Mahlangu, Harare, Zimbabwe
Professor John H. McB. Miller, Ayr, United Kingdom
Dr Jochen Norwig, Bonn, Germany
Professor Giovanni M. Pauletti, Ohio, USA
Dr Celeste Aurora Sánchez González, Havana, Cuba
Professor Gerhard Scriba, Jena, Germany
Dr Mingzhe Xu, Beijing, China
Representation from intergovernmental organizations 3

Council of Europe
represented by Dr Andrea Lodi, European Pharmacopoeia, Strasbourg, France
2
Unable to attend: Professor Asita De Silva, Colombo, Sri Lanka; Ms Anne Hayes, Dublin, Ireland; Ms Togi
Junice Hutadjulu, Jakarta, Indonesia; Dr Rodrigo Martins Bretas, Brasília, Brazil; Dr Richard Rukwata, Harare,
Zimbabwe; and Dr Abdelaali Sarakha, Saint Denis, France.
3
Unable to attend: European Commission (EC), Brussels, Belgium; European Medicines Agency (EMA),
Amsterdam, Netherlands; World Bank Group, Washington DC, USA; World Intellectual Property Organization
(WIPO), Geneva, Switzerland; and World Trade Organization (WTO), Geneva, Switzerland.
xii
International Atomic Energy Agency (IAEA)

Dr Aruna Korde, Radiopharmaceutical Scientist, Vienna, Austria
United Nations Development Programme (UNDP)
Dr Jean-Michel Caudron, Head of Quality Assurance, Antwerp, Belgium
United Nations Population Fund (UNFPA)
Ms Seloi Mogatle, Technical Specialist, Procurement Services Branch, Copenhagen,
Denmark; Mr David Hill, David Hill & Associates, Elsenham, United Kingdom and
Mr William Potter, Stapleford Scientific Services Ltd, Cambridge, United Kingdom
United Nations Children’s Fund (UNICEF)
Dr Peter Svarrer Jakobsen, Quality Assurance Specialist, Copenhagen, Denmark
United Nations Industrial Development Organization (UNIDO)
Mr Wilko von Kluechtzner, Associate Industrial Development Expert, Vienna, Austria
World Customs Organization (WCO)
Ms Jingwan Chen, Secretary Customs and Border Trade Professionals, Brussels, Belgium
State actors (pharmacopoeias) 4

Farmacopea Argentina
Dr Melina Assalone and Dr María Celeste de Angelis, Buenos Aires, Argentina
Farmacopeia Brasileira
Dr Arthur Leonardo Lopes da Silva, Health Regulatory Agency, Brasília, Brazil
British Pharmacopoeia
Ms Helen Corns, Medicines and Healthcare Products Regulatory Agency, London, United
Kingdom
Chinese Pharmacopoeia
Dr Xiaoxu Hong, Beijing, China
European Pharmacopoeia (also representing Council of Europe)
Dr Andrea Lodi, Council of Europe, Strasbourg, France
Indonesian Pharmacopoeia
Dr Togi Junice Hutadjulu and Ms Sri Hayanti, National Agency of Drug and Food Control,
Jakarta, Indonesia
Japanese Pharmacopoeia
Dr Tsuyoshi Ando, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
Unable to attend: Indian Pharmacopoeia, Ghaziabad, India; and Mexican Pharmacopoeia, Mexico City,
4
Mexico.
xiii
Pharmacopoeia of the Republic of Korea

Dr SangAeh Park and Dr Nam-Hee Kim, Ministry of Food and Drug Safety,
Chungcheongbuk-do, Republic of Korea
State Pharmacopoeia of the Russian Federation
Dr Olga Gubareva and Dr Elena Kovaleva, Federal State Budgetary Institution, Moscow,
Russian Federation
Pharmacopoeia of Ukraine
Dr Maryna Dmitriieva, Ministry of Health, Kharkov, Ukraine
World Health Organization 5

Access to Medicines and Health Products (MHP)
Dr Mariângela Simão, Assistant Director-General
Health Products Policy and Standards (HPS)
Dr Clive Ondari, Director
Norms and Standards for Pharmaceuticals (NSP)
Dr Sabine Kopp, Team Lead, NSP (and Secretary of the ECSPP)
Dr Herbert Schmidt, Technical Officer
Dr Steve Estevão Cordeiro, Consultant
Ms Sinéad Jones, Administrative Assistant
Ms Claire Vogel, Office Assistant
Contraception and Fertility Care (CFC)
Dr Petrus Steyn, Scientist
Medicines Assessment (MED)
Mr Laurence Nzumbu, Technical Officer
Mr Wondiyfraw Zeleke Worku, Technical Officer
Mrs Hua Yin, Technical Officer
Prequalification (PQT)
Mr Deus Mubangizi, Coordinator
Dr Joey Gouws, Team Lead, Inspection Services
Dr Dimitrios Catsoulacos, Technical Officer
Mr Mustapha Chafai, Technical Officer
Ms Stephanie Croft, Technical Officer
Mr Vimal Sachdeva, Technical Officer
Mrs Iveta Streipa, Technical Officer
Dr Matthias Stahl, Team Lead; and Dr Andrew Chemwolo, Technical Officer, Medicines Assessment.
5
xiv
Regulation and Safety (REG)
Mr Hiiti Sillo, Team Lead, Regulatory Systems Strengthening
Dr Alireza Khadem Broojerdi, Scientist
Mr Mohamed Refaat, Technical Officer
Regulatory Convergence and Networks (RCN)
Dr Samvel Azatyan, Team Lead, RCN
Mrs Marie Valentin, Technical Officer
Technical Standards and Specifications (TSS)
Dr Ivana Knezevic, Team Leader, Norms, Standards and Biologicals
Dr Dianliang Lei, Scientist
Report writer
Dr Sian Lewis, London, United Kingdom
Representation from WHO Regional Offices 6

Regional Office for the Americas, Washington DC, USA
Mr Murilo Freitas
Regional Office for the Eastern Mediterranean, Cairo, Egypt
Dr Houda Langar
Dr Adi Al-Nuseirat
Regional Office for South-East Asia, New Delhi, India
Dr Manisha Shridhar
Regional Office for Africa; Regional Office for Europe; and Regional Office for the Western Pacific.
6
xv
Declarations of interest
Declarations of interest made by members of the WHO Expert Committee on
Specifications for Pharmaceutical Preparations and technical advisers are listed below:
Dr H. Abboud, Professor E. Adams, Professor M.D.V. Bermejo Sanz, Dr M. Brits, Professor
T.G. Dekker, Dr V. Dias Sousa, Dr D. Dimas, Professor I. Fradi Dridi, Dr A. García-Arieta,
Mr J. Gaeseb, Ms M. Hirschhorn, Professor E.A. Kaale, Dr A. Krauss, Dr M.Y. Low, Ms G.N.
Mahlangu, Professor J.H.McB. Miller, Mr S. Kisoma, Dr J. Molzon, Dr J. Norwig, Mrs L.
Paleshnuik, Ms H. Park, Dr L. Rägo, Dr C.A. Sánchez González, Dr B. Santoso, Dr D. Sato,
Professor G. Scriba, Dr G.N. Singh, Dr R. Bose, Dr L. Stoppa, Dr J. Sun and Dr M. Xu reported
no conflict of interest.
Dr P. Doerr reported that she provided consultancy services to the Bill and Melinda Gates
Foundation in 2019 and 2020. This disclosure does not constitute a conflict of interest, as
the Foundation does not manufacturer any product relevant to the topic of the meeting.
Professor G.M. Pauletti declared that he had presented collaboration with WHO and the
outcome of a WHO project to the International Pharmaceutical Federation, a non-State
actor in official relations with WHO. This does not present a conflict of interest for this
meeting.
Dr A.J. Van Zyl reported that he has worked as an independent consultant and auditor
to assess compliance with good manufacturing practice for the pharmaceutical industry
and has organized training workshops. This disclosure does not constitute a conflict of
interest as the companies involved do not manufacture any specific product relevant to
the topic of the meeting.
xvi
OPEN SESSION
The open session was attended by ECSPP members and 23 non-State actors.
Due to the pandemic of COVID-19, the open session of the World Health
Organization (WHO) Expert Committee on Specifications for Pharmaceutical
Preparations (ECSPP) meeting was held virtually, prior to the private and closed
sessions, on 6 October 2020.
Introduction and welcome

Dr Clive Ondari, Director, Health Products Policy and Standards (HPS),
welcomed participants to the open session for stakeholders and said that
ECSPP’s aim was to provide information in a transparent way. He highlighted
the value of in-person interactions achieved in open sessions, even if they
are virtual.
Dr Ondari introduced ECSPP’s standard-setting work which covers
quality assurance, regulatory guidance and good practices related to medicines,
the WHO model scheme and quality control specifications.
The first ECSPP was convened in 1947, and its recommendations are
relevant for many parts of WHO, from country and regional offices to other
expert committees and partnerships. As its decisions affect the quality of widely
used medicines, the Expert Committee serves not only WHO Member States but
also many programmes within WHO and other international organizations.
I. Expert Committee on Specifications for Pharmaceutical

Preparations processes and procedures
Dr Sabine Kopp, Team Lead, Norms and Standards for Pharmaceuticals (NSP)
and Secretary of the Expert Committee, briefly described ECSPP processes and
procedures.
Like all WHO expert committees, the ECSPP is governed by strict rules
and procedures which are set out in the WHO Basic Documents. Members
of the ECSPP are selected from the WHO Expert Advisory Panel on The
International Pharmacopoeia and Pharmaceutical Preparations (EAP) on the
basis of their education, background and experience; and following an official
nomination process.
The Expert Committee meets once a year to review NSP’s ongoing
work on quality assurance and control. All norms, standards and guidelines
reviewed by the ECSPP are developed in consultation with the EAP and a wide
range of national and international partners, including national authorities,
international organizations, non-State actors, EAP members, specialists, WHO
collaborating centres, pharmacopoeial authorities and regional and interregional
1
regulatory groups. All texts are also issued for public comment. If the Expert
Committee decides that more work is required, the document returns for
consultation. If it decides that a consensus has been reached, the guideline is
adopted and published as an annex to the Expert Committee’s meeting report
where it becomes WHO technical guidance. The report is then presented by the
WHO Director-General to WHO Member States for implementation.
Dr Kopp emphasized the importance of the ECSPP’s work in developing
robust international norms and standards to support a global approach to dossier
submissions and inspections of manufacturers; standardize critical information
for procurers; promote convergence and collaboration among national regulatory
authorities (NRAs); and enable patients to access safe and effective medicines.
For more information on the ECSPP’s role in developing WHO norms
and standards, see section 1.1.
II. Update on new guidelines, norms and standards

Dr Kopp introduced the latest guidelines, norms and standards adopted by the
ECSPP which were published in the Expert Committee’s fifty-fourth meeting
report. These include 7 :
■■ 13 new and revised general medicines quality assurance and
regulatory guidance texts;
■■ 13 new and revised specifications for active substances and specific
dosage forms;
■■ 2 new and revised general chapters in The International
Pharmacopoeia; and
■■ 6 new International Chemical Reference Substances (ICRS).
III. Technical agenda topics of the Fifty-fifth Expert Committee

on Specifications for Pharmaceutical Preparations
The WHO Secretariat to the ECSPP summarized the topics on the agenda of the
Fifty-fifth ECSPP meeting and provided:
■■ a brief update on WHO’s latest activities to support quality
assurance, regulatory guidance and technical specifications of
pharmaceuticals related to COVID-19 (section 10);
■■ an overview of The International Pharmacopoeia, which provides
analytical methods and specifications for active pharmaceutical
WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-fourth report. Geneva:
7
World Health Organization; 2020 (WHO Technical Report Series, No. 1025; https://www.who.int/
publications-detail/978-92-4-000182-4, accessed 5 October 2020).
2
OPEN SESSION
ingredients (APIs), finished pharmaceutical products (FPPs),

excipients and radiopharmaceuticals (section 5.1);
■■ a list of monographs and other pharmacopoeial texts in development
(sections 5 and 6);
■■ a short summary of draft guidance on good manufacturing practices
and inspection, including on water for pharmaceutical use, and the
inclusion of health-based exposure limits in cleaning validation
(section 7);
■■ a list of key regulatory guidance texts to be discussed by the ECSPP,
including an update on the policy for, and definition of, WHO-listed
authorities (WLAs) (section 9);
■■ an overview of the WHO Biowaiver Project, including what it does,
how it works and its latest results (section 9.1); and
■■ a brief review of the guidance being developed in collaboration
with international partners, including the European Union (EU),
the European Medicines Agency (EMA) and the Pharmaceutical
Inspection Co-operation Scheme (PIC/S) (section 7.1.1), the
International Atomic Energy Agency (IAEA) (section 7.1.2) and the
United Nations Population Fund (UNFPA) (section 8.2).
Dr Kopp emphasized WHO’s commitment in providing a coherent
approach to setting norms and standards and supporting their implementation
so that all Member States benefit from them. The Organization strives to ensure
that all its norms and standards are globally applicable and that they address the
real needs of Member States.
IV. Points of discussion

Dr Ondari invited the participants in the open session to raise queries or
comments about the ECSPP’s work and the proposed agenda for the Expert
Committee’s Fifty-fifth meeting. The three main topics of discussion are
summarized below.
■■ The scope and remit of ECSPP. Asked about the role of the ECSPP
in setting standards for herbal medicines, Dr Kopp confirmed that the
ECSPP provides guidance on the collection and processing of plant
materials used for medicines and on their production and quality
control. The WHO Secretariat works with the WHO Department
of Traditional, Complementary and Integrative Medicine to ensure
that the guidance is relevant and welcomes suggestions for new or
updated guidance as necessary (1 – 6).
3
■■ The accessibility of ECSPP’s work. Participants expressed their

support for the ECSPP and for the open session in raising awareness
and understanding of the Expert Committee’s work. They suggested,
however, that the ECSPP could improve access to its work by
making its working documents more visible and by indicating how
users could find adopted guidance. The WHO Secretariat confirmed
that work is underway to address both these concerns. A new
website is in development that will enable stakeholders to sign up
for email alerts when a new working document is published. An
index of all adopted guidelines is also in development (section 3.3).
■■ ECSPP and COVID-19 activities. When asked how non-State actors
could support the ECSPP in strengthening the Access to COVID-19
Tools (ACT) Accelerator initiative, the WHO Secretariat stressed the
importance of advocacy, widespread promotion of relevant guidance
and pharmacopoeial texts and feedback on further guidance
required. One participant asked whether more monographs relevant
to COVID-19 were planned. The WHO Secretariat answered that
as soon as any new or repurposed medicine has been approved
for use against COVID-19, ECSPP would prepare a monograph, if
one is not publicly available in other pharmacopoeias. The WHO
Secretariat also said that any information that becomes available for
a COVID-19-related monograph would be shared with stakeholders
through the usual channels.
This concluded the open session.
4
PRIVATE AND CLOSED SESSIONS
The private and closed sessions were attended by ECSPP members, technical
advisers, international organizations and State actors.
The Fifty-fifth meeting of the ECSPP was held on 12–19 October 2020. Due
to the COVID-19 pandemic, the meeting was held virtually by Cisco Webex.
To maximize the efficiency of this online format, some agenda items were
covered by correspondence prior to the online sessions.
Opening
The meeting was officially opened by Dr Mariângela Simão, Assistant Director-
General, Access to Medicines and Health Products, on behalf of WHO Director-
General, Dr Tedros Adhanom Ghebreyesus.
After welcoming all participants to the meeting, Dr Simão gave
recognition to the enormous pressure on scientists and health professionals,
as well as politicians, as they strive to bring COVID-19 under control. She
described the range of activities that WHO is undertaking to support the
global effort, including: establishing an independent panel to review global and
national pandemic responses; collating and publishing daily data on the number
of confirmed cases and deaths per country and region in an online dashboard;
producing weekly epidemiological and operational updates; developing country
and technical guidance; providing advice for the public; and leading numerous
initiatives to accelerate research and development of diagnostics, vaccines and
therapeutics, including the international Solidarity trial to collect robust data
from around the world on the most effective treatments for COVID-19.
WHO is also a partner in the newly-launched Access to COVID-19
Tools (ACT) Accelerator to expedite the development, production and equitable
access to COVID-19 tests, treatments and vaccines. Launched at the end of April
2020, this ground-breaking global collaboration brings together governments,
scientists, businesses, civil society, philanthropists and global health organizations
in an effort to speed up an end to the pandemic and to ensure high-level control
of COVID-19 in the medium term. The Accelerator initiative has four pillars
of work: diagnostics, treatments, vaccines and health system strengthening.
For each pillar, a WHO-led Access and Allocation workstream is developing
the principles, frameworks and mechanisms necessary to ensure the fair and
equitable allocation of these tools. For each pillar well-conceived international
norms and standards will remain paramount, as developed by the ECSPP and
other expert committees.
Dr Simão emphasized the importance of norms and standards for
clinical trials or to produce and test the quality of vaccines, therapeutics, medical
devices and diagnostics in ensuring successful outcomes for patients, not only
5
of COVID-19 but of all diseases. She reminded participants that the Director-
General has long identified WHO’s standard-setting activities as a core function
of WHO, saying that he sees the expert committees as the backbone of WHO's
standard-setting process. Earlier in 2020, WHO created a new division under the
Chief Scientist’s Office to streamline and coordinate WHO’s work in this area,
including the work of the NSP Team, led by the Secretary to the ECSPP.
Election of chairpersons and rapporteurs

The ECSPP appointed Dr Petra Doerr as Chair of the meeting, Dr Adrian Krauss
as Co-Chair and Dr Luisa Stoppa and Professor Eliangiringa Amos Kaale as
rapporteurs.
Participation in Expert Committee on Specifications

for Pharmaceutical Preparations meetings
Members of the ECSPP were reminded by correspondence of the rules governing
participation in the ECSPP meeting, to which Expert Committee members and
technical advisers are invited in their personal capacities. In all cases, participation
is by invitation only.
Meetings of the ECSPP adhere to WHO procedures for expert committee
meetings. They comprise three broad types of session:
a. open sessions for sharing information and updates, which are for
non-State actors and members of the EAP, held this year on
6 October 2020, prior to the other ECSPP sessions;
b. private sessions, during which specific monographs, guidelines
and other proposed documents are discussed; these are for ECSPP
members, technical advisers, international organizations and State
actors; and
c. closed sessions, for agreeing to ECSPP recommendations and for

finalization of the report; these are for ECSPP members only.
All decisions of the ECSPP are taken by its Expert Committee members
during a closed session.
The Expert Committee noted the rules.
6
1. General policy
1.1 Process for development of WHO norms and standards
Dr Sabine Kopp described how the World Health Organization (WHO) norms,
standards and specifications for inclusion in The International Pharmacopoeia
(7) are developed and the role of the Expert Committee on Specifications for
Pharmaceutical Preparations (ECSPP). As stated by Dr Mariângela Simão,
developing, establishing and promoting international standards for food and
for biological, pharmaceutical and similar products are part of WHO’s core
mandate (Article 2, WHO Constitution). The activity involves expert committees
established by the WHO World Health Assembly or the Executive Board, which
are governed by set rules and procedures.
The ECSPP is responsible for WHO’s guidance for the quality of medicines
and regulatory standards throughout their life cycle, from development to
delivery. WHO is thus responsible for more than 130 official guidance texts and
guidelines. It works closely with a wide range of partners, including national and
regional authorities and groupings, international organizations, professional and
other associations, non-State actors, quality assurance and regulatory experts,
WHO collaborating centres and pharmacopoeia authorities and secretariats.
Dr Kopp emphasized the critical value of the ECSPP’s work, given the importance
to WHO and the broader United Nations group of ensuring patients’ access to
safe, quality-assured medicines. It features prominently in the UN Sustainable
Development Goals, for example.
All monographs, guidance texts, good practices, model schemes and
guidelines adopted by the ECSPP are developed in response to recommendations
and requests from WHO governing bodies and programmes or in response to
major public health needs. They are widely circulated for public comment (with at
least two rounds of consultation for each document), reviewed by expert groups
and discussed at annual ECSPP meetings before they are adopted by consensus.
In all cases, the norms and standards developed by the ECSPP are intended to:
■■ be ready for adoption into national legislation;
■■ enable collaboration with other authorities;
■■ enable work-sharing (for example, through regional networks); and
■■ enable reliance on decisions from other regulatory authorities and
laboratories.
All decisions taken at the ECSPP’s annual meetings are recorded in
publicly-available meeting reports published in the WHO Technical Report
Series (8).
The Expert Committee noted the process.
7
2. Quality assurance: collaboration initiatives
2.1 International Meeting of World Pharmacopoeias
Members of the ECSPP were updated by correspondence on the latest
International Meeting of World Pharmacopoeias (IMWP). Each pharmacopoeia
addresses a different country or region but all work to protect public health
by creating and making available public standards to ensure the quality of
medicines. They meet each year to share experience and expertise and find ways
to synchronize their work.
The Eleventh IMWP, in February 2020, was hosted by WHO and the
European Directorate for the Quality of Medicines & HealthCare (EDQM) in
Strasbourg, France. National and regional pharmacopoeial authorities at the
meeting strengthened their cooperation by agreeing on a new framework for
exchanging information within the Pharmacopoeial Discussion Group (PDG).
The framework, which will be trialled for a year, lays out new modalities for
cooperation and is expected to improve information exchange within the Group.
Participants of the IMWP also adopted a white paper on the added value
of pharmacopoeial standards for public health which will be published by WHO
on the world pharmacopoeias’ behalf. Other results of the meeting were:
■■ an exchange of information on the pharmacopoeias’ responses to
the N-nitrosamine contamination of medicines;
■■ the issuance of a global pharmacopoeial alert to ensure rapid
discussion and collaboration among pharmacopoeias in response to
the COVID-19 pandemic (section 10.2.2);
■■ the launching of a WHO-hosted website and file-sharing platform
for world pharmacopoeias to exchange knowledge and work
together more effectively; and
■■ an agreement to meet more frequently.
The next IMWP meeting was to be hosted by the Mexican Pharmacopoeia

in Mexico City, Mexico, in February 2021 but will now be held virtually, in view
of the COVID-19 pandemic. More information is available at: https://www.
who.int/teams/health-product-and-policy-standards/pharmacopoeia/world-
pharmacopoeias.
The Expert Committee thanked the EDQM for hosting the Eleventh
IMWP, expressed its support for the IMWPs and encouraged WHO to continue
serving as the secretariat for those events. It noted, in particular, the value of the
global pharmacopoeial alert and its work to address questions on the quality of
therapeutics in response to COVID-19. The Expert Committee also encouraged
WHO and its pharmacopoeial partners to publish articles about both the alert
and the broader IMWP in open-access peer-reviewed journals.
8
3. Nomenclature, terminology and databases
3.1 International nonproprietary names for
pharmaceutical substances
Members of the ECSPP were updated by correspondence on WHO’s latest
work on international nonproprietary names (INNs) which serve to identify
pharmaceutical substances or APIs. WHO collaborates with INN experts and
national nomenclature committees in choosing a single name that is acceptable
worldwide for each active substance to be marketed as a pharmaceutical. Since
the turn of the century, increasing globalization and rapid scientific and technical
development have fuelled a rapid rise in the number of new biological products
that are developed and approved for use. This trend, which is expected to
continue, is reflected in the growing number of INN requests received each year,
which rose from around 150 in 2000 to nearly 350 in 2020.
Four activities were highlighted:
■■ INN consultations. Every year, a global INN consultation is
convened to discuss proposals for new INNs and any objections to
existing ones. This year, an additional ad hoc meeting was held to
consider INNs for medical substances pertinent to the COVID-19
pandemic. Of 30 INN requests submitted, 23 were for biological
substances (including 13 monoclonal antibodies) and seven for
chemical substances. One request was withdrawn; INNs were
selected for the other 29.
■■ Improving INNs for cell therapy. The INN cell therapy application
form has been revised to elicit more information on the substance,
for substances claimed to be stem cells and for those claimed to be
stromal cells. In recognition of the importance of harmonizing cell
definitions, a white paper covering regulatory issues for advanced
therapies is being drafted, to be shared with all regulators.
■■ School of INN (SoINN). This virtual school, available at https://
extranet.who.int/soinn, promotes INNs as a central theme in
teaching and learning for all health professionals. The school offers
online webinars and courses in the science of nomenclature of
pharmaceutical substances and also publications to raise awareness
about the INN programme in the scientific and educational
community. Since its launch in October 2019, the website has
been visited by nearly 3,000 unique visitors. Work is underway to
translate courses into Chinese, French and Spanish.
■■ “Stem in a pill”. The aim of this School of INN project is to review all
stems in a pill and to categorize them into pharmacological classes.
9
It is progressing slowly, with only 14 classes completed so far. The

project would benefit from more input from experts in clinical
pharmacology.
More information is available at: https://www.who.int/medicines/services/inn
The Expert Committee noted the update.
3.2 Quality assurance terminology

Members of the ECSPP were reminded by correspondence that all the terms
and definitions used in ECSPP norms, standards, guidelines and reports are
published in the Quality Assurance of Medicines Terminology Database (9). This
database, which is updated every year, is intended to harmonize the terminology
and prevent any misunderstanding that may arise from different interpretations
of terms. More information is available at: https://www.who.int/publications/m/
item/quality-assurance-of-medicines-terminology-database.
The Expert Committee noted the latest update of the database and
encouraged the WHO Secretariat to continue updating the database annually.
3.3 Guidelines and guidance texts adopted by the Expert

Committee on Specifications for Pharmaceutical Preparations
Members of the ECSPP were updated by correspondence on WHO’s work to
consolidate all the guidelines and guidance texts adopted by the ECSPP. Until
now, each adopted guideline has been published as an annex to the relevant
annual ECSPP report. They are also available as a collection of norms and
standards on the WHO website (10), where they are categorized into six broad
topics: development, distribution, inspections, regulatory standards, production,
quality control and prequalification. More than 130 ECSPP-endorsed guidelines,
standards and good practices are also reproduced in the e-publication, Quality
assurance of pharmaceuticals 2019 (11). Both the website and the e-publication
are being transferred to new systems and formats.
In 2020, following a request from WHO partners and donors, a full
updated list of current ECSPP-adopted guidelines, standards and good practices
was drawn up under the six categories used on the WHO website. The list is
intended to encourage broader implementation of WHO norms and standards.
Members of the ECSPP agreed, by correspondence, that the new list
could be useful but expressed some reservations about whether it was ready for
publication. They made several suggestions for improvements.
The Expert Committee noted the update and agreed that the new list
should be integrated into the ECSPP report (Annex 1).
10
4. Quality control – national laboratories
4.1 External Quality Assurance Assessment Scheme
Members of the ECSPP were updated by correspondence on activities in the
External Quality Assurance Assessment Scheme (EQAAS) which offers a
platform for pharmaceutical quality control laboratories (PQCLs) to measure
their performance in a confidential system of blind testing.
Organized by WHO with assistance from EDQM, EQAAS has been
evaluating the technical performance of PQCLs since 2000. This proficiency
testing scheme serves to: demonstrate the reliability of laboratory analytical
results objectively, independently verify a laboratory’s competence, establish
mutual confidence with collaborating networks and support continuous
improvement in performance.
EQAAS is run according to international standards for proficiency
testing set by the International Organization for Standardization (ISO) and the
International Electrotechnical Commission (IEC). Since the Scheme started,
laboratories in all six WHO regions have participated in more than 1,100 studies,
with 33 tests.
4.1.1 Final report on phase 9

The 43 participants in phase 9 of the EQAAS (from all WHO regions) were
asked to complete three procedures, with chewable mebendazole tablets as the
common test sample. Most of the laboratories passed the tests, which were well
designed, and the results obtained were subject to sound statistical evaluation.
■■ Test 1: laboratories were asked to determine in triplicate the
percentage content of mebendazole using liquid chromatography.
Three laboratories reported unacceptable results.
■■ In test 2, they were asked to confirm the polymorphic form of
mebendazole by infrared absorption spectrophotometry. Five
laboratories reported a wrong result and nine did not report a result.
■■ Test 3 comprised conducting the dissolution test and determining
the percentage of mebendazole released after 60 minutes. Seven
laboratories reported unsatisfactory results and five did not report
a result.
Laboratories that provided acceptable results were encouraged to use
the EQAAS as a stimulus for continuous improvement. Laboratories that failed
a test were asked to investigate the root cause and to use the results to inform
targeted action plans and training as necessary. They were invited to take
part in a post-EQAAS phase 9 assistance programme to support laboratories
11
in identifying and investigating problems of quality and to take corrective

or preventive action to prevent their recurrence. Four laboratories chose to
participate. More information on phase 9 of the EQAAS and the assistance
programme is to be published in the journal WHO Drug Information.
The Expert Committee noted the update and encouraged WHO to
continue the EQAAS in support of national and regional PQCLs, including
continuing the post-assessment assistance programme.
4.1.2 Update on phase 10

Three procedures have been confirmed for the EQAAS phase 10:
■■ Test 1 is to assay by means of a complexometric titration, using zinc
sulfate dispersible tablets.
■■ Test 2 is to perform a disintegration test on zinc sulfate dispersible
tablets.
■■ Test 3 is to conduct counter-ion identification testing using two
blinded zinc salt samples to identify which sample is zinc sulfate.
12
5. Quality control – specifications and tests
5.1 The International Pharmacopoeia
Dr Herbert Schmidt, Technical Officer, NSP, presented an overview of The
International Pharmacopoeia (1) which is a collection of quality specifications for
pharmaceutical substances and dosage forms, together with supporting general
methods of analysis. The collection, which is free to use, serves as source material
for reference or adaptation by any WHO Member State that wishes to establish
pharmaceutical requirements. It provides the means for national quality control
laboratories, procurers and public pharmacies to independently check the quality
of a medicine at any time during its shelf life.
The International Pharmacopoeia provides standards for essential
medicines for meeting global public health priorities. It therefore includes
mainly medicines that are on the WHO Model List of Essential Medicines, are
the subject of invitations to submit an expression of interest for prequalification,
or are recommended by WHO and United Nations programmes on specific
diseases. The International Pharmacopoeia is developed in collaboration with
laboratories and expert groups and in consultation with stakeholders. The
process for preparing monographs, which is governed by publicly available rules
and procedures, is designed to ensure complete transparency and to enable the
participation of all interested parties. Before its inclusion in the collection, each
monograph must be formally adopted by the ECSPP.
First published in the 1950s, The International Pharmacopoeia will be
available in its 10th edition in 2020 as a digital publication on the WHO website
and on USB memory sticks. The 10th edition will contain five new texts, 10
revised texts and one corrected text, as agreed by the Fifty-fourth ECSPP in 2019.
They include two monographs on sofosbuvir and sofosbuvir tablets, which are
the first public standards to be made available for these medicines. Two texts
have been removed. The 10th edition was prepared with strong support from
ECSPP experts, EDQM, WHO collaborating centres, collaborating laboratories
and organizations, the ICRS Board and many WHO colleagues.
The 10th edition of The International Pharmacopoeia contains 373
monographs on pharmaceutical substances, 150 monographs on specific dosage
forms, 8 monographs on general dosage forms and 71 methods of analysis.
5.2 General chapters

5.2.1 Dissolution test for oral dosage forms
The ECSPP was asked to consider revisions to the general chapter on a dissolution
test for solid oral dosage forms (chapter 5.5) in The International Pharmacopoeia
to include a section on analysis of suspensions and powders for suspension.
13
The existing chapter is based on the corresponding internationally harmonized

text by the PDG; the proposed amendment is specific to The International
Pharmacopoeia and is not part of the PDG text.
The proposed revision was discussed in May 2020 at an informal
consultation on Screening Technologies, Laboratory Tools and Pharmacopoeial
Specifications for Medicines and was sent for public consultation in July–
August 2020.
The ECSPP discussed the revised chapter, noting that the current draft of
the monograph covers only oral suspensions and powders for oral suspension.
It commented that it should be extended to include granules for oral suspension.
The Expert Committee adopted the revised chapter, subject to the
changes discussed.
5.2.2 General identification tests

The ECSPP was asked to consider revisions to the chapter on general identification
tests (chapter 2.1) in The International Pharmacopoeia to avoid the use of
harmful reagents. The revisions follow a recommendation made at the informal
Specifications for Medicines in May 2020. They build on previous work to avoid
harmful reagents in methods of analysis in The International Pharmacopoeia,
including revisions to replace mercury salts in non-aqueous titration (chapter
2.6) and to replace chromium (VI) salts in the colour of liquids (chapter 1.11).
The Expert Committee discussed the revision, including comments
received during the public consultation, and adopted the revised chapter.
5.2.3 Test for histamine-like substances

The ECSPP considered a proposal to remove the test for histamine-like substances
(vasodepressor substances, chapter 3.6) from The International Pharmacopoeia,
and all references to the test in individual monographs. Thus, references to the
test would be deleted in monographs on bleomycin sulfate and spectinomycin
hydrochloride, and references to the test in the monograph on streptomycin
sulfate would be replaced by the statement: “streptomycin sulfate is produced by
methods of manufacture designed to eliminate or minimize substances lowering
blood pressure”.
This proposal follows a recommendation made at the informal
Specifications for Medicines in May 2020 and is in line with the ECSPP’s overall
strategy to phase out animal testing where possible and justified (the test for
vasodepressor substances is performed on cats).
The proposed revisions to The International Pharmacopoeia were sent
out for public consultation in August–September 2020.
14
Quality control – specifications and tests
The ECSPP reviewed the revisions and discussed whether, in

monographs on aminoglycosides, the test should be replaced by a statement
that the described substance should be produced by methods of manufacture
designed to eliminate or minimize substances that lower blood pressure.
The Expert Committee agreed to omit chapter 3.6 from The
International Pharmacopoeia and all references to the test for histamine-like
substances (vasodepressor substances) in specific monographs. It further
agreed that a small group of experts should provide advice on the statement
for manufacturers.
5.3 General monographs for dosage forms

5.3.1 Powders for inhalation
The ECSPP was asked to consider a new general chapter on powders for
inhalation for inclusion in The International Pharmacopoeia. The chapter,
which was drafted in early 2020, is based on the chapters on preparations
for inhalation in the European and Japanese pharmacopoeias which were
harmonized bilaterally.
The first draft was discussed at the informal consultation of experts on
Screening Technologies, Laboratory Tools and Pharmacopoeial Specifications
for Medicines in May 2020 and sent for public consultation in July–August 2020.
The draft has been revised to address all the comments made.
The Expert Committee adopted the monograph.
5.3.2 Liquid preparations for oral use

The ECSPP was asked to consider a revision to the general monograph on liquid
preparations for oral use in The International Pharmacopoeia to comply with the
new section on suspension and powders for suspension in the dissolution test
for oral dosage forms (chapter 5.5).
As the revision was required as a consequence of the adopted revisions to
the dissolution test for oral dosage forms, it was not sent for public consultation.
The ECSPP discussed the revision, noting that it should include a
requirement for compliance with the dissolution test for oral dosage forms for
powders and granules for oral suspension.
The Expert Committee adopted the revised monograph, subject to the
changes discussed.
15
5.4 Specifications and draft monographs for medicines, including

paediatric medicines, and candidate medicines for COVID-19
5.4.1 COVID-19 therapeutics
Many medicines currently being investigated for the treatment of COVID-19 are
repurposed. While investigations continue, in order for any medicine to be safe
and efficacious, it must be of assured quality for its intended use. Pharmacopoeial
monographs support objective assessment of the quality of medicines by
providing methods, acceptance criteria and supporting information.
Dexamethasone sodium phosphate

Dexamethasone phosphate injection
The ECSPP was asked to consider a revision to the monographs on dexamethasone
sodium phosphate and dexamethasone phosphate injection, to change prescription
of dexamethasone sodium phosphate ICRS to prescription of dexamethasone
phosphate ICRS. Dexamethasone phosphate is considered to be less hygroscopic
and should therefore be a more suitable quantitative reference substance.
The change was proposed during discussions with the custodial centre
for ICRS, the EDQM and has been agreed by the ICRS Board. It was further
discussed at the informal consultation on Screening Technologies, Laboratory
Tools and Pharmacopoeial Specifications for Medicines in May 2020, where
participants agreed to the revision and recommended its submission to the
ECSPP without public consultation.
The ECSPP discussed both monographs and agreed to correct an error
in the name of the new reference substance in the text of one of the monographs.
The Expert Committee adopted the revised monographs, subject to
the change discussed.
Remdesivir
Remdesivir intravenous infusion

The ECSPP was asked to consider the inclusion of two new monographs,
on remdesivir and remdesivir intravenous infusion, in The International
Pharmacopoeia. The proposed monographs would be the first public specifications
for remdesivir API and FPP and, as such, are expected to play an important
role in ensuring access to safe, effective and quality-assured medicines in the
treatment of COVID-19.8 Based on information submitted by manufacturers, the
proposed monographs were drafted in September 2020.
Subsequent to the Fifty-fifth ECSPP meeting, the WHO issued a conditional recommendation on
8
20 November 2020 against the use of remdesivir in COVID-19 patients: https://www.who.int/news-
room/feature-stories/detail/who-recommends-against-the-use-of-remdesivir-in-covid-19-patients,
accessed 29 January 2021.
16
Laboratory investigations are due to start soon; and both monographs

are scheduled to be sent for public consultation at the end of 2020 or beginning
of 2021. After the public consultation, the draft monographs and the comments
received will be discussed in May 2021 at the informal consultation on
for Medicines before it is finalized.
The ECSPP discussed various aspects of the monographs, including
potential alternative methods to verify the identity of remdesivir and to
determine its purity and content. The Expert Committee suggested the need
to consider recommended storage conditions. It also encouraged the WHO
Secretariat to develop a public standard on remdesivir sterile concentrate.
The Expert Committee adopted the monographs, subject to finalization
by a group of experts in line with the proposed next steps.
5.4.2 Antiviral medicines, including antiretrovirals

Dolutegravir sodium
Dolutegravir tablets
In 2018, the ECSPP was asked to consider inclusion of new monographs on
dolutegravir sodium and dolutegravir tablets in The International Pharmacopoeia.
The proposed monographs would be the first public standards for dolutegravir
and would therefore be expected to be important in ensuring access to safe,
effective, quality-assured antiretrovirals.
In 2019, the ECSPP discussed the proposed texts for both monographs
which had already been through a round of informal consultation with experts
and public consultation. Since that meeting, the monographs on dolutegravir
sodium and dolutegravir tablets have been refined further, following laboratory
investigations and discussion at the informal consultation of experts on
for Medicines in May 2020. Further laboratory investigations are underway for
both. Once these are completed, both monographs will be subject to a second
public consultation.
The Expert Committee agreed with the next steps and adopted both
monographs, subject to finalization by experts after an additional round
of public consultation. Should major comments be received during the
consultation, the monograph should be resubmitted to the ECSPP at its
meeting in 2021.
17
Zanamivir
Zanamivir powder for inhalation, pre-metered
Draft monographs on zanamivir and zanamivir powder for inhalation, pre-
metered, were proposed for inclusion in The International Pharmacopoeia. Both
monographs are based on submissions from a manufacturer and on laboratory
investigations. In order to align the tests and specifications with those of other
pharmacopoeias as closely as possible, the monograph on zanamivir powder
for inhalation, pre-metered, was prepared in partnership with The British
Pharmacopoeia, while the monograph on zanamivir drew on information in
existing monographs.
The two draft monographs were discussed at the informal consultation
on Screening Technologies, Laboratory Tools and Pharmacopoeial Specifications
for Medicines in May 2020 and sent for public consultation in July–September
2020. Laboratory investigations are underway for both, and the results and any
further revisions will be discussed at the informal consultation in May 2021.
The ECSPP discussed various aspects of the draft monographs, including
the methods prescribed to determine the water content of zanamivir.
The Expert Committee adopted the monographs, subject to finalization
by experts, in line with the proposed next steps. Should major comments be
received during the consultation, the monograph should be resubmitted to
the ECSPP at its meeting in 2021.
5.4.3 Medicines for tropical diseases

Albendazole chewable tablets
A revision to the monograph on albendazole chewable tablets was proposed
in response to information received from a manufacturer. In particular, the
proposal is to revise the test for dissolution by recommending use of different
dissolution media for different dosage strengths.
The proposed revision was discussed at the July 2020 meeting of the
Working Group on albendazole for The International Pharmacopoeia and verified
by laboratory testing. It was then drafted and sent for public consultation in
July–August 2020. After further laboratory investigations conducted in August–
October 2020, additional modifications to the test for dissolution were proposed.
The monograph on albendazole will be revised in line with
recommendations from the Fifty-fourth ECSPP in 2019, and the new monograph
on albendazole tablets is being prepared.
The Expert Committee adopted the revised monograph on albendazole
chewable tablets, subject to finalization by experts after an additional round of
public consultation. Should major comments be received during consultation,
the monograph should be resubmitted to the ECSPP at its meeting in 2021.
18
Ivermectin tablets
ECSPP members were asked to consider a revision to the monograph on
ivermectin tablets to align quantitative determination of the finished product
monograph with the provisions in the API monograph.
The proposed change emerged from discussions with the custodial centre
for ICRS, the EDQM, and has been agreed by the ICRS Board. It was further
discussed at the informal consultation on Screening Technologies, Laboratory
Tools and Pharmacopoeial Specifications for Medicines in May 2020, where
participants agreed to the revision and recommended that it be submitted to the
ECSPP without public consultation.
The Expert Committee adopted the revised monograph.
5.4.4 Medicines for maternal, newborn, child and adolescent health

Norethisterone enantate
Norethisterone enantate injection
The ECSPP was asked to consider a revision of the monograph on norethisterone
enantate and to adopt a new monograph on norethisterone enantate injection
on the basis of a submission from a manufacturer and laboratory investigations.
The draft revisions and new text were first proposed in June 2017 by a
collaborating laboratory. Since then, they have been sent for public consultation
(July–September 2017), presented at three ECSPP meetings (2017, 2018 and
2019), further revised and discussed at three informal consultations on Screening
Technologies, Laboratory Tools and Pharmacopoeial Specifications for Medicines
(2018, 2019 and 2020). A fourth draft of revisions includes the results of the latest
rounds of discussion and laboratory investigations.
The ECSPP provided feedback on the current versions of both
monographs and noted that laboratory investigations are still underway.
The Expert Committee noted the progress made and requested that
both monographs be resubmitted for possible adoption at the ECSPP meeting
in 2021.
Estradiol valerate and norethisterone injection

A draft monograph on estradiol valerate and norethisterone injection was
proposed for inclusion in The International Pharmacopoeia. The methods and
specifications in the monograph are based on a submission from a manufacturer
and on laboratory investigations.
The proposed draft was received in September 2018 and presented to
the ECSPP meeting in 2018. It was subsequently discussed by the ECSPP in
October 2019 and at two informal consultations on Screening Technologies and
19
Pharmacopoeial Specifications for Medicines in 2019 and 2020. After laboratory

investigations, the monograph will be sent for public consultation.
The Expert Committee noted the progress made and requested that
the monograph be resubmitted for possible adoption at its meeting in 2021.
5.4.5 Excipients
Sodium starch glycolate
Sodium laurilsulfate
Hydroxypropylcellulose, low-substituted
Three draft monographs for excipients were presented at the ECSPP for possible
inclusion in The International Pharmacopoeia: on sodium starch glycolate,
sodium laurilsulfate and hydroxypropylcellulose, low-substituted. All three texts
are based on monographs developed by the PDG, with editorial modifications
to bring them in line with the house style of The International Pharmacopoeia.
The monographs were sent for public consultation in August–October
2020 and the comments received are due to be discussed at the next informal
Specifications for Medicines, in 2021.
The proposal to include the excipient monographs is part of ongoing
efforts to benefit from PDG’s offer to publish general chapters and monographs
in The International Pharmacopoeia (with due recognition of the source) and so
promote broader use of global quality standards. The International Pharmacopoeia
has already accepted several chapters, including on the dissolution test for oral
dosage forms.
The Expert Committee adopted all three monographs, subject to
their finalization by experts. It asked the WHO Secretariat with developing
a concept for future work on excipient monographs in The International
Pharmacopoeia, considering the need for such monographs from a public
health perspective and addressing known deficiencies in quality. The concept

note should include ways to harmonize specifications on excipients with
those in other pharmacopoeias.
5.5 Update on the virtual informal consultation on Screening

Technologies, Laboratory Tools and Pharmacopoeial
Specifications for Medicines
ECSPP members were updated by correspondence on the annual informal
Specifications for Medicines which took place in May 2020. This year, due
to the COVID-19 pandemic, the consultation was held as a series of virtual
meetings. At the consultation, 17 international experts were updated on the
20
44 monographs and general texts under development for The International

Pharmacopoeia. The experts discussed draft proposals and reports of laboratory
investigations; and provided guidance on future work.
21
6. Quality control: international reference materials
6.1 Update on International Chemical Reference Substances
The ECSPP subgroup on ICRS updated members of the Expert Committee on
ICRS activities by correspondence.
ICRS are used to identify and determine the purity or assay of
pharmaceutical substances and preparations or to verify the performance of test
methods. The EDQM has been the custodial centre for ICRS since 2010 and is
responsible for establishing, storing and distributing ICRS.
Since the latest meeting of the ECSPP, in October 2019, the ICRS Board
has released the following chemical reference substances, established by the
EDQM for use according to the provisions of The International Pharmacopoeia:
■■ estradiol valerate ICRS, batch 1; and
■■ moxifloxacin hydrochloride ICRS, batch 1.
Some of EDQM’s achievements in relation to ICRS in 2019 include
completing four ICRS establishment reports for WHO (three of which were
adopted) and monitoring 22 standards for continuous fitness for purpose (with
no significant findings on quality).
The WHO Secretariat thanked EDQM for its work in establishing,
storing and distributing ICRS and for providing guidance and support to
primary standards; the ICRS Board for reviewing the reports and releasing the
ICRS; and the collaborating laboratories for participating in collaborative trials
to determine the assigned content.
The Expert Committee noted the report and confirmed the release
of estradiol valerate ICRS, batch 1 and moxifloxacin hydrochloride ICRS,
batch 1.
22
7. Quality assurance: good manufacturing
practice and inspection
7.1 Inspection guidelines and good practices
with partner organizations
7.1.1 Revision of good manufacturing practices for sterile products
Members of the ECSPP were updated by correspondence on the progress in
revising the WHO good manufacturing practices for sterile pharmaceutical
products (12), which has continued since 2017. The work is performed in
collaboration with the EU, the EMA, PIC/S and WHO to align standards across
the world. The establishment of a common language is expected to benefit
authorities and manufacturers, save resources and, ultimately, improve patients’
access to good quality medicines.
The revised guidance has new sections on scope, utilities, environmental
and process monitoring and introduces the principles of quality risk management
to allow for the inclusion of new technologies and innovative processes.
First drafted at the end of 2017, it was revised internally and sent for public
consultation between December 2017 and March 2018. The public consultation
resulted in 6,200 comments from more than 140 companies and organizations
which were used to make further revisions to the guidance, approved by the
Inspection Working Group at the EMA in November 2019.
At its Fifty-fourth meeting, the ECSPP commended the work to
harmonize guidance on sterile products but, given the extent of the changes
made to the document in 2019, called for a second public consultation before
consideration of the guidance for adoption by WHO. In February 2020, WHO
sent the latest version of the guidance for consultation in parallel with a targeted
consultation led by the EU. The 318 comments received were reviewed by a
WHO-convened international working group and recommendations for action
were shared with the PIC/S-EMA drafting group. The EU consultation closed
in July 2020 and the comments received are still being reviewed by the EU and
EMA. The suggested actions by both the WHO- and the EU-led processes will
be considered to finalize the guidance.
The Expert Committee noted the progress report and expressed its
support for continued collaboration with the EU, EMA and PIC/S to harmonize
guidance on sterile products. It asked for a revised guideline to be presented, if
feasible, for possible adoption at its next meeting in 2021.
7.1.2 Good manufacturing practices for

radiopharmaceuticals for investigational use
Members of the ECSPP were updated by correspondence on the development
of good manufacturing practices (GMP) guidelines for radiopharmaceuticals by
23
the IAEA and WHO. In late 2019, the ECSPP adopted the International Atomic
Energy Agency and World Health Organization guideline on good manufacturing
practices for radiopharmaceuticals (13), subject to finalization by a small group of
experts. The final version was shared with ECSPP members before its inclusion
in the fifty-fourth ECSPP meeting report.
The newly adopted guideline covers compounding and dispensing of
radiopharmaceuticals, representing one part of IAEA and WHO work to update
broader guidance on GMP for radiopharmaceuticals, as recommended by IAEA
experts in early 2018. The other two areas are investigational radiopharmaceuticals
and cold kits used in industrial radiopharmaceutical production.
In June 2020, at a virtual meeting of experts, IAEA and WHO decided to
focus first on a guideline on GMP for radiopharmaceuticals for investigational
use. A working group has been formed to agree on a structure for the guideline
and to start drafting the text. The group is scheduled to meet, virtually or face-to-
face as appropriate, at the end of October 2020.
7.2 Approaches to carryover limits in cleaning validation

ECSPP member, Dr Adriaan J. Van Zyl, presented a new draft of points to
consider when including health-based exposure limits (HBELs) in cleaning
validation, as recommended by the Fifty-fourth ECSPP in 2019.
Updating of the WHO guidance on validation and its seven appendices
started in 2013. The main text and six appendices have now been revised and
adopted by the ECSPP. The appendices are those on validation of heating,
ventilation and air-conditioning systems (14); validation of water systems for
pharmaceutical use (15); validation of analytical procedures (16); validation
of computerized systems (17); guidelines on qualification (18); and validation of
non-sterile processes (19). Updating of the appendix on cleaning validation
(20) was discussed during the informal consultation on Good Practices for the
Manufacture and Inspection of Health Products in July 2019 and presented at
the ECSPP meeting in October 2019. Much of the discussion at both meetings
was on the methods for establishing limits for carryover in safe cleaning as
these limits are important for assessing the risk of whether a dedicated facility is
required and also to prevent cross-contamination in shared facilities.
The Fifty-fourth ECSPP agreed that guidelines for inspectorates and
manufacturers should be harmonized and considered whether HBELs should
be included in WHO guidelines where appropriate. After a discussion, the
Expert Committee recommended that, first, a text be written to introduce
the topic and its complexities and to establish common understanding in this
area before potentially including the concept as a requirement in international
guidelines.
24
Quality assurance: good manufacturing practice and inspection
During the past year, the WHO Secretariat has coordinated preparation
of a document presenting the main points to be considered in reviewing the
current status of and approaches to cleaning validation in multi-product
facilities and a science-based approach to establishing safe carryover limits.
The document covers documentation, equipment, cleaning agents, sampling,
cleanability studies, risk management, guidance for setting HBELs, acceptance
criteria, analytical procedures, data integrity, cleaning verification, visual
inspection, cleaning capability, personnel, quality metrics and life cycle.
The draft document was sent for public consultation in May–June 2020
and the draft, and the more than 450 comments received, were discussed by an
expert group of inspectors during the virtual meetings that replaced the planned
consultation on Good Practices for the Manufacture and Inspection of Health
Products in August 2020. The expert group recommended that consideration
and application of HBELs should extend beyond cleaning validation and
urged the ECSPP to consider extending the inclusion of HBELs and their
implementation to relevant GMP guidelines.
A second public consultation generated approximately 200 comments
which were reviewed by an expert working group and used to further refine the
draft document. The main comments addressed definitions of terms (including
point of departure and verification), established cleaning limits, selection
of cleaning agents, sampling, HBEL setting, quantification of visually clean
criteria and calculation of cleaning capability. There were several requests for
editorial changes and a request to remove the section on quality metrics and key
performance indicators.
The ECSPP noted the work that had been involved in finalizing
the document in view of its anticipated large impact on pharmaceutical
manufacturers and inspectors. It reviewed the latest draft document and
suggested use of the term “qualified expert” rather than “qualified person” in the
guidance for setting HBELs. The Expert Committee also suggested that a list of
abbreviations be added.
The Expert Committee adopted Points to consider when including
health-based exposure limits in cleaning validation (Annex 2), subject to the
changes discussed. It recommended that the existing cleaning validation
guideline be opened for review and updated in accordance with the latest
good practices.
7.3 Water for pharmaceutical use

Dr Adriaan J. Van Zyl and Dr Sabine Kopp reported on the revision of WHO good
manufacturing practices: water for pharmaceutical use (21), as recommended by
the ECSPP in 2020, to integrate the WHO guideline on Production of water for
injection by means other than distillation (22).
25
Recently, after extensive consultation with stakeholders, several

pharmacopoeias have adopted revised monographs on water for injection that
include production by non-distillation techniques, such as reverse osmosis. In
2017, the ECSPP recommended that the WHO Secretariat collect feedback on
whether the WHO specifications and GMP on water for injection should be
revised and how. After discussion in several consultations, the ECSPP agreed that
the monograph on water for injection in The International Pharmacopoeia and
the WHO guideline on water for pharmaceutical use both be revised to include
technologies other than distillation for the production of water for injection.
A guideline on the production of water for injection by means other
than distillation was drafted in early 2019 and, after two rounds of expert and
public consultations and revision, was adopted by the ECSPP in October 2019.
In early 2020, a proposal was drafted for revising the WHO good manufacturing
practices: water for pharmaceutical use to incorporate the newly adopted
guideline. The proposed revision was sent to stakeholders, including the EAP,
and sent for public consultation in May 2020. The text and more than 360
comments received were discussed at a virtual meeting of inspectors in August
2020, in lieu of the annual consultation on Good Practices for Health Products
Manufacture and Inspection. The text was then revised and sent out again for
feedback, including to the EAP and the public. This consultation generated
approximately 140 comments which were reviewed by an expert working group.
The comments received included requests to expand the section on stages of
qualification; address minimizing contamination rather than preventing it;
delete water quality specifications for other grades of water; clarify operational
considerations under the three-phased approach to validation; and make several
editorial changes. The text was revised accordingly and presented to the ECSPP.
The ECSPP acknowledged the importance of the document and thanked
all those involved in reviewing and revising it. It discussed the latest changes and
made suggestions for minor revisions.
The Expert Committee adopted the revised WHO good manufacturing

practices: water for pharmaceutical use (Annex 3).
7.4 Guideline on data integrity

Dr Adriaan J. Van Zyl informed ECSPP members on the development of a
new guideline on data integrity intended to replace the WHO Guidance on
good data and record management practices (23) which is considered to be
too lengthy, especially in comparison with the texts of many other agencies
that have been adjusted recently to better reflect current expectations and
focus on necessary information. The new guideline, which was recommended
by the Fifty-fourth ECSPP in 2019, covers 10 main areas: data governance,
quality risk management, management review, outsourcing, training, data, data
26
integrity, good documentation practices, computerized systems, and corrective

and preventive actions. It includes an annex with 10 examples of data integrity
management, from quality risk management to data entry, changes and controls.
A first draft of the new guideline was sent to stakeholders, including
the EAP, and sent for public consultation between November 2019 and January
2020. The text, and more than 440 comments received, were discussed at a virtual
meeting of inspectors in June 2020 which replaced the annual consultation
on Good Practices for Health Products Manufacture and Inspection. The text
was then revised and sent out again for feedback, including to the EAP and the
public. The WHO Secretariat received approximately 650 comments during
this second consultation. The suggestions were to reorganize the introduction;
add information on data governance, data transfer and computerized systems;
extend the section on controls in quality risk management; clarify management
review systems and action in case of noncompliance; add a new section on data
review and approval; refine some of the examples; and make several editorial
changes. The text was revised accordingly for presentation to the ECSPP. Some
new definitions were added to the glossary and others were revised.
The ECSPP reviewed the latest changes and discussed issues including
compliance with data protection legislation and best practices, timeframes for
retaining data and requirements on data transfer. It also discussed the scope
of the document, such as the value of including vector control products and
data on safety and efficacy generated in clinical research under good clinical
practice. ECSPP members therefore proposed new wording for the scope and
suggested adding the term “medical products” to the glossary. Overall, the
Expert Committee expressed strong support for the new guideline on data
integrity, commenting that it is comprehensive and much improved. ECSPP
members agreed that the new guideline will be of great value to industry and
inspectors and thanked all those involved in collating, reviewing and integrating
the hundreds of comments received.
The Expert Committee adopted the Guideline on data integrity
(Annex 4), subject to the changes discussed.
7.5 Points to consider for manufacturers and inspectors:

environmental aspects of manufacturing for
the prevention of antimicrobial resistance
Members of the ECSPP were updated by correspondence on activities for the
prevention of antimicrobial resistance (AMR) in manufacturing and inspection.
Against a backdrop of rising global concern about AMR, the ECSPP, at its meeting
in October 2019, adopted a document outlining points for manufacturers and
inspectors to consider in preventing AMR (24). It recommended that WHO
conduct a survey of pharmaceutical manufacturers that are engaged in synthesis
27
and/or production of antimicrobials to collect information on current waste

and wastewater management practices and to verify correct implementation of
the recommendations in the newly adopted document (18). WHO developed
a survey and sent it to 39 manufacturers of APIs that are part of the WHO
Prequalification (PQ) Programme. A total of 29 manufacturers completed the
survey and the NSP and PQ teams collated and analysed their responses.
ECSPP members were given an overview of the findings, as follows:
■■ 89% of respondents showed a basic understanding of WHO
requirements on waste management and AMR by agreeing that
antimicrobials should not be released into water streams or, if they
are, only at concentrations within established limits.
■■ 62% of respondents reported that they used incineration to dispose
of waste, 31% that they recycled their waste and 14% that they used
zero-liquid discharge to reduce environmental contamination with
antimicrobials.
■■ 7% of respondents send aqueous waste to a municipal plant without
treating it.
■■ Only one respondent submitted detailed information on their risk
management approach; most could not provide a clear rationale for
their decontamination procedures.
■■ 31% of respondents did not adhere to any discharge targets; 55%
claimed to follow national requirements, although it was unclear
that they are designed to control antimicrobial residues at levels that
are adequate to prevent AMR.
■■ 55% of respondents rated their compliance with the points in the
ECSPP document (24) as high, and 41% rated their compliance as
medium.
■■ All respondents estimated that they would require 0–2 years to

implement adequate waste management programmes to prevent
contamination of the environment with antimicrobials.
The Expert Committee noted the report on the manufacturers’ survey
and encouraged the WHO Secretariat to publish the results in a regulatory
journal. It encouraged national inspectorates to include aspects of waste
management during GMP inspections in collaboration with and in accordance
with the legal authority of environmental agencies. The Expert Committee
also urged the WHO Secretariat to assist national inspectorates and
manufacturers in implementing the recommendations in Points to consider
for manufacturers and inspectors: environmental aspects of manufacturing for
the prevention of AMR (24).
28
7.6 Recommendations from the virtual consultation on

good practices for health products and inspection
ECSPP members were updated by correspondence on the annual consultation
on Good Practices for Health Products and Inspection which took place
in July 2020 as a series of virtual meetings due to the COVID-19 pandemic.
During the meetings, groups of experts discussed GMPs for sterile products
and radiopharmaceuticals (sections 7.1.1 and 7.1.2), points to consider when
including HBELs in cleaning validation (section 7.2), GMP for water for
pharmaceutical use (section 7.3) and guidelines for data integrity (section 7.4).
The group made a series of proposals for future activities:
■■ Update WHO guideline on Good manufacturing practices:
supplementary guidelines for the manufacture of investigational
pharmaceutical products for clinical trials in humans (25). This
document, which was published in 1996, should be updated urgently,
especially in view of inspections for COVID-19 therapeutics.
■■ Determine whether WHO guidelines on transfer of technology in
pharmaceutical manufacturing (26) should also be updated. This
document was published in 2011 and, like that cited above, may
require updating, not least to support inspections for COVID-19
therapeutics.
■■ Explore the preparation of a GMP guideline on required practices
during research and development of medical products. Tackling
the COVID-19 pandemic requires rapid development of therapies,
which in turn urgently requires preparation of a guideline on the
manufacture of developmental and pilot batches and the sequential
data on stability that are submitted in product applications for
marketing authorization and prequalification. Data obtained
from these batches have an effect on a product’s stability, process
validation, analytical method development and validation; however,
there are currently no regulatory guidelines.
The Expert Committee noted the update and agreed to update the
WHO guideline on Good manufacturing practices: supplementary guidelines
for the manufacture of investigational pharmaceutical products for clinical
trials in humans. It asked the WHO Secretariat to explore whether the WHO
guidelines on transfer of technology in pharmaceutical manufacturing should
also be updated and whether a guideline on good practices in the research
and development of medical products should be prepared.
29
8. Quality assurance: distribution and supply chain
8.1 Shelf life for supply and procurement of medical products
The ECSPP was updated by correspondence on the progress in implementing
the Points to consider for setting the remaining shelf life of medical products upon
delivery guideline (27) adopted by the Expert Committee in 2019. The purpose
of the guideline is to facilitate the national authorization of imports, support
efficient processing, ensure sufficient stocks, address barriers to access and
supply, prevent dumping and stock-outs and prevent donations of nearly out-
of-date medical products. In adopting it, the ECSPP acknowledged the value
of a new guideline for guiding procurement agencies, regulators and other
stakeholders; harmonizing policies in this area; and addressing the problem of
short remaining shelf lives of donated medicines during emergencies.
During the past year, the WHO Secretariat was contacted by and
met various colleagues involved in procurement to consider how best to help
implement the new guideline. WHO colleagues plan to draft an advocacy note
to showcase WHO guidance on importation, good storage and distribution and
acceptable remaining shelf life and to ask WHO Country Offices to advocate
for use of the guidance by national regulatory and customs authorities and
by quality control laboratories. WHO colleagues have committed themselves
to cover the topic of acceptable remaining shelf life at the (virtual) Suppliers
Summit in October 2020 to increase awareness in countries of the new WHO
guideline and to better manage stocks by conducting forecasting exercises.
The Expert Committee noted the update and recommended proceeding
with the next steps implementing the WHO guidance texts (on importation,
acceptable remaining shelf life and good storage and distribution) through
WHO procurement channels and networks.
8.1.1 Revision to the guideline on remaining shelf life

Members of the ECSPP were also asked to consider amending the guideline
on remaining shelf life to include the example of emergency health kits. The
topic of inclusion of health kits for use in emergencies in the guideline was
raised during the 2019 public consultation on the guideline; however, the 2019
ECSPP decided to focus first on individual medical products. These kits are
distributed by a group of agencies and humanitarian organizations - including
the International Committee of the Red Cross, Médecins Sans Frontières, Save
the Children, United Nations Children’s Fund, United Nations Population Fund
and WHO. Since publication of the guideline, however, members of these
agencies and organizations have submitted a draft proposal for an amendment.
The Expert Committee recommended circulation for public
consultation of the proposed amendment to consider emergency health kits
30
Quality assurance: distribution and supply chain
for use in humanitarian emergency response as an additional example to the

Points to consider for setting the remaining shelf life of medical products upon
delivery guideline.
8.2 Updated and new WHO guidance, procedures and

operational documents for pharmaceutical procurement
8.2.1 World Health Organization/United Nations Population
Fund prequalification guidance on condoms
Ms Seloi Mogatle, Mr David Hill and Mr William Potter, United Nations
Population Fund (UNFPA), and Dr Sabine Kopp, WHO, summarized the
updating of the existing prequalification guidance texts for contraceptive devices
and condoms, published in 2008, which no longer reflect understanding and
evidence in the field. As agreed by the ECSPP in October 2018, UNFPA and
WHO separated aspects of the current procedures for contraceptive devices and
condoms into seven documents:
■■ Prequalification programme guidance for contraceptive devices:
male latex condoms, female condoms and intra-uterine devices;
■■ technical specifications for male latex condoms;
■■ specifications for plain lubricants;
■■ guidance on testing of male latex condoms;
■■ recommendations for condom storage and shipping temperatures;
■■ guidance on conducting post-market surveillance of condoms; and
■■ condom quality assurance.
The first three documents were sent for expert and public consultation,
subsequently revised and adopted by the ECSPP in 2019.
The documents on testing male latex condoms, storage and shipping
recommendations and post-market surveillance were presented to the ECSPP
for adoption. All three were restructured and revised in the first half of
2019, sent to the EAP and then sent for public consultation in July 2019. The
comments received were reviewed by a group of specialists in October 2019
and new drafts were prepared for expert and public consultation in May 2020.
The comments received were reviewed and revised versions were presented to
the ECSPP. The ECSPP reviewed the three documents, noting that many of
the comments received were requests for minor editorial changes. It further
noted that all the comments received had been considered and addressed
and that all three documents were supported by the regulatory agencies that
submitted comments.
31
The Expert Committee adopted the following guidelines:

Recommendations for condom storage and shipping temperatures (Annex 5),
Guidance on testing of male latex condoms (Annex 6) and Guidance on
conducting post-market surveillance of condoms (Annex 7).
32
9. Regulatory guidance and model schemes
9.1 Proposal to waive in vivo bioequivalence requirements for
medicines on the WHO Model List of Essential Medicines
Professor Maria del Val Bermejo Sanz and Professor Giovanni Pauletti described
the WHO Biowaiver Project and presented its work during the past year. As part
of its 2006 guidance on waiving bioequivalence requirements for immediate-
release oral solid dosage forms on the WHO Model List of Essential Medicines,
WHO provided a list of APIs that are eligible for biowaiver. In 2017, at its Fifty-
second meeting, the ECSPP recommended that the WHO Secretariat revise the
Biowaiver List based on experimental laboratory data.
The Biowaiver Project, started in 2018, is based on sound methods
developed and optimized for the Project and detailed in the WHO protocol
for equilibrium solubility tests to classify APIs for biowaiver according to the
Biopharmaceutics Classification System framework. In 2018, during the pilot
phase of the project (cycle I), a first set of three APIs was classified for a revised
WHO list. A second set of 15 APIs was prioritized in collaboration with the
WHO PQ Team and sent for public consultation before being classified in 2019
as part of cycle II. The results of cycles I and II were collated in a living document,
the WHO Biowaiver List, which was published as an annex to the report of the
Fifty-fourth ECSPP (28). The results were also published in the peer-reviewed,
open-access journal ADMET & DMMPK (29).
In 2020, a set of 11 APIs was prioritized and classified in cycle III; the
data were presented to this year’s ECSPP and will be integrated into an updated
version of the Biowaiver List (Annex 8).
A fourth set of 10 APIs has been prioritized and the list was presented
to the ECSPP as the proposed focus of cycle IV of the Biowaiver Project in 2021
(Table 1).
Table 1
Prioritized APIs proposed for study in cycle IV of the Biowaiver Project.
API in WHO Model Therapeutic area Indication Highest

List of Essential therapeutic
Medicines a dose (mg) b
abacavir Antiretrovirals Treatment and 600 mg
prevention of HIV
infection
33
Table 1 continued
Dexamethasone * (1) Gastrointestinal (1) Antiemetic (1) (3) 0.75–9
medicines medicines mg a day,
(2) Immunomodulators (2) Acute depending on
and antineoplastics lymphoblastic the disease
leukaemia being treated
(3) Medicines for pain
(2) 40 mg
and palliative care (2) Multiple
myeloma
(3) Medicines for
other common
symptoms in
palliative care
Doxycycline (1) Antiprotozoals (1) Antimalarial (1) and (2)
(2) Antibacterials medicines 100 mg (as
(2) Antibiotics hyclate)
(access group)
Ethambutol Antibacterials Antituberculosis 2g
medicines
Isoniazid Antibacterials Antituberculosis 300 mg
medicines
hydroxychloroquine Medicines for diseases Disease-modifying 400–600 mg
of joints agents used
in rheumatoid
disorders
Lamivudine Antiretrovirals Treatment and 300 mg

prevention of HIV
levonorgestrel Medicines for Oral hormonal 1.5 mg
reproductive health contraceptives
and perinatal care
Nifurtimox Antiprotozoal African 10.0 mg/kg
medicines trypanosomiasis
and American
trypanosomiasis
34
Regulatory guidance and model schemes
Table 1 continued
Proguanil Antiprotozoals Antimalarial 100 mg (as
medicines hydrochloride)
* dexamethasone has been characterized in an expedited fashion to address the current global public health
emergency. Results are presented in Annex 8.
a 21st WHO Model List of Essential Medicines (2019) (30).
b
According to Summary of product characteristics from WHO Prequalification or national/regional regulatory
authority.
The list of proposed APIs includes two medicines that are in clinical
trials for use in the COVID-19 pandemic in early 2020: dexamethasone
and hydroxychloroquine. In June 2020, at the informal consultation on
Regulatory Guidance for Multisource Products, participants urged an expedited
characterization of the solubility of dexamethasone tablets at 6 mg per day (the
dosage used in the COVID-19 Recovery Trial). The WHO Secretariat therefore
expedited the characterization of dexamethasone and the results have been
integrated into the latest Biowaiver List and shared with the ECSPP.
Professor Bermejo Sanz also presented two proposals for extending the
Biowaiver Project, as recommended by the group of experts at the informal
consultation on Regulatory Guidance for Multisource Products:
■■ A short-term exploratory study, potentially during cycle IV, to
consider API stability under pH conditions representative of
the stomach and small intestine, in order to support regulatory
decisions. This would involve measuring API stability for a period
equivalent to the estimated in-vivo contact of the substance in
gastric fluid (e.g. 1 h at pH 1.2, 37 °C) and small intestinal fluid (e.g.
3–6 h at pH 6.8, 37 °C) and quantifying the parent drug molecule
with the validated analytical method.
■■ A medium- to long-term study to define the suitability of the
system for performing in-vitro permeability experiments that
would generate meaningful results for classification according to the
Biopharmaceutics Classification System. The study would involve
comparison of the experimental design of acceptable in-vitro cell
culture models (e.g. Caco-2, MDCK), including recommended
model substances and limited validation requirements. The time
frame for this study would be defined after the COVID-19 pandemic.
35
The ECSPP thanked all those involved in enabling the Biowaiver Project
to characterize the solubility profiles of prioritized APIs through experimental
laboratory data, including the network of laboratories involved in expediting
characterization of dexamethasone for public health during the current
pandemic. The Expert Committee discussed various aspects of the Project and
made several suggestions for improvement. The topics of discussion included:
the consistency of results from different laboratories, inclusion of polymorphic
forms in the Project’s studies and consideration of API stability and potential
quantification of degradation.
The Expert Committee agreed to integrate the results of cycle III into
the Biowaiver List (Annex 8). It further suggested promotion of the results of
the Biowaiver Project by presentation at scientific conferences, publication
in peer-reviewed and open-access journals and by advocacy, engagement and
partnership. The Expert Committee accepted the prioritized APIs proposed
for study in cycle IV and supported the planning of two exploratory projects
on stability and permeability.
9.2 WHO Certification Scheme on the quality of pharmaceutical

products moving in international commerce
Dr Celeste Aurora Sánchez González and Dr Sabine Kopp gave an update on
the revision of the WHO Certification Scheme on the quality of pharmaceutical
products moving in international commerce (“the Scheme”) as twice
recommended by the ECSPP. The Scheme is a voluntary international agreement
designed to assure participating countries of the quality of the pharmaceutical
products they import and export. In operation since 1969, the Scheme was
amended four times between 1975 and 1997. It currently works by issuing three
types of certificate for quality assurance: a certificate of a pharmaceutical product
(CPP), a statement of the marketing authorization status of a pharmaceutical
product and a batch certificate.

New worldwide trends pose a number of challenges to the operation of
the Scheme since 2007 and the ECSPP recommended that the Scheme be revised
at its Forty-third meeting in 2008. An interim solution, a question-and-answer
document on the Scheme’s function, was developed in 2010 (and revised in
2015), but the Scheme itself remains unchanged.
In 2017, the ECSPP again called for the Scheme to be revised and a
series of revisions was proposed by the WHO Secretariat and sent for public
consultation in 2018. These were discussed by the ECSPP in 2018.
A second round of consultation in 2019 raised some 180 comments.
A group of 14 regulatory authorities interested in collaborating with WHO
on revising the Scheme were brought together in a series of virtual meetings
in August 2020 that were held in lieu of this year’s informal consultation on
36
Regulatory Tools for Medicines. Participants reviewed all the comments received
and shared practical experiences and challenges in operating the Scheme. After
the meeting, the Scheme was further revised, based on the feedback of the
participants, before being presented to the Expert Committee. The latest draft
includes revisions to:
■■ allow participation of regional and multi-State organizations;
■■ maintain an updated list of current participants;
■■ ensure that certificate-issuing countries include a firm declaration
that the competent regional or national authority meets the Scheme’s
requirements for notification to the Director-General of WHO;
■■ include the concept of reliance among participating authorities and
promotion of its use to ensure timely access to medicines;
■■ improve the transparency of information on manufacturing (in a
revised model template);
■■ discourage legalization procedures that unduly delay certificates;
■■ establish standard time frames for decision-making (20–30 working
days); and
■■ reflect current procurement practices (by removing statements on
marketing authorization from the Scheme and clarifying that batch
(lot) release certificates are not part of the Scheme).
Minor editorial changes were also incorporated into the latest proposed
revision.
The ECSPP thanked all those involved in revising the Scheme and
thoroughly reviewed the provisions of the amended Scheme, discussing points,
including membership renewals, the definition of regional authorities and
what constitutes an efficient surveillance system. ECSPP members requested a
number of further revisions, in particular to: acknowledge different types and
pathways for marketing authorizations; introduce provision for links to product
marketing authorization webpages, if available; make ensuring GMP compliance
regardless of location an option rather than an obligation; and removing the
reference to GMP for assuring the quality of APIs.
The Expert Committee emphasized that options should be explored
for promoting a shift to use of electronic systems and certificates by authorities
implementing the Scheme. It also recommended that certifying authorities be
encouraged to ensure that they have the competence and capacity to implement
the Scheme by citing the WHO Global Benchmarking Tool in the Scheme’s
preamble and adding it to the list of references.
The Expert Committee noted that, once the revised Scheme guidelines
are adopted, a number of implementation and operating issues might have
37
to be addressed; for example, by incorporating an additional set of questions

and answers.
The Expert Committee adopted the revised WHO Certification
Scheme on the quality of pharmaceutical products moving in international
commerce (Annex 9), subject to the changes discussed. It requested WHO
to ensure speedy implementation of the revised Scheme and encouraged the
WHO Secretariat to work with interested parties to facilitate implementation
of the Scheme through electronic systems, including e-CCPs (certificates of
pharmaceutical products).
9.3 Good practices in regulatory decision-making

9.3.1 Good reliance practices in the regulation of medical products
Dr Samvel Azatyan and Mrs Marie Valentin, WHO Regulatory Convergence
and Networks, updated the ECSPP on the development of the proposed good
reliance practices (GRelP) in the regulation of medical products. The aim of
this high-level document, which was prepared in parallel to the concise good
regulatory practice (GRP) guidance, is to provide a more efficient approach to
regulatory oversight, thereby promoting access to quality-assured, effective, safe
medical products.
In September 2019, a consultation on GRelP concluded that the concept
note of the Pan American Health Organization and the Pan American Network
for Drug Regulatory Harmonization on regulatory reliance principles (31) be used
as the basis for a high-level WHO document on good reliance practices. Results
and suggestions from a WHO survey conducted on behalf of the International
Pharmaceutical Regulators Programme on reliance in June 2019 (32) were also
considered in preparing the document. The document, drafted in early 2020,
covers: basic definitions and key concepts in reliance; the six principles of reliance
(universality, sovereignty of decision-making, transparency, respect for a national
and regional legal basis, consistency and competence); general considerations;

potential barriers; and enablers. Examples of GReIP are annexed.
The document was then considered in a targeted consultation with
stakeholders in April–May 2020 and in two public consultations, in June–
July 2020 and August–September 2020. The main comments from the public
consultations were to: simplify the title and align it with the guideline for GRP;
reinforce the importance of “sameness of product” and local capacity; ensure
that reliance timelines allow for local assessment; and emphasize safeguarding
and strengthening local competence and capacity. Examples of using reliance
were added to the annex, including examples on unilateral recognition, reliance
in pharmacovigilance and reliance in public health emergencies. After each
consultation, all the comments were collated, reviewed and addressed through
revisions.
38
The ECSPP reviewed the high-level document, discussed the terms

used in the title (“regulation” rather than “regulatory oversight” or “regulatory
assessment”), definition of terms and key concepts, deletion of stringent
regulatory authorities in Annex 1 and the concept of “reliance on reliance”. It
suggested that additional explanation be provided of “reliance on reliance” with,
for example, practical examples or questions and answers.
The Expert Committee recognized the importance of the new guideline,
noting that it will shape the strategies for many of WHO’s regulatory activities
in Member States and that its implementation may have implications for other
documents and guidelines.
The Expert Committee adopted Good reliance practices in the
regulation of medical products: high-level principles and considerations
(Annex 10).
9.3.2 Good regulatory practices in the regulation of medical products

Dr Samvel Azatyan and Mrs Marie Valentin updated the ECSPP on the
development of Good regulatory practices for regulation of medical products.
Originally drafted in 2016, the document is a response to requests from
national authorities responsible for regulatory oversight of medical products for
guidance in addressing common gaps in regulatory practices identified during
benchmarking exercises.
The draft document was revised several times at stakeholder consultations
in 2016 and 2017. In September 2019, an international consultation of experts
discussed the text again and agreed to redraft it as a short, concise document
focusing on scope, intended use, purpose, principles, enablers and examples for
policy-makers and regulators. They agreed that the concise guidance should be
complemented by a series of guidance texts providing practical tools and tactics
for implementing GRP, such as case studies or practice guides.
The concise guidance was drafted in the first half of 2020; it identifies
nine principles of good regulatory practices: legality, consistency, independence,
impartiality, proportionality, flexibility, clarity, efficiency and transparency.
The document was sent for public consultation in August–September 2020,
resulting in 410 comments from 19 parties. Most of the comments were for
revisions to: reinforce the role of industry and stakeholders in ensuring good
regulatory practices through, for example, public consultation and user feedback
mechanisms; include the performance of medical devices; emphasize flexibility
and responsiveness in the regulatory framework; ensure consistency in risk-
based regulatory oversight across all products and entities; and add some terms
to the glossary.
All the comments were reviewed and, as appropriate, incorporated into a
revised version before presentation to the ECSPP.
39
The ECSPP thanked all those involved in preparing the document,

reviewed the newly drafted guidance and made several suggestions for
improvements. Topic of discussion included: shared responsibilities of regulating
and regulated parties in achieving efficient regulatory environments; the role of
patients as increasingly active stakeholders; the importance of inter- and intra-
organizational coordination and collaboration; and the appropriateness of the
guideline title (“regulation” rather than “regulatory oversight”).
The Expert Committee adopted Good regulatory practices in the
regulation of medical products (Annex 11).
9.4 Update on WHO-listed authorities

Mr Hiiti Sillo, Team Lead, Regulatory Systems Strengthening, updated ECSPP
members on the development of a policy for evaluating and publicly designating
regulatory authorities as “WHO-listed authorities” (WLAs). The policy aims
to ensure a transparent and evidence-based pathway for global recognition
of regulatory authorities that meet and apply WHO and other internationally
recognized standards and guidelines, as well as good regulatory practices. The
WLA designation is intended to replace the concept of a “stringent regulatory
authority”.
The first draft of the policy was based on a concept note published
in May 2019 and on the 493 comments received on the note after it was sent
for public comment. It was subsequently discussed at two consultations with
Member States and interested stakeholders (first in September 2019 and again
in June–July 2020) and in two public consultations (December 2019–February
2020 and August–September 2020). After each consultation, the comments
received were collated, reviewed and used to revise the draft document.
Participants in the meetings and consultations voiced their overall support for
the draft WLA policy and for the roadmap for developing operational guidance
for implementation, including the performance evaluation framework. The

latest draft policy includes the context, purpose, scope and operating principles
of evaluating and publicly listing WLAs and also a definition of a WLA.
The new policy is intended to promote trust among regulatory
authorities, increase the pool of authorities that contribute to the WHO PQ
programme and increase investment in and improvement of regulatory systems.
Members of the ECSPP discussed the WLA definition, noting that
regulatory authorities may apply for a WLA listing for specific regulatory
functions, for product streams and for all regulatory functions, as defined in the
WHO Global Benchmarking Tool. They suggested a minor clarification of
the definition.
The Expert Committee also discussed aspects of the draft WLA policy
including the interim list of NRAs as a proxy for WLAs and the necessity for
40
transitional arrangements for existing reference authorities (such as stringent

regulatory authorities), to be addressed in the WLA operational guidance.
The ECSPP noted that, once the new definition is accepted, it should be
integrated into all relevant documents that currently refer to stringent regulatory
authorities. It further noted that the WLA definition and draft policy will also
be presented to the Expert Committee on Biological Standardization in October
2020 and is expected to be approved and published by WHO by the end of 2020.
It will be tested during 2021 and become fully operational in early 2022.
The Expert Committee adopted the definition of a WLA as “a
regulatory authority or a regional regulatory system which has been
documented to comply with all the relevant indicators and requirements
specified by WHO for the requested scope of listing based on an established
benchmarking and performance evaluation process”, in which “regulatory
authority” is understood to cover all the institutions, working together in
an integrated and effective manner, that are responsible for the regulatory
oversight of medical products in a given country or region. The Expert
Committee asked the WHO Secretariat to prepare a situation analysis and
to propose ways to replace references to “stringent regulatory authorities” by
“WLAs” in relevant WHO documents and guidance texts.
9.5 Recommendations from the virtual consultation on

Regulatory Guidance for Multisource Products
ECSPP members were updated by correspondence on the annual consultation
on Regulatory Guidance for Multisource Products between the NSP Team and
the PQ Team - Assessment Group. This year, due to the COVID-19 pandemic,
the consultation was held as a series of virtual meetings.
The annual meeting provides a regular platform for the two teams to
exchange information on their current activities and to discuss potential future
activities in the areas of bioequivalence and biowaiver, assisted by specialists in
the field. Participants were updated on activities for supporting PQ applicants
in designing bioequivalence studies for prequalification.
■■ Product-specific guidance texts. After discussion, the group
of experts suggested consideration of whether product-specific
guidance texts from the PQ Team on the design of bioequivalence
studies could be presented to the ECSPP with a view to making it
more generally available to regulators.
■■ WHO List of International Comparator Products. The experts
emphasized the importance of the WHO List of International
Comparator Products (33) in guiding the development of
multisource pharmaceutical products as a critical tool for both
41
manufacturers and regulators. The group suggested pro-active

triggering of an update, also to align it with the latest WHO Model
List of Essential Medicines.
■■ WHO guidance on registration requirements to establish
interchangeability for generics. The experts recommended
consideration of whether the WHO guidance on biowaivers (34)
should be revised in view of the text recently published by the
International Council for Harmonisation of Technical Requirements
for Pharmaceuticals for Human Use (ICH) (35). In addition, they
suggested consideration of the Council’s progress with regard to the
new guidance on bioequivalence for immediate-release solid oral
dosage forms (36) to update the section on highly variable drugs,
with provisions on average scaled criteria for the extent of absorption
(area under the curve {AUC}).
■■ WHO Biowaiver Project cycle IV (2021). The experts agreed on a
potential set of APIs for cycle IV for presentation to the ECSPP and
proposed two further exploratory studies (see section 9.1).
The Expert Committee noted the update and asked the WHO
Secretariat to explore the feasibility of receiving product-specific guidance
texts from the PQ Team on the design of bioequivalence studies with a view
to making them more generally available to regulators. It further urged
the WHO Secretariat to continue updating the WHO List of International
Comparator Products (33) and to evaluate possible revision of Annex 6 to
Multisource (generic) pharmaceutical products: guidelines on registration
requirements to establish interchangeability (37).
42
10. Miscellaneous: update on activities
related to COVID-19
Dr Sabine Kopp updated ECSPP members on the range of activities undertaken
in response to the COVID-19 pandemic, which include developing and sharing
specifications, leveraging existing guidelines and supporting new activities.
10.1 Oxygen specifications

The NSP Team worked with the Medical Devices and Diagnostics Team to
provide specifications for oxygen for medical use. Drawing on information
in The International Pharmacopoeia, they prepared a document outlining
the requirements for the pharmaceutical quality of oxygen for medical use.
This document will form part of a compilation of advice on oxygen use for
Member States.
10.2 Therapeutic specifications

Work is also underway to improve and include monographs in The International
Pharmacopoeia that could have a direct bearing on treatment of COVID-19.
This includes revising the monograph on dexamethasone phosphate injection
to improve the test for related substances and preparing new monographs on
remdesivir and remdesivir intravenous infusion (section 5.4.1).
In February 2020, the IMWP triggered action through the global
pharmacopoeial alert system for COVID-19. Pharmacopoeial alerts enable rapid
discussions among pharmacopoeias in order to respond to urgent public health
needs. The pharmacopoeial alert system brings pharmacopoeias together to
support the global response to COVID-19, including by providing guidance and
information to manufacturers, regulators and stakeholders on critical medicines
(both new and repurposed) being used or investigated to treat the disease. For
example, world pharmacopoeias have collaborated to map the availability in
world pharmacopoeias of monographs on medicines that are being investigated
for COVID-19 and to publish the map online (38). Many pharmacopoeias have
improved the accessibility of supportive pharmacopoeial texts by making them
freely available online.
In addition to issuing a global pharmacopoeial alert, the IMWP
established a subgroup of interested pharmacopoeias to explore the development
of IMWP monographs for two therapeutic products being tested for use
in COVID-19, for which there are no public specifications: remdesivir and
favipiravir. While the originator of remdesivir was not interested in participating
in the project, the manufacturer of favipiravir is working with the subgroup on a
collaborative IMWP specification.
43
10.3 Existing guidance

In April 2020, the NSP Team collated the most relevant ECSPP-adopted guidance
on pharmaceutical quality assurance and regulation of medicines and published
it online (39). The list is structured to mirror the different phases of a product’s
life cycle. It draws on existing guidance texts to support the development,
production, evaluation, distribution and quality control of medicines that might
be or are already being used to treat COVID-19.
The NSP Team also contributed to a question-and-answer document
prepared by the PQ Inspections Team to address queries about regulatory
flexibility during the COVID-19 pandemic (40). The aim of the document,
which will be updated periodically, is to help manufacturers understand potential
differences in regulatory expectations during the pandemic.
10.4 New activities

Dr Kopp summarized three new activities related to COVID-19:
■■ proposals for new or updated guidelines by the PQ Inspection
and Local Production and Assistance teams, considered to be
particularly useful in the global response to COVID-19 (section 7.6);
■■ expedited biowaiver studies, in particular on solubility
characterization of dexamethasone tablets, which has been
completed (section 9.1); and
■■ practical considerations for PQCLs during COVID-19, which
were summarized by the director of the PQCL and the WHO
Collaborating Centre in South Africa in an article in The Journal of
Medical Laboratory Science & Technology South Africa in September
2020 (41). The aim of the article is to inform PQCL managers
and support them in ensuring safe working environments for
analytical and administrative staff and continued service throughout

the pandemic.
Members of the ECSPP also mentioned the initiative of the Pan American
Health Organization to list essential medicines for managing patients admitted
to intensive care units with suspected or confirmed COVID-19 (42) as an
additional activity related to COVID-19.
The Expert Committee noted the update and acknowledged the
value, and encouraged the use, of existing guidance texts in the context of
the COVID-19 pandemic.
44
11. Closing remarks
The Expert Committee thanked the Chair and the WHO Secretariat for
their exceptional work in ensuring such a smooth virtual meeting under the
challenging circumstances of COVID-19.
The Chair thanked the ECSPP for its standard-setting work, which
has an impact for many people in all of WHO’s Member States by enabling
access to quality-assured medical products. She thanked the WHO Secretariat
for supporting the Expert Committee and all ECSPP members for their active
participation. Dr Sabine Kopp thanked participants for their contributions and
for the high-quality discussions held during the meeting. Dr Kopp thanked
the Chair, the Co-Chair and the rapporteurs for contributing to making the
meeting efficient.
The Chair closed the meeting.
45
12. Summary and recommendations
The WHO ECSPP advises the Director-General of WHO in the area of
medicines quality assurance. It oversees maintenance of The International
Pharmacopoeia and provides guidance for use by relevant WHO units and
regulatory authorities in WHO Member States, to ensure that medicines meet
unified standards of quality, safety and efficacy. The ECSPP’s guidance texts
are developed through a broad consensus-building process, including iterative
public consultations. Representatives of international organizations, State
actors, non-State actors, pharmacopoeias and relevant WHO departments are
invited to the ECSPP’s annual meetings to provide updates and input to the
Expert Committee’s discussions.
At its Fifty-fifth meeting, held virtually from 12 to 19 October 2020,
the ECSPP received updates on cross-cutting issues from other WHO bodies,
including the Prequalification Team, the Regulatory Systems Strengthening
Unit and the INN Team. Updates were also provided by partner organizations,
including the IMWP, the IAEA and UNFPA, on collaborative projects. The
ECSPP was further updated on the latest work to ensure that manufacturers and
inspectors address AMR.
The EDQM, as the custodial centre in charge of ICRS for use with
monographs of The International Pharmacopoeia, updated the ECSPP on its
activities. The results of the latest phase of the EQAAS, which is organized by
WHO with the assistance of EDQM, were also reported.
The ECSPP reviewed new and revised specifications and general texts
for the quality control testing of medicines for inclusion in The International
Pharmacopoeia. The Expert Committee adopted 17 pharmacopoeial texts (4
general chapters, 11 new and revised monographs, including 10 that are subject
to a final review by a subgroup and 2 corrections), and confirmed the release
of 2 new ICRS established by the custodial centre for use in connection with
The International Pharmacopoeia.
The ECSPP reviewed proposals for new and updated quality assurance
and regulatory guidance and adopted 10 new guidance texts. In line with last
year’s recommendations, the ECSPP updated the WHO Biowaiver List as an
annex to its report. Moreover, it agreed to annex a consolidated list of all current
guidelines and guidance texts adopted by the ECSPP. After an update from
the Regulatory Systems Strengthening unit and further discussion, the Expert
Committee adopted a definition of “WHO-listed authorities” (WLAs).
The sections that follow summarize the specific decisions and
recommendations made by the ECSPP during its Fifty-fifth meeting in 2020.
46
Summary and recommendations
12.1 Guidelines and decisions adopted and recommended for use

The following guidelines and decisions were adopted and recommended for use:
■■ Points to consider when including health-based exposure limits in
cleaning validation (Annex 2)
■■ Good manufacturing practices: water for pharmaceutical use (Annex 3)
■■ Guideline on data integrity (Annex 4)
■■ World Health Organization/United Nations Population Fund
recommendations for condom storage and shipping temperatures
(Annex 5)
guidance on testing of male latex condoms (Annex 6)
■■ World Health Organization/United Nations Population Fund guidance
on conducting post-market surveillance of condoms (Annex 7)
■■ WHO “Biowaiver List”: proposal to waive in vivo bioequivalence
requirements for WHO Model List of Essential Medicines immediate-
release, solid oral dosage forms (Annex 8)
■■ WHO Certification Scheme on the quality of pharmaceutical products
moving in international commerce (Annex 9)
■■ Good reliance practices in the regulation of medical products: high-
level principles and considerations (Annex 10)
■■ Good regulatory practices in the regulation of medical products
(Annex 11)
12.2 Texts adopted for inclusion in The International Pharmacopoeia

The ECSPP adopted the texts, chapters and monograph listed below.
12.2.1 General chapters

■■ Dissolution test for solid oral dosage forms (revision)
■■ General identification tests (revision)
12.2.2 Monographs
General monographs for dosage forms
■■ Powders for inhalation (new)
■■ Liquid preparations for oral use (revision)
47
COVID-19 therapeutics
■■ dexamethasone sodium phosphate (correction)
■■ dexamethasone phosphate injection (correction)
■■ remdesivir (new)*
■■ remdesivir intravenous infusion (new)*
Antiviral medicines, including antiretrovirals

■■ dolutegravir sodium (new)*
■■ dolutegravir tablets (new)*
■■ zanamivir (new)*
■■ zanamivir powder for inhalation, pre-metered (new)*
Medicines for tropical diseases

■■ albendazole chewable tablets (revision)*
■■ ivermectin tablets (revision)
Excipients
■■ sodium starch glycolate (new)*
■■ sodium laurilsulfate (new)*
■■ hydroxypropylcellulose, low-substituted (new)*
12.2.3 Omissions
The ECSPP agreed to omit the following text from The International
Pharmacopoeia:
■■ test for histamine-like substances (vasodepressor substances),

including the whole of Chapter 3.6 and all reference to
vasodepressor substances in the monographs on bleomycin sulfate,
spectinomycin hydrochloride and streptomycin sulfate.
12.2.4 ICRS
The ECSPP confirmed the release of the following ICRS that have been newly
characterized by the custodial centre, EDQM:
■■ estradiol valerate ICRS, batch 1; and
■■ moxifloxacin hydrochloride ICRS, batch 1.
48
12.3 Recommendations
The ECSPP made recommendations on norms and standards for pharmaceuticals,
listed below. Progress in completing the suggested actions will be reported to the
ECSPP at its Fifty-sixth meeting in October 2021.
The Expert Committee recommended that the WHO Secretariat, in
collaboration with experts as appropriate, take the actions listed below.
12.3.1 The International Pharmacopoeia

■■ Continue preparation of monographs, general methods, texts and
general supplementary information, including two IAEA/WHO
specifications for radiopharmaceuticals, in accordance with the
2020–2021 workplan and as decided at the meeting.
■■ Develop a concept for future work on monographs on excipients
in The International Pharmacopoeia, including consideration of
whether such monographs are necessary from a public health
perspective, known quality deficiencies and ways to harmonize
specifications with those in other pharmacopoeias.
12.3.2 Quality control – national laboratories

■■ Continue the EQAAS to support national and regional PQCLs,
including continuation of the post-assessment assistance
programme.
12.3.3 Good manufacturing practices and related areas

■■ Continue collaboration with the EU, EMA and PIC/S to harmonize
guidance on sterile products and, if feasible, present such guidance
for possible adoption at the next ECSPP meeting, in 2021.
■■ Continue preparation of a new IAEA/WHO text on GMP for
radiopharmaceuticals for investigational use.
■■ Open the WHO guideline on cleaning validation to review, and
update it in accordance with the latest good practices, including
the newly adopted Points to consider when including health-based
exposure limits in cleaning validation.
■■ Publish the results of the survey of pharmaceutical manufacturers
that engage in synthesis and/or production of antimicrobials on
their waste and wastewater management practices in a regulatory
journal.
49
■■ Assist national inspectorates and manufacturers in implementing

recommendations made in the Points to consider for manufacturers
and inspectors: environmental aspects of manufacturing practices for
the prevention of AMR.
■■ Update the WHO guidance on Good manufacturing practices:
supplemental guidelines for the manufacture of investigational
pharmaceutical products for clinical trials in humans.
■■ Determine whether the WHO guidelines on transfer of technology in
pharmaceutical manufacturing should be updated.
■■ Explore whether a new guideline is required on good practices
during the research and development of medicinal products.
12.3.4 Distribution and supply chain

■■ Encourage WHO colleagues involved in procurement to support
implementation of Points to consider for setting the remaining shelf
life of medical products upon delivery.
■■ Circulate for public consultation the proposed amendment to
include emergency health kits for use in humanitarian emergency
response as an additional example to the Points to consider for setting
the remaining shelf life of medical products upon delivery guideline.
12.3.5 Regulatory mechanisms

■■ Start the next phase of the WHO Biowaiver Project (cycle IV),
to continue the Biopharmaceutics Classification System-based
classification of further APIs: abacavir, doxycycline, ethambutol,
isoniazid, hydroxychloroquine, isoniazid, lamivudine, levonorgestrel
and proguanil.
■■ Undertake a pilot expansion study in cycle IV of the WHO Biowaiver

Project to consider API stability under pH conditions representative
of the stomach and small intestine.
■■ Promote the results of the WHO Biowaiver Project in publications,
advocacy, engagement and partnerships.
■■ Explore the feasibility of presenting product-specific guidance
texts of the PQ Team on the design of bioequivalence studies to
the ECSPP with a view to making them more generally available to
regulators.
■■ Continue updating the WHO List of International Comparator
Products.
50
■■ Evaluate a possible revision of WHO multisource (generic)

pharmaceutical products: guidelines on registration requirements to
establish interchangeability (30).
■■ Ensure speedy implementation by WHO of the revised WHO
certification scheme on the quality of pharmaceutical products moving
in international commerce.
■■ Work with interested parties to facilitate implementation of the
WHO Certification Scheme with electronic systems, including the
use of e-CCPs.
■■ Prepare a situation analysis and propose a way to replace references
to stringent regulatory authorities (SRAs) with WLAs in relevant
WHO documents and guidance.
12.3.6 Other
■■ Continue to serve as the WHO Secretariat for IMWPs and to publish
articles about the IMWP, especially the pharmacopoeial global alert
on COVID-19, in open-access peer-reviewed journals.
■■ Continue annual updating of the Quality Assurance of Medicines
Terminology Database.
■■ Promote the use of existing guidelines and guidance in the context
of the COVID-19 pandemic.
51
Acknowledgements
The Expert Committee acknowledges the following contributors at WHO:
Dr A. Al-Nuseirat, WHO Regional Office for the Eastern Mediterranean; Dr S.
Azatyan, Group Lead, Regulatory Convergence and Networks; Professor H.H.
Balkhy, Assistant Director-General, Antimicrobial Resistance; Dr R. Ballocco,
Unit Head, International Nonproprietary Names and Classification of Medical
Products; Ms B. Cappello, Essential Medicines; Dr D. Catsoulacos, Inspection
Services; Mr M. Chafai, Inspection Services; Ms H.L. Choi, Medicines Assessment;
Mr M. Conrad, Inspection Services; Ms E. Cooke, Director, Regulation and
Prequalification Department; Ms S. Croft, Inspection Services; Dr N. Dellepiane,
Consultant, Regulatory System Strengthening; Dr J. Dong, Local Production and
Assistance; Dr S. Estevão Cordeiro, Norms and Standards for Pharmaceuticals;
Mr M. Freitas Dias, WHO Regional Office for the Americas; Dr V. Gigante,
Norms and Standards for Pharmaceuticals; Dr J. Gouws, Team Lead, Inspection
Services; Dr L. Gwaza, Facilitated Product Introduction; Ms S. Jones, Norms
and Standards for Pharmaceuticals; Dr A. Khadem Broojerdi, Regulation and
Safety; Dr I. Knezevic, Team Lead, Norms and Standards for Biological Products;
Dr S. Kopp, Team Lead, Norms and Standards for Pharmaceuticals; Dr H.
Langar, WHO Regional Office for the Eastern Mediterranean; Ms S. Laroche,
Global Supply Policies; Dr S. Lewis, Consultant, Norms and Standards for
Pharmaceuticals; Dr D. Lei, Norms and Standards for Biological Products; Mr D.
Mubangizi, Unit Lead, Prequalification; Mr M. Musonda, Prequalification;
Mr L. Nzumbu, Medicines Assessment; Dr C. Ondari, Director, Health Product
Policy and Standards; Dr R. Ostad Ali Dehaghi, Regulation and Safety; Mr M.
Refaat, Regulation and Safety; Dr M. Roldao Santos, Regulatory System
Strengthening; Mr V. Sachdeva, Inspection Services; Ms A. Sands, Incidents and
Substandard/Falsified Medical Products; Dr H. Schmidt, Norms and Standards
for Pharmaceuticals; Dr M. Shridhar, WHO Regional Office for South-East

Asia; Mr H. Sillo, Team Lead, Regulation and Safety; Dr M. Simão, Assistant
Director-General, Access to Medicines and Health Products; Dr M. Stahl, Team
Lead, Medicines Assessment; Dr P. Steyn, Contraception and Fertility Care;
Mrs I. Streipa, Inspection Services; Mrs M. Valentin,Regulatory Convergence
and Networks; Ms C. Vogel, Norms and Standards for Pharmaceuticals; Mr W.Z.
Worku, Medicines Assessment; and Mrs H. Yin, Medicines Assessment.
Technical guidance included in this report was prepared with the
financial assistance of the Bill & Melinda Gates Foundation, the German
Federal Ministry of Health, The Global Fund to Fight AIDS, Tuberculosis and
Malaria and the United Nations Development Programme.
The Expert Committee also acknowledges with thanks the valuable
contributions made to its work by the following agencies, institutions,
52
Acknowledgements
organizations, pharmacopoeias, WHO collaborating centres, WHO programmes

(especially the Regulatory and Prequalification Teams) and individuals:
Brazilian Health Surveillance Agency, Brasília DF, Brazil; Center for
Drug Evaluation and Research, Food and Drug Administration, Silver Spring
(MD), USA; Comisión Federal para la Protección contra Riesgos Sanitaríos,
and Administration and Finance, Secretaria de Salud, Mexico City, Mexico;
European Commission, Brussels, Belgium; European Directorate for the Quality
of Medicines & HealthCare, Council of Europe, Strasbourg, France; European
Healthcare Distribution Association, Brussels, Belgium; European Medicines
Agency, Amsterdam, Netherlands; Global Self-Care Federation (formerly
World Self Medication Industry), Nyon, Switzerland; International Atomic
Energy Agency, Vienna, Austria; International Federation of Pharmaceutical
Manufacturers and Associations, Geneva, Switzerland; International Generic
and Biosimilar Medicines Association, Brussels, Belgium; International
Pharmaceutical Excipients Council Federation ASBL, Brussels, Belgium;
International Pharmaceutical Federation, The Hague, Netherlands; International
Society for Pharmaceutical Engineering, Tampa (FL), USA; Medicines for Europe,
Brussels, Belgium; Medicines and Healthcare Products Regulatory Agency,
Inspection, Enforcement and Standards Division, London, United Kingdom;
National Agency of Drug and Food Control, Jakarta Pusat, Indonesia; National
Food and Drug Authority, Kampala, Uganda; Parenteral Drug Association,
Bethesda (MD), USA; Pharmaceutical Inspection Co-operation Scheme,
Geneva, Switzerland; Swissmedic, Swiss Agency for Therapeutic Products, Bern,
Switzerland; The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva,
Switzerland; The Stop TB Partnership, Geneva, Switzerland; Therapeutic Goods
Administration, Woden, ACT, Australia; Turkish Medicines and Medical Devices
Agency, Ankara, Turkey; United Nations Children’s Fund, Supply Division,
Copenhagen, Denmark; United Nations Development Programme, Châtelaine,
Switzerland; United Nations Industrial Development Organization, Geneva,
Switzerland; United Nations Population Fund, Copenhagen, Denmark.
Laboratoire National de Contrôle des Produits Pharmaceutiques, Dély
Ibrahim, Algeria; Instituto Nacional de Medicamentos, Buenos Aires, Argentina;
Expert Analytic Laboratory, Centre of Drug and Medical Technology Expertise,
Yerevan, Armenia; University of Liège, Liège, Belgium; Laboratoire National de
Contrôle de Qualité des Médicaments et Consommables Médicaux, Cotonou,
Benin; Agency for Medicinal Products and Medical Devices, Control Laboratory,
Sarajevo, Bosnia and Herzegovina; Instituto Nacional de Controle de Qualidade
em Saúde, Rio de Janeiro, Brazil; Laboratoire National de Santé Publique,
Ouagadougou, Burkina Faso; National Product Quality Control Centre, Ministry
of Health, Phnom Penh, Cambodia; Laboratoire National de Contrôle de Qualité
des Médicaments et d’Expertise, Yaoundé, Cameroon; Departamento de Control
53
Nacional, Unidad de Control de Calidad de Medicamentos Comercializados,

Institutu de Salud Pública, Santiago de Chile, Chile; Changzhou Center for
Food and Drug Control, Changzhou, China; Chengdu Institute for Food and
Drug Control, Sichuan, China; Chongqing Institute for Food and Drug Control,
Chongqing City, China; Dalian Drug Quality Control Institute, Dalian City,
China; Guangzhou Municipal Institute for Drug Control, Guangzhou, China;
Hubei Institute For Drug Control, Wuhan, China; Jiangsu Institute for Food
and Drug Control, Nanjing, China; Guangdong Institute for Drug Control,
Guangdong, China; National Institutes for Food and Drug Control, Beijing,
China; Shandong Institute for Food and Drug Control, Shandong, China;
Shenzhen Institute for Drug Control Jiangsu Province, Shenzhen, China; Sichuan
Institute for Food and Drug Control, Sichuan, China; Suzhou Institute for Drug
Control, Jiangsu, China; Tianjin Institute for Drug Control, Tianjin, China;
Wuxi Institute For Drug Control, Jiangsu, China; Xiamen Institute for Food and
Drug Control, Xiamen, China; Zhejiang Institute for Drug and Food Control,
Zhejiang, China; Medicamentos y Productos Biológicos, Instituto Nacional de
Vigilancia de Medicamentos y Alimentos, Bogotá, Colombia; Laboratorio de
Análisis y Asesoría Farmacéutica, Facultad de Farmacia, Universidad de Costa
Rica, San José, Costa Rica; Laboratorio de Normas y Calidad de Medicamentos,
Caja Costarricense de Seguro Social, Universidad de Costa Rica, Alajuela, Costa
Rica; Laboratoire National de la Santé Publique, Abidjan, Côte d’Ivoire; Agency
for Medicinal Products and Medical Devices of Croatia, Official Medicines
Control Laboratory Division, Zagreb, Croatia; Oficina Sanitaria Panamericana,
WHO on behalf of Centro para el Control Estatal de Medicamentos, Havana,
Cuba; National Organization for Drug Control and Research, Cairo, Egypt;
Food, Medicine and Healthcare Administration and Control Authority of
Ethiopia, Addis Ababa, Ethiopia; Jimma University Laboratory of Drug Quality,
Jimma, Ethiopia; Centrale Humanitaire des Métiers de la Pharmacie, Clermont
Ferrand, France; Center for Pharmaceutical Advancement and Training, Accra,
Ghana; Food and Drugs Board, Quality Control Laboratory, Accra, Ghana;
Laboratoire National de Contrôle de Qualité des Medicaments, Conakry,
Guinea; Laboratory for Quality Evaluation and Control, National Institute of
Pharmacy, Budapest, Hungary; National Quality Control Laboratory of Drug
and Food, National Agency for Food and Drug Control, Yogyakarta, Indonesia;
Food and Drugs Control Laboratories, Ministry of Health and Medical
Education, Tehran, Islamic Republic of Iran; Caribbean Public Health Agency
Drug Testing Laboratory, Kingston, Jamaica; Mission for Essential Drugs and
Supplies, Nairobi, Kenya; National Quality Control Laboratory for Drugs and
Medical Devices, Nairobi, Kenya; Central Analytical Laboratory, Bishkek City,
Kyrgyzstan; Arwan Pharmaceutical Industries Lebanon s.a.l., Jadra, Lebanon;
Food and Drug Quality Control Centre, Ministry of Health, Vientiane, Lao
People’s Democratic Republic; Ministry of Health, Maseru, Lesotho; Laboratoire
54
Acknowledgements
de Contrôle de Qualité des Médicaments, Agence du Médicament de Madagascar,

Antananarivo, Madagascar; Centre for Quality Control, National Pharmaceutical
Control Bureau, Petaling Jaya, Selangor, Malaysia; Laboratoire National de la
Santé du Mali, Bamako, Mali; Laboratoire National de Contrôle de Qualité des
Médicaments, Nouakchott, Mauritania; Laboratoire National de Contrôle des
Médicaments, Rabat, Morocco; National Laboratory for Medicine Quality Testing
Ministry of Health, Maputo, Mozambique; Quality Surveillance Laboratory,
Windhoek, Namibia; National Medicines Laboratory, Department of Drug
Administration, Kathmandu, Nepal; Laboratoire National de Santé Publique et
d’Expertise, Niamey, Niger; National Agency for Food and Drug Administration
and Control, Abuja, Nigeria; Central Quality Control Laboratory, Directorate
General of Pharmaceutical Affairs and Drug Control, Ministry of Health,
Muscat, Oman; Drug Control and Traditional Medicine Division, National
Institute of Health, Islamabad, Pakistan; Getz Pharma (Pvt.) Ltd, Karachi,
Pakistan; Instituto Especializado de Análisis, Universidad de Panamá, Panama;
Centro Nacional de Control de Calidad, Instituto Nacional de Salud, Lima, Peru;
Bureau of Food and Drugs, Department of Health, Muntinlupa City, Philippines;
Laboratory for Quality Control of Medicines, Medicines Agency, Ministry
of Health, Chisinau, Republic of Moldova; Saudi Food and Drug Authority,
Section Head of Operations Performance Measurement, Riyadh, Saudi Arabia;
Laboratoire National de Contrôle des Médicaments, Dakar Etoile, Senegal; Drug
Quality Control Laboratory, Ministry of Health, Victoria, Seychelles; National
Pharmaceutical Quality Control Laboratory, Registrar Pharmacy Board of Sierra
Leone, Freetown, Sierra Leone; WHO Collaborating Centre for Drug Quality
Assurance, Pharmaceutical Division, Applied Sciences Group, Singapore; Adcock
Ingram Healthcare, Bryanston, South Africa; Research Institute for Industrial
Pharmacy, North-West University, Potchefstroom, South Africa; National Drug
Quality Assurance Laboratory, Ministry of Health, Colombo, Sri Lanka; National
Drug Quality Control Laboratory, Directorate General of Pharmacy, Federal
Ministry of Health, Khartoum, Sudan; Pharmaceutical Analysis Laboratory, R&D,
Tanzania Food and Drug Authority, Dar es Salaam, United Republic of Tanzania;
School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es
Salaam, United Republic of Tanzania; Bureau of Drug and Narcotic, Department
of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand;
Laboratoire National de Contrôle des Médicaments, Tunis, Tunisia; National
Drug Quality Control Laboratory, National Drug Authority, Kampala, Uganda;
Central Laboratory for Quality Control of Medicines, Ministry of Health, Kiev,
Ukraine; Laboratory of Pharmaceutical Analysis, State Pharmacological Centre,
Ministry of Health, Kiev, Ukraine; Laboratorio Control de Productos Ministerio
de Salud Pública, Comisión Para El Control de Calidad de Medicamentos,
Montevideo, Uruguay; Instituto Nacional de Higiene “Rafael Rangel”, Caracas,
Venezuela; National Institute of Drug Quality Control, Hanoi, Viet Nam; Zambia
55
Medicines Regulatory Authority, Lusaka, Zambia; Medicines Control Authority

of Zimbabwe, Harare, Zimbabwe.
African Pharmacopoeia, Abuja, Nigeria; Farmacopea Argentina, Buenos
Aires, Argentina; Austrian Pharmacopoeia, Vienna, Austria; State Pharmacopoeia
of the Republic of Belarus, Minsk, Belarus; Belgian Pharmacopoeia Commission,
Brussels, Belgium; Agency for Medicinal Products and Medical Devices,
Sarajevo, Bosnia and Herzegovina; Farmacopeia Brasileíra, Brasília DF, Brazil;
Bulgarian Drug Agency, Sofia, Bulgaria; Farmacopea Chilena, Valparaíso, Chile;
Chinese Pharmacopoeia Commission, Beijing, China; Agency for Medicinal
Products and Medical Devices, Zagreb, Croatia; Pharmaceutical Services,
Nicosia, Cyprus; Czech Pharmacopoeia Commission, Prague, Czechia; Danish
Pharmacopoeia Commission, Copenhagen, Denmark; Permanent Commission
of the Egyptian Pharmacopoeia, Cairo, Egypt; State Agency of Medicines,
Tartu, Estonia; Pharmacopoeial Committee of the Eurasian Economic Union,
Moscow, Russian Federation; European Pharmacopoeia, European Directorate
for the Quality of Medicines and HealthCare, Council of Europe, Strasbourg,
France; Finnish Medicines Agency Pharmacopoeia Committee, Finnish
Medicines Agency, Helsinki, Finland; Pharmacopée française, Agence Nationale
de Sécurité du Médicament et des Produits de Santé, Saint-Denis, France;
German Pharmacopoeia Commission, Bonn, Germany; Greek Pharmacopoeia
Commission, Holargos Attikis, Greece; Hungarian Pharmacopoeia Commission,
Budapest, Hungary; Icelandic Medicines Agency, Reykjavik, Iceland; Indian
Pharmacopoeia Commission, Ghaziabad, India; Indonesian Pharmacopoeia
Commission, Jakarta Pusat, Indonesia; The International Pharmacopoeia,
World Health Organization, Geneva, Switzerland; Iranian Pharmacopoeia,
Tehran, Islamic Republic of Iran; Italian Pharmacopoeia Commission, Rome,
Italy; Committee of the Japanese Pharmacopoeia, Pharmaceutical Affairs Food
Sanitation Council, Tokyo, Japan; The State Pharmacopoeia of the Republic of
Kazakhstan, Almaty, Kazakhstan; Lithuanian Pharmacopoeia Commission,
Vilnius, Lithuania; Malta Medicines Authority, San Gwann, Malta; Mexican

Pharmacopoeia, México DF, Mexico; Norwegian Pharmacopoeia Authority,
Oslo, Norway; Pakistan Pharmacopoeia Commission, Islamabad, Pakistan;
Philippines Pharmacopoeia, Manila, Philippines; Polish Pharmacopoeia
Commission, Warsaw, Poland; Portuguese Pharmacopoeia, Porto, Portugal;
Pharmacopoeia of the Republic of Korea, Chuncheongbuk-do, Republic of
Korea; Romanian Pharmacopoeia Commission, Bucharest, Romania; State
Pharmacopoeia Council of the Ministry of Health of the Russian Federation,
Moscow, Russian Federation; Serbian Pharmacopoeia, Belgrade, Serbia; Slovak
Pharmacopoeia Commission, Bratislava, Slovakia; Slovenian Pharmacopoeia
Commission, Ljubljana, Slovenia; Spanish Pharmacopoeia, Madrid, Spain;
Swedish Pharmacopoeia Commission, Uppsala, Sweden; Swiss Pharmacopoeia,
Bern, Switzerland; Thai Pharmacopoeia Commission, Nonthaburi, Thailand;
56
Acknowledgements
Turkish Medicines and Medical Devices Agency, Department of Analysis and

Control Laboratories, Vice Presidency of Economic Assessments and Laboratory
Services, Ankara, Turkey; Pharmacopoeia of Ukraine, Ukrainian Scientific
Pharmacopoeial Center for Quality of Medicines, Kharkov, Ukraine; British
Pharmacopoeia Commission, Medicines and Healthcare Products Regulatory
Agency, London, United Kingdom; United States Pharmacopeia, Rockville (MD),
USA; Vietnamese Pharmacopoeia Commission, Hanoi, Viet Nam.
WHO Centre Collaborateur pour la Conformité des Médicaments,
Laboratoire National de Contrôle des Produits Pharmaceutiques, Algiers,
Algeria; WHO Collaborating Centre for Drug Quality Assurance, Therapeutic
Goods Administration Laboratories, Woden, ACT, Australia; WHO
Collaborating Centre for Drug Quality Assurance, National Institutes for
Food and Drug Control, Beijing, China; WHO Collaborating Centre for Drug
Quality Assurance, Pharmaceutical Laboratory, Centre for Analytical Science,
Health Sciences Authority, Singapore; WHO Collaborating Centre for Quality
Assurance of Drugs, North-West University, Potchefstroom, South Africa;
WHO Collaborating Centre for Quality Assurance of Essential Drugs, Bureau of
Drug and Narcotic, Department of Medical Sciences, Ministry of Public Health,
Nonthaburi, Thailand.
Antimicrobial Resistance Division, WHO, Geneva, Switzerland;
Regulation and Prequalification, WHO, Geneva, Switzerland; Global Malaria
Programme, Universal Health Coverage/Communicable and Noncommunicable
Diseases, WHO, Geneva, Switzerland; Global Tuberculosis Programme, WHO,
Geneva, Switzerland; HIV/AIDS, WHO, Geneva, Switzerland; International
Nonproprietary Names and Classification of Medical Products, WHO,
Geneva, Switzerland; Office of the Legal Counsel, WHO, Geneva, Switzerland;
Prequalification, WHO, Geneva, Switzerland; Prevention and Control of
Noncommunicable Diseases, WHO, Geneva, Switzerland; Regulation of
Medicines and other Health Technologies, WHO, Geneva, Switzerland;
Technologies Standards and Norms, WHO, Geneva, Switzerland.
WHO Regional Office for Africa, Brazzaville, Congo; WHO Regional
Office for the Americas, Washington DC, USA; WHO Regional Office for
the Eastern Mediterranean, Cairo, Egypt; WHO Regional Office for Europe,
Copenhagen, Denmark; WHO Regional Office for South-East Asia, New Delhi,
India; WHO Regional Office for the Western Pacific, Manila, Philippines.
Dr H. Abboud, National Drug Quality Assurance and Research
Laboratories, Damascus, Syrian Arab Republic; ACS Dobfar S.p.A., Italy; Dr S.
Adam, Senior Manager for Regulatory and Scientific Affairs, International
Federation of Pharmaceutical Manufacturers and Associations, Geneva,
Switzerland; Professor E. Adams, Pharmaceutical Analysis, K.U. Leuven, Leuven,
Belgium; Dr A. Adisa, Principal Evaluator, Therapeutic Goods Administration,
Woden, Australia; Dr F. Aguilar-Parrilla, Bayer AG, Berlin, Germany; Mr Y.
57
Al‑Nujaym, Saudi Food and Drug Authority, Riyadh, Saudi Arabia; Professor V.R.
Alamà, Universidad Cardenal, Valencia, Spain; Dr I. Aljuffali, Executive Vice-
President, Drug Sector, Saudi Food and Drug Authority, Riyadh, Saudi Arabia;
Dr J. Albanese, Director, Analytical Strategy and Compliance, Janssen Research
and Development, USA; Mr I. Alstrup, Medicines Inspector, Danish Medicines
Agency, Copenhagen, Denmark; Dr M. Ali Alqubati, Pharmacist, Sana’a, Yemen;
Mr D. Anderson, Global Business Unit Quality Director, Solvay, Brussels,
Belgium; Dr T. Ando, Division of Pharmacopoeia and Standards for Drugs,
Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Mr K. Andrei,
Federal State Budgetary Institution, Scientific Centre for Expert Evaluation of
Medicinal Products of the Ministry of Health of the Russian Federation, Moscow,
Russian Federation; Dr M.H. Al Rubaie, Director General, Ministry of Health,
Muscat, Oman; Ms Y. Anastasio, National Administration of Drugs, Food and
Medical Devices, Buenos Aires, Argentina; Dr B. Appiasam-Dadson, Food and
Drugs Authority, Accra, Ghana; Mr R. Arcuri, Executive President, FarmaBrasil
Group, Brasilia, Brazil; Dr A. Arias, Senior Advisor, Health Canada, Ottawa,
Canada; Ms S. Arsac-Janvier, International Committee of the Red Cross, Geneva,
Switzerland; Dr M. Assalone, Technical Secretary of Argentinian Pharmacopoeia,
Medicines National Institute, Buenos Aires, Argentina; Aurobindo Pharma
Limited, Hyderabad, India; Ms S. Ayral, World Trade Organization, Geneva,
Switzerland; Dr O. Badary, National Organization for Drug Control and Research,
Cairo, Egypt; Ms H. Baião, Infarmed, Lisbon, Portugal; Mr N. Banerjee,
Microbiology Head, Aurobindo Pharma, East Windsor (NJ), USA; Mr A. Bansal,
Drugs Inspector, Central Drugs Standard Control Organisation, New Delhi,
India; Mr A. Barojas, Technical Adviser, Product Quality and Compliance,
Durham (NC), USA; Mr I. Basade, Mylan Laboratories Ltd, Hyderabad, India;
Professor S.A.O. Bawazir, Saudi Food and Drug Authority, Riyadh, Saudi Arabia;
Professor M. Beksinska, Deputy Executive Director, MatCH Research Unit,
Durban, South Africa; Dr M. Belayneh, Pharmacist, United States Agency for
International Development, Washington DC, USA; Professor M. Bermejo-Sanz,

Department of Pharmaceutical Technology and Pharmaceutics, Universidad
Miguel Hernández de Elche, Alicante, Spain; Mr L. Blankenfeldt, trans-o-flex
Express GmbH, Weinheim, Germany; Dr A. Blommaert, Faculty of Pharmacy,
Paris, France; Ms R.F. Boadu, Food and Drugs Authority, Accra, Ghana; Mr S.
Bodemeier, Ritex GmbH, Bielefeld, Germany; Mr B. Boedecker, Hanover,
Germany; Mr M. Boisen, Quality Intelligence Manager, Novo Nordisk A/S,
Bagsværd, Denmark; Mr K. Bokaba, Medicines Control Council, South Africa;
Ms A. Bonneure, Active Pharmaceutical Ingredients Committee, European
Chemical Industry Council, Brussels, Belgium; Ms V. Bonilla, Comisión para el
Control de Calidad de Medicamentos, Montevideo, Uruguay; Professor R.
Boudet-Dalbin, Paris, France; Mr R.M. Bretas, Good Manufacturing Practice
Inspector, Health Regulatory Agency, Brasília, Brazil; Dr M. Brits, Operations
58
Acknowledgements
Manager, Research Institute for Industrial Pharmacy Inc., Centre for Quality
Assurance of Drugs, North-West University, Potchefstroom, South Africa; Dr R.
Bose, Deputy Drugs Controller, Central Drugs Standard Control Organization,
Ministry of Health and Family Welfare, New Delhi, India; Ms Y. Bowman,
Netherlands; Mr D. Brunner, Pharmaceutical Inspection Co-operation Scheme,
Geneva, Switzerland; Dr T. Brusselmans, Directorate General Inspection,
Industry Division, Medicines, Federal Agency for Medicines and Health Products,
Brussels, Belgium; Ms K. Bugge Skou, Scientific Officer, Lægemiddelstyrelsen,
Danish Medicines Agency, Denmark; Dr N. Bunnuan, Director, Manufacturing
Quality Assurance, LifeStyles, Bangkok, Thailand; Mr M. Bursian, Head Archive
Operations, Grünenthal GmbH, Aachen, Germany; Mr Y. Cai, Process Support
Specialist, Fresenius Kabi SSPC, Wuxi, China; Dr M. Camelia, Radiologist,
Federal Institute for Drugs and Medical Devices, Bonn, Germany; Ms S.
Camplisson, Director of Pharmaceutical Technology, Allergan Pharmaceuticals
Ireland, Westport, Ireland; Dr A.M. Cancel, Product Quality and Compliance,
FHI 360, Durham, NA, USA; Mr Y. Cao, Deputy Director of the 4th Divison
Inspections, Centre for Food and Drug Inspection of National Medical Products
Administration, Beijing, China; Dr N. Cappuccino, Chair, Science Committee,
International Generic and Biosimilar Medicines Association, Geneva,
Switzerland; Mr G. Carroll, General Manager Development Programme,
Operations Manager and Senior Inspector, Inspections Enforcement and
Standardization, Medicines and Healthcare Products Regulatory Agency,
London, United Kingdom; Ms M. Casais, Senior Advisor, Bill & Melinda Gates
Foundation, London, United Kingdom; Dr J.M. Caudron, United Nations
Development Programme, Châtelaine, Switzerland; Mr S. Cavalheiro Filho,
Assistant Manager, Regulatory Affairs, International Federation of Pharmaceutical
Manufacturers and Associations, Geneva, Switzerland; Mr S. Champaneri,
Certification Manager/Product Technical Specialist, British Standards Institution,
London, United Kingdom; Dr T. Chanprapaph, Thailand Food and Drug
Administration, Nonthaburi, Thailand; Ms P. Chauhan, Global Regulatory
eCommerce & Intelligence, Reckitt Benckiser Healthcare, Hull, United Kingdom;
Ms J. Chen, World Customs Organization, Brussels, Belgium; Mr M.R.
Chowdhury, Novartis (Bangladesh) Ltd, Site Data Integrity Lead, Dhaka,
Bangladesh; Dr Lakshman Chunduru, Laurus Labs, India; Dr W.K. Chui,
Department of Pharmacy, Faculty of Science, National University of Singapore,
Singapore; Ms A. Clark, Senior External Engagement Manager, United States
Pharmacopeia, Rockville (MD), USA; Ms A. Cockrell, Executive Director, Society
of Quality Assurance, Charlottesville (VA), USA; Dr R. Conocchia, European
Medicines Agency, Amsterdam, Netherlands; Ms A.G. Cord’homme, Product
Safety Manager, Health, Environmental and Regulatory Services, Puteaux,
France; Dr A.R. Cornelio Geyer, Agência Nacional de Vigilância Sanitária
(Anvisa), Brasilía, Brazil; Dr H. Corns, Principal Pharmacopoeial Scientist,
59
Medicines and Healthcare Products Regulatory Agency, London, United

Kingdom; Dr R. Cumberbatch, Director, International and Regulatory Affairs,
Animal Health Institute, Washington DC, USA; Ms V. Dagois, Director, CAPE-
Expert, Cannet, France; Mr H. Dahmani, Pharmacist Quality Assessor, National
Control Laboratory of Tunisia, Tunis, Tunisia; Mr D.I. Dalal, Executive Quality
Assurance, Zim Laboratories Ltd, Nagpur, India; Mrs H.H. Dam, Officer, Drug
Business Administration Division, Drug Administration of Viet Nam, Hanoi,
Viet Nam; Ms Daryani, Indonesian Pharmacopoeia Commission, National
Agency of Drug and Food Control, Jakarta Pusat, Indonesia; Mr D.X. Da Silva,
Technical Regulatory and Innovation Analyst, Sindusfarma, São Paulo, Brazil;
Ms C. Daugherty, Specialist, Quality Regulatory Intelligence, GlaxoSmithKline
plc, Montrose, United Kingdom; Dr M.C. De Angelis, Technical Secretary,
Argentinian Pharmacopoeia, Buenos Aires, Argentina; Professor T. Dekker,
Research Institute for Industrial Pharmacy, North-West University, Potchefstroom,
South Africa; Dr V. Dias Sousa, Directorate Advisor, Brazilian Health Surveillance
Agency, Brasilía, Brazil; Dr M. Dmitriieva, Scientifc Secretary, Ukrainian
Scientific Pharmacopoeial Center for Quality of Medicines, State Service of
Ukraine on Medicinal Products, Ministry of Health, Kharkov, Ukraine; Professor
E. Doelker, Geneva, Switzerland; Dr D. Dimas, Good Manufacturing Practice
Inspector, National Organization for Medicines, Attiki, Greece; Mr J. Dobaria,
Hetero Labs Ltd, Hyderabad, India; Dr P. Doerr, Bern, Switzerland; Dr O.
Douglas; Mrs S. Dube-Mwedzi, South Africa Development Community,
Medicines Regulatory Harmonization Project Coordinator, Zazibona
Inspectorate, Medicines Control Authority of Zimbabwe, Harare, Zimbabwe; Mr
W. Drummond, Senior Director, Charles River, Laboratories, Horsham (PA),
USA; Professor G. Dutta, Quality Manager, A.N. Pharmacia Laboratories Pvt
Ltd., West Bangal, India; Egis Pharmaceuticals Plc., Budapest, Hungary; Mr A.
Evans, Medicines and Healthcare Products Regulatory Agency, London, United
Kingdom; Executive Direction of International Operation, Comision Federal
para la Proteccion contra Riesgos Sanitarios, Mexico City, Mexico; Mr M. Falcon,

Regulations and Standards Surveillance Manager, LFB S.A., Courtaboeuf Cedex,
France; Dr A.M. Fallas, Technical Director, Gutis Ltda, San José, Costa Rica;
Professor R. Fernandopulle, General Sir John Kotelawala Defence University,
Ratmalana, Sri Lanka; Ms G.F. Ferreiro, Centro para el Control Estatal de
Medicamento, Equipos y Dispositivos Médicos, Havana, Cuba; Ms M.P. Filliot,
Global Quality Management APIs & Strategic Raw Materials, Bayer Consumer
Care A.G., Basel, Switzerland; Dr G. Fischer, Head of Quality Regulatory
Intelligence, Boehringer Ingelheim Corporate Center GmbH, Rhein, Germany;
Mr M. Fleischer, Director, Quality, Transport, World Courier, Berlin, Germany;
Dr A. Flueckiger, former Head of Occupational Health and Toxicology, Roche,
PattenIn, Germany; Dr R. Forsyth, Senior Consultant, Forsyth Pharmaceutical
Consulting, Royersford (PA), USA; Professor I. Fradi Dridi, Service Pharmacie,
60
Acknowledgements
Centre National de Greffe de Moelle Osseuse, Faculté de Pharmacie de Monastir,

Monastir, Tunisia; Mr G.M. Francis, Pharmacy and Poisons Board, Nairobi,
Kenya; Mr M. Friis, Epista Life Science, Hørsholm, Denmark; Ms K. Froidbise,
Head of Division Industry, Directorate General Inspection, Federal Agency for
Medicines and Health Products, Brussels, Belgium; Ms R. Gadde, Vice President,
Global Health, Becton Dickinson, Franklin Lakes (NJ), USA; Mr J. Gaeseb,
Namibia Medicines Regulatory Council, Ministry of Health and Social Services,
Windhoek, Namibia; Mr A. Garcia-Aríeta, Head of Service on Pharmacokinetics
and Generic Medicines, Division of Pharmacology and Clinical Evaluation,
Department of Human Use Medicines, Spanish Agency of Medicines and Medical
Devices, Madrid, Spain; Mr O. Garg, Chairman and Managing Director, Cupid
Ltd, Nashik, India; Mr J. Gaeseb, Windhoek, Namibia; Dr K. Gao, National
Institutes for Food and Drug Control, Beijing, China; Professor A. Genazzani,
Novara, Italy; Dr M. Gencoglu, Regulatory Affairs Manager, International
Federation of Pharmaceutical Manufacturers and Associations, Geneva,
Switzerland; Mr J. Gerofi, Managing Director, Enersol, Sydney, Australia; Ms A.L.
Ghilini, Quality Control Director, Minakem SAS, Dunkerque, France; Dr G.
Gildeeva, Federal State Budgetary Institution, Scientific Centre for Expert
Evaluation of Medicinal Products, Ministry of Health, Moscow, Russian
Federation; Mrs E. Gladkaya, Head, Quality Assurance Division, Federal State
Budgetary Institution, Scientific Centre for Expert Evaluation of Medicinal
Products, Ministry of Health, Moscow, Russian Federation; Ms B. Goede, Senior
International Product Manager, Virology, Roche, San Francisco (CA), USA;
Mr C. B. Goldsmith Químico Farmacéutico, Santiago, Chile; Dr J. Gordon,
Wolfville, Nova Scotia, Canada; Mr D. Greney, Quality Assurance Director,
Recipharm, Kaysersberg, France; Mr P. Goyal, Senior Manager Quality, Lupin
Ltd, Mumbai, India; Ms O. Gubareva, Head, International Cooperation
Department, Federal State Budgetary Institution, Scientific Centre for Expert
Evaluation of Medicinal Products, Ministry of Health, Moscow, Russian
Federation; Ms I. Guerra, Associate Manager, Regeneron UK, Tarrytown
(NY), USA; Ms N.M. Guerrero Rivas, Radiofarmacia de Centroamérica, S.A.,
Panamá, Panama; Ms M. Guest, Associate Principal Scientist, AstraZeneca
Pharmaceuticals, Macclesfield, United Kingdom; Ms R.C. Guimarães, Quality
Deputy Director, Bio-Manguinhos-Fiocruz, Rio de Janeiro, Brazil; Mr C.S.
Gumpally, Senior Executive, Neopharma LLC, Abu Dhabi, United Arab Emirates;
Professor Z.P. Guo, Chinese Pharmacopoeia Commission, Beijing, China; Guilin
Pharmaceutical Company Ltd, Guilin, China; Ms P. Hauschildt de Oliveira
Mendes, Regulatory Expert, Health Regulatory Agency, Brasília, Brazil; Mr O.
Hawari, Quality Assurance Manager, External Collaborations, Hoffman La Roche,
Mississauga, ON, Canada; Ms Sri Hayanti, National Agency of Drug and Food
Control, Jakarta, Indonesia; Mr W. Heimes, Administration Manager, European
Compliance Academy Foundation, Heidelberg, Germany; Dr R. Hernández
61
Medina, Mexican Pharmacopoeia, Mexico City, Mexico; Dr M. Heuermann,

Official Medicines Control Laboratory, Münster, Germany; Mr D. Hill, David
Hill & Associates, International Latex Consultancy, Elsenham, United Kingdom;
Ms M. Hirschhorn, Head, Quality and Chemistry Sector, Comisión para el
Control de Calidad de Medicamentos, Montevideo, Uruguay; Mr J. Hodgson,
Pharmaceutical Inspection Co-operation Scheme Secretariat, Geneva,
Switzerland; Mr P. van der Hoeven, European Chemical Industry Council,
Managing Director, Association for Professionals in Infection Control and
Epidemiology, Brussels, Belgium; Dr P. Holland, Medicines and Healthcare
Products Regulatory Agency, London, United Kingdom; Mr M. Holmes,
Management Committee Member, Pharmaceutical and Healthcare Sciences
Society, Swindon, United Kingdom; Ms B. Holst, Danish Medicines Agency,
Copenhagen, Denmark; Mr G. Holzem, Senior Manager, Grünenthal GmbH,
Aachen, Germany; Dr X. Hong, Pharmacopoeia of the People’s Republic of
China, Beijing, China; Professor J. Hoogmartens, Catholic University of Leuven,
Leuven, Belgium; Ms S. Hoogmoed, Regulatory Affairs and Assurance Manager,
ACIC Pharmaceuticals Inc., Coral Springs (FL), USA; Mr I. Hussain, Information
Technology Good Practice Validation Manager, Zealand Pharma IT, Soeborg,
Denmark; Dr N. Hussain, Associate Director, Gilead Sciences, London, United
Kingdom; Ms T.J. Hutadjulu, National Agency of Drug and Food Control, Jakarta,
Indonesia; Dr K.E. Iddir, Director, Direction de la pharmacie et du médicament
de Tunisie, Tunis, Tunisia; Indian Pharmaceutical Congress, Chennai, India; Mr
S. Indoe, Associate Director, Merck Manufacturing Division, Pharmaceutical
technical Operations Logistics and Distribution Technology, Merck & Co.,
Kenilworth (NJ), USA; Indus Medicare, Hyderabad, India; Ipca Laboratories
Ltd., Maharashtra, India; Dr G.P.S. Jadaun, Senior Scientific Officer, Indian
Pharmacopoeia Commission, Ghaziabad, India; Mr J. Jadav, Senior Executive,
Assurance, Concord Biotech Ltd., Ahmedabad, India; Dr S.A. Jaffar, Director
General, Pharmaceutical Affairs and Drug Control, Ministry of Health, Muscat,
Oman; Dr P. Jakšić, Principal Advisor for Pharmacopoeia, Official Medicines

Control Laboratory Division, Agency for Medicinal Products and Medical
Devices, Zagreb, Croatia; Professor S. Jin, Chief Expert for Pharmaceutical
Products, National Institutes for Food and Drug Control, Beijing, China; Mr D.
John, Senior Technical Manager, Animal Health Europe, Brussels, Belgium;
Mr J.L. Jouve, A3P association, eCompliance SIG Chairman, Lyon, France; Dr U.
Juárez-Sevilla, Mexican Pharmacopoeia, Mexico City, Mexico; Ms A. Julsing,
Medicines Control Council, Pretoria, South Africa; Professor E.A. Kaale, School
of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam,
United Republic of Tanzania; Mr B. Kalaivani, Manager Assurance and Risk
Assessment, TTK Healthcare Ltd, Protective Devices Division, Chennai, India;
Ms J. Kalina, Corporate Affairs Manager, European Healthcare Distribution
Association, Brussels, Belgium; Dr S. Kamakshinatha, Pharmedices Technical
62
Acknowledgements
Services, Chennai, India; Mr S. Kare Nielsen, Chairman, Novo Nordisk Focus

Group on Supply Chain, Novo Nordisk A/S, Bagsværd, Denmark; Karex,
Selangor, Malaysia; Mr A. Kayongo, Consultant, UBOPACT Africa Ltd, Mukono,
Uganda; Dr S. Keitel, Director, European Directorate for the Quality of
Medicines and Health Care, Council of Europe, Strasbourg, France; Mr A.
Kessete, Acting Head, Product Evaluation and Registration, National Medicines
and Food Administration, Ministry of Health, Asmara, Eritrea; Mr D. Kharote,
Assistant General Manager, Serum Institute of India Pvt. Ltd, Pune, India; Dr S.
Khoja, Deputy General Manager, Quality Assurance, Skant Healthcare Ltd, Vapi,
India; Mr S. Kigera, Mission for Essential Drugs and Supplies, Nairobi, Kenya;
Mrs K. Kikule, Arlington (VA), USA; Dr N.H. Kim, Pharmaceutical
Standardization Research and Drug Research Division, National Institute of
Food and Drug Safety Evaluation, Chungcheongbuk-do, Republic of Korea;
Mr S. Kisoma, Tanzania Medicines and Medical Devices Authority, Dar-es-
Salaam, United Republic of Tanzania; Dr N.N.K. Kkrumah, Medicines Evaluation
and Registration Department, Food and Drug Administration, Cantonment-
Accra, Ghana; Mr S. Klidzia, Assurance Lead, Fujifilm Diosynth Biotechnologies,
Bryan (TX), USA; Dr E Klenke, Head Preclinical Review, Bern, Switzerland;
Mrs W. Kongsuk, Bureau of Drug and Narcotic, Department of Medical Sciences,
Nonthaburi, Thailand; Dr A. Korde, Technical Officer, Radioisotope Products
and Radiation Technology Section, Division of Physical and Chemical Sciences,
International Atomic Energy Agency, Vienna, Austria; Dr E. Kovaleva, Deputy
Director of the Centre for Evaluation and Control of Medicinal Products,
Moscow, Russian Federation; Dr A. Krauss, Woden, Australia; Mr P. Kumar,
Senior Manager, Institutions, International Business Division, HLL Lifecare Ltd,
Trivandrum, India; Dr A. Kupferman, Industy Pharmacist, Bangkok, Thailand;
Dr Z. Kusynova, Lead for Policy, Practice and Compliance, International
Pharmaceutical Federation, The Hague, Netherlands; Dr W. Kwiringira, National
Drug Quality Control Laboratory, National Drug Authority, Kampala, Uganda;
Ms I. Laccisaglia, Global Quality Specialist, Kuehne+Nagel, Contern, Luxemburg;
Professor J. Ladutko Mikhailovna, Department of Technology of Dosage
Forms, Federal State Budgetary Educational Institution of Higher Education,
St Petersburg State Chemical Pharmaceutical University, Ministry of Health,
Moscow, Russian Federation; Mr K. Laenen, Quality and Regulatory Affairs
Manager, Medicines for Europe, Brussels, Belgium; Laurus Labs Limited,
Visakhapatnam, Italy; Ms L. Lavergne. Technical Coordinator, Pharmacist,
Quality Medicine for All, Paris, France; Professor B.J. Lee, College of Pharmacy,
Ajou University, Suwon, Republic of Korea; Ms Y. Lee, Ministry of Food and
Drug Safety, Seoul, Republic of Korea; Professor M.P. Lefranc, International
ImMuno Information Genetics System, Laboratoire d’Immunogénétique
Moléculaire, Toulouse, France; Dr K.C. Leong, Health Science Authority,
Singapore; Ms F. Lessa, Programme Specialist, Health Systems and Services,
63
Medicines and Health Technologies Unit, Pan American Health Organization,

Washington DC, USA; Dr B. Li, Director General, National Institutes for Food
and Drug Control, Ministry of Public Health, Beijing, China; Dr J. Lidner, Parallel
Distribution and Certificates, Committees and Inspections Department,
European Medicines Agency, Amsterdam, Netherlands; Dr M. Limoli, Senior
International Health Advisor, Center for Biologics Evaluation and Research,
Food and Drug Administration, Silver Spring (MD), USA; Dr R. Lino de Brito
and Agência Nacional de Vigilancia Sanitaría, Brasília, Brazil; Mr L. Locks, World
Trade Organization, Geneva, Switzerland; Dr A. Lodi, Head of Laboratory,
European Directorate for the Quality of Medicines and Health Care, Council of
Europe, Strasbourg, France; Dr S. Logez, Procurement and Supply Management
Specialist, United Nations Development Programme, Geneva, Switzerland; Ms S.
Lohani, General Manager, Beximco Pharmaceuticals Ltd, Gazipur, Bangladesh;
Ms H. Longden, Senior Marketing Manager, Informatics and Regulatory
Compliance, Waters Corporation, Milford (MA), USA; Dr A.L. Lopes da Silva,
Health Regulation Specialist, Brazilian Pharmacopoeia Coordination, Brazilian
Health Regulatory Agency, Brasilía, Brazil; Ms A. López de la Rica Manjavacas,
Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain;
Ms M.Y. Low, Director, Pharmaceutical Division, Applied Sciences Group, Health
Sciences Authority, Singapore; Ms B. Lugosi-Czangár, Validation Manager,
Gedeon Richter Plc, Budapest, Hungary; Lupin Ltd, Mumbai, India; Dr C. Macé,
Senior Health Procurement and Supply Chain Advisor, Global Fund/Health
Implementation Support Team, United Nations Development Programme,
Geneva, Switzerland; Mr D. Madan, Quality Control Specialist, Mylan Dublin
Respiratory, Dublin, Ireland; Mr T. Madigan, Good Distribution Practice
Inspector, Medicines and Healthcare Products Regulatory Agency, London,
United Kingdom; Mr P. Magyari, Plant Manager, Gedeon Richter Plc, Budapest,
Hungary; Ms G.N. Mahlangu, Director, Technical Services, Medicines Control
Authority, Harare, Zimbabwe; Professor S.F. Malan, Director of School of
Pharmacy, University of the Western Cape, Bellville, South Africa; Dr J.D. Mallet,
Paris, France; Dr K.P. Mang, Head of Segment Management Process Analytics,
Mettler-Toledo GmbH, Giessen, Germany; Mangalam Drugs and Organics
Limited, Mumbai, India; Ms L. Margaryants, Scientific Centre of Drug and
Medical Technology Expertise, Yerevan, Armenia; Mrs D. Marin, Director, Drug
Inspectorate Unit, Ministry of Health, Belize; Dr C. Masinga, Lab Supervisor,
Virbac Veterinary, Johannesburg, South Africa; Dr J.Y. Martey, Accra, Ghana;
Mr W. Mathiya, Pharmacy Medicines and Poisons Board of Malawi, Lilongwe,
Malawi; Mrs R. Matos Gonçalves, Brazilian Health Regulatory Agency, Brasília,
Brazil; Dr J.L. Mazert, Paris, France; Dr A. Matias, Quality Control First Line
Leader, GlaxoSmithKline Plc, Grand Rapids (MI), USA; Mr D. McCartney, Head
of SRHR Connect, International Planned Parenthood Federation, London,
United Kingdom; Dr R.D. McDowall, Director, RD McDowall Ltd, Bromley,
64
Acknowledgements
United Kingdom; Professor M. McIntosh, Monash Institute of Pharmaceutical

Sciences, Monash University, Parkville, Australia; Dr F. Meadows, Senior
Technical Advisor, US Pharmacopeial Convention, Rockville (MD), USA; Mr M.
Meakin, Vice-President, Global Quality Regulatory and Compliance, DHL
Supply Chair, Leicester, United Kingdom; Professor B. Meddah, Laboratoire
National de Contrôle de Médicaments, Direction du Médicament et de la
Pharmacie, Rabat, Morocco; Ms C. Mendy, Director, Scientific and Regulatory
Affairs, Global Self-Care Federation, Nyon, Switzerland; Professor V. Merino
Sanjuán, Facultad de Farmacia, Valencia, Spain; Dr S. Mielcarek, Good
Manufacturing Practice Inspector, Chief Pharmaceutical Inspectorate, Warsaw,
Poland; Dr G. Mignot, Saint Paul, France; Ms R.K. Miller, Director of Regulatory
Affairs, Parenteral Drug Association, Bethesda (MD), USA; Mr J. Miller,
Assistant-Director Scientific Affairs, Parenteral Drug Association, Bethesda
(MD), USA; Dr J.H.McB. Miller, Ayr, Scotland; Mr K. Miura, Membrane Sales
Department, Daicen Membrane Systems Ltd, Tokyo, Japan; Ms G. Mkomagi,
Tanzania Food and Drug Authority, Dar-es-Salaam, United Republic of Tanzania;
Mr K. Mochizuki, Chief Executive Officer, Xpro Associates LLC, Yokohama,
Japan; Dr N. Modutlwa, Gaborone, Botswana; Dr S. Mogatle, United Nations
Population Fund, UN City, Copenhagen, Denmark; Mr B.R. Mohanty, Indus
Medicare Ltd, Hyderabad, India; Mr D. Moholkar, Head, Assurance, Natco
Pharma Ltd, Dehradun, India; Dr J.A. Molzon, Bethesda (MD), USA; Mr S.
Mooney, Senior Regulatory Affairs Specialist, Charles River Laboratories,
Wilmington (MA); Dr K. Moore, Manager, Pharmacopeial Harmonization, US
Pharmacopeia, Rockville (MD), USA; Ms T. Moore, Medicines and Healthcare
Products Regulatory Agency, Good Manufacturing Practice inspector, London,
United Kingdom; Mr R. Moorthy, Quascenta Pte Ltd, Singapore; Ms M. Morales
Sánchez, Medical Devices and Other Technologies Direction, Instituto Nacional
de Vigilancia de Medicamentos y Alimentos, Bogotá, Colombia; Ms S. P. Morales,
Quality Control Director, PiSA Pharmaceutical Co, Guadalajara, Mexico; Dr C.
de la Morena Criado, Head of Service, Quality Evaluation, Department of
Chemistry and Pharmaceutical Technology, Spanish Agency of Medicines and
Medical Devices, Madrid, Spain; Mr M. Multhauf, Consultant Pharmaceutical
Engineering, European Compliance Academy Foundation, European Compliance
Academy, Heidelberg, Germany; Mr M. Muñoz, Good Manufacturing Practice
Coordinator, Grünenthal Chile, Santiago, Chile; Ms M. Muñozcano Quintanar,
Comisión Federal para la Protección contra Riesgos Sanitarios, Mexico City,
Mexico; Ms C. Munyimba-Yeta, Director Operations (Plant), NRB Pharma
Zambia Ltd, Lusaka, Zambia; Mylan Laboratories Ltd, Hyderabad, India; Ms C.
Mvurume, Regulatory Officer, Medicines Control Authority, Harare, Zimbabwe;
Mr A. Mwipi, Dublin, Ireland; Professor H. Nakagawa, Graduate School of
Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan; Dr B. Naik,
General Manager Technical Services, Mangalam Drugs & Organics Ltd, Vapi,
65
India; Mr K. Nakano, Senior Consultant, Bunzen Co. Ltd, Sagamihara, Japan;

Dr N. Nakashima, Senior Director for International Programmes, Associate
Centre Director for Asia Training Centre, Pharmaceuticals and Medical Devices
Agency, Tokyo, Japan; Dr P. Nandi, Vice President Global Regulatory Affairs,
Laurus Labs, India; Dr C. Nanga, Ministry of Health, Ouagadougou, Burkina
Faso; Dr S. Narendran, Assistant Drug Controller, Central Drugs Standard
Control Organization, Ministry of Health and Family Welfare, New Delhi, India;
Professor G. Navas, Professor of Pharmaceutical Analysis, School of Pharmacy,
University of Panama, Panamá City, Panama; Ms S. Nazzaro, Senior Program
Officer, Product Introduction, Market Dynamics and Access, Bill & Melinda
Gates Foundation, Seattle (WA), USA; Ms J. Netterville, Associate Director,
AstraZeneca plc, Gaithersburg (MD), USA; Professor A. Nicolas, Paris, France;
Dr B. Ning, National Institutes for Food and Drug Control, Beijing, China; Dr J.
Norwig, Federal Institute for Drugs and Medical Devices, Bonn, Germany;
Mr D. Nti, Food and Drugs Authority, Accra, Ghana; Mr S. Nyamryenchin, Third
Secretary, Embassy of Mongolia, Geneva, Switzerland; Dr A. Nyika, Senior
Regulatory Officer/Good Manufacturing Practice Inspector, Zazibona Inspections
Coordinator, Medicines Control Authority, Harare, Zimbabwe; Dr C. Ogeto,
Mission for Essential Medicines and Supplies, Nairobi, Kenya; Mr T. Oi, Deputy
Director, Office of the Committee on Oversight of Pharmaceuticals and Medical
Devices Safety Regulation, Health Science Division, Minister’s Secretariat,
Ministry of Health, Labour and Welfare, Tokyo, Japan; Ms L. P. Ojeda, Head of
International Affair Office, Centro para el Control Estatal de Medicamentos,
Equipos y Dispositivos Médicos, Cuba; Mrs A. Ojoo, Technical Specialist,
Paediatric Formulations, UNICEF Supply Division, Nordhavn, Copenhagen,
Denmark; M.T. Okuwoga, National Agency for Food and Drug Administration
and Control, Ajuba, Nigeria; Professor D.W. Oliver, North-West University,
Potchefstroom, South Africa; Dr H. Okuda, Deputy Director-General, National
Institute of Health Sciences, Tokyo, Japan; Ms A. Olivares, Comisión Federal para
la Protección contra Riesgos Sanitarios, Mexico City, Mexico; Dr C. Ondo,

Ministry of Health, Bata, Equatorial Guinea; Mr J. Opit, Assistant Assurance
Manager, Abacus Parenteral Drugs Ltd, Kampala, Uganda; Mr P. Osatapirat,
Thailand Food and Drug Administration, Nonthaburi, Thailand; Mr J.V.
Oudtshoorn, South African Health Products Regulatory Authority, South Africa;
Ms A. Paavola, Senior Researcher, Finnish Medicines Agency, Helsinki, Finland;
Dr N.B. Patel, Assistant Manager, Assurance, Mepro Pharmaceuticals Pvt. Ltd,
Surendranagar, India; Mr A. Padua, Assurance, Allergan Sales LLC, Irvine (CA),
USA; Mrs L.M. Paleshnuik, LP Inc., Ottawa, Canada; Ms H. Park, Ministry of
Drug and Food Safety, Chungcheongbuk-do, Republic of Korea; Dr S. Park,
Ministry of Drug and Food Safety, Chungcheongbuk-do, Republic of Korea;
Dr S. Parkash, Assistant Vice-President, Regulatory Affairs, Laurus Labs Ltd,
Hyderabad, India; Dr S. Parra, Manager, Generic Drugs Quality Division 1,
66
Acknowledgements
Bureau of Pharmaceutical Sciences, Therapeutic Products Directorate, Health

Canada, Ottawa, Canada; Mr Y Patel, Information Technology Validation
Consultant, GC Biotherapeutics Inc., Quebec, Canada; Dr S.R. Srinivas Patnala,
Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa; Professor
G.M. Pauletti, Associate Dean for Graduate Studies, Gustavus & Henry Pfeiffer
Chair, Department of Pharmaceutical and Administrative Sciences, University of
Health Sciences & Pharmacy, St Louis College of Pharmacy, St Louis (MI), USA;
Mr S.T. Pedersen, Senior Director, External Affairs, Quality Intelligence and
Inspection, Novo Nordisk A/S, Bagsværd, Denmark; Dr G. Penzlin, Bundesinstitut
für Arzneimittel und Medizinprodukte, Bonn, Germany; Dr L. Perez Albela Vera,
Pfizer Inc., New York City (NY), USA; Ms C. Planchon, Inspection, Federal
Agency for Medicines and Health Products, Brussels, Belgium; Ms T. Poh Suan,
Senior Manager, Assurance, Karex, Selangor, Malaysia; Ms S. Polovic, Head of
Inspectorate, Agency for Medicinal Products and Medical Devices, Zagreb,
Croatia; Dr A. Porrás, Unit Chief, Medicines and Health Technologies, WHO
Regional Office for the Americas, Washington DC, USA; Ms K. Porras, Instituto
Nacional de Vigilancia de Medicamentos y Alimentos, Bogota, Colombia; Dr W.
Potter, Stapleford Scientific Services Ltd, Cambridge, United Kingdom; Mr S.
Prasad, General Manager Corporation, Quality Control, Akums Drugs and
Pharmaceuticals Ltd, New Delhi, India; Dr S. Pretorius, Research Institute for
Industrial Pharmacy Inc., Centre for Quality Assurance of Drugs, Potchefstroom,
South Africa; Ms S. Pulido, PiSA Farmacéutica, Guadalajara, Mexico; Ms H.
Qorani, Jordan Food and Drug Administration, Amman, Jordan; Ms Z. Raditladi,
Manager, Quality Management, Botswana Medicines Regulatory Authority,
Gaborone, Botswana; Mrs P. Rafidison, University of Paris, Paris, France; Dr L.
Rägo, Secretary-General, Council of International Organizations of Medical
Sciences, Geneva, Switzerland; Professor M.A.U. Rahman, Controller
(Engineering), AGP Limited, Karachi, Pakistan; Mr C. Ranga, Deputy Drugs
Controller (I), Central Drugs Standard Control Organization, New Delhi, India;
Ms G. Rao, Aurobindo Pharma Ltd, India; Ms E. Ratkowska, Good Manufacturing
Practice Inspector, Chief Pharmaceutical Inspectorate, Warsaw, Poland; Mr K.
Rehemtulla, Drug Registration Officer, Tanzania Food and Drugs Authority,
United Republic of Tanzania; Mr R. dos Reis, Health Regulatory Agency, Brasília,
Brazil; Dr H.K. Remmelt Van Der Werf, European Directorate for the Quality of
Medicines and Health Care, Council of Europe, Strasbourg, France; Professor
M. Rizzi, University of Piemonte Orientale, Novara, Italy; Dr J.L. Robert,
Luxembourg; Mr N. Robert, Chief Executive Officer, Robert Neri Consulting,
France; Dr J. Robertson, Hertfordshire, United Kingdom; Professor K. Rocha
Rezende, Universidade Federal de Goiás, Faculdade de Farmácia BioPk,
Laboratório de Biofarmácia e Farmacocinética, Goiás, Brazil; Ms I. Rodríguez,
Comisión para el Control de Calidad de Medicamentos, Montevideo, Uruguay;
Dr J. Isasi Rosas, Inspection Services, Centro Nacional de Control de Calidad,
67
Lima, Peru; Mr T. Rücker, General Manager, Letzner Pharmawasseraufbereitung

GmbH, Hückeswagen, Germany; Mr R.T. Rukwata, Head of Licensing and
Inspection, Medicines Control Authority, Harare, Zimababwe; Dr J. Sabartova,
Prague, Czechia; Dr E.I. Sakanyan, Director, Centre of the Pharmacopoeia and
International Collaboration, Federal State Budgetary Institution, Scientific Centre
for Expert Evaluation of Medicinal Products, Moscow, Russian Federation;
Mr H. Sakurai, Specialist for Inspection, Office of Manufacturing/Quality and
Compliance, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Ms K.
Salin, Environmental Strategist, Scientific Expertise, Swedish Medical Products
Agency, Uppsala, Sweden; Dr A. Salinas Rivera, Institute of Public Health,
Santiago, Chile; Dr P. Salo, Head of Pharmaco-Chemical Section, Finnish
Medicines Agency, Helsinki, Finland; Sandoz, Mumbai, India; Mr Y. Samson,
Director, Kereon AG, Basel, Switzerland; Dr C.A. Sánchez González, Adviser,
Centre para el Control de Medicamentos, Equipos y Dispositivos Médicos,
Havana, Cuba; Sanofi, Gentilly, France; Sanofi Pasteur, Marcy-l’Étoile, France;
Dr B. Santoso, Yogyakarta, Indonesia, Yogyakarta, Indonesia; Ms A. Saragih,
Indonesian Pharmacopoeia Commission, National Agency of Drug and Food
Control, Yogyakarta, Indonesia; Dr D. Sato, Chief Management Officer,
Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; Mr N. Schaaf,
Programme Manager, Swedish Water House, Stockholm International Water
Institute, Stockholm, Sweden; Dr P.E. Schaeffer, Regulatory Affairs, Regulatory
Science and Policy Associate, European Union Region/Asia, Middle East and
European Region, Sanofi-Aventis R&D, Chilly-Mazarin, France; Dr S.
Schäfermann, Research Associate, Medi-Quality Security Institute, Kanazawa
University, Kanazawa, Japan; Dr J. Schläpfer, Head, Sector Management Services
and International Affairs, Swissmedic, Bern, Switzerland; Mr J. Screbo, JS
International Auditing & Consulting, Stockholm, Sweden; Professor G.K.E.
Scriba, Professor, Pharmaceutical Chemistry, Friedrich-Schiller University, Jena,
Germany; Mrs P. Serpa, Coordinator, National Sanitary Surveillance Agency,
Brasiliía, Brazil; Serum Institute of India, Pune, India; Shanghai Desano Chemical
Pharmaceutical Co. Ltd, Shanghai, China; Ms H. Sharma, Manager, Rusan
Pharma, Mumbai, India; Professor G. Shashkova, Moscow, Russian Federation;
Shenyang Antibiotic, Shenyang, China; J. Shin, Medical Officer, World Health
Organization, Geneva, Switzerland; Mrs V. Shridhankar, Cipla Ltd, Mumbai,
India; Dr S.C. Shubat, Director, United States Accepted Names Program,
American Medical Association, Chicago (IL), USA; Mr S. Shull, Manufacturing
Process Engineer IV, Abbvie, Cincinnati (OH), USA; Dr M. Sibutha, Quality
Control Manager, Datlabs, Belmont, Zimbabwe; Mr D. Silva, Sindusfarma,
Sindicato da Indústria de Produtos Farmacêuticos, São Paulo, Brazil; Dr W.C.
Simon, Associate Director, Bureau of Pharmaceutical Sciences, Ottawa, Canada;
Dr G.N. Singh, Ghaziabad, India; Dr G.P. Singh, Senior Scientific Officer,
Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare,
68
Acknowledgements
Ghaziabad, India; Ms I. Šipić, Public Relations Office, Croatian Agency for

Medicinal Products and Medical Devices, Zagreb, Croatia; Ms M. Skiba, Good
Manufacturing Practice Inspector, Chief Pharmaceutical Inspectorate, Warsaw,
Poland; Ms J. Skutnik-Wilkinson, Associate Director, Quality Intelligence,
Biogen, Research Triangle Park (NC), USA; Dr L. Smallshaw, Co-Chair, European
Compliance Academy Foundation Board, European Compliance Academy,
Heidelberg, Germany; Mr D. Smith, Principal Scientist, SSI Schaefer Systems
SA, Pretoria, South Africa; Dr D.J. Snodin, Principal, Xiphora Biopharma
Consulting, Bristol, United Kingdom; Mrs M. Soares, Brasília, Brazil; Mr T.
Spooner, Director, Engineering, Amgen Inc., West Greenwich (RI), USA;
Dr Sornakumar, Senior Manager Qulaity Assurance, Sequent Research Ltd,
Hyderabad, India; Mr E. Sousa Silva, Health Regulatory Agency, Brasília, Brazil;
Dr A. Ssenkindu, National Drug Authority, Kampala, Uganda; Dr L. Stoppa,
Inspections and Certifications Department, Manufacturing Authorisation Office,
Italian Medicines Agency, Rome, Italy; Dr C. Strnadova, Senior Scientific Advisor,
Therapeutic Products Directorate of Health Canada, Ottawa, Canada; Ms Y.
Suarez, Health Regulatory Agency, Brasília, Brazil; Dr J. Sun, Deputy Director
General Department of Drug and Cosmetics Supervision, China Food and Drug
Administration, Beijing, China; Dr D. Sun Cuilian, Deputy Laboratory Director,
Pharmaceutical Laboratory, Pharmaceutical Division, Health Sciences Authority,
Singapore; Dr P. Svarrer Jakobsen, United Nations Children’s Fund, Supply
Division, Copenhagen, Denmark; Ms E. Tack, Directorate General Inspection,
Distribution Division, Distribution and Publicity Medicines Entity, Federal
Agency for Medicines and Health Products, Brussels, Belgium; Dr A. Terhechte,
Bezirksregierung Münster, Bonn, Germany; Ms A. Tiley, Head, Global Sustainable
Antibiotics Program, Centrient Pharmaceuticals, Rotterdam, Netherlands; Dr R.
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United Kingdom; Dr J.M. Trapsida, Niamey, Niger; Mr S. Tripathi, Assurance
Head, Rusoma Laboratories Pvt. Ltd, Indore, India; Mr F. Trucco, Ministerio de
Salud Pública, Montevideo, Uruguay; TTK Healthcare Ltd, Chennai, India;
Mr N. Twitchen, Executive Director, Global Quality Assurance, The Female
Health Company (UK), London, United Kingdom; Mr C. Twumasi-Danquah,
Food and Drugs Authority, Accra, Ghana; Professor N. Udupa, Research Director,
Health Sciences, Manipal Academy of Higher Education, Manipal, India; Dr A.J.
Van Zyl, George, South Africa; Dr K. Vashi, Vice-President, Technical Operations,
Mangalam Drugs & Organics Ltd, Valsad, India; Dr C.C.F. Vidotti, Ministry of
Health, Brasília, Brazil; Dr O. del Rosario Villalva Rojas, Executive Director,
Quality Control Laboratories, National Quality Control Center, National Institute
of Health, Lima, Peru; Mr W. Von Kluechtzner, United Nations Industrial
Development Organization, Vienna, Austria; Mr A. Walsh, President, Center for
Pharmaceutical Cleaning Innovation, Hillsborough (NJ), USA; Ms M. Wanyama,
Mission for Essential Drugs and Supplies, Nairobi, Kenya; Mr W. Watson, Senior
69
Director, Gilead Sciences, Cambridge, United Kingdom; Dr P. Weiglmeier,

Validation Management and Technical Transfer, Fareva, Feucht, Germany; Dr K.
Weisser, Senior Assessor, Paul-Ehrlich-Institut, Langen, Germany; Mr J. Welink,
Medicines Evaluation Board, Utrecht, Netherlands; Ms K. Wessberg, Senior
Director, Regulatory Affairs, Abbott Park (IL), USA; Professor A. Wessels, North
West University, Potchefstroom, South Africa; Dr M. Wiggens, Merck & Co. Inc.,
Kenilworth (NJ), USA; Mr K. Wilberforce, Directorate of Laboratory Services,
National Drug Authority, Kampala, Uganda; Ms C. Winfield, Senior Director,
Regulatory Operations, International Society for Pharmacopepidemiology,
Bethesda (MD), USA; Dr C. Wirthumer-Hoche, Head, Austrian Medicines and
Medical Devices Agency, Vienna, Austria; Ms K. van Wonderen, Health and
Youth Care Inspectorate, Ministry of Health, Welfare and Sport, DA Heerlen, The
Netherlands; Mr W. Wulandari, Good Manufacturing Practice Inspector,
Indonesian Food and Drug Authority, Jakarta Pusat, Indonesia; Dr M. Xu, Deputy
Director, Institiute for Chemical Drug Control, China National Institutes for
Food and Drug Control, China; Dr T. Yi, National Medical Products
Administration, Beijing, China; Dr L.M. Yong, Health Science Authority,
Singapore; Dr J. Zhang, Guangzhou Institute for Drug Control, Guangzhou,
China; Zhejiang Jiangbei Pharmaceutical Co. Ltd, Zhejiang, China.
70
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42. Essential medicines list for management of patients admitted to intensive care units with
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74
Annex 1
Guidelines and guidance texts adopted by the Expert
Committee on Specifications for Pharmaceutical
Preparations
As recommended by World Health Organization (WHO) partners and donor
organizations, a full and updated list of WHO norms and standards for
medicines, quality assurance and regulatory guidance texts adopted by the
Expert Committee and published in the WHO Technical Report Series has been
drawn up as follows.
75
76

LIST OF NORMS AND STANDARDS FOR
PHARMACEUTICALS GUIDELINES
Category Guideline TRS Annex Year comments
All guidelines Procedure for the development of World Health 1019 Annex 1 2019
Organization medicines quality assurance guidelines
Development Development of paediatric medicines: points to consider 970 Annex 5 2012
in formulation
Development Pharmaceutical development of multisource (generic) 970 Annex 3 2012
finished pharmaceutical products: points to consider
Distribution Pharmacy services
Distribution FIP - WHO good pharmacy practices: standards for 961 Annex 8 2011
quality of pharmacy services
Distribution Starting materials
Distribution Control and safe trade of starting materials for https://www.who.int/medicines/publications/
pharmaceutical products qa_starter/en/
Distribution/ WHO good trade and distribution practices for 966 Annex 6 2016
Quality assurance pharmaceutical starting materials
Distribution Compounding
Distribution FIP - WHO technical guidelines: Points to consider in 966 Annex 2 2016
the provision by health-care professionals of children-
specific preparations that are not available as authorized
products
Distribution Monitoring
Distribution/ WHO guidelines on the conduct of surveys of the quality 966 Annex 7 2016
Quality assurance of medicines
Distribution Finished Products
Distribution/ WHO certification scheme on the quality of https://www.who.int/medicines/areas/quality_
Regulatory standards pharmaceutical products moving in international safety/regulation_legislation/certification/en/
commerce
Distribution/ WHO pharmaceutical starting materials certification 917 Annex 3 2003
Regulatory standards scheme (SMACS): guidelines on implementation
Distribution/ WHO guidelines on import procedures for medical 1019 Annex 5 2019
Regulatory standards products
Distribution Procurement
Distribution/ WHO model quality assurance system for procurement 986 Annex 3 2014 EN
Quality assurance agencies
Distribution/ Système modèle d’assurance de la qualité de l’OMS pour 986 Annex 3 2014 FR
Quality assurance les agences d’approvisionnement
Distribution/ WHO model quality assurance system for procurement 986 Appendix 6 2014
Quality assurance agencies: Interagency finished pharmaceutical product
questionnaire
Distribution/ WHO model quality assurance system for procurement 986 Annex 4 2014 EN
Annex 1
Quality assurance/ agencies: aide-memoire for inspection
Inspections
77
78

Distribution Procurement (continued)
Distribution/ Système modèle d’assurance de la qualité de l’OMS pour 986 Annex 4 2014 FR
Quality assurance/ les agences d’approvisionnement: aide-mémoire pour
Inspections les inspections
Distribution Storage
Distribution WHO good storage and distribution practices for 1025 Annex 7 2020
medical products
Distribution Points to consider for setting the remaining shelf-life 1025 Annex 8 2020
of medical products upon delivery
Distribution WHO model guidance for the storage and transport 961 Annex 9 2011
of time- and temperature-sensitive pharmaceutical
products
Distribution WHO model guidance for the storage and transport 992 Annex 5 2015
of time- and temperature-sensitive pharmaceutical
products: Technical supplements
Distribution Technical supplements to WHO Technical Report 961 Annex 9 2011
Series, No. 961, 2011: Introduction to the Technical
Supplements
Distribution Supplement 1: Selecting sites for storage facilities 961 Annex 9 2011
Distribution Supplement 2: Design and procurement of storage facilities 961 Annex 9 2011
Distribution Supplement 3: Estimating the capacity of storage facilities 961 Annex 9 2011
Distribution Storage (continued)
Distribution Supplement 4: Building security and fire protection 961 Annex 9 2011
Distribution Supplement 5: Maintenance of storage facilities 961 Annex 9 2011
Distribution Supplement 6: Temperature and humidity monitoring 961 Annex 9 2011
systems for fixed storage areas
Distribution Supplement 7: Qualification of temperature-controlled 961 Annex 9 2011
storage areas
Distribution Supplement 8: Temperature mapping of storage areas 961 Annex 9 2011
Distribution Supplement 9: Maintenance of refrigeration equipment 961 Annex 9 2011
Distribution Supplement 10: Checking the accuracy of temperature 961 Annex 9 2011
control and monitoring devices
Distribution Supplement 11: Qualification of refrigerated road vehicles 961 Annex 9 2011
Distribution Supplement 12: Temperature-controlled transport 961 Annex 9 2011
operations by road and by air
Distribution Supplement 13: Qualification of shipping containers 961 Annex 9 2011
Distribution Supplement 14: Transport route profiling qualification 961 Annex 9 2011
Distribution Supplement 15: Temperature and humidity monitoring 961 Annex 9 2011
systems for transport operations
Distribution
Annex 1
Supplement 16: Environmental management of 961 Annex 9 2011
refrigeration equipment
79
80

Inspection
Inspection/Production WHO general guidance on hold-time studies 992 Annex 4 2015
Inspection WHO guidelines for drafting a site master file 961 Annex 14 2011
Inspection WHO guidance on good manufacturing practices: 996 Annex 4, 2016
Model inspection report Appendix 1
Inspection WHO good manufacturing practices on inspection: 996 Annex 4, 2016
Example of a risk category assessment of the site Appendix 2
depending on level of compliance and inspection
frequency
Inspection Quality managent system requirements for national 1025 Annex 5 2020
good manufacturing practice inspectorates
Inspection WHO guidelines on pre-approval inspections 902 Annex 7 2002
Inspection WHO guidelines for Inspection of pharmaceutical 823 Annex 2 1992
manufacturers
Inspection Desk assessment
Inspection/ WHO good practices for desk assessment of compliance 1010 Annex 9 2018
Regulatory standards with good manufacturing practices, good laboratory
practices and good clinical practices for medical
products regulatory decisions
Production WHO good manufacturing practices
Production WHO good manufacturing practices for pharmaceutical 986 Annex 2 2014 EN
products: Main principles
Production Bonnes pratiques de fabrication de l’OMS des produits 986 Annex 2 2014 FR
pharmaceutiques: Grands principes
Production Frequently asked questions: WHO good manufacturing https://www.who.int/medicines/areas/
practices in pharmaceutical practice quality_safety/quality_assurance/gmp/en/
Production WHO good manufacturing practices for active 957 Annex 2 2010 EN
pharmaceutical ingredients (bulk drug substances)
Production Bonnes pratiques de fabrication de l’OMS pour les 957 Annex 2 2010 FR
substances actives pharmaceutiques
Production WHO good manufacturing practices for the manufacture 885 Annex 5 1999
of pharmaceutical excipients
Production WHO good manufacturing practices for sterile 961 Annex 6 2011
pharmaceutical products
Production WHO good manufacturing practices for biological 966 Annex 3 2016
products (jointly with the Expert Committee on
Biological Standardization)
Production WHO good manufacturing practices for blood 961 Annex 4 2011
establishments (jointly with the Expert Committee on
Biological Standardization)
Annex 1
81
82

Production WHO good manufacturing practices (continued)
Production WHO good manufacturing practices for pharmaceutical 957 Annex 3 2010 EN
products containing hazardous substances
Production Bonnes pratiques de fabrication de l’OMS pour les 957 Annex 3 2010 FR
produits pharmaceutiques contenant des substances
dangereuses
of investigational pharmaceutical products for clinical
trials in humans
of herbal medicines
Production/ IAEA - WHO good manufacturing practices for 1025 Annex 2 2020
Regulatory standards radiopharmaceutical products
Production WHO good manufacturing practices for water for 970 Annex 2 2012 EN
pharmaceutical use
Production Bonnes pratiques de fabrication de l’OMS pour l’eau à 970 Annex 2 2012 FR
usage pharmaceutique
Production 製薬用水に対するWHO管理基準 (WHO good 970 Annex 2 2012 JP
manufacturing practices for water for pharmaceutical
use)
Production Production of water for injection by means other than 1025 Annex 3 2020
distillation
Production WHO good manufacturing practices (continued)
Production WHO good manufacturing practices for heating, 1010 Annex 8 2018
ventilation and air-conditioning systems for non-sterile
pharmaceutical dosage forms (part 1)
Production WHO good manufacturing practices for heating, 1019 Annex 2 2019
ventilation and air-conditioning systems for non-sterile
pharmaceutical products (part 2): interpretation of
guidelines
Production/Quality WHO good manufacturing practices: Guidelines on 1019 Annex 3 2019
assurance validation
Production Risk analysis
Production/ WHO guidelines on quality risk management 981 Annex 2 2013
Regulatory standards
Production/Inspection WHO good manufacturing practices on environmental 1025 Annex 6 2020
aspects of manufacturing: points to consider for
manufacturers and inspectors for the prevention of
antimicrobial resistance
Production Technology transfer
Production WHO guidelines on transfer of technology in 961 Annex 7 2011
pharmaceutical manufacturing
Annex 1
83
84

Production Processing practices for herbals
Production WHO good practices for the processing of herbal 1010 Annex 1 2018
medicines
Production Data management
Production/ WHO good data and record management practices 966 Annex 5 2016 EN
Quality assurance
Production/ Bonnes pratiques de l’OMS de gestion des données et 966 Annex 5 2016 FR
Quality assurance des enregistrements
Quality control Screening tests
Quality control Basic tests for drugs: pharmaceutical substances, https://apps.who.int/iris/bitstream/handle/
medicinal plant materials and dosage forms 10665/42020/9241545135.pdf?sequence=1
Quality control Pharmacopoeias
Quality control WHO good pharmacopoeial practices 996 Annex 1 2016
Quality control WHO good pharmacopoeial practices: chapter on 1010 Annex 6 2018
compounding
Quality control WHO good pharmacopoeial practices: chapter on herbal 1010 Annex 7 2018
medicines
Quality control International Pharmacopoeia and International Reference Standards
Quality control The International Pharmacopoeia (Ph. Int.) https://www.who.int/teams/health-product-
and-policy-standards/pharmacopoeia
Quality control The International Pharmacopoeia: Procedure for the 1025 Annex 1 2020
development of monographs and other texts
Quality control The International Pharmacopoeia: Revised concepts and 1003 Annex 2 2017
future perspectives
Quality control The International Pharmacopoeia: Updating mechanism 992 Annex 2 2015
for the section on radiopharmaceuticals
Quality control The International Pharmacopoeia: Related substances 943 Annex 1 2007
tests - dosage form monographs guidance notes
Quality control WHO International Chemical Reference Substances https://www.edqm.eu/en/WHO-ICRS-
(availability, price, ordering) Reference-Substances-1393.html
Quality control Release procedure for International Chemical Reference 981 Annex 1 2013
Substances
Quality control WHO general guidelines for the establishment, 943 Annex 3 2007
maintenance and distribution of chemical reference
substances
Quality control WHO recommendations on risk of transmitting animal 908 Annex 1 2003
spongiform encephalopathy agents via medicinal
products
Annex 1
85
86

Quality control Analysis of Samples
Quality control WHO considerations for requesting analysis of medicines 1010 Annex 3 2018
samples
Quality control WHO model certificate of analysis 1010 Annex 4 2018
Quality control Laboratory Guidelines
Quality control WHO good practices for pharmaceutical quality control 957 Annex 1 2010
laboratories
Quality control WHO good practices for pharmaceutical microbiology 961 Annex 2 2011
laboratories
Quality control/ WHO good chromatography practices 1025 Annex 4 2020
Inspection
Quality control/ WHO guidelines for preparing a laboratory information 961 Annex 13 2011
Inspection file
Quality control Plant materials
Quality control Quality control methods for medicinal plant materials https://apps.who.int/iris/bitstream/
handle/10665/41986/9241545100.
pdf?sequence=1
Quality control WHO guidelines for selecting marker substances of 1003 Annex 1 2017
herbal origin for quality control of herbal medicines
Quality control Testing of suspect samples
Quality control/ WHO guidance on testing of “suspect” falsified 1010 Annex 5 2018
Distribution medicines
(Monitoring)
Regulatory standards Stability
Regulatory standards WHO guidelines on stability testing of active 1010 Annex 10 2018
pharmaceutical ingredients and finished pharmaceutical
products
Regulatory standards Stability conditions for WHO Member States by 2018
Region - Appendix 1 to the Stability testing of active
pharmaceutical ingredients and finished pharmaceutical
products (Update of 24 August 2018)
Regulatory standards Interchangeability
Regulatory standards WHO guidelines on interchangeable multisource 1003 Annex 6 2017
(generic) pharmaceutical products: registration
requirements to establish interchangeability
Regulatory standards WHO “Biowaiver List”: proposal to waive in vivo 1025 Annex 12 2020
bioequivalence requirements for WHO Model List of
Essential Medicines immediate-release, solid oral dosage
forms
Annex 1
87
88

Regulatory standards Interchangeability (continued)
Regulatory standards WHO biopharmaceutics classification system: protocol 1019 Annex 4 2019
to conduct equilibrium solubility experiments for the
classification of active pharmaceutical ingredients for
biowaiver
Regulatory standards WHO guidance for organizations performing in vivo 966 Annex 9 2016
bioequivalence studies
Regulatory standards WHO list of international comparator pharmaceutical 1003 Annex 5 2017
products and general background notes
Regulatory standards WHO guidance on the selection of comparator 992 Annex 8 2015
pharmaceutical products for equivalence assessment
of interchangeable multisource (generic) products
Regulatory standards List of International Comparator products (September https://www.who.int/medicines/areas/
2016) quality_safety/quality_assurance/
list_int_comparator_prods_after_public_
consult30.9.xlsx?ua=1
Regulatory standards Medical devices
Regulatory standards WHO global model regulatory framework for medical 1003 Annex 4 2017
devices including in vitro diagnostic medical devices
Regulatory standards Others
Regulatory standards WHO general guidance on variations to multisource 966 Annex 10 2016
Regulatory standards WHO good review practices for national and regional 992 Annex 9 2015
regulatory authorities
Regulatory standards WHO guidelines on submission of documentation for a 986 Annex 6 2014
multisource (generic) finished product: Quality part
Regulatory standards/ WHO recommendations for quality requirements when 992 Annex 6 2015
Quality control plantderived artemisinin is used as a starting material
in the production of antimalarial active pharmaceutical
ingredients
Regulatory standards/ UNFPA-WHO technical specifications for male latex 1025 Annex 10 2020
Quality control condoms
Regulatory standards/ UNFPA-WHO specifications for plain lubricants 1025 Annex 11 2020
Quality control
Regulatory standards/ WHO guidelines for sampling of pharmaceutical 929 Annex 4 2005
Distribution products and related materials
(Monitoring)
Regulatory standards/ WHO guidelines for drafting a site master file 961 Annex 14 2011
Inspection
Regulatory standards/ WHO guidelines for the preparation of a contract 957 Annex 7 2010
Annex 1
Inspection research organization master file
89
90

Regulatory standards Others (continued)
Regulatory standards WHO guidelines on active pharmaceutical ingredient 948 Annex 4 2008
master file procedure
Regulatory standards International nonproprietary names for biological and 948 Annex 5 2008
biotechnological substances: a review
Regulatory standards WHO guidelines for the registration of fixed-dose 929 Annex 5 2005 EN
combination medicinal products
Regulatory standards Corrected chinese version 929 Annex 5 2005 CH
固定剂量复方制剂注册指导原则
WHO guidelines for the registration of fixed-dose
combination medicinal products
Regulatory standards/ WHO guidelines on packaging for pharmaceutical 902 Annex 9 2002
Production products
Regulatory standards Collaborative procedure
Regulatory standards WHO collaborative procedure in the assessment and 1010 Annex 11 2018
accelerated national registration of pharmaceutical
products and vaccines approved by stringent regulatory
authorities
Regulatory standards WHO good practices of national regulatory authorities in 1019 Annex 6 2019
implementing the collaborative registration procedures
for medical products
Regulatory standards WHO guidelines on the implementation of quality 1025 Annex 13 2020
management systems for national regulatory authorities
Prequalification
Prequalification UNFPA-WHO prequalification programme guidance 1025 Annex 9 2020
for contraceptive devices: Male latex condoms, female
condoms and intrauterine devices
Prequalification WHO collaborative procedure between the WHO 966 Annex 8 2016
prequalification team and national regulatory
authorities in the assessment and accelerated national
registration of WHO-prequalified pharmaceutical
products and vaccines
Prequalification WHO procedure for prequalification of pharmaceutical 961 Annex 10 2011
products
Prequalification WHO guidelines on variations to a prequalified product 981 Annex 3 2013
Prequalification WHO guidelines on submission of documentation for a 970 Annex 4 2012
multisource (generic) finished pharmaceutical product
for the WHO Prequalification of Medicines Programme:
quality part
Prequalification WHO prequalification of quality control laboratories: 1003 Annex 3 2017
procedure for assessing the acceptability, in principle,
of quality control laboratories for use by United Nations
agencies
Prequalification WHO guidelines on the requalification of prequalified 957 Annex 6 2010
dossiers
Annex 1
91
92

Prequalification
Prequalification WHO procedure for assessing the acceptability, in 953 Annex 4 2009
principle, of active pharmaceutical ingredients for use in
Prequalification WHO guidelines on submission of documentation for 986 Annex 5 2014
prequalification of finished pharmaceutical products
approved by stringent regulatory authorities
Annex 2
Points to consider when including Health-Based Exposure
Limits (HBELs) in cleaning validation
1. Introduction and background 94

2. Scope 95
3. Glossary 95
4. Historical approach in cleaning validation 97
5. New approach using HBELs in cleaning validation 97
5.1 Documentation 98
5.2 Equipment 98
5.3 Cleaning agents 98
5.4 Sampling 99
5.5 Cleanability studies 99
5.6 Risk management 100
5.7 Guidance for Health-Based Exposure Limits (HBELs) setting 100
5.8 Acceptance criteria 102
5.9 Analytical procedures 102
5.10 Data integrity 103
5.11 Cleaning validation and cleaning verification 103
5.12 Visually clean 104
5.13 Cleaning process capability 104
5.14 Personnel 104
5.15 Life cycle 104
References 104
Further reading 106
Appendix 1 Using Health-Based Exposure Limits (HBELs) to assess risk in
cleaning validation 107
93
1. Introduction and background

The World Health Organization (WHO) has published the guideline entitled
Good manufacturing practices for pharmaceutical products: main principles in
the WHO Technical Report Series, No. 986, Annex 2, 2014 (1).
The WHO Supplementary guidelines on good manufacturing practice:
validation were published in 2006 and were supported by seven appendices.
The main text (2) and its appendixes (3, 4, 6, 7, 8, 9) were revised between 2006
and 2019. Appendix 3, relating to cleaning validation (5), was not updated at
that time. Its revision, however, was discussed during an informal consultation
held in Geneva, Switzerland, in July 2019. The outcome of the discussion was
presented to the WHO Expert Committee on Specifications for Pharmaceutical
Products (ECSPP) meeting in October 2019. The ECSPP acknowledged the
importance of harmonization in regulatory expectations with regards to
cleaning validation approaches. The Expert Committee recommended a “Points
to consider” document be prepared in order to describe the current approaches
used in cleaning validation and highlighting the complexities involved in order
to establish a common understanding. A revision of the relevant appendix would
then be considered by the Expert Committee thereafter.
Some of the main principles of good manufacturing practices (GMP)
include the prevention of mix-ups and the prevention of contamination and
cross-contamination. Multi-product facilities in particular, have a potential risk
of cross-contamination. It is therefore important that manufacturers identify
all risks relating to contamination and cross-contamination and identify and
implement the appropriate controls to mitigate these risks.
These controls may include, for example, technical and organizational
measures, dedicated facilities, closed systems, cleaning and cleaning validation.
It is strongly recommended that manufacturers review their existing
technical and organizational measures, suitability of cleaning procedures and

appropriateness of existing cleaning validation studies.
Technical controls, such as the design of the premises and utilities
(e.g. heating, ventilation and air-conditioning [HVAC], water and gas), should
be appropriate for the range of products manufactured (e.g. pharmacological
classification, activities and properties). Effective controls should be implemented
to prevent cross-contamination when air is re-circulated through the HVAC
system.
Organizational controls, such as dedicated areas and utilities, dedicated
equipment, procedural control, and campaign production, should be considered
where appropriate as a means to reduce the risk of cross-contamination.
Measures to prevent cross-contamination and their effectiveness should
be reviewed periodically in accordance with authorized procedures.
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Annex 2
It should be noted that the above examples are described in more detail
in other documents. The focus of this document is on Health-Based Exposure
Limits (HBELs) setting in cleaning validation.
2. Scope
This document provides points to consider for a risk and science-based approach
when considering HBELs, based on pharmacological and toxicological data, in
cleaning validation.
This document further provides points to consider when reviewing the
current status and approaches to cleaning validation in multiproduct facilities.
The principles described in this document may be applied in facilities
where active pharmaceutical ingredients (APIs), investigational medical products
(IMP), vaccines, human and veterinary medical products are manufactured. The
principles may also be considered, where appropriate, in facilities where medical
devices are manufactured.
This document should be read in conjunction with the main GMP text
and supplementary texts on validation (1–9).
3. Glossary
Adjustment factor (safety factors). Numerical factor used in a quantitative risk
assessment to represent or allow for the extrapolation, uncertainty, or variability
of an observed exposure concentration and its associated health outcome in a
particular laboratory species or exposed population to an exposure concentration
for the target population (for example, from animals to human patients and
short-term exposure to chronic exposure) that would be associated with the
same delivered dose. Adjustment factors can also be used when dealing with
clinical data, e.g. when a study population is not representative of the general
population (10).
Cleanability. The ability of a cleaning procedure to effectively remove material,
cleaning agent residue and microbial contamination.
Cleaning validation. The collection and evaluation of data, from the cleaning
process design stage through cleaning at commercial scale, which establishes
scientific evidence that a cleaning process is capable of consistently delivering
clean equipment, taking into consideration factors such as batch size, dosing,
toxicology and equipment size.
Contamination. The presence of undesired foreign entities of a chemical,
microbiological or physical nature in or on equipment, a starting material, or an
95
intermediate or pharmaceutical product during handling, production, sampling,

packaging, repackaging, storage or transport.
Cross-contamination. Contamination of a starting material, intermediate
product or finished product with another starting material or product.
Health Based Exposure Limits (HBELs). See definition of Permitted Daily
Exposure (PDE)
Margin of safety. The margin of safety is the ratio between the cleaning
acceptance limit based on HBEL and the process residue data.
Maximum safe carryover (MSC). The maximum amount of carryover of a
residual process residue (API, cleaning agent, degradant, and so forth) into
the next product manufactured without presenting an appreciable health risk
to patients.
Maximum safe surface residue (MSSR). The MSSR is the maximum amount
of process residue that can remain on equipment surfaces and still be safe to
patients. The MSSR is mathematically calculated by dividing the Maximum
Safe Carryover (MSC) by the total area of shared contact (MSC/Total Product
Contact Surface Area).
Permitted daily exposure (PDE). PDE represents a substance-specific dose
that is unlikely to cause an adverse effect if an individual is exposed at or below
this dose every day for a lifetime.
Point of departure (of the HBEL calculation). The dose-response point that
marks the beginning of a low-dose extrapolation to derive an HBEL. This
point can be a No Observed Adverse Effect Level (NOAEL) or No Observed
Effect Level (NOEL), Lowest Observed Adverse Effect Level (LOAEL) or
Lowest Observed Effect Level (LOEL), or Benchmark Dose Level (BMDL) for
an observed effect [the highest dose at which no unwanted/adverse effect is
observed (NOEL/NOAEL), or, if unavailable, the dose at which a significant
adverse effect is first observed (LOEL/LOAEL)].
Verification. Evidence that the equipment is clean (i.e. that residues are reduced
from prior operations to levels no higher than those that are predetermined and
specified as acceptable). Appropriate methods should be used and, depending
upon the circumstances, may include visual inspection, analytical and microbial
(as applicable) testing of swab and/or rinse samples.
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4. Historical approach in cleaning validation

For details on the historical approaches in cleaning validation, see the WHO
Technical Report Series, No. 1019, Annexure 3, Appendix 3, 2019 (5).
The acceptance criteria for cleaning validation recommended in
historical GMP texts did not account for HBELs. A cleaning limit based on
HBELs should be calculated and compared against an existing cleaning limit.
Historically established cleaning limits may be used when these are more
stringent than HBELs. Any alert and action limits should not be based on
historically established cleaning limits, but should be based on a statistical
analysis if existing data (i.e. statistical process control).
Where the historical approach cannot be satisfactorily justified, and in
view of the risks of contamination and cross-contamination, the new approaches,
as described below, should be prioritized and implemented.
5. New approach using HBELs in cleaning validation

Historical cleaning validation approaches often merely showed that using a
defined cleaning procedure achieved an objective of meeting historical limits. In
many instances, no development work or cleanability studies were done nor was
consideration given to pharmacological and toxicological data for establishing
limits for cleaning residues.
Manufacturers should ensure that their cleaning procedures are
appropriately developed and that their cleaning validation provides scientific
evidence that residues of identified products that can be manufactured in
shared facilities are removed to levels considered as safe for patients. Control
measures should be implemented to mitigate the risks of contamination and
cross-contamination.
This approach should include at least the following points (some of
which are further described in the text below):
■■ risk assessment to identify cross-contamination hazards, analyse
risks, and to identify risk controls;
■■ cleaning procedure development studies including cleanability
studies, where applicable (e.g. new products or cleaning procedures);
■■ determination of technical and organizational controls;
■■ HBELs setting;
■■ selection of appropriate analytical procedures; and
■■ cleaning process control strategy.
97
Manufacturers should describe and implement their policy and

approaches, including the points mentioned above, in a document such as a
master plan.
Genotoxic and carcinogenic substances, degradants and other
contaminants (if relevant) should be identified and their risks evaluated.
Appropriate action should be taken where required (11).
5.1 Documentation
Risk management principles, as described by WHO and other guidelines on
quality risk management (12), should be applied to assist in identifying and
assessing risks. The appropriate controls should be identified and implemented
to mitigate contamination and cross-contamination.
The policy and approaches in cleaning and cleaning validation require
that good scientific practices should be applied (including the use of appropriate
equipment and methods). This should be described in a cleaning validation
master plan. Development studies, cleaning and cleaning validation should
be performed in accordance with predefined, authorized standard operating
procedures, protocols and reports, as appropriate. Records should be maintained
and available.
The design and layout of documents, and the reporting of data and
information, should be in compliance with the principles of good documentation
practices (13) and should also meet data integrity requirements (14).
5.2 Equipment
Cleaning validation should cover direct product contact surfaces. Non-contact
surfaces should be included in cleaning validation where these have been
identified as areas of risk.
Authorized drawings of equipment should be current, accurate and
available. Equipment surface area calculations should be documented and

justified. The source data for these calculations should be available. The calculated
values should be used in the calculations in cleaning validation.
All shared equipment and components, including those that are difficult
to clean (for example sieves, screens, filters and bags [such as centrifuge bags])
should be considered in cleaning validation and calculations.
Where the need is identified, dedicated equipment and or components
should be used.
5.3 Cleaning agents

Cleaning agents (including solvents and detergents used in cleaning processes)
should be selected based on cleaning process development studies including
cleanability studies. They should be appropriate for their intended use.
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Annex 2
There should be proof of effectiveness and appropriateness of the selected

cleaning agent.
Other points to consider include the concentration in which these are
used, their composition and removal of their residues to an acceptable level.
5.4 Sampling
Historically, cleaning validation has focused mainly on product contact surface
areas.
A combination of at least two or three methods should normally be
used. These include swab samples, rinse samples and visual inspection. Visual
inspection should always be performed where possible and safe to do so.
Sampling should be carried out by swabbing whenever possible. Rinse samples
should be taken for areas which are inaccessible for swab sampling. The sampling
materials and method should not influence the result.
Appropriate sampling procedures, swab material and sampling
techniques should be selected and used to collect swab and rinse samples. The
detail should be clearly described in procedures and protocols. The number of
swabs, location of swabbing, swab area, rinse sample volume and the manner
in which the samples are collected should be scientifically justified.
Swab and rinse sample methods should be validated for commercial
product manufacturing and verified for IMPs. Recovery should be shown to be
possible from all product contact materials sampled in the equipment with all
the sampling methods used.
Where microbiological sampling is carried out, a compendial or validated
method should be used.
The manner in which collected samples are stored (if required) and
prepared for analysis should be appropriate, described in detail and included in
the cleaning validation.
5.5 Cleanability studies

Before a new cleaning procedure is validated and adopted for routine use, a
cleanability study should be performed in order to determine the appropriateness
of the procedure for removing for example product residue, cleaning agents
and microorganisms. For cleaning procedures that have already been validated
where the data show that the cleaning procedure is effective and consistent, or
where risk assessment indicated that cleanability studies may not be required,
this may be considered acceptable.
99
5.6 Risk management

Risk management should be implemented with a focus on the identification,
evaluation, assessment and control of risks to mitigate the risk of contamination
and cross-contamination.
Measures should include technical and organizational controls in order
to deliver a verified or validated cleaning process (12).
5.7 Guidance for Health-Based Exposure Limits (HBELs) setting

Manufacturers should establish, document and implement a company-wide
policy on HBELs setting for shared facilities.
The appropriateness of the production and control of various APIs or
various products in shared facilities should be evaluated on the basis of scientific
data and information.
This is applicable to products already produced in a facility as well as
when new products are planned to be introduced into a facility, for example,
through a change control procedure.
Procedures should be established and implemented describing how the
scientific and toxicological data and information are obtained and considered
and how HBELs are established.
Data and information should be gathered and critically evaluated by a
qualified expert. A qualified expert is an individual with relevant qualifications
including educational background (e.g. toxicology, pharmacology or related
health fields), certifications (e.g. (e.g. Diplomate of the American Board of
Toxicology (DABT), European Registered Toxicologist (ERT) and with adequate
experience in the practice of deriving HBELs, such as occupational exposure
limits (OELs), PDEs for residual solvents, elemental impurities, and product
contamination/nonconformances. The data and evaluation should be presented
in a report that is peer-reviewed by another qualified expert (10, 15). The data
and information presented should be free from bias.

Where this service is outsourced by the manufacturer, appropriate
measures should be put in place in order to ensure that the data obtained are
reliable. GMP requirements, such as vendor qualification, agreements and other
related aspects, should be considered.
Note: The HBEL value for the same substance sometimes differs when it is
determined by different individuals. The reason for the difference between the
values should be clarified and investigated.
The report for each substance should include scientific detail and
information, as applicable, such as:
■■ substance identification
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Annex 2
■■ chemical structure
■■ clinical indication
■■ mode of action
■■ route of administration (Note: Where there is more than one route of
administration, separate HBELs should be derived for each route)
■■ preclinical/nonclinical data, for example, of acute and repeat-dose
toxicity data
–– genotoxicity data
–– carcinogenicity data
–– reproductive and developmental toxicity data
–– immunotoxicity and sensitization data
■■ clinical data
■■ pharmacodynamics and pharmacokinetics
■■ identification of the critical effect(s)
■■ point of departure for the HBEL calculation(s)
■■ adjustment factors
■■ justification of the selected lead rationale (if calculations with
different points of departure were made).
The report should be reviewed for its completeness and appropriateness
by the manufacturer’s designated internal personnel or by an appointed external
person. The person should have in-depth knowledge, appropriate qualifications
and experience (see above). A summary document may be prepared from the
report, for each relevant substance, which contains the key pharmacological/
toxicological characteristics of the compound, the effect that drives the HBEL
(“lead effect”), the basis of the rationale that has been used to set the HBEL and
the HBEL itself including the route/s of exposure for which the HBEL(s) is/are
valid (15, 16, 17, 18, 19).
The scientific report and calculated PDE value should be used when
defining the limits used in cleaning validation.
Note: If no NOAEL is obtained, the LOAEL may be used. Alternative approaches
to the NOAEL, such as the benchmark dose, may also be used. The use of other
approaches to determine HBELs could be considered acceptable if adequately and
scientifically justified (16, 17).
Manufacturers should periodically consider new data and information
on HBELs. Appropriate action, such as the updating of PDE reports, should be
taken where required.
101
Note: therapeutic macromolecules and peptides are known to degrade and denature
when exposed to pH extremes and/or heat, and may become pharmacologically
inactive. The cleaning of biopharmaceutical manufacturing equipment is typically
performed under conditions which expose equipment surfaces to pH extremes and/
or heat, which would lead to the degradation and inactivation of protein-based
products. In view of this, the determination of health-based exposure limits using
PDE limits of the active and intact product may not be required.
Where other potential routes of cross-contamination exist, the risks posed
should be considered on a case-by-case basis.
5.8 Acceptance criteria

The limits established in cleaning validation should be scientifically justified.
Historically, some manufacturers have specified acceptance criteria
where HBELs and related toxicity data were not included in the determination
of such acceptance criteria.
Criteria such as Maximum Safe Carryover (MSC) and Maximum Safe
Surface Residue (MSSR) values should be calculated. Calculations and data
should be available and comply with data integrity principles. The calculation
should include values of PDE, maximum daily dose, batch size and total shared
equipment surface areas, sample areas, sample dilution volumes and recovery
factors.
MSC and MSSR should be calculated and presented, for example, in
table form listing preceding and following product values. The cleanability
value obtained should be considered in determining the acceptability of the
procedure(s) and whether other controls including separate, dedicated facilities
are required (for example of IMPs see EudraLex Volume 4 Part 1 Chapter 3.6,
Annex 15, Annex 13).
The margin of safety should be identified.
5.9 Analytical procedures

Samples obtained in cleaning validation should be analyzed by using procedures
that are validated for their intended use. The procedures should be developed in
accordance with the principles of Analytical Quality by Design.
Specific methods, such as High-performance Liquid Chromatography
(HPLC), should be used where appropriate. UV spectrophotometric methods
and testing for total organic carbon (TOC) may be used where indicated and
where justified. Non-specific methods should only be used where specific
methods cannot be employed and their use can be justified, for example, based
on the outcome of risk assessment.
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Annex 2
Where analytical procedures were developed and validated off-site, the

scope and extent of validation when these are transferred to the site, should be
defined and justified. This includes procedures that are transferred from research
and development laboratories to site laboratories. Analytical procedures should
be able to quantify residue levels at the maximum safe surface residue level. (For
analytical procedure validation, see reference 6.)
Manufacturers should ensure that the procedures remain in a validated
state.
5.10 Data integrity

Data, information and results pertaining to, for example, HBELs, PDE reports,
results obtained from cleaning validation and calculations, should be scientific
and should be in compliance with the principles as contained in data integrity
guidelines (14).
5.11 Cleaning validation and cleaning verification

Cleaning validation
The cleaning procedure should be validated (5).
Cleaning validation should include proof of, for example, the applicability
of the procedure to clean equipment that:
■■ had been kept in an unclean state for a period of time (dirty
equipment hold time);
■■ are used after a product is planned (e.g. change from one product to
another product);
■■ are used in a campaign, where multiple batches of a product are
produced one after the other; and/or
■■ are stored in a clean state for defined periods of time (clean
equipment hold time).
HBELs should be considered when establishing carryover limits in
cleaning validation.
Cleaning verification
The company should describe the policy and approach to cleaning verification.
Cleaning verification is where the effectiveness of the validated cleaning
procedure is routinely verified. The approach may include swab or rinse samples
and should include the same sampling and testing procedures used in cleaning
validation. The results obtained from testing on a routine basis should be
reviewed and subjected to statistical trending if possible.
103
5.12 Visually clean

Visually clean is an important criterion in cleaning validation. It should be
one of the acceptance criteria used on a routine basis. Personnel responsible
for visual inspection should be appropriately trained and qualified and training
records should be kept.
Where visual inspection is used as a quantitative method, then Visible
Residue Limits (VRLs) should be determined. The process to determine the
limit should be appropriately described in procedures and protocols covering,
for example, concentrations, method of spiking, surface areas, material of
construction and other conditions such as light (LUX level) and angles. The
acceptability of visual inspection should be determined by comparing the VRL
of that compound to the MSSR with an appropriate safety margin.
5.13 Cleaning process capability

The cleaning procedure should remain in a validated state. It is recommended
that Process Capability (Cpk) be calculated and Statistical Process Control (SPC)
be used to support cleaning verification results and data. For example, the results
from cleaning verification sample analysis could be statistically trended. The
capability (Cpk) of the cleaning process is then calculated using an appropriate
statistical technique.
Data should be presented, for example, in graph form, and the capability
of the process in relation to control limits and the margin of safety should be
presented and discussed as part of continuous improvement over the life cycle.
5.14 Personnel
Personnel should be trained on the procedures and principles of cleaning and
cleaning validation, including contamination and cross-contamination control,
HBELs setting, equipment disassembly, visual inspection, sampling, testing and
statistical calculations, as appropriate and based on their responsibilities.
5.15 Life cycle

Cleaning procedures, cleaning validation and cleaning verification should be
included in the life cycle approach described by the company.
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Further reading
■■ Comparison of Permitted Daily Exposure with 0.001 Minimal Daily Dose for Cleaning Validation.
May 02, 2017. Ester Lovsin Barle, Camille Jandard, Markus Schwind, Gregor Tuschl, Claudia Sehner,
David G. Dolan. Pharmaceutical Technology. Volume 41, Issue 5, pages 42–53.
■■ ICH Topic Q3A (R2). Note for guidance on impurities testing: Impurities in new drug substances
(www.ich.org).
■■ Regulatory Toxicology and Pharmacology. ADE Supplement, Volume 79, Supplement 1, Pages
S1-S94 (15 August 2016) (https://www.sciencedirect.com/journal/regulatory-toxicology-and
pharmacology/vol/79/suppl/S1, accessed 25 September 2020).
■■ Sehner C, Schwind M, Tuschl G, Lovsin Barle E. What to consider for a good quality PDE document?
Pharm Dev Technol. 2019;24(7):803-811. doi:10.1080/10837450.2019.1592188
106
Annex 2
Appendix 1
Using Health-Based Exposure Limits (HBELs) to assess risk
in cleaning validation*
Permitted Daily Exposure (PDE)
The Permitted Daily Exposure (PDE) can be calculated based on the data and
information obtained. For example:
NOAEL × weight adjustment

PDE =
F1 × F2 × F3 × F4 × F5
Where NOAEL is no-observed adverse effect level, and
F represents various adjustment factors. The value selected for each
factor should be justified. All adjustment factors should ideally be
compound-specific. Default values should only be used where no
compound-specific data are available.
The PDE is derived by dividing the NOAEL for the critical effect by various
adjustment factors (also referred to as safety-, uncertainty-, assessment- or
modifying factors) to account for various uncertainties and to allow extrapolation
to a reliable and robust no-effect level in the human or target animal population.
(Note: The values for the factors cited below are defaults and should only be used in
the absence of compound-specific information).
F1 to F5 are addressing the following sources of uncertainty:
■■ F1: A factor (values between 2 and 12) to account for extrapolation
between species;
■■ F2: A factor of 10 to account for variability between individuals;
■■ F3: A factor 10 to account for repeat-dose toxicity studies of short
duration, i.e., less than 4-weeks;
■■ F4: A factor (1-10) that may be applied in cases of severe toxicity,
e.g. non-genotoxic carcinogenicity, neurotoxicity or teratogenicity;
■■ F5: A variable factor that may be applied if the no-effect level was
not established. When only an LOEL is available, a factor of up to
10 could be used depending on the severity of the toxicity.
Barle, E.L. Using Health-Based Exposure Limits to assess risk in cleaning validation. Pharmaceutical
*
Technology
107
The use of additional modifying factors to address residual uncertainties

not covered by the above factors may be accepted provided they are well
supported with literature data and an adequate discussion is provided to support
their use (17).
If no NOAEL is obtained, the lowest-observed-adverse-effect level (LOAEL)
may be used.
Calculating Maximum Safe Carryover (MSC) and

Maximum Safe Surface Residue (MSSR)
MSC and MSSR can be calculated by using HBELs, to determine the risks
associated with cleaning validation.
Step 1. Calculate MSC:
PDE a (ug) × Batch size b (kg)

MSC a (g) =
Maximum Daily Dose b (mg)
Where a = product a
b = product b or subsequent product
Step 2. Tabulate the data
API PDE MDD Batch size Shared

ug/day mg/day Kg Equipment
surface (m2)
1
2
3
4
5
Step 3. Calculate MSSR (mg/m2)
MSC a (g) × 1000

MSSR =
Shared surface for b (m2)
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Annex 2
Step 4. Tabulate the data for MSSR and identify where there is a risk, based on
the MSSR that are not met when considering the cleanability of the procedure or
the Visual Residue Limit of the compound / product.
MSSR Following product b

1 2 3 4 5 6
Pre- 1
Ce-
ding 2
3
Product a
4
5
6
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Annex 3
Good manufacturing practices: water for
pharmaceutical use
Background
Unlike other product or process ingredients, water is usually drawn from an
on‑demand system and is not subject to testing and batch or lot release prior
to use. Thus it is essential that water quality (including microbiological and
chemical quality) throughout production, storage and distribution processes is
controlled.
In recent years, following extensive consultations with stakeholders,
several pharmacopoeias have adopted revised monographs on water for injection
(WFI) that allow for production by non-distillation technologies. In 2017, the
World Health Organization (WHO) Expert Committee on Specifications for
Pharmaceutical Preparations (ECSPP) recommended that the WHO Secretariat
collect feedback on whether or not they should revise the WHO specifications
and good manufacturing practices (GMP) on WFI and, if so, how to do so.
Following several consultations, the ECSPP agreed that the monograph in The
International Pharmacopoeia (Water for injections) and the guideline WHO Good
manufacturing practices: water for pharmaceutical use (1), should both be revised
to allow for technologies other than distillation for the production of WFI.
In early 2019, the WHO Secretariat commissioned a draft guidance text
for the production of WFI by means other than distillation. Following several
public consultations, the text was presented to the Fifty-fourth ECSPP. The
Expert Committee adopted the Production of water for injection by means other
than distillation guideline and recommended that it should also be integrated
into WHO’s existing guideline on Good manufacturing practices: water for
pharmaceutical use.
This document is a revision of WHO Good manufacturing practices:
water for pharmaceutical use, previously published in the WHO Technical Report
Series, No. 970, Annex 2, 2011.
1. Introduction and scope 113

2. Background to water requirements and uses 113
3. General principles for pharmaceutical water systems 115
111
4. Water quality specifications 115

4.1 Pharmacopoeial specifications 115
4.2 Drinking-water 116
4.3 Bulk purified water 118
4.4 Bulk water for injections 120
5. General considerations for water purification systems 121
6. Water storage and distribution systems 123
7. Good practices for water systems 123
8. System sanitization and bioburden control 125
9. Storage vessels 126
10. Water distribution 127
11. Operational considerations including some qualification and
validation principles 128
12. Continuous system monitoring 129
13. Maintenance of water systems 130
14. System reviews 131
15. Inspection of water systems 131
References 132
Further reading 133
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Annex 3
1. Introduction and scope

1.1 This document concerns water for pharmaceutical use (WPU) produced,
stored and distributed in bulk form. It provides information on different
specifications for WPU; good practices for the management of the quality
of water systems; water treatment (production) systems; water storage and
distribution systems; commissioning, qualification and validation; sampling
and testing; and the routine monitoring of water.
1.2 The focus of this document is on the treatment, storage and distribution
of treated water used in pharmaceutical applications. It excludes the
production, storage and usage of water in quality-control laboratories.
1.3 This document does not cover water for administration to patients in the
formulated state or the use of small quantities of water in pharmacies to
compound individually prescribed medicines.
1.4 The document can be used in whole or in part, as appropriate, to the section
and application under consideration.
1.5 In addition to this document, the “Further reading” section at the end of this
document includes publications that can serve as additional background
material when planning, installing and operating systems intended to
provide WPU.
1.6 This document is supplementary to the WHO good manufacturing practices
for active pharmaceutical ingredients (2), and the WHO good manufacturing
practices for pharmaceutical products: main principles (3).
2. Background to water requirements and uses

2.1 Water is a widely used substance in the pharmaceutical industry and
other sectors involved in manufacturing pharmaceutical products. It is
extensively used as a raw material or starting material in the production,
processing and formulation of active pharmaceutical ingredients (APIs),
intermediates and finished pharmaceutical products (FPP), in the
preparation of solvents and reagents, and for cleaning (e.g. washing and
rinsing). Water has unique chemical properties due to its polarity and
hydrogen bonds. These include a relatively high boiling point, high specific
heat, cohesion, adhesion and density. These include contaminants that
may be hazards in themselves or that may be able to react with product
substances, resulting in hazards to health. Water should therefore meet
appropriate quality standards to mitigate these risks.
113
2.2 The microbiological and chemical quality of water should be controlled

throughout production, storage and distribution. While chemical test
results can normally be obtained without delay, results from microbiological
testing are normally available only after water has already been used as
microbiological tests may require periods of incubation. The assurance of
quality to meet the on-demand expectation of water is therefore essential.
2.3 To reduce the risks associated with the production, storage and distribution
of water, and considering the properties and use, it is essential:
■■ to ensure the appropriate design, installation, operation and
maintenance of WPU, pre-treatment, treatment, storage and
distribution systems;
■■ to continuously or periodically perform sanitization;
■■ to take the appropriate measures in order to minimize chemical and
microbial contamination; and
■■ to minimize microbial proliferation and endotoxin formation,
where applicable.
2.4 Different grades of water quality exist. The appropriate water quality,
meeting its defined specification (such as described in a pharmacopoeia),
should be used for the intended application.
2.5 The application of specific types of water to processes and dosage forms
should be considered.
2.6 Pharmaceutical manufacturers should use the appropriate grade of WPU
during, for example, the manufacture of APIs and different dosage forms,
for different stages in washing and cleaning, and in the synthesis of
materials and products.
2.7 The grade of water used should take into account the nature and intended
use of the intermediate or FPP and the stage in the manufacturing process
at which the water is used.
2.8 Bulk water for injections (BWFI) should be used, for example, in the
manufacture of injectable products, such as dissolving or diluting substances
or preparations during the manufacturing of parenteral products, and for
the manufacture of water for preparation of injections. BWFI should also
be used for the final rinse after the cleaning of equipment and components
that come into contact with injectable products, as well as for the final
rinse in a washing process in which no subsequent thermal or chemical
depyrogenization process is applied.
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3. General principles for pharmaceutical water systems

3.1 Pharmaceutical water production, storage and distribution systems should
be designed, installed, commissioned, qualified, validated, operated and
maintained to ensure the consistent and reliable production of water of
appropriate quality.
3.2 The capacity of these systems should be enough to meet both the minimum
and peak demand. These systems should be able to operate continuously
for significant periods of time in order to avoid the inefficiencies and
equipment stresses that occur when equipment cycles turn on and off too
frequently.
3.3 Qualification may include stages such as preparing User Requirement
Specifications (URS), Factory Acceptance Tests (FAT), Site Acceptance Tests
(SAT), as well as installation qualification (IQ), operational qualification
(OQ), and performance qualification (PQ). The release and use of the system
should be approved by the quality unit, e.g. quality assurance (QA) at an
appropriate stage of qualification and validation (see section 11 below).
3.4 Water sources and treated water should be monitored regularly for chemical,
microbiological and, where appropriate, endotoxin contamination. The
performance of water treatment, storage and distribution systems should
also be monitored. Records of the results monitored, trend analysis and any
actions taken should be maintained.
4. Water quality specifications

4.1 Pharmacopoeial specifications
4.1.1 Pharmacopoeias include specifications for water used in bulk and in
dosage forms. Where this document refers to specifications, such as
those in pharmacopoeias, the relevant, current publications should be
used. This document does not attempt to duplicate such material. Where
subtle points of difference exist between pharmacopoeial specifications,
the manufacturer should choose the appropriate specification in
accordance with the related marketing authorization submitted to the
relevant medicine’s regulatory authority. Pharmacopoeial requirements
or guidance for WPU are described in national, regional and
international pharmacopoeias (4) and limits for various impurities, or
classes of impurities, are either specified or recommended. Requirements
or guidance are given in pharmacopoeias on the microbiological and
chemical quality of water.
115
4.2 Drinking-water
Note: The requirements for the design, construction and commissioning of drinking
water systems are usually controlled through local regulations. Drinking water
systems are not usually qualified or validated, but subjected to commissioning.1
4.2.1 The quality of drinking-water is covered by the WHO guidelines
for drinking-water quality (5) and standards from the International
Organization for Standardization (ISO) and other regional and national
agencies. Drinking-water should comply with the relevant regulations
laid down by the relevant authority.
4.2.2 Drinking-water may be derived from a natural or stored source.
Examples of natural sources include springs, wells, rivers, lakes and seas.
The condition of the source water should be considered when choosing
a treatment to produce drinking- water.
4.2.3 Drinking-water should be supplied under continuous positive pressure
by a plumbing system free from any defects that could lead to
contamination.
4.2.4 Drinking-water may be derived from a public water supply system.
This includes an off-site source, such as a municipality. Appropriate
drinking-water quality should be ensured by the supplier. Tests should
be conducted to guarantee that the drinking-water delivered is of
drinking quality. This testing is typically performed on water when
taken from the water source. Where required, quality may be achieved
through processing on-site.
4.2.5 Where drinking-water is purchased in bulk and transported to the
user by water tankers, controls should be put into place to mitigate
any associated risks. Vendor assessment and authorized certification

activities, including confirmation of the acceptability of the delivery
vehicle, should be undertaken in a similar way to that used for any other
starting material.
4.2.6 It is the responsibility of the pharmaceutical manufacturer to assure that
the source water supplying the purified water (PW) treatment system
meets the appropriate drinking-water requirements. In these situations,
the point at which drinking-water quality is achieved should be identified
and a water sample taken and tested at defined intervals thereafter.
See documents listed under Further reading.

1
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Annex 3
4.2.7 If drinking-water is used directly in certain stages of pharmaceutical

manufacture, such as in the production of APIs or in the feedwater
for the production of higher qualities of WPU, then testing should
be carried out periodically by the water user’s site; for example, at the
point of use, to confirm that the quality meets the standards required
for drinking-water. The selection of tests to be performed, and the
frequency of testing, should be based on a risk assessment.
4.2.8 Where drinking-water is produced through the treatment of raw water
by a system on-site, the system configuration and water-treatment steps
used should be described.
4.2.9 Examples of typical processes employed to produce drinking-water
may include:
■■ desalination;
■■ filtration;
■■ softening;
■■ disinfection or sanitization, such as by ozone or sodium
hypochlorite (chlorine);
■■ iron (ferrous) removal;
■■ precipitation; and
■■ the reduction of concentration of specific inorganic and/or organic
materials.
4.2.10 Controls should be implemented to minimize the microbiological
contamination of sand filters, carbon beds and water softeners. The
techniques selected should be appropriate and may include backflushing,
chemical and/or thermal sanitization and frequent regeneration.
4.2.11 The quality of drinking-water should be monitored routinely to account
for environmental, seasonal or supply changes which may have an impact
on the source water quality.
4.2.12 Where drinking-water is stored and distributed by the user, the storage
and distribution systems should minimize the degradation of the water
quality prior to use. After any such storage, testing should be carried out
routinely and in accordance with a defined procedure. The storage and
distribution of drinking-water should be done in a manner to ensure a
turnover or recirculation of the water, if possible.
4.2.13 The equipment and systems used to produce and store drinking-water
should be able to be drained or flushed, and sanitized.
117
4.2.14 Storage tanks should be closed with appropriately protected vents and
should allow for visual inspection.
4.2.15 Distribution pipework should be able to be drained or flushed, and
sanitized.
4.2.16 The scope and extent of commissioning for the system should be
identified and justified.
4.2.17 If possible, the results from testing drinking-water should be subjected
to statistical analysis in order to identify trends and changes. If
the drinking-water quality changes significantly, but is still within
specification, the direct use of this water as a WPU, or as the feedwater
to downstream treatment stages, should be reviewed for any potential
risks. The appropriate action should be taken and documented.
4.2.18 Changes to an in-house system or to its operation should be made in
accordance with change control procedures.
4.2.19 Additional testing should be considered if there is any change in the raw
water source, treatment techniques or system configuration.
4.3 Bulk purified water

4.3.1 Bulk purified water (BPW) should meet the relevant pharmacopoeial
specifications for chemical and microbiological purity. The appropriate
and applicable test procedures should be followed.
4.3.2 BPW should be prepared from drinking-water as a minimum-quality
feedwater.
4.3.3 Any appropriate, qualified purification technique, or sequence of

techniques, may be used to prepare BPW. BPW could be prepared by, for
example, ion exchange, reverse osmosis (RO), RO/electro-deionization
(EDI), ultrafiltration, or any combination of these techniques.
4.3.4 The following are examples of aspects that should be considered when
configuring a water purification system or defining URS:
■■ the quality of feedwater and its variation over seasons;
■■ the quantity of water required by the user;
■■ the required water-quality specification;
■■ the sequence of purification stages required;
■■ the number and location of sampling points
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Annex 3
■■ design of sampling points in such a way so as to avoid potential

contamination;
■■ unit process steps provided and documented with the appropriate
instrumentation to measure parameters such as flow, pressure,
temperature, conductivity and total organic carbon;
■■ material of construction;
■■ sanitization strategy;
■■ main components;
■■ interlocks, controls and alarms; and
■■ appropriate software, electronic data management, system security
and audit trail.
4.3.5 Ambient-temperature systems such as ion exchange and ultrafiltration
are especially susceptible to microbiological contamination, particularly
when equipment is static during periods of no or low demand for water.
Sanitization at defined intervals (e.g. based on the data collected from the
system validation and system behaviour), as well as other controls, should
be defined to prevent and minimize microbiological contamination.
4.3.6 Methods for sanitizing each stage of purification should be appropriate
and validated. The removal of any agents used for sanitization should be
proven.
4.3.7 The following controls, for example, should be considered in order to
minimize microbial contamination:
■■ the maintenance of water flow at all times in the storage and
distribution system to prevent water from stagnating;
■■ control of temperature in the system, for example, by heat exchangers
or room cooling in order to reduce the risk of microbial growth;
■■ the provision of ultraviolet disinfection at appropriate locations in
the system;
■■ the use of water-treatment system components that can periodically
be thermally sanitized above 70 °C for a defined period of time, or
chemically sanitized using, for example, ozone, hydrogen peroxide
and/or peracetic acid; and
■■ a combination of thermal and chemical sanitization, if required.
4.3.8 BPW should have appropriate alert and action limits for chemical and
microbiological purity determined from a knowledge of the system
and data trending. BPW should be protected from recontamination and
microbial proliferation.
119
4.4 Bulk water for injections

4.4.1 BWFI should meet the relevant pharmacopoeial specifications for
chemical and microbiological purity (including endotoxins). BWFI is
the highest quality of pharmacopoeial WPU.
4.4.2 BWFI is not a final dosage form. It is an intermediate bulk product
suitable to be used as an ingredient during formulation.
4.4.3 As a robust technique should be used for the production of BWFI, the
following are examples of what should be considered when configuring
a water purification system or defining URS:
■■ the quality of feedwater and its variation over seasons;
■■ the quantity of water required by the user;
■■ the required water-quality specification;
■■ the sequence of purification stages required, where appropriate;
■■ based on the selection of components, material of construction and
type of system, the appropriate URS, qualification and validation;
■■ the optimum generator size or generators with variable control to
avoid over-frequent start/stop cycling;
■■ blow-down and dump functions;
■■ cool-down venting to avoid contamination ingress;
■■ appropriately located sampling points designed in such a way so as
to avoid potential contamination;
■■ appropriate instrumentation to measure parameters as required;
■■ sanitization strategy;
■■ interlocks, controls and alarms; and
■■ electronic data storage, system security and audit trail.

4.4.4 BWFI may be prepared, for example, by distillation as the final
purification step. Alternatively, BWFI may be produced by means other
than distillation. Techniques such as deionisation, electro deionization,
nanofiltration, ultrafiltration, water-softening, descaling, pre-filtration
and degasification, ultraviolet treatment, along with other techniques,
may be considered in conjunction with a single or double pass RO
system. For full details, see Production of water for injection by means
other than distillation as published in the WHO Technical Report Series,
No. 1025, Annex 3, 2020 (6).
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Annex 3
4.4.5 BWFI should have appropriate microbial and chemical alert and action
limits and should also be protected from recontamination and microbial
proliferation.
5. General considerations for water purification systems

5.1 Pharmaceutical manufacturers should apply the current principles of
quality risk management (7) in selecting and using the appropriate water
purification systems. An appropriate method for the production of WPU
should be used.
5.2 Risks and controls should be identified for each stage of the production,
storage, distribution, use and monitoring of WPU.
5.3 Risks identified should be evaluated in order to determine the scope
and extent of validation and qualification of the system, including the
computerized systems used for the production, control and monitoring
of WPU.
5.4 Risk management should be an ongoing part of the quality management
process for WPU. A mechanism to review or monitor events associated
with the production, storage, distribution and use of WPU should be
implemented.
5.5 Procedures for managing changes and deviations should be followed.
Where applicable, the appropriate risk and impact assessments should be
carried out in such a way that changes and deviations are managed.
5.6 The chosen water purification system, method or sequence of purification
steps must be appropriate in order to ensure the production of water of
the intended grade. Based on the outcome of the risk assessment, the
following should at least be considered when selecting the water treatment
system and method:
■■ the quality of the available feedwater and the variation over time
(seasonal changes);
■■ the availability of suitable support facilities for the system (e.g.
electricity, heating, steam, chilled water and compressed air);
■■ the extent of pre-treatment required;
■■ the sequence of purification steps required;
■■ the design and location of sampling points;
■■ the sanitization strategy;
121
■■ the availability of water-treatment equipment on the market;

■■ the reliability and robustness of the water-treatment equipment in
operation;
■■ the yield or efficiency of the purification system;
■■ the ability to adequately support and maintain the water purification
equipment;
■■ the continuity of operational usage considering hours/days/years
and planned downtime;
■■ the total life-cycle of the system (including capital, operation and
maintenance);
■■ the final water quality specification; and
■■ the minimum, average and maximum quantity of water required by
the user.
5.7 The specifications for water purification equipment, storage and distribution
systems should take into account at least the following:
■■ the location of the plant room;
■■ the extremes in temperature that the system will encounter;
■■ the risk of contamination, for example, from materials of
construction (contact materials) and the environment;
■■ the adverse impact of adsorptive contact materials;
■■ hygienic or sanitary design, where required;
■■ corrosion resistance;
■■ freedom from leakage;
■■ system configuration to avoid or minimize proliferation of
microbiological organisms;
■■ tolerance to cleaning and sanitizing agents (thermal and/or

chemical);
■■ the sanitization strategy;
■■ system capacity and output requirements; and
■■ the provision of all necessary instruments, test and sampling points
in order to allow for all the relevant critical quality parameters of the
complete system to be monitored.
5.8 The design, configuration and layout of the water purification equipment,
storage and distribution systems should also take into account the following
physical considerations:
■■ the ability to collect samples;
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Annex 3
■■ the space available for the installation and environment around the
system;
■■ structural loadings on buildings;
■■ the provision of adequate access for maintenance and monitoring;
and
■■ the ability to safely handle regeneration and sanitization chemicals.
6. Water storage and distribution systems

6.1 Where drinking water is stored and distributed, the appropriate controls
should be determined and implemented in order to mitigate risks. This
applies to all stages in the supply, storage and distribution of drinking-water.
6.2 The water storage and distribution systems for PW and BWFI should be
appropriately designed, installed, qualified, operated and maintained in
order to ensure the storage and distribution of water is of consistent quality
to the user points.
7. Good practices for water systems

7.1 The components of water systems, including but not limited to pipework,
valves and fittings, seals, diaphragms and instruments, should be appropriate
and remain suitable during the full range of operational conditions such
as temperature and pressure of the system at rest, in operation and during
sanitization. The construction materials should be of adequate quality.
7.2.1 As a minimum, the following design and construction practices should be
considered.
For drinking water storage, supply and distribution systems on-site
Materials of construction should be selected based on the following
requirements:
■■ ability to operate at the temperatures/pressures required;
■■ lack of impact on the final water quality;
■■ resistant to sanitizing chemicals;
■■ threaded and flanged joints are permitted; and
■■ sample valves should preferably be of sanitary design.
Note that the system may have a design life at the end of which it should be
replaced or adequately modified.
123
For purified water and bulk water for injection systems

Note: Construction standards are generally aligned with potable water
standards up to the process stage (e.g. RO).
■■ Materials of construction should be appropriate. It should be non-
leaching, non-adsorbing, non-absorbing and resistant to corrosion.
Stainless-steel grade 316L or polyvinylidene chloride (PVDC) is
generally recommended. The choice of material should take into
account the intended sanitization method.
■■ Stainless steel systems should be orbitally welded, with manual
welds where necessary. Inter-weldability between materials should
be demonstrated with the maintenance of weld quality through a
defined process. Documentation for such a system should be kept and
should include, as a minimum, the qualification of the welder, set-up
for welding (e.g. machine), work session test pieces (coupons or weld
samples), proof of quality of gas used, welding machine calibration
record, weld identification and heat numbers, and logs of all welds.
Records, photographs or videos of inspection of a defined proportion
of welds (e.g. 100% of manual welds, 10% of orbital welds).
■■ Joints should be made using sanitary connections, for example,
hygienic clamp joints. Threaded joints should not be permitted.
Polyvinylidene fluoride or polyvinylidene difluoride (PVDF) systems
should be fusion joined and visually inspected.
■■ Passivation should be considered for stainless steel systems, for
example, for non-electropolished surfaces (after initial installation
and after significant modification) in accordance with a documented
procedure defining the solution to be used, its concentration, the
temperature and contact time.
■■ Internal finish should be smooth.

■■ Flanges, unions and valves should be of a hygienic or sanitary
design. Valves should be diaphragm type forged or machined body,
with points of use constructed so that they can drain. Sample valves
should be sanitary type with the surface roughness of 1.0 micrometer
RA or lower for PW and WFI systems and are typically installed
between process stages and on the distribution loop return. The
appropriate checks should be carried out in order to ensure that the
correct seals and diaphragms are used and that they are fitted and
tightened correctly.
■■ The system should be installed to promote drainability with a
recommended minimum slope of 1/100.
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Annex 3
■■ Where appropriate, pressure or hydro-tests for leaks, spray-ball

functionality test and flow turbulence should be considered.
■■ Provision should be made for in-line measurement for total organic
carbon (TOC), conductivity, pressure, flow and temperature.
■■ Documents should provide evidence of system components
and qualification. These include as applicable drawings, original
or certified copies of certificates of conformity for materials of
construction, records of on-site tests performed, weld/joining records,
calibration certificates, system pressure test records and records of
passivation.
8. System sanitization and bioburden control

8.1 Water-treatment, storage and distribution systems should be subjected to
controls that will reduce the risk of contamination and the proliferation of
microbiological organisms.
8.2 Controls may include using chemical and/or thermal sanitization
procedures as appropriate for production, storage and distribution systems.
The procedure and conditions used (such as times and temperatures, as
well as the frequency), should be defined and proven to be effective for
sanitizing all relevant parts of the system. The techniques employed should
be considered during the design stage of the system as the procedure and
technique may impact on the components and materials of construction.
8.3 Systems that operate and are maintained at elevated temperatures (e.g.
> 70 °C) are generally less susceptible to microbiological contamination
than systems that are maintained at lower temperatures. When lower
temperatures are required due to the water treatment processes employed,
or the temperature requirements for the water in use, special precautions
should be taken to prevent the ingress of contaminants including
microorganisms (see section 9.2 for guidance).
8.4 Where the chemical sanitization of the water systems is part of the
biocontamination control programme, a validated procedure should be
followed in order to ensure that the sanitizing process selected is effective
and that the sanitizing agent has been effectively removed.
8.5 Records of sanitization should be maintained.
8.6 Other control techniques to be considered may include:
125
■■ The maintenance of a continuous circulation of water maintaining

turbulent flow evidenced by, for example, a Reynolds number of
> 4000.
■■ Ensuring hygienic design, including the use of zero dead leg
diaphragm valves where possible, and minimizing dead legs
elsewhere. Areas of possible dead legs should be measured and
calculated.
■■ Installing pipework in a manner to allow for full drainage, if
required. A guidance figure for the slope is not less than 1/100.
■■ Considering the use of ultraviolet lamps in the system where needed
with independent monitoring.
■■ Maintaining the system at an elevated temperature (e.g. > 70 °C), if
required.
9. Storage vessels
9.1 Storage vessels should be appropriate for their intended use.
9.2 As a minimum, the following should be considered:
■■ the design and shape to ensure drainage of water from the vessel,
when required;
■■ construction materials;
■■ capacity, including buffer capacity, between the steady state, water
generation rate and the potentially variable simultaneous demand
from user points, short-term reserve capacity in the event of failure
of the water-treatment system or the inability to produce water (e.g.
due to a regeneration cycle);
■■ prevention of stagnant water in the vessel (e.g. the headspace where

water droplets can accumulate) and the need for the use of a spray-
ball or distributor devices to wet the inner surfaces of the vessel;
■■ the fitting of bacteria-retentive, hydrophobic vent filters which are
tested for their integrity at appropriate intervals;
■■ the fitting of sanitary design pressure safety valves or bursting discs
provided with external rupture indicators to ensure that loss of
system integrity is detected;
■■ the design and sanitization, as required, of level indicators;
■■ the design and location of valves, sampling points and monitoring
devices and sensors; and
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Annex 3
■■ the need for heat exchangers or jacketed vessels. Where these are
used, double tube sheet or double plate heat exchangers should be
considered.
10. Water distribution

10.1 The water distribution system should be designed as a loop, with
continuous circulation of BPW and BWFI. Where this is not the case,
the appropriate justification for using a non-recirculating one-way
system should be provided as well as robust measures implemented to
monitor these.
10.2 As a minimum, the following should be considered:
■■ controls to minimize proliferation of contaminants;
■■ material of construction, joints and impact as a result of sanitization;
and
■■ the design and location of devices, sensors and instruments such as
flow meters, conductivity sensors, TOC analysers and temperature
sensors.
10.3 Filtration should not be used in distribution loops or at take-off user
points.
10.4 Where heat exchangers are used, they should be arranged in continually
circulating loops or sub-loops in order to avoid unacceptable static water
in the system.
10.5 When the temperature is reduced for processing purposes, the reduction
should occur for the minimum necessary time. The cooling cycles and
their duration should be proven satisfactory during the qualification of the
system.
10.6 Circulation pumps should be of a sanitary design with the appropriate seals
to prevent contamination of the system.
10.7 Where stand-by pumps are provided, they should be configured or
managed to avoid zones where stagnant water is trapped within the system.
10.8 Consideration should be given to preventing contamination in systems
where parallel pumps are used. There should be no stagnant water
remaining in a pump when the pumps is not being used.
10.9 Components should be identified and labelled. The direction of flow
should be indicated.
127
11. Operational considerations including some

qualification and validation principles
11.1 Water systems should be appropriately qualified and validated (8). The
scope and extent of qualification should be determined based on risk
assessment. (See also point 3.3. above.)
11.2 When commissioning work is done, this should be documented.
Commissioning is not a replacement for qualification.
11.3 In order to demonstrate the reliability and robustness of a system and
its performance, a three-phase approach should be used for validation,
covering at least one year of operation over different seasons. Tests on the
source water (drinking-water) should be included within the validation
programme and continued as part of the routine monitoring, and these
results should meet specifications.
Note: A typical phase 1 to 3 approach for a new system is described below.
When changes are made to existing systems, the phase(s) and length of each
phase, as well as sampling points and frequency of sampling should be based
on documented risk assessment.
Phase 1
Phase I should cover a period of at least two weeks.
Procedures and schedules should cover at least the following activities and
testing approaches:
■■ chemical and microbiological testing in accordance with a defined
plan;
■■ sample, test and monitoring of the incoming feedwater to verify

its quality;
■■ sample, test and monitoring after each step in the purification
process;
■■ sample, test and monitoring at each point of use and at other
defined sample points including the end of the distribution loop;
■■ verification of operating ranges;
■■ operating, cleaning, and maintenance;
■■ sanitizing procedures and operating ranges;
■■ demonstrate the consistent production and delivery of product water
of the required quality and quantity;
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Annex 3
■■ establishing provisional alert and action levels; and

■■ test-failure procedure.
The system should be monitored intensively for its performance. Water
should not be used for product manufacturing during this phase.
Phase 2
Phase 2 should cover at least a further test period of two weeks after the
satisfactory completion of Phase 1. The system should be monitored while
deploying all the standard operating procedures (SOPs). The sampling
programme should be generally the same as in Phase 1. The use of the
water for product manufacturing purposes during this phase may be
acceptable, provided that Phase 1 and ongoing Phase 2 data demonstrate
the appropriate water quality and the practice is approved by QA.
The approach should also:
■■ demonstrate consistent system operation within established ranges;
and
■■ demonstrate consistent production and delivery of water of the
required quantity and quality when the system is operated in
accordance with the SOPs.
Phase 3
Phase 3 should follow phase 2 ensuring that the duration of Phase I, 2 and
3 cover at least 12 months. The sample locations, sampling frequencies
and tests may be reduced according to a routine plan which should be
based on the established procedures and data from Phase 1 and Phase 2.
Data should be trended, for example, quarterly and a system review should
be undertaken after the completion of Phase 3 as part of the evaluation
of system performance capability. The appropriate action should be taken
where such a need is identified.
Water can be used during this phase. The data and information obtained
during Phase 3 should demonstrate the reliable performance of the system
over this period of time covering the different seasons.
12. Continuous system monitoring

12.1 The system should be subject to continuous monitoring.
12.2 A monitoring plan should be followed where samples are collected in
accordance with a written procedure.
129
12.3 A combination of online and offline instruments, linked to appropriately

qualified alarm systems, should be used. Parameters such as flow, pressure,
and temperature should be monitored with online instruments – as well as
conductivity and TOC, where possible. Periodic offline testing to confirm
the results from online testing is recommended. Other parameters may be
monitored through offline testing.
12.4 Offline testing (including physical, chemical and microbiological attributes)
should be done in accordance with a predetermined programme.
12.5 Samples should be taken from points of use and dedicated sample points
where required. All water samples should be taken using the same
methodology as detailed in production procedures, for example, using a
hose and with a suitable flushing and drainage procedure in place.
12.6 Tests should be carried out to ensure that the relevant pharmacopoeia
specification (and approved company specification, where applicable)
has been met. This may include the microbiological quality of water, as
appropriate.
12.7 The results for identified quality attributes should be subjected to
statistical analysis at defined intervals, for example, monthly, quarterly
and annually, in order to identify trends. The results should be within
defined control limits, such as 3 sigma.
12.8 Alert and action levels should be established based on historically reported
data.
12.9 Adverse trends and out-of-limit results should be investigated for the root
cause, followed by the appropriate corrective and preventive actions.
Where microbial contamination of BWFI occurs, the micro-organism
should be identified.
13. Maintenance of water systems

13.1 WPU systems should be maintained in accordance with an approved and
documented maintenance programme. Records should be kept.
13.2 The maintenance programme should take into account at least the
following:
■■ defined frequency for system elements e.g. filters, instruments, gauges;
■■ the calibration programme;
■■ SOPs for specific tasks;
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Annex 3
■■ the control and storage of approved spare parts;

■■ preventive maintenance and maintenance plan and instructions,
including cleaning after maintenance;
■■ a review and approval of systems for use upon completion of work;
and
■■ a record and review of problems and faults during maintenance
14. System reviews

14.1 WPU systems should be reviewed at described intervals (e.g. annually)S.
The review should be documented.
14.2 The review team should be comprised of representatives from, for example,
engineering, utilities, validation, QA, quality control, microbiology,
production and maintenance.
14.3 Examples of matters to be included in the review are:
■■ changes made since the last review;
■■ system performance trends and capability;
■■ quality trends;
■■ failure events and alarm history;
■■ investigations;
■■ out-of-specification and out-of-limit results;
■■ alert and action limits;
■■ assessing compliance with current GMP requirements for WPU
systems;
■■ verification of documentation being current;
■■ maintenance and calibration history;
■■ records such as log books and electronic data; and
■■ the appropriateness of the software and the computerized system
linked to the water system, for example, SCADA (Supervisory
Control and Data Acquisition), including audit trail, authorized
users with access and privileges.
15. Inspection of water systems

15.1 WPU (BPW and BWFI) systems are subjected to regulatory inspections.
Users should conduct audits and self-inspection of water systems at regular
intervals. Records should be maintained.
131
15.2 This document can be used as the basis of an audit and inspection. A tour
of the water system, treatment system, storage and distribution system, as
well as visible pipework and user points, should be performed to ensure
that the system is appropriately designed, installed, qualified, validated,
maintained and monitored.
References
1. WHO Good manufacturing practices: water for pharmaceutical use. In: WHO Expert Committee
on Specifications for Pharmaceutical Preparations: forty-sixth report. Geneva: World Health
Organization; 2012: Annex 2 (WHO Technical Report Series, No. 970; https://apps.who.int/iris/
bitstream/handle/10665/75168/WHO_TRS_970.pdf?sequence=1, accessed 29 July 2020).
2. WHO Good manufacturing practices for active pharmaceutical ingredients. In: WHO Expert
Committee on Specifications for Pharmaceutical Preparations: forty-fourth report. Geneva: World
Health Organization; 2010: Annex 2 (WHO Technical Report Series No. 957; https://apps.who.
int/iris/bitstream/handle/10665/44291/WHO_TRS_957_eng.pdf?sequence=1, accessed 29 July
2020).
3. WHO Good manufacturing practices for pharmaceutical products: main principles. In: WHO
Expert Committee on Specifications for Pharmaceutical Preparations: forty-eighth report.
Geneva: World Health Organization; 2014: Annex 2 (WHO Technical Report Series, No. 986 https://
apps.who.int/iris/bitstream/handle/10665/112733/WHO_TRS_986_eng.pdf?sequence=1,
accessed 29 July 2020).
4. The International Pharmacopoeia. Geneva, World Health Organization (https://www.who.int/
medicines/publications/pharmacopoeia/en/ and https://apps.who.int/phint/2019/index.html#p/
home, accessed 1 May 2020).
5. WHO Guidelines for drinking-water quality: fourth edition, incorporating the first addendum;
2017 (https://www.who.int/water_sanitation_health/publications/drinking-water-quality-
guidelines-4-including-1st-addendum/en/, accessed 1 May 2020).
6. WHO Production of water for injection by means other than distillation: fifty-fourth report.
https://www.who.int/docs/default-source/medicines/who-technical-report-series-who-expert-
committee-on-specifications-for-pharmaceutical-preparations/trs1025-annex3.pdf?sfvrsn=
caebed51_2, accessed 29 July 2020).
7. WHO Guidelines on quality risk management. In: WHO Expert Committee on Specifications for
Annex 2 (WHO Technical Report Series, No. 981: https://www.who.int/medicines/areas/quality_
safety/quality_assurance/Annex2 TRS-981.pdf?ua=1, accessed 1 May 2020).
8. WHO Guidelines on validation. In: WHO Expert Committee on Specifications for Pharmaceutical
Preparations: fifty-third report. Geneva: World Health Organization; 2019: Annex 3 (WHO
Technical Report Series, No. 1019; https://www.who.int/medicines/areas/quality_safety/quality_
assurance/WHO_TRS_1019_Annex3.pdf?ua=1, accessed 1 May 2020).
132
Annex 3
Further reading
■■ American Society of Mechanical Engineers. Bioprocessing Equipment Standard. ASME — BPE
2019.
■■ Banes PH. Passivation: understanding and performing procedures on austenitic stainless-steel
systems. Pharmaceutical Engineering, 1990: 41.
■■ Guide to inspections of high purity water systems. Maryland, US Food and Drug Administration,
1993 (http://www.fda.gov/ICECI/InspectionGuides).
■■ Biotechnology. Equipment. Guidance on testing procedures for cleanability. British Standards
Publishing. BS EN 12296, 1998.
■■ European Medicines Agency, 2020. Guideline on the quality of water for pharmaceutical use.
EMA/CHMP/CVMP/QWP/496873/2018, Amsterdam, Netherlands (https://www.ema.europa.eu/
en/documents/scientific-guideline/guideline-quality-water-pharmaceutical-use_en.pdf).
■■ European Pharmacopoeia: see website for the publishers of the European Pharmacopoeia and
supplements (http://www.pheur.org/).
■■ Harfst WH. Selecting piping materials for high-purity water systems. Ultra-pure water, May/June
1994.
■■ International Organization for Standardization (ISO) for drinking water ISO 24512:2007 consisting
of the following International Standards:
— ISO 24510, Activities relating to drinking water and wastewater services — Guidelines for the
assessment and for the improvement of the service to users
management of wastewater utilities and for the assessment of wastewater services
management of drinking water utilities and for the assessment of drinking water services
■■ ISPE Baseline Guide Volume 4: Water and Steam Systems. International Society for Pharmaceutical
Engineering, 2019.
■■ ISPE Baseline Guide Volume 5: Commissioning and Qualification. Second edition. International
Society for Pharmaceutical Engineering, 2019.
■■ Noble PT. Transport considerations for microbial control in piping. Journal of Pharmaceutical
Science and Technology, 1994, 48: 76–85.
■■ Pharmaceutical Inspection Co-operation Scheme. PIC/S; Inspection of utilities; P1 009-1. Geneva,
Pharmaceutical Inspection Co-operation Scheme, 2002.
■■ Tverberg JC, Kerber SJ. Effect of nitric acid passivation on the surface composition of mechanically
polished type 316 L sanitary tube. European Journal of Parenteral Sciences, 1998, 3: 117–124.
■■ US Food and Drug Administration. Guide to inspections of high purity water systems, high
purity water systems (7/93), 2009 (http://www.fda.gov/ICECI/Inspections/InspectionGuides/
ucm074905.htm).
■■ US Pharmacopeia: published annually (see http://www.usp.org/).
■■ World Health Organization, 2018. A global overview of national regulations and standards for
drinking-water quality (https://apps.who.int/iris/bitstream/handle/10665/272345/9789241513
760-eng.pdf?ua=1).
■■ World Health Organization, 2018. Developing drinking-water quality regulations and standards:
general guidance with a special focus on countries with limited resources (https://apps.who.int/
iris/bitstream/handle/10665/272969/9789241513944-eng.pdf?ua=1).
133
■■ World Health Organization, 1997. Guidelines for drinking-water quality, 2nd edition: Volume 3
- Surveillance and control of community supplies (https://apps.who.int/iris/bitstream/handle/
10665/42002/9241545038.pdf?sequence=1&isAllowed=y).
■■ World Health Organization, 2018. Management of radioactivity in drinking-water (https://apps.
who.int/iris/bitstream/handle/10665/272995/9789241513746-eng.pdf?ua=1).
■■ World Health Organization, 2019. Microplastics in drinking water (https://apps.who.int/iris/
bitstream/handle/10665/326499/9789241516198-eng.pdf?ua=1).
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Annex 4
Guideline on data integrity
This document replaces the WHO Guidance on good data and record management
practices (Annex 5, WHO Technical Report Series, No. 996, 2016) (1).

2. Scope 137
3. Glossary 138
4. Data governance 140
5. Quality risk management 144
6. Management review 145
7. Outsourcing 146
8. Training 146
9. Data, data transfer and data processing 147
10. Good documentation practices 148
11. Computerized systems 149
12. Data review and approval 152
13. Corrective and preventive actions 152
References 153
Further reading 153
Appendix 1 Examples in data integrity management 155
135

1.1. In recent years, the number of observations made regarding the integrity of
data, documentation and record management practices during inspections
of good manufacturing practice (GMP) (2), good clinical practice (GCP),
good laboratory practice (GLP) and Good Trade and Distribution Practices
(GTDP) have been increasing. The possible causes for this may include
(i) reliance on inadequate human practices; (ii) poorly defined procedures;
(iii) resource constraints; (iv) the use of computerized systems that are
not capable of meeting regulatory requirements or are inappropriately
managed and validated (3, 4); (v) inappropriate and inadequate control of
data flow; and (vi) failure to adequately review and manage original data
and records.
1.2. Data governance and related measures should be part of a quality system,
and are important to ensure the reliability of data and records in good
practice (GxP) activities and regulatory submissions. The data and records
should be ‘attributable, legible, contemporaneous, original’ and accurate,
complete, consistent, enduring, and available; commonly referred to as
“ALCOA+”.
1.3. This document replaces the WHO Guidance on good data and record
management practices (Annex 5, WHO Technical Report Series, No. 996,
2016) (1).
2. Scope
2.1. This document provides information, guidance and recommendations to
strengthen data integrity in support of product quality, safety and efficacy.
The aim is to ensure compliance with regulatory requirements in, for

example clinical research, production and quality control, which ultimately
contributes to patient safety. It covers electronic, paper and hybrid systems.
2.2. The guideline covers ”GxP” for medical products. The principles could also
be applied to other products such as vector control products.
2.3. The principles of this guideline also apply to contract givers and contract
acceptors. Contract givers are ultimately responsible for the integrity of data
provided to them by contract acceptors. Contract givers should therefore
ensure that contract acceptors have the appropriate capabilities and comply
with the principles contained in this guideline and documented in quality
agreements.
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2.4. Where possible, this guideline has been harmonised with other published
documents on data integrity. This guideline should also be read with other
WHO good practices guidelines and publications including, but not limited
to, those listed in the references section of this document.
3. Glossary
The definitions given below apply to the terms used in these guidelines. They
may have different meanings in other contexts.
ALCOA+. A commonly used acronym for “attributable, legible, contemporaneous,
original and accurate” which puts additional emphasis on the attributes of being
complete, consistent, enduring and available throughout the data life cycle for
the defined retention period.
Archiving. Archiving is the process of long-term storage and protection of
records from the possibility of deterioration, and being altered or deleted,
throughout the required retention period. Archived records should include
the complete data, for example, paper records, electronic records including
associated metadata such as audit trails and electronic signatures. Within a GLP
context, the archived records should be under the control of independent data
management personnel throughout the required retention period.
Audit trail. The audit trail is a form of metadata containing information
associated with actions that relate to the creation, modification or deletion of
GxP records. An audit trail provides for a secure recording of life cycle details
such as creation, additions, deletions or alterations of information in a record,
either paper or electronic, without obscuring or overwriting the original record.
An audit trail facilitates the reconstruction of the history of such events relating
to the record regardless of its medium, including the “who, what, when and
why” of the action.
Backup. The copying of live electronic data, at defined intervals, in a secure
manner to ensure that the data are available for restoration.
Certified true copy or true copy. A copy (irrespective of the type of media
used) of the original record that has been verified (i.e. by a dated signature or by
generation through a validated process) to have the same information, including
data that describe the context, content, and structure, as the original.
Data. All original records and true copies of original records, including source
data and metadata, and all subsequent transformations and reports of these
data which are generated or recorded at the time of the GMP activity and which
137
allow full and complete reconstruction and evaluation of the GMP activity. Data
should be accurately recorded by permanent means at the time of the activity.
Data may be contained in paper records (such as worksheets and logbooks),
electronic records and audit trails, photographs, microfilm or microfiche, audio
or video files or any other media whereby information related to GMP activities
is recorded.
Data criticality. This is defined by the importance of the data for the quality and
safety of the product and how important data are for a quality decision within
production or quality control.
Data governance. The sum total of arrangements which provide assurance of
data quality. These arrangements ensure that data, irrespective of the process,
format or technology in which it is generated, recorded, processed, retained,
retrieved and used will ensure an attributable, legible, contemporaneous, original,
accurate, complete, consistent, enduring and available record throughout the
data life cycle.
Data integrity risk assessment (DIRA). The process to map out procedures,
systems and other components that generate or obtain data; to identify and
assess risks and implement appropriate controls to prevent or minimize lapses
in the integrity of the data.
Data life cycle. All phases of the process by which data are created, recorded,
processed, reviewed, analysed and reported, transferred, stored and retrieved and
monitored, until retirement and disposal. There should be a planned approach
to assessing, monitoring and managing the data and the risks to those data, in
a manner commensurate with the potential impact on patient safety, product
quality and/or the reliability of the decisions made throughout all phases of the
data life cycle.
Dynamic data. Dynamic formats, such as electronic records, allow an interactive

relationship between the user and the record content. For example, electronic
records in database formats allow the user to track, trend and query data;
chromatography records maintained as electronic records allow the user or
reviewer (with appropriate access permissions) to reprocess the data and expand
the baseline to view the integration more clearly.
Electronic signatures. A signature in digital form (bio-metric or non-biometric)
that represents the signatory. In legal terms, it is the equivalent of the handwritten
signature of the signatory.
Good practices (GxP). An acronym for the group of good practice guides
governing the preclinical, clinical, manufacturing, testing, storage, distribution
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and post-market activities for regulated pharmaceuticals, biologicals and medical

devices, such as GLP, GCP, GMP, good pharmacovigilance practices (GVP) and
good distribution practices (GDP).
Hybrid system. The use of a combination of electronic systems and paper
systems.
Medical product. A term that includes medicines, vaccines, diagnostics and
medical devices.
Metadata. Metadata are data that provide the contextual information required
to understand other data. These include structural and descriptive metadata,
which describe the structure, data elements, interrelationships and other
characteristics of data. They also permit data to be attributable to an individual.
Metadata that are necessary to evaluate the meaning of data should be
securely linked to the data and subject to adequate review. For example, in the
measurement of weight, the number 8 is meaningless without metadata, such
as, the unit, milligram, gram, kilogram, and so on. Other examples of metadata
include the time or date stamp of an activity, the operator identification (ID)
of the person who performed an activity, the instrument ID used, processing
parameters, sequence files, audit trails and other data required to understand
data and reconstruct activities.
Raw data. The original record (data) which can be described as the first-
capture of information, whether recorded on paper or electronically. Raw data
is synonymous with source data.
Static data. A static record format, such as a paper or electronic record, that
is fixed and allows little or no interaction between the user and the record
content. For example, once printed or converted to static electronic format
chromatography records lose the capability of being reprocessed or enabling
more detailed viewing of baseline.
4. Data governance
4.1. There should be a written policy on data integrity.
4.2. Senior management should be accountable for the implementation of
systems and procedures in order to minimise the potential risk to data
integrity, and to identify the residual risk using risk management techniques
such as the principles of the guidance on quality risk management from
WHO (5) and The International Council for Harmonisation of Technical
Requirements for Pharmaceuticals for Human Use (ICH) (6).
139
4.3. Senior management is responsible for the establishment, implementation

and control of an effective data governance system. Data governance should
be embedded in the quality system. The necessary policies, procedures,
training, monitoring and other systems should be implemented.
4.4. Data governance should ensure the application of ALCOA+ principles.
4.5. Senior management is responsible for providing the environment to
establish, maintain and continually improve the quality culture, supporting
the transparent and open reporting of deviations, errors or omissions and
data integrity lapses at all levels of the organization. Appropriate, immediate
action should be taken when falsification of data is identified. Significant
lapses in data integrity that may impact patient safety, product quality or
efficacy should be reported to the relevant medicine regulatory authorities.
4.6. The quality system, including documentation such as procedures and
formats for recording and reviewing of data, should be appropriately
designed and implemented in order to provide assurance that records and
data meet the principles contained in this guideline.
4.7. Data governance should address the roles, responsibilities, accountability
and define the segregation of duties throughout the life cycle and consider
the design, operation and monitoring of processes/systems to comply
with the principles of data integrity, including control over authorized and
unauthorized changes to data.
4.8. Data governance control strategies using quality risk management (QRM)
principles (5) are required to prevent or mitigate risks. The control
strategy should aim to implement appropriate technical, organizational
and procedural controls. Examples of controls may include, but are not
limited to:
■■ the establishment and implementation of procedures that will
facilitate compliance with data integrity requirements and
expectations;
■■ the adoption of a quality culture within the company that
encourages personnel to be transparent about failures, which
includes a reporting mechanism inclusive of investigation and
follow-up processes;
■■ the implementation of appropriate controls to eliminate or reduce
risks to an acceptable level throughout the life cycle of the data;
■■ ensuring sufficient time and resources are available to implement
and complete a data integrity programme; to monitor compliance
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Annex 4
with data integrity policies, procedures and processes through

e.g. audits and self-inspections; and to facilitate continuous
improvement of both;
■■ the assignment of qualified and trained personnel and provision
of regular training for personnel in, for example, GxP, and the
principles of data integrity in computerized systems and manual/
paper based systems;
■■ the implementation and validation of computerized systems
appropriate for their intended use, including all relevant data integrity
requirements in order to ensure that the computerized system has the
necessary controls to protect the electronic data (3); and
■■ the definition and management of the appropriate roles and
responsibilities for contract givers and contract acceptors, entered
into quality agreements and contracts including a focus on data
integrity requirements.
4.9. Data governance systems should include, for example:
■■ the creation of an appropriate working environment;
■■ active support of continual improvement in particular based on
collecting feedback; and
■■ review of results, including the reporting of errors, unauthorized
changes, omissions and undesirable results.
4.10. The data governance programme should include policies and procedures
addressing data management. These should at least where applicable,
include:
■■ management oversight and commitment;
■■ the application of QRM;
■■ compliance with data protection legislation and best practices;
■■ qualification and validation policies and procedures;
■■ change, incident and deviation management;
■■ data classification, confidentiality and privacy;
■■ security, cybersecurity, access and configuration control;
■■ database build, data collection, data review, blinded data,
randomization;
■■ the tracking, trending, reporting of data integrity anomalies, and
lapses or failures for further action;
141
■■ the prevention of commercial, political, financial and other

organizational pressures;
■■ adequate resources and systems;
■■ workload and facilities to facilitate the right environment that
supports DI and effective controls;
■■ monitoring;
■■ record-keeping;
■■ training; and
■■ awareness of the importance of data integrity, product quality and
patient safety.
4.11. There should be a system for the regular review of data for consistency with
ALCOA+ principles. This includes paper records and electronic records in
day-to-day work, system and facility audits and self-inspections.
4.12. The effort and resources applied to assure the integrity of the data should
be commensurate with the risk and impact of a data integrity failure.
4.13. Where weaknesses in data integrity are identified, the appropriate
corrective and preventive actions (CAPA) should be implemented across
all relevant activities and systems and not in isolation.
4.14. Changing from paper-based systems to automated or computerised
systems (or vice-versa) will not in itself remove the need for appropriate
data integrity controls.
4.15. Records (paper and electronic) should be kept in a manner that ensures
compliance with the principles of this guideline. These include but are not
limited to:
■■ ensuring time accuracy of the system generating the record,

accurately configuring and verifying time zone and time
synchronisation, and restricting the ability to change dates, time
zones and times for recording events;
■■ using controlled documents and forms for recording GxP data;
■■ defining access and privilege rights to GxP automated and
computerized systems, ensuring segregation of duties;
■■ ensuring audit trail activation for all interactions and restricting the
ability to enable or disable audit trails (Note: ‘back-end’ changes and
‘hard’ changes, such as hard deletes, should not be allowed). Where
audit trials can be disabled then this this action should also appear
in the audit trail;
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■■ having automated data capture systems and printers connected to

equipment and instruments in production (such as Supervisory
Control and Data Acquisition (SCADA), Human Machine Interface
(HMI) and Programme Logic Control (PLCs) systems), in , quality
control, and in clinical research (such as Clinical Data Management
(CDM) systems), where possible;
■■ designing processes in a way to avoid the unnecessary transcription
of data or unnecessary conversion from paper to electronic and vice
versa; and
■■ ensuring the proximity of an official GxP time source to site of GxP
activity and record creation.
4.16. Systems, procedures and methodology used to record and store data
should be periodically reviewed for effectiveness. These should be updated
throughout the data life cycle, as necessary, where new technology
becomes available. New technology implementation must be evaluated
before implementation to verify the impact on data integrity.
5. Quality risk management

Note: documentation of data flows and data process maps are recommended to
facilitate the assessment, mitigation and control of data integrity risks across the
actual and intended data process(es).
5.1. Data Integrity Risk Assessment (DIRA) should be carried out in order to
identify and assess areas of risk. This should cover systems and processes
that produce data or, where data are obtained and inherent risks. The
DIRAs should be risk-based, cover the life cycle of data and consider data
criticality. Data criticality may be determined by considering how the data
is used to influence the decisions made. The DIRAs should be documented
and reviewed, as required, to ensure that it remains current.
5.2. The risk assessments should evaluate, for example, the relevant GxP
computerised systems, supporting personnel, training, quality systems and
outsourced activities.
5.3. DI risks should be assessed and mitigated. Controls and residual risks
should be communicated. Risk review should be done throughout the
document and data life cycle at a frequency based on the risk level, as
determined by the risk assessment process.
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5.4. Where the risk assessment has highlighted areas for remedial action, the
prioritisation of actions (including the acceptance of an appropriate level
of residual risk) and the prioritisation of controls should be documented
and communicated. Where long-term remedial actions are identified, risk-
reducing short-term measures should be implemented in order to provide
acceptable data governance in the interim.
5.5. Controls identified may include organizational, procedural and technical
controls such as procedures, processes, equipment, instruments and other
systems in order to both prevent and detect situations that may impact
on data integrity. Examples include the appropriate content and design of
procedures, formats for recording, access control, the use of computerized
systems and other means.
5.6. Efficient risk-based controls should be identified and implemented
to address risks impacting data integrity. Risks include, for example,
the deletion of, changes to and exclusion of data or results from data
sets without written justification, authorisation where appropriate,
and detection. The effectiveness of the controls should be verified (see
Appendix 1 for examples).
6. Management review
6.1. Management should ensure that systems (such as computerized systems
and paper systems) are meeting regulatory requirements in order to
support data integrity compliance.
6.2. The acquisition of non-compliant computerized systems and software
should be avoided. Where existing systems do not meet current
requirements, appropriate controls should be identified and implemented
based on risk assessment.

6.3. The effectiveness of the controls implemented should be evaluated through,
for example:
■■ the tracking and trending of data;
■■ a review of data, metadata and audit trails (e.g. in warehouse and
material management, production, quality control, case report
forms and data processing); and
■■ routine audits and/or self-inspections, including data integrity and
computerized systems.
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7. Outsourcing
7.1. The selection of a contract acceptor should be done in accordance with
an authorized procedure. The outsourcing of activities, ownership of data,
and responsibilities of each party (contract giver and contract accepter)
should be clearly described in written agreements. Specific attention
should be given to ensuring compliance with data integrity requirements.
Provisions should be made for responsibilities relating to data when an
agreement expires.
7.2. Compliance with the principles and responsibilities should be verified
during periodic site audits. This should include the review of procedures
and data (including raw data and metadata, paper records, electronic data,
audit trails and other related data) held by the relevant contract accepter
identified in risk assessment.
7.3. Where data and document retention are contracted to a third party,
particular attention should be given to security, transfer, storage, access
and restoration of data held under that agreement, as well as controls to
ensure the integrity of data over their life cycle. This includes static data and
dynamic data. Mechanisms, procedures and tools should be identified to
ensure data integrity and data confidentiality, for example, version control,
access control, and encryption.
7.4. GxP activities, including outsourcing of data management, should not be
sub-contracted to a third party without the prior approval of the contract
giver. This should be stated in the contractual agreements.
7.5. All contracted parties should be aware of the requirements relating to data
governance, data integrity and data management.
8. Training
8.1. All personnel who interact with GxP data and who perform GxP activities
should be trained in relevant data integrity principles and abide by
organization policies and procedures. This should include understanding
the potential consequences in cases of non-compliance.
8.2. Personnel should be trained in good documentation practices and measures
to prevent and detect data integrity issues.
8.3. Specific training should be given in cases where computerized systems are
used in the generation, processing, interpretation and reporting of data and
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where risk assessment has shown that this is required to relevant personnel.
Such training should include validation of computerized systems and for
example, system security assessment, back-up, restoration, disaster recovery,
change and configuration management, and reviewing of electronic data
and metadata, such as audit trails and logs, for each GxP computerized
systems used in the generation, processing and reporting of data.
9. Data, data transfer and data processing

9.1. Data may be recorded on paper or captured electronically by using
equipment and instruments including those linked to computerised
systems. A combination of paper and electronic formats may also be used,
referred to as a “hybrid system”.
9.2. Data integrity consideration are also applicable to media such as
photographs, videos, DVDs, imagery and thin layer chromatography
plates. There should be a documented rationale for the selection of such
a method.
9.3. Risk-reducing measures such as scribes, second person oversight,
verification and checks should be implemented where there is difficulty
in accurately and contemporaneously recording data related to critical
process parameters or critical quality attributes.
9.4. Results and data sets require independent verification if deemed necessary
from the DIRA or by another requirement.
9.5. Programmes and methods (such as processing methods in sample analysis
(see also Good Chromatography Practices, TRS 1025) should ensure that
data meet ALCOA+ principles. Where results or data are processed using
a different method/parameters, then each version of the processing method

should be recorded. Data records, content versions together with audit trails
containing the required details should allow for reconstruction of all data
processing in GxP computerized systems over the data life cycle.
9.6. Data transfer/migration procedures should include a rationale and be
robustly designed and validated to ensure that data integrity is maintained
during the data life cycle. Careful consideration should be given to
understanding the data format and the potential for alteration at each
stage of data generation, transfer and subsequent storage. The challenges of
migrating data are often underestimated, particularly regarding maintaining
the full meaning of the migrated records.
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Data transfer should be validated. The data should not be altered during or after
it is transferred to the worksheet or other application. There should be an audit
trail for this process. The appropriate quality procedures should be followed if
the data transfer during the operation has not occurred correctly. Any changes
in the middle layer software should be managed through the appropriate Quality
Management Systems (7).
10. Good documentation practices

Note: The principles contained in this section are applicable to paper data.
10.1. Good documentation practices should be implemented and enforced to

ensure compliance with ALCOA+ principles.
10.2. Data and recorded media should be durable. Ink should be indelible.
Temperature-sensitive or photosensitive inks and other erasable inks
should not be used. Where related risks are identified, means should be
identified in order to ensure traceability of the data over their life cycle.
10.3. Paper should not be temperature-sensitive, photosensitive or easily

oxidizable. If this is not feasible or limited, then true or certified copies
should be generated.
10.4. Specific controls should be implemented in order to ensure the integrity

of raw data and results recorded on paper records. These may include, but
are not limited to:
■■ control over the issuance and use of loose paper sheets at the time of
recording data;
■■ no use of pencil or erasers;
■■ use of single-line cross-outs to record changes with the identifiable
person who made the change, date and reason for the change
recorded (i.e. the paper equivalent to an electronic audit trail);
■■ no use of correction fluid or otherwise, obscuring the original record;
■■ controlled issuance of bound, paginated notebooks;
■■ controlled issuance and reconciliation of sequentially numbered
copies of blank forms with authenticity controls;
■■ maintaining a signature and initial record for traceability and
defining the levels of signature of a record; and
■■ archival of records by designated personnel in secure and controlled
archives.
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11. Computerized systems

(Note. This section highlights some specific aspects relating to the use of
computerized systems. It is not intended to repeat the information presented in
the other WHO guidelines here, such as the WHO Guideline on computerized
systems (3), WHO Guideline on validation (2) and WHO Guideline on good
chromatography practices (7). See references.)
11.1. Each computerized system selected should be suitable, validated for its
intended use, and maintained in a validated state.
11.2. Where GxP systems are used to acquire, record, transfer, store or process
data, management should have appropriate knowledge of the risks that the
system and users may pose to the integrity of the data.
11.3. Software of computerized systems, used with GxP instruments and
equipment, should be appropriately configured (where required) and
validated. The validation should address for example the design,
implementation and maintenance of controls in order to ensure the
integrity of manually and automatically acquired data; ensure that Good
Documentation Practices will be implemented; and that data integrity
risks will be appropriately managed throughout the data life cycle. The
potential for unauthorized and adverse manipulation of data during the
life cycle of the data should be mitigated and, where possible, eliminated.
11.4. Where electronic instruments (e.g. certain pH meters, balances and
thermometers) or systems with no configurable software and no electronic
data retention are used, controls should be put in place to prevent the
adverse manipulation of data and to prevent repeat testing to achieve the
desired result.
11.5. Appropriate controls for the detection of lapses in data integrity

principles should be in place. Technical controls should be used whenever
possible but additional procedural or administrative controls should
be implemented to manage aspects of computerised system control
where technical controls are missing. For example, when stand-alone
computerized systems with a user-configurable output are used, Fourier-
transform infrared spectroscopy (FTIR) and UV spectrophotometers
have user-configurable output or reports that cannot be controlled
using technical controls. Other examples of non-technical detection and
prevention mechanisms may include, but are not limited to, instrument
usage logbooks and electronic audit trails.
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Access and privileges

11.6. There should be a documented system in place that defines the access and
privileges of users of systems. There should be no discrepancy between
paper records and electronic records where paper systems are used to
request changes for the creation and inactivation of users. Inactivated
users should be retained in the system. A list of active and inactivated
users should be maintained throughout the system life cycle.
11.7. Access and privileges should be in accordance with the role and
responsibility of the individual with the appropriate controls to ensure
data integrity (e.g. no modification, deletion or creation of data outside
the defined privilege and in accordance with the authorized procedures
defining review and approval where appropriate).
11.8. A limited number of personnel, with no conflict of interest in data, should

be appointed as system administrators. Certain privileges such as data
deletion, database amendment or system configuration changes should
not be assigned to administrators without justification – and such activities
should only be done with documented evidence of authorization by
another responsible person. Records should be maintained and audit trails
should be enabled in order to track activities of system administrators.
As a minimum, activity logging for such accounts and the review of logs
by designated roles should be conducted in order to ensure appropriate
oversight.
11.9. For systems generating, amending or storing GxP data, shared logins or
generic user access should not be used. The computerised system design
should support individual user access. Where a computerised system
supports only a single user login or limited numbers of user logins and
no suitable alternative computerised system is available, equivalent control
should be provided by third-party software or a paper-based method that
provides traceability (with version control). The suitability of alternative
systems should be justified and documented (8). The use of legacy hybrid
systems should be discouraged and a priority timeline for replacement
should be established.
Audit trail
11.10. GxP systems should provide for the retention of audit trails. Audit trails
should reflect, for example, users, dates, times, original data and results,
changes and reasons for changes (when required to be recorded), and
enabling and disenabling of audit trails.
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11.11. All GxP relevant audit trails should be enabled when software is installed
and remain enabled at all times. There should be evidence of enabling the
audit trail. There should be periodic verification to ensure that the audit
trail remains enabled throughout the data life cycle.
11.12. Where a system cannot support ALCOA+ principles by design (e.g.

legacy systems with no audit trail), mitigation measures should be taken
for defined temporary periods. For example, add-on software or paper-
based controls may be used. The suitability of alternative systems should
be justified and documented. This should be addressed within defined
timelines.
Electronic signatures
11.13. Each electronic signature should be appropriately controlled by, for
example, senior management. An electronic signature should be:
■■ attributable to an individual;
■■ free from alteration and manipulation
■■ be permanently linked to their respective record; and
■■ date- and time-stamped.
11.14. An inserted image of a signature or a footnote indicating that the

document has been electronically signed is not adequate unless it was
created as part of the validated electronic signature process. The metadata
associated with the signature should be retained.
Data backup, retention and restoration

11.15. Data should be retained (archived) in accordance with written policies
and procedures, and in such a manner that they are protected, enduring,
readily retrievable and remain readable throughout the records retention
period. True copies of original records may be retained in place of the
original record, where justified. Electronic data should be backed up
according to written procedures.
11.16. Data and records, including backup data, should be kept under conditions
which provide appropriate protection from deterioration. Access to
such storage areas should be controlled and should be accessible only by
authorized personnel.
11.17. Data retention periods should be defined in authorized procedures.
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11.18. The decision for and manner in which data and records are destroyed,
should be described in written procedures. Records for the destruction
should be maintained.
11.19. Backup and restoration processes should be validated. The backup
should be done routinely and periodically be restored and verified
for completeness and accuracy of data and metadata. Where any
discrepancies are identified, they should be investigated and appropriate
action taken.
12. Data review and approval

12.2. There should be a documented procedure for the routine and periodic
review, as well as the approval of data. Personnel with appropriate
knowledge and experience should be responsible for reviewing and
checking data. They should have access to original electronic data and
metadata.
12.3. The routine review of GxP data and meta data should include audit trails.
Factors such as criticality of the system (high impact versus low impact)
and category of audit trail information (e.g. batch specific, administrative,
system activities, and so on) should be considered when determining the
frequency of the audit trail review.
12.4. A procedure should describe the actions to be taken where errors,
discrepancies or omissions are identified in order to ensure that the
appropriate corrective and preventive actions are taken.
12.5. Evidence of the review should be maintained.
12.6. A conclusion, where required, following the review of original data,
metadata and audit trail records should be documented, signed and dated.
13. Corrective and preventive actions

13.1. Where organizations use computerized systems (e.g. for GxP data
acquisition, processing, interpretation, reporting) which do not meet
current GxP requirements, an action plan towards upgrading such systems
should be documented and implemented in order to ensure compliance
with current GxP.
13.2. When lapses in GxP relevant data regarding data integrity are identified,
a risk-based approach may be used to determine the scope of the
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investigation, root cause, impact and CAPA, as appropriate. Health

authorities, contract givers and other relevant organizations should be
notified if the investigation identifies a significant impact or risk to, for
example, materials, products, patients, reported information or data in
application dossiers, and clinical trials.
References
1. Guidelines on good manufacturing practices for pharmaceutical products: main principle. In:
WHO Expert Committee on Specifications for Pharmaceutical Preparations: forty-eighth report.
Geneva: World Health Organization; 2013: Annex 2 (WHO Technical Report Series, No. 986; https://
www.who.int/medicines/areas/quality_safety/quality_assurance/TRS986annex2.pdf?ua=1,
accessed 4 May 2020).
2. Good manufacturing practices: guidelines on validation. In: WHO Expert Committee on
Specifications for Pharmaceutical Preparations; fifty-third report. Geneva: World Health
Organization; 2019: Annex 3 (WHO Technical Report Series, No. 1019; http://digicollection.org/
whoqapharm/documents/s23430en/s23430en.pdf, accessed 5 May 2020).
systems. In: WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-third
report. Geneva: World Health Organization; 2019: Annex 3 (WHO Technical Report Series, No. 1019;
https://www.who.int/medicines/areas/quality_safety/quality_assurance/WHO_TRS_1019_
Annex3.pdf?ua=1, accessed 4 May 2020).
4. Guidelines on quality risk management. In: WHO Expert Committee on Specifications for
Annex 2 (WHO Technical Report Series, No. 981; https://www.who.int/medicines/areas/quality_
safety/quality_assurance/Annex2TRS-981.pdf, accessed 4 May 2020).
5. ICH harmonised tripartite guideline. Quality risk management Q9. Geneva: International
Conference on Harmonisation of Technical Requirements for Registration of Pharmaceutical for
Human Use; 2005 (https://database.ich.org/sites/default/files/Q9%20Guideline.pdf, accessed
12 June 2020).
6. Good chromatography practices. In: WHO Expert Committee on Specifications for Pharmaceutical
Preparations: fifty-fourth report. Geneva: World Health Organization; 2020: Annex 4 (WHO
Technical Report Series, No. 1025; https://www.who.int/publications/i/item/978-92-4-000182-4,
accessed 12 June 2020).
7. MHRA GxP data integrity guidance and definitions; Revision 1: Medicines & Healthcare Products
Regulatory Agency (MHRA), London, March 2018 (https://assets.publishing.service.gov.uk/
government/uploads/system/uploads/attachment_data/file/687246/MHRA_GxP_data_integrity_
guide_March_edited_Final.pdf, accessed 12 June 2020).
Further reading
■■ Data integrity and compliance with CGMP guidance for industry: questions and answers guidance
for industry. U.S. Department of Health and Human Services, Food and Drug Administration;
2016 (https://www.fda.gov/files/drugs/published/Data-Integrity-and-Compliance-With-Current-
Good-Manufacturing-Practice-Guidance-for-Industry.pdf, accessed 15 June 2020).
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■■ Good Practices for data management and integrity in regulated GMP/GDP environments.
Pharmaceutical Inspection Convention and Pharmaceutical Inspection Co-operation Scheme
(PIC/S), November 2018 (https://picscheme.org/layout/document.php?id=1567, accessed 15
June 2020).
■■ Baseline guide Vol 7: risk-based manufacture of pharma products; 2nd edition.
■■ ISPE Baseline ® Guide, July 2017. ISPEGAMP ® guide: records and data integrity; March 2017.
■■ Data integrity management system for pharmaceutical laboratories PDA Technical Report, No. 80;
August 2018.
■■ ICH harmonised tripartite guideline. Pharmaceutical Quality System Q10. Geneva: International
Conference on Harmonisation of Technical Requirements for Registration of Pharmaceutical for
Human Use; 2008 (https://database.ich.org/sites/default/files/Q10%20Guideline.pdf, accessed
2 October 2020).
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Appendix 1
Examples in data integrity management
This Appendix reflects on some examples in data integrity management in order
to support the main text on data integrity. It should be noted that these are
examples and are intended for the purpose of clarification only.
Example 1: Quality risk management and

data integrity risk assessment
Risk management is an important part of good practices (GxP). Risks should be
identified and assessed and controls identified and implemented in order to assist
manufacturers in preventing possible DI lapses.
As an example, a Failure Mode and Effects Analysis (FMEA) model (or
any other tool) can be used to identify and assess the risks relating to any system
where data are, for example, acquired, processed, recorded, saved and archived.
The risk assessment can be done as a prospective exercise or retrospective exercise.
Corrective and preventive action (CAPA) should be identified, implemented and
assessed for its effectiveness.
For example, if during the weighing of a sample, the entry of the date
was not contemporaneously recorded on the worksheet but the date is available
on the print-out from a weighing balance and log book for the balance for that
particular activity. The fact that the date was not recorded on the worksheet may
be considered a lapse in data integrity expectations. When assessing the risk
relating to the lack of the date in the data, the risk may be considered different
(lower) in this case as opposed to a situation when there is no other means of
traceability for the activity (e.g. no print-out from the balance). When assessing
the risk relating to the lapse in data integrity, the severity could be classified as
“low” (the data is available on the print-out); it does not happen on a regular
basis (occurrence is “low”), and it could easily be detected by the reviewer
(detection is “high”) – therefore the overall risk factor may be considered low.
The root cause as to why the record was not made in the analytical report at the
time of weighing should still be identified and the appropriate action taken to
prevent this from happening again.
Example 2: Good documentation practices in data integrity

Documentation should be managed with care. These should be appropriately
designed in order to assist in eliminating erroneous entries, manipulation and
human error.
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Formats
Design formats to enable personnel to record or enter the correct information
contemporaneously. Provision should be made for entries such as, but not
limited to, dates, times (start and finish time, where appropriate), signatures,
initials, results, batch numbers and equipment identification numbers. When a
computerized system is used, the system should prompt the personnel to make
the entries at the appropriate step.
Blank sheets of paper

The use of blank sheets should not be encouraged. Where blank sheets are used
(e.g. to supplement worksheets, laboratory notebooks and master production
and control records), the appropriate controls have to be in place and may
include, for example, a numbered set of blank sheets issued which are reconciled
upon completion. Similarly, bound paginated notebooks, stamped or formally
issued by designated personnel, allow for the detection of unofficial notebooks
and any gaps in notebook pages. Authorization may include two or three
signatures with dates, for example, “prepared by” or “entered by”, “reviewed by”
and “approved by”.
Error in recording data

Care should be taken when entries of data and results (electronic and
paper records) are made. Entries should be made in compliance with good
documentation practices. Where incorrect information had been recorded,
this may be corrected provided that the reason for the error is documented, the
original entry remains readable and the correction is signed and dated.
Example 3: Data entry

Data entry includes for example sample receiving registration, sample analysis
result recording, logbook entries, registers, batch manufacturing record entries
and information in case report forms. The recording of source data on paper
records should be done using indelible ink, in a way that is complete, accurate,
traceable, attributable and free from errors. Direct entry into electronic records
should be done by responsible and appropriately trained individuals. Entries
should be traceable to an individual (in electronic records, thus having an
individual user access) and traceable to the date (and time, where relevant).
Where appropriate, the entry should be verified by a second person or entered
through technical means such as the scanning of bar-codes, where possible,
for the intended use of these data. Additional controls may include the locking
of critical data entries after the data are verified and a review of audit trails for
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critical data to detect if they have been altered. The manual entry of data from a
paper record into a computerized system should be traceable to the paper records
used which are kept as original data.
Example 4: Dataset
All data should be included in the dataset unless there is a documented,
justifiable, scientific explanation and procedure for the exclusion of any result
or data. Whenever out of specification or out of trend or atypical results are
obtained, they should be investigated in accordance with written procedures.
This includes investigating and determining CAPA for invalid runs, failures,
repeats and other atypical data. The review of original electronic data should
include checks of all locations where data may have been stored, including
locations where voided, deleted, invalid or rejected data may have been stored.
Data and metadata related to a particular test or product should be recorded
together. The data should be appropriately stored in designated folders. The data
should not be stored in other electronic folders or in other operating system
logs. Electronic data should be archived in accordance with a standard operating
procedure. It is important to ensure that associated metadata are archived
with the relevant data set or securely traceable to the data set through relevant
documentation. It should be possible to successfully retrieve all required data
and metadata from the archives. The retrieval and verification should be done
at defined intervals and in accordance with an authorized procedure.
Example 5: Legible and enduring

Data and metadata should be readable during the life cycle of the data.
Electronic data are normally only legible/readable through the original software
application that created it. In addition, there may be restrictions around the
version of a software application that can read the data. When storing data
electronically, ensure that any restrictions which may apply and the ability to
read the electronic data are understood. Clarification from software vendors
should be sought before performing any upgrade, or when switching to an
alternative application, to ensure that data previously created will be readable.
Other risks include the fading of microfilm records, the decreasing
readability of the coatings of optical media such as compact disks (CDs) and
digital versatile/video disks (DVDs), and the fact that these media may become
brittle.
Similarly, historical data stored on magnetic media will also become
unreadable over time as a result of deterioration. Data and records should be
stored in an appropriate manner, under the appropriate conditions.
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Example 6: Attributable
Data should be attributable, thus being traceable to an individual and where
relevant, the measurement system. In paper records, this could be done through
the use of initials, full handwritten signature or a controlled personal seal. In
electronic records, this could be done through the use of unique user logons that
link the user to actions that create, modify or delete data; or unique electronic
signatures which can be either biometric or non-biometric. An audit trail should
capture user identification (ID), date and time stamps and the electronic signature
should be securely and permanently linked to the signed record.
Example 7: Contemporaneous
Personnel should record data and information at the time these are generated
and acquired. For example, when a sample is weighed or prepared, the weight
of the sample (date, time, name of the person, balance identification number)
should be recorded at that time and not before or at a later stage. In the case
of electronic data, these should be automatically date- and time-stamped. In
case hybrid systems are to be used, including the use for an interim period, the
potential and criticality of system breaches should be covered in the assessment
with documented mitigating controls in place. (The replacement of hybrid
systems should be a priority with a documented CAPA plan.) The use of a scribe
to record an activity on behalf of another operator should be considered only
on an exceptional basis and should only take place where, for example, the act
of recording places the product or activity at risk, such as, documenting line
interventions by aseptic area operators. It needs to be clearly documented when
a scribe has been applied.
“In these situations, the recording by the second person should be
contemporaneous with the task being performed, and the records
should identify both the person performing the task and the person
completing the record. The person performing the task should
countersign the record wherever possible, although it is accepted
that this countersigning step will be retrospective. The process for
supervisory (scribe) documentation completion should be described
in an approved procedure that specifies the activities to which the
process applies.” (Extract taken from the Medicines & Healthcare
Products Regulatory Agency (MHRA) GxP data integrity guidance
and definitions (10).)
A record of employees indicating, their name, signature, initials or other mark
or seal used should be maintained to enable traceability and to uniquely identify
them and the respective action.
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Example 8: Changes
When changes are made to any GxP result or data, the change should be
traceable to the person who made the change as well as the date, time and reason
for the change. The original value should not be obscured. In electronic systems,
this traceability should be documented via computer generated audit trails
or in other metadata fields or system features that meet these requirements.
Where an existing computerized system lacks computer-generated audit trails,
personnel may use alternative means such as procedurally controlled use of log-
books, change control, record version control or other combinations of paper
and electronic records to meet GxP regulatory expectations for traceability to
document the what, who, when and why of an action.
Example 9: Original
The first or source capture of data or information and all subsequent data
required to fully reconstruct the conduct of the GxP activity should be available.
In some cases, the electronic data (electronic chromatogram acquired through
high-performance liquid chromatography (HPLC)) may be the first source of
data and, in other cases, the recording of the temperature on a log sheet in a
room – by reading the value on a data logger. This data should be reviewed
according to the criticality and risk assessment.
Example 10: Controls

Based on the outcome of risk assessment which should cover all areas of data
governance and data management, appropriate and effective controls should be
identified and implemented in order to assure that all data, whether in paper
records or electronic records, will meet GxP requirements and ALCOA+
principles. Examples of controls may include, but are not limited to:
■■ the qualification, calibration and maintenance of equipment, such as

balances and pH meters, that generate printouts;
■■ the validation of computerized systems that acquire, process,
generate, maintain, distribute, store or archive electronic records;
■■ review and auditing of activities to ensure that these comply with
applicable GxP data integrity requirements;
■■ the validation of systems and their interfaces to ensure that the
integrity of data will remain while transferring between/among
computerized systems;
■■ evaluation to ensure that computerized systems remain in a
validated state;
■■ the validation of analytical procedures;
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Annex 4
■■ the validation of production processes;

■■ a review of GxP records;
■■ ensuring effective review and oversight of the Batch Release Systems
and processes by using different oversight and review techniques to
ensure that data have not changed since the original entry; and
■■ the investigation of deviations, out of trend and out of specifications
results.
Example 11: Accuracy

Points to consider for assuring accurate GxP records:
■■ the entry of critical data into a computer by an authorized person
(e.g. entry of a master processing formula) requires an additional
check on the accuracy of the data entered manually. This check may
be done by independent verification and release for use by a second
authorized person or by validated electronic means. For example,
to detect and manage risks associated with critical data, procedures
would require verification by a second person;
■■ validation and control over formulae for calculations including
electronic data capture systems;
■■ ensuring correct entries into the laboratory information
management system (LIMS) such as fields for specification ranges;
■■ other critical master data, as appropriate. Once verified, these
critical data fields should normally be locked in order to prevent
further modification and only be modified through a formal change
control process;
■■ the process of data transfer between systems should be validated;
■■ the migration of data including planned testing, control and
validation; and
■■ when the activity is time-critical, printed records should display the
date and time stamp.
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Annex 5
World Health Organization/United Nations Population
Fund Recommendations for condom storage and shipping
temperatures
Background
The report of the Fifty-fourth meeting of the World Health Organization (WHO)
Expert Committee on Specifications for Pharmaceutical Preparations (ECSPP) in
2019 (1)) stated the following:
As agreed at the ECSPP meeting in October 2018, the United Nations
Population Fund (UNFPA) and WHO have separated different aspects
of the current procedures for contraceptive devices and condoms and are
developing seven different documents:
■■ prequalification programme guidance for contraceptive devices: male
latex condoms, female condoms and intrauterine devices;
■■ condom quality assurance;
■■ recommendations for condom storage and shipping temperatures; and
■■ guidance on conducting post-market surveillance of condoms.
All seven documents were revised in the first half of 2019, then sent to
the Expert Advisory Panel (EAP) and put out for public consultation in
July 2019. The comments received were reviewed by specialists in October
2019, prior to being presented to the ECSPP. At UNFPA’s request, the
ECSPP focused on the first three documents (on UNFPA’s Prequalification
Programme guidance, condom quality assurance, and specifications
for plain lubricants), noting that all comments have been addressed. It
suggested some further minor revisions, including recommending changes
to clarify that, while the specifications for plain lubricants are principally
targeted at procurement agencies, they may also be used by regulators
for public procurement. The next steps for the remaining four documents
include incorporating comments from the latest consultations and then
bringing them back to the ECSPP for possible adoption at its next meeting
in 2020.
161

Prequalification Programme guidance for contraceptive devices: male
latex condoms, female condoms and intrauterine devices (2);
■■ World Health Organization/United Nations Population Fund technical
specifications for male latex condoms (3); and
specifications for plain lubricants (4).
The Expert Committee further recommended proceeding with the next steps
as discussed.
This is one of the four remaining working documents in this series.
1. Introduction 163
2. During shipment 163
3. Warehouse storage 164
References 165
Further reading 166
162
Annex 5
1. Introduction
Good quality condoms conforming to the World Health Organization (WHO)/
United Nations Population Fund (UNFPA) technical specifications for male latex
condoms (3) have excellent storage properties. The combination of individual
condom packaging, inner boxes and shipping containers is designed to protect
the condoms during shipping and storage. Nevertheless, storage under poor
conditions and/or rough handling during shipping might adversely affect the
properties of the condoms. Extended exposure to excessively high temperatures
(over 40 °C) may adversely affect shelf life. This document provides guidance
on the shipping and storage of condoms to help ensure they conform to
WHO/UNFPA Specification and ISO 4074:2015 requirements until after the
manufacturer’s stated expiry date.
The individual primary packages specified in the WHO/UNFPA
technical specification for male latex condoms protect the condoms from
exposure to oxygen, ozone and water. Nevertheless, as with all medicines and
medical devices, the products should be protected for exposure to any form
of contamination including dust, pests and water. Although the individual
packages protect the condoms from water and moisture vapour excessively
high humidity and direct exposure to water may damage the inner boxes and
shipping cartons.
This guidance is to be referred along with WHO Good distribution
practices for pharmaceutical products (5).
2. During shipment
Store condoms in dry conditions away from direct sources of heat and sunlight.
The mean kinetic temperature 1 (MKT) during shipment should not
exceed 30 °C. Peak temperatures should not exceed 50 °C 2. The use of calibrated
data loggers to monitor all shipments that originate, terminate or transit hot
climatic zones is recommended. WHO maintains a list of suitable prequalified
data loggers 3.
1
Temperatures during shipping can be monitored using data loggers. Most modern data loggers can
automatically calculate and print out the mean kinetic temperature (MKT) (in some cases, data has to be
downloaded and analysed using provided software).
2
Brief, short term temperature excursions up to 50 °C have limited impact on MKT. If during shipping
the MKT exceeds 30 °C and/or peak temperatures exceed 50 °C, a risk assessment should be conducted
to assess whether or not the properties of the condoms in the consignment have been compromised.
Random sampling and testing of condoms for burst properties is recommended to support the risk
assessment.
3
https://apps.who.int/immunization_standards/vaccine_quality/pqs_catalogue/categorypage.aspx?id_
cat=35
163
Ideally, data loggers can calculate the MKT either automatically or by

using software supplied with the data loggers after data has been downloaded.
3. Warehouse storage
Store in well ventilated, dry conditions away from direct sources of heat,
including sunlight.
Long-term (i.e. one month to a year) average storage temperature should
be less than 30 °C. Short-term (i.e. up to one month) temperature excursions
should not exceed 40 °C. The recommended limit for short term exposure is
cumulative over the total period of storage.
Condom factories prequalified by UNFPA will have provided evidence
to verify the claimed shelf life of the product. The shelf life is determined by
accelerated and real-time studies, conducted at or referenced to a specific
temperature (30 +5/ −2 °C) because this is the MKT of the most extreme climate
in climatic zones III and IV 4. Research has demonstrated that properly packaged
good-quality condoms stored at average temperatures in tropical climates do
not deteriorate during storage. More information about the recommendations
for storage and shipment, and the rationale for choosing 30 + 5/ −2 °C as the
storage temperature for stability studies, is given in the Technical Basis Paper of
the WHO/UNFPA technical specifications for male latex condoms (3).
Since the shelf life of the condoms will have been determined at 30 + 5/
−2 °C, air-conditioned storage is not necessary but it would be an advantage
in hot climates, if available. In hot climates, it is important that condoms are
stored in a well-ventilated environment away from direct sunlight and other
sources of heat in order to minimize the exposure of the condoms to high
temperatures. Similar precautions should be taken during transportation and
delivery. In general, the storage temperature should be as low as can practically
be achieved. Condoms stored outdoors in shipping containers are particularly

vulnerable as the temperatures inside containers can be substantially above
ambient temperatures resulting in faster deterioration.
Storage time in shipping containers should be minimized. The condoms
are sealed in individual foil packages which are themselves packed in cardboard.
The cardboard storage containers are vulnerable to moisture and should be
stored in a dry storeroom away from walls and placed on pallets to protect
against rising damp. Ideally, cartons should be stored at least 10 cm off the floor,
30 cm away from the walls and stacked no more than 2.4 metres high. It should
More details on climatic zones can be found in WHO Stability testing of active pharmaceutical ingredients
4
and finished pharmaceutical products (6).

164
Annex 5
be ensured that the floor of the storage area is paved with concrete and the walls
and floor should not get damp due to seepage of water or rain water condensate.
The ambient temperature in the warehouse should be recorded.
Condoms are fully protected by the individual foil package. However,
cosmetic damage to the foil and damage to the outer packaging can make the
product appear damaged and therefore less acceptable to the user.
In accordance with good storage practices, potential contaminants of any
sort (e.g. powders or liquids) should be avoided to reduce risk to the end users of
the condoms.
Condoms should be left in their original cartons and inner boxes
until needed for distribution. The cartons should be positioned so that the lot
number and expiry date are visible. If any additional information, such as local
registration identification numbers, is required this should be affixed to the
shipping cartons adjacent to the lot numbers and expiry dates to permit all the
information to be readily seen during storage. The cartons should be identified
and their locations recorded to ensure that specific lots can be located. Lots
should be released on a first expiry—first out basis (FEFO).
Recalled, damaged or expired condoms should be clearly labelled and
kept in a separate, clearly identified and segregated quarantine area. The disposal
of such condoms should be in accordance with local procedures for the disposal
of damaged medical devices.
References
1. WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-fourth report.
Geneva: World Health Organization; 2020 (WHO Technical Report Series, No. 1025; https://www.
who.int/publications-detail/978-92-4-000182-4, accessed 20 May 2020).
2. World Health Organization/United Nations Population Fund Prequalification Programme
guidance for contraceptive devices: male latex condoms, female condoms and intrauterine
devices. In: WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-
fourth report. Geneva: World Health Organization; 2020: Annex 9 (WHO Technical Report Series,
No. 1025; trs1025-annex9.pdf (who.int), accessed 14 January 2021).
3. World Health Organization/United Nations Population Fund Technical specifications for male
latex condoms. In: WHO Expert Committee on Specifications for Pharmaceutical Preparations:
fifty-fourth report. Geneva: World Health Organization; 2020: Annex 10 (WHO Technical Report
Series, No. 1025; https://www.who.int/publications-detail/978-92-4-000182-4, accessed 20 May
2020).
4. World Health Organization/United Nations Population Fund UNFPA-WHO specifications for plain
lubricants. In: WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-
No. 1025; trs1025-annex11.pdf (who.int), accessed 14 January 2021).
5. WHO Good Storage and Distribution Practices for Medical Products published in WHO Technical
Report Series, No. 1025, 2020 Annex 7 trs1025-annex7.pdf (who.int) , accessed 14 January 2021).
165
6. Stability testing of active pharmaceutical ingredients and finished pharmaceutical products. In:
WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-second report.
regulatory-standards/trs1010-annex10-who-stability-testing-of-active-pharmaceutical-
ingredients.pdf, accessed 2 February 2021).
Further reading
■■ UNFPA-published Condom programming for HIV prevention—An operations manual for
programme managers and PATH’s procurement capacity toolkit: Tools and resources for
procurement of reproductive health supplies and safe disposal and management of unused,
unwanted, contraceptives (http://www.unfpa.org/resources/safe-disposal-and-management-
unused-unwanted-contraceptives, accessed 20 May 2020).
166
Annex 6
Fund Guidance on testing of male latex condoms
Background
2019 (1) stated the following:
Population Fund (UNFPA) and WHO have separated out different aspects
of the current procedure for contraceptive devices and condoms and are
All seven documents were revised in the first half of 2019, then sent to
the Expert Advisory Panel (EAP) and put out for public consultation in
July 2019. The comments received were reviewed by specialists in October
2019, prior to being presented to the ECSPP. At UNFPA’s request, the
ECSPP focused on the first three documents (on UNFPA’s Prequalification
Programme guidance, condom quality assurance and specifications
for plain lubricants), noting that all comments have been addressed. It
suggested some further minor revisions, including recommending changes
to clarify that, while the specifications for plain lubricants are principally
targeted at procurement agencies, they may also be used by regulators
for public procurement. The next steps for the remaining four documents
include incorporating comments from the latest consultations and then
bringing them back to the ECSPP for possible adoption at its next meeting
in 2020.
167

technical specifications for male latex condoms (3); and
as discussed.
This is one of the four remaining working documents in this series.
1. Introduction 170
2. Determination of length 170
3. Determination of width 171
4. Determination of thickness 171
4.1 Mass method 172
4.2 Micrometer method 173
5. Determination of bursting volume and pressure 174
5.1 Loading of the condom onto the mandrel 175
5.2 Ensuring the correct inflation length 175
5.3 Checking that the condom does not slip during inflation 176
5.4 Calibrating the volume and pressure measuring equipment 176
5.5 Correcting for variations in atmospheric pressure owing to the altitude

of the test laboratory 177
5.6 Other factors to consider in the burst testing of condoms 177
5.7 Cleanliness of the air supply hole in the mandrel 178
5.8 Maintenance of the supply air pressure and the air flow rate 178
5.9 Maintenance of the air temperature from the compressor 178
6. Determination of stability and shelf life 178
7. Freedom from holes 181
7.1. The water leak test (hang and roll) 181
7.2 The electrical test 182
7.3 The water leak test (hang and squeeze) 183
8. Visibly open seals (ISO 4074:2015, Annex N) 183
168
Annex 6
9. Visible defects (ISO 4074:2015, Annex M and WHO/UNFPA

Technical specifications for male latex condoms) 183
10. Determination of package seal integrity 184
References 186
169
1. Introduction
Condoms, procured as part of a public procurement programme or otherwise,
are tested as per the World Health Organization (WHO)/United Nations Fund
Population (UNFPA) specification by independent laboratories. In addition, there
may be specific programme requirements which would have been incorporated
in the purchase orders. These testing laboratories have to be accredited to the
current version of ISO 17025 General requirements for the competence of testing
and calibration laboratories (5), and use the test methods in the current version of
ISO 4074 Natural rubber latex male condoms – Requirements and test methods (6),
in order to be considered for testing services. The following guidance has been
developed to assist the laboratories to standardize testing and reduce variability.
This guidance is intended to supplement the information on conducting the
tests specified in ISO 4074:2015 (6).
2. Determination of length
Condom length can be measured manually, using a suitable calibrated mandrel,
or automatically, using one of the dedicated automatic instruments now available
(ISO 4074:2015, Annex D).
The automatic methods have the advantage that data can usually be
transferred directly to any computerized record system, although it is important
that the equipment is validated for the correct handling of the data and regularly
calibrated following the methods recommended by the manufacturer.
A standard mandrel, described in ISO 4074:2015 (6), is used to normalize
the measurements as different condom designs can have different shapes at the
teat and closed end.
As a rolled condom can retain the memory of the roll when unrolled, it is
permitted to stretch the condom a little (no more than 20 mm, and not more than
twice) when unrolled to help remove any wrinkles persisting after the unrolling.
Condoms can be measured without removing the lubricant but handling
a lubricated condom can be difficult as the lubricant can cause the condom
to stick to itself in pleats or creases. A lubricated condom may also not hang
freely over the mandrel and, if stretched, can be held in the extended state by
the lubricant. The condom can be powdered to ease the handling problems, as
described in the standard, with or without removal of the lubricant.
Owing to the way the bead is formed, the condom length may not be
exactly the same at all points around the condom. It is important to measure
the length at several points and record the minimum. The instrumental methods
may do this automatically.
When measuring the length manually, it is important that the
measurement is taken with the bead of the condom at eye level to avoid any
170
Annex 6
parallax errors. It may be easier to position the mandrel on a stand to bring it

up to the eye level of the operator. Again, the instrumented methods will take
this into account. While fixing the length mandrel, it should be ensured that it is
fixed on a horizontal plane without slanting.
Note that measurement of condom length should be rounded to the
nearest 1 mm.
3. Determination of width
Condom width can be measured directly, using a ruler, or automatically using
one of the dedicated automatic instruments now available (ISO 4074:2015,
Annex E).
The automatic methods have the advantage that data can usually be
transferred directly to any computerized record system, although it is important
that the equipment is validated for correct handling of the data and regularly
calibrated following the methods recommended by the manufacturer.
When measuring directly, using a ruler calibrated in mm, it is important
that the condom is positioned so that the axis of the condom is exactly
perpendicular to the ruler.
Note that the end of a ruler can get worn and the corners rounded so it
is better to position the condom to use another point (e.g. the 10, 20 or 100 mm
index) as the zero. The condom should be measured at the narrowest point
within the range 20 to 50 mm from the open end.
Condoms can be measured without removing the lubricant but handling
a lubricated condom can be difficult as the lubricant can cause the condom to
stick to itself in pleats or creases. Gently manipulate the condom to smooth out
any such creases, ensuring that the condom is not stretched as sometimes the
lubricant can hold the condom in an extended state. It may be better to remove
the lubricant and lightly powder the condom, especially if the same condoms
will be used for the determination of length.
Note that the condom width should be measured to the nearest
0.5 mm which will require the measurement to be interpolated if the scale is in
whole mm.
4. Determination of thickness
ISO 4074:2015 Annex F (6) allows two methods for the measurement of
thickness, one based on the direct measurement by a micrometer, and the other
by mass. The mass method was introduced owing to the fact that the precision
and reproducibility of the micrometer method was found to be relatively poor.
171
One of the reasons for this is to accommodate condoms where the surface is
not smooth and, also, it is thought that the pressure applied by the foot of the
micrometer to ensure good contact with the material under test can compress
the film slightly. In some cases, this pressure has also been found to be well
outside the specified range.
Any lubricant on the condom is removed by washing or wiping the
condom with propan-2-ol, and removing the lubricant can make the condom
difficult to handle. If any powder is added to facilitate handling and sample
preparation, this must be removed before measuring.
The thickness of a condom can vary along and around the condom and,
for this reason, thickness is measured at three points on the condom: the mid-
point (± 5 mm) of the condom, 30 ± 5 mm from the closed end and 30 ± 5 mm
from the open end. If the micrometer method is used, then three measurements,
approximately equally spaced around the condom, are taken at each location
and averaged. The mass method, of course, will give the average thickness of the
sample being measured. For textured condoms, the thickness is usually measured
using the micrometer method at the point specified and agreed between the
manufacturer and the buyer of the condoms.
4.1 Mass method

The mass method calculates the volume of the sample by dividing the mass of
the sample by the density of natural rubber. If the length and width of the sample
are known, then the thickness can be simply calculated.
The formula, as given in Annex F of ISO 4074:2015, is:
1 1
Thickness (in mm.) = × ×m
0.92 A
using a density of 0.92 g/cm3, and where A is the area of the test piece (length in
mm. x 20) in mm2 and m is the mass of the sample in mg. If the condom is not
parallel-sided, then measure both of the long sides and use the average.
The method specifies the test piece for tensile testing as the sample. This
has the advantage that many laboratories already have the cutting die to give a
20 mm wide ring test piece from a condom.
Whilst there will be very slight differences in the density of the condom,
caused by differences in the formulations, these will not cause any significant
changes in the calculated thickness.
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Annex 6
4.2 Micrometer method

The micrometer method measures the thickness of the sample directly using a
calibrated dial or digital micrometer capable of reading to the nearest 0.001 mm.
If the condom is textured, then micrometer measurements on the textured
portion can give false results. In this case, measure the condom at a non-textured
region as close as possible to the specified points (and report this with the results).
Alternatively, the mass method could be used. Zero the gauge after measuring
each sample.
Because of the compressibility of rubber, it is essential that the foot
pressure is within the specified range of 22 ± 5 kPa and measuring the foot
pressure should form part of the regular calibration procedure for the gauge.
Note that powder or lubricant on the shaft of the gauge may increase friction
when the gauge is used, altering the foot pressure. For this reason, it is important
to ensure that the gauge is kept clean.
It is essential that the foot of the micrometer is exactly parallel to the
platen. If not, then the edge of the foot, rather than the face, will contact the
sample. Under the defined load, the edge can dig into the sample and give a false
reading. A photograph of an incorrectly adjusted gauge is shown in figure 1.
Correct alignment can be checked by measuring a slip gauge or a feeler gauge
using several positions around the very edge of the foot of the micrometer
(figure 2). If the micrometer is correctly set up, the readings will be the same
from all sides of the foot.
Fig. 1
The foot of this micrometer is incorrect and will give the wrong reading
173
Fig. 2
Showing the measurement positions to confirm that the foot is parallel to the platen
Note that, according to clause 6.4.12 of ISO 17025:2017 (5), “The laboratory shall
take practicable measures to prevent unintended adjustments of equipment from
invalidating results”. It is therefore recommended that parts of the gauge that should
not be adjusted during routine use, such as the gauge mount, are made tamper-evident.
A small sticky label signed by an authorized person and placed over the part is a simple
way to achieve this.
5. Determination of bursting volume and pressure

The burst properties of condoms are important and are frequently one of the
parameters that show up differences in inter-laboratory testing (ISO 4074:2015,
Annex H). There can be many reasons for testing variability of which the following
are thought to be the most important.
■■ loading of the condom onto the mandrel;
■■ correct inflation length;
■■ slippage of the condom during inflation;
■■ correct calibration of pressure and volume measuring equipment;
■■ any corrections for variations in atmospheric pressure owing to the
altitude of the test laboratory;
■■ cleanliness of the air supply hole in the mandrel;
■■ maintenance of the supply air pressure and the air flow rate; and
■■ maintenance of the air temperature from the compressor.
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Annex 6
Note that recommendations for calibrating the air inflation equipment

are given in Annex O of ISO 4074:2015.
5.1 Loading of the condom onto the mandrel

Condoms are almost always tested lubricated and a lubricated condom can be
difficult to handle. One of the problems resulting from this is that the condom
may be stretched too far on loading. In this situation, especially with burst
test machines that use a wide supporting mandrel, the lubricant can cause
the condom to stick to the mandrel or inflation cuff, preventing the extended
condom from recovering fully. As a result, the tested length of the condom is
less than it should be. This will lead to a falsely low burst volume and a higher
burst pressure.
Note: The opposite situation can occur, especially if the operator is
trying too hard to avoid stretching the condom. This can give a condom that
is positioned too loosely on the mandrel. In this case, the tested length will be
greater than specified giving burst volumes that are erroneously high and burst
pressures too low.
The correct way to load the condoms is as follows:
■■ Remove the condom from the pack, taking care not to damage it
(it is recommended that gloves or finger cots are worn).
■■ Whilst it is permitted to unroll the condom before loading, it will
generally be much easier to unroll the condoms directly onto the
supporting rod or mandrel.
■■ Place the rolled condom onto the top of the supporting rod or
mandrel and, using the finger tips, stroke the condom down a little
at a time, allowing the condom to relax for a few seconds after
each stroke.
■■ Ensure that the condom is not stretched as it is unrolled over the
supporting rod/mandrel.
5.2 Ensuring the correct inflation length

As described in 5.1 above, ensuring the correct length of the condom to
be inflated is important. Assuming that the condom is loaded correctly, this
length will be dictated by the length of the supporting rod or mandrel. This will
generally be adjustable and can be checked using the following method or one
recommended by the equipment manufacturer:
■■ Load the condom onto the test machine.
■■ Clamp the condom.
175
■■ Mark the condom, using a suitable pen or marker, as closely as

possible to the top of the external clamping collar. Depending on
the type of burst test machine, clamping the condom will also start
the inflation. In this case, the inflation needs to be stopped as soon
as possible so the condom can be marked, or the condom marked
as soon as possible and the test aborted so that the condom is not
inflated and burst. Some burst testing machines release the condom
as soon as inflation is stopped. If this function cannot be temporarily
disabled for calibration purposes, it may be necessary to mark the
correct inflation length on the condom first.
■■ Measure the length of the condom to the mark using the condom
length measuring mandrel described in Annex D of ISO 4074:2015
(6). The length to the mark should be 150 ± 3 mm.
■■ If the tested length is outside of these limits, adjust the machine and
repeat the measurement to confirm that the tested length is correct.
■■ Repeat for each inflation head on the test equipment.
5.3 Checking that the condom does not slip during inflation
Most air inflation equipment clamps the condom by inflating an elastic cuff
against a rigid collar, clamping the condom in between.
Obviously, no matter how carefully the condom has been loaded onto
the test equipment, if it is not firmly held by this clamping mechanism and the
condom slips during the test, then errors will be introduced into the results.
The effectiveness of the clamping system can be checked in a similar fashion
to the inflation length described in 5.2 above. In this case, after marking
the condom, allow it to inflate whilst watching the mark. Any slippage in the
clamping mechanism will be shown by the mark moving upwards (usually
erratically) as the condom inflates. It is also important to check if the machine
has inflation cuffs that these do not leak air into the condom, as any unmonitored
air entering the condom will give false results. This can be checked by inflating
the cuff, turning off the air supply (if the machinery will allow this) and checking
that the cuff remains inflated over a period of several minutes. If the testing
machine does not permit the cuff to remain inflated when the air supply is turned
off, a systematic difference between the volume readings for different test heads
may indicate that a cuff is leaking.
Again, check all the inflation heads on the test equipment.
5.4 Calibrating the volume and pressure measuring equipment

Owing to the different types of condom burst equipment used in the industry,
no recommendations on the calibration and verification procedures can be
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Annex 6
made here, other than to calibrate the machines following the manufacturer’s
instructions. The calibration interval again can be specified by the manufacturer,
and will typically be between one and four times a year, although, if the
equipment is subject to heavy use, it may be worth calibrating more frequently.
If there are any reasons to suspect that the results from a particular machine
or test head are not accurate, then investigation and re-calibration should be
undertaken immediately.
5.5 Correcting for variations in atmospheric pressure

owing to the altitude of the test laboratory
The calibration procedure for inflation test machines will often require the
average atmospheric pressure to be entered. It is important that this is adjusted
accordingly, especially for test laboratories situated at high altitudes. More
detailed instructions will usually be found in the manufacturer’s support
literature or can be sought directly from the manufacturer.
5.6 Other factors to consider in the burst testing of condoms

■■ Ensure that the flow rate is within the specified range of 24-30 dm3/
min.
■■ When a condom is inflated, there is a region of high stress between
the part of the condom that is firmly clamped and the adjacent
freely expanding part. Owing to the characteristics of latex dipping,
this zone is also usually the thinnest. Care must be taken to remove
any potential for damage in this area. ISO 4074:2015 (6) specifies
that the edge of the rigid collar is rounded with no sharp edges but
this edge should be checked regularly to ensure that it has not been
nicked or damaged and is still adequately smooth.
■■ Inflation testing machines can test a lot of condoms between service
intervals and in general these condoms will be lubricated. It is not
uncommon for lubricant to build up in the various holes supplying
air to the condom or the piping connecting the condom to the
pressure transducer. Not only can this lubricant build-up affect the
accuracy of the test procedures, but contamination of the pressure
transducer by lubricant can mean an expensive replacement. Powder
and fragments of rubber can also partially or completely block these
apertures. It is recommended that there is a daily inspection and
cleaning of these apertures, and that the piping to the transducer is
inspected and cleaned regularly.
177
■■ Be aware of the possibility that the test heads in a multi-headed

inflation test machine can differ. Monitor the individual heads and,
if any of them appear to be giving consistently different results to the
others investigate, and rectify if necessary.
■■ Consider storing a batch of control condoms and testing a few of
them every day, depending on the number of test heads on the
machine, before starting to use the inflation equipment. If the results
from these control condoms are within the expected trend, that
gives an assurance that the equipment is working properly. It can
also be useful in detecting and quantifying any differences between
operators. Graphing the results on, say, a mean and range chart will
help identify if any significant changes occur.
5.7 Cleanliness of the air supply hole in the mandrel

The air supply point in the mandrel should be cleaned regularly to avoid partial
blockage by accumulated powder and lubricant.
5.8 Maintenance of the supply air pressure and the air flow rate
A dedicated air compressor should be provided for the inflation tester. Using a
compressor that may not have adequate capacity to meet with the demand of
maximum use by other operations in the laboratory could cause the air pressure
in the inflation tester to have momentary fluctuation and variations from the
time of daily calibration checks.
5.9 Maintenance of the air temperature from the compressor

The air compressor for inflation tester should be located in such a manner that it
is not subject to extreme variations during the operation during the day, which
could affect the density of the air.
6. Determination of stability and shelf life

A requirement of ISO 4074:2015 annexes K and L (6) is that condoms should
comply with the key physical property requirements (that is, burst volume and
pressure, freedom from holes and package integrity) throughout their claimed
shelf life. The shelf life can only be established by a real-time study carried out
at 30° C (+5, −2° C). However, a provisional shelf life can be claimed whilst the
real-time study is in progress, provided that satisfactory data from accelerated
ageing studies are available to support the claim. A full description of the
requirements for real-time and accelerated ageing stability studies is given in
Annexes K and L of ISO 4074:2015 (6).
178
Annex 6
The following are points to note when conducting these ageing studies:
■■ The condoms used in the studies must comply with the requirements
of ISO 4074:2015 (6). The studies can only be done with condoms that
have been stored in bulk for the maximum period of time specified by
the manufacturer between dipping and packaging in individual sealed
containers. ISO 4074:2015 (6) specifies that this period shall not
exceed two years. WHO/UNFPA technical specifications, however,
specify a maximum storage period of six months. By agreement with
UNFPA, it is acceptable for manufacturers to conduct stability studies
on condoms that have been stored for six months between dipping
and packaging to verify shelf life claims for procurement under the
WHO/UNFPA prequalification scheme.
Some manufacturer’s formulation may require a certain time period
of maturation of condoms before their burst properties could
stabilize. It is recommended to allow the required maturation time
before the condoms are foiled and this minimum maturation time
be validated and applied while conducting stability studies.
■■ Minimum stability requirements (clause 11.2) (6) must be established.
■■ Three different lots of condoms must be used in the studies. These
production lots from where samples are drawn for stability studies
should represent the actual normal commercial batch sizes of the
manufacturer and not just three sub-lots of the manufacturer.
■■ Select and condition sufficient extra condoms to cover repeat testing
if necessary.
■■ Ensure that there are contingency arrangements in place in case of
equipment breakdown or power failures. You do not want to have to
start the studies again from scratch.
■■ Ensure that the calibration and measurement of temperature are
monitored correctly and the trends are reviewed to pick up early
warning signals for initiating appropriate corrective and preventive
actions.
■■ Ensure that the system of recording temperature and raising alerts
in case of outages in temperature conditions are in a good state of
repair throughout the long period of stability studies and the alert
signals are responded to immediately.
■■ The claimed shelf life cannot exceed five years from the date of
manufacture.
■■ The date of manufacture can be either the date of dipping or the
date the condoms were sealed in their individual containers. Note
179
that the labelled date of manufacture cannot be more than two years
from the date of dipping or six months to comply with UNFPA
requirements, as noted above.
■■ Monitor the physical properties of the condoms at intervals during
the real-time study. Two methods are described in clause K.2.4 (6)
of the standard. These are:
–– Measure the airburst properties of a sample of 125 condoms
from each lot and compare against the requirements of the
standard, using the Acceptance Quality Limit (AQL) of 1.5
(accept on five failures or fewer, reject on six or more). If one
of the three lots of condoms fails, carry out an investigation
and analyse the root cause of failure. Investigation could also
be carried out by analysing more samples from that batch
representing that time point. If the root cause is common to
the other two batches as well, the stability studies should be
stopped. If there are no assignable causes for variation at any one
specific time point, the study can continue but must be stopped
if more than one set of samples fail. At the end of the proposed
or claimed shelf life, carry out the test with larger sample sizes as
per the requirements of ISO 4074:2015 (6).
–– Alternatively, measure the airburst properties of a set of
32 condoms from each lot. Calculate the standard deviation
(or 95% confidence interval) for burst volume and pressure.
If the mean value, minus three times the standard deviation,
approaches the minimum limits defined in the standard (as
described in the note to clause K.2.4 {6}), this can indicate that
the condoms will not pass the requirements of the standard if the
study is continued and the stability study should be terminated.
■■ If the manufacturer has condoms where the shelf life has been
confirmed by a real-time study, then these condoms can be used
as controls in an accelerated ageing study of a new or modified
condom, as described in clause L.3 (6).
■■ If there are no condoms to act as controls in this way, then the
provisional shelf life must be estimated following the procedures in
clause L.2 (6).
■■ Existing condoms whose shelf lives were established following the
procedures of earlier versions of ISO 4074 (i.e. 2002 {7} and 2014
{8}) can be considered to be compliant. However, considering the
several changes that have taken place between 2002 and now, the
manufacturer should initiate fresh real time stability studies as per
180
Annex 6
the requirements of ISO 4074:2015 (6), for the products that are
currently being manufactured.
■■ If any significant changes are made to the condom formulation,
manufacturing procedures or packaging, then the shelf life will need
to be re-confirmed. A significant change, as explained in ISO 16038,
Rubber condoms – Guidance on the use of ISO 4074 in the quality
management of natural rubber latex condoms (9), is one that can be
regarded as having the potential to affect performance adversely. If a
change is deemed by the manufacturer not to require confirmation
of shelf life, the reasons for this decision and all supporting test data
shall be documented.
7. Freedom from holes

The ISO 4074:2015 Annex M (6) standard has two methods for performing the
test for holes. The volume of water dispensed is dependent upon the average
length and average width (taken at 75 ± 5 mm from the closed end excluding
the reservoir tip) of 13 condoms as described in the standard.
7.1. The water leak test (hang and roll)

A suspended condom is filled with a specified volume of water and examined
for visible water leakage through its walls. In the absence of any visible leakage,
the condom is then rolled on coloured absorbent paper which is subsequently
examined for signs of leakage of water from the condom. Condoms with visible
holes less than 25 mm from the open end are not considered as defective in this
test. The test must be carried out exactly as described in the Standard.
Points to note:
■■ Before testing, using a calibrated apparatus, ensure that the volume
and temperature of the water dispensed are within the specified
limits for the test.
■■ Ensure that the condom is secured on the mount in such a way
as to avoid slippage during water dispensation, especially for the
condoms that need volumes of more than 300 dm3.
■■ The condom may be tapped gently to remove air bubbles present on
the inner surface of the condom.
■■ It is essential that the rolling is carried out correctly. The water-
filled condom must be rolled for a distance sufficient to allow the
whole surface of the condom to contact the paper. This distance
is frequently underestimated. When training operators, it can be
181
helpful to mark the condom to show how far the condom must be
rolled. The condom must be rolled through at least two complete
revolutions (WHO/UNFPA do not recommend rolling more than
10 revolutions).
■■ Ensure that the correct amount of pressure is applied to the condom.
The hand (with fingers spread) should be maintained 25 to 35 mm
above the paper.
■■ When testing the closed end of the condom, maintain a similar level
of pressure as when rolling and do not slide the condom over the
paper.
■■ The coloured absorbent paper should be one that makes it easy to
identify the blots made by the presence of holes on the condom
wall. It should also allow for the rolling of the condom body for the
required revolutions as per ISO 4074. Under no circumstances shall
multiple absorbent papers be joined using adhesive tape.
■■ The condom walls may be carefully wiped with soft absorbent cloth
or paper to remove excess moisture and lubricant thus allowing for
easier detection of leaks.
7.2 The electrical test

Points to note:
■■ The equipment should be routinely calibrated and/or verified for
effectiveness, and maintained as per manufacturer’s specifications.
This includes routine changing of the electrolyte solution as build-
up of lubricant may affect the efficacy of the test. In addition to
calibration, the equipment and the technique should be verified
routinely for effectiveness in detecting the holes.

■■ The different parameters that affect the test, such as voltage, should
be checked before each batch/lot test, using calibrated apparatus, for
conformity to specified limits.
■■ Not more than 25 mm of the condom should be left unexposed to
the electrolyte.
■■ Any leaks detected by the system should always be confirmed by
the rolling method described in the Water Leak Test. Note that ISO
4074:2015 (6) specifies the Hang and Roll method must be used -
not the ASTM D3492 Hang and Squeeze method (10).
■■ Note that the condoms have to be observed during filling in order to
detect any holes (see M 3.3.7, third line {6})
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Annex 6
7.3 The water leak test (hang and squeeze)

This method is very similar to the Hang and Roll method except that the condom
is not rolled. Instead, pressure is applied to the condom by gently squeezing it
whilst it is hanging, full of water, on the test equipment. The test must be carried
out exactly as described in the ASTM D3492 – 15 Annex A3 (10) Standard.
Points to note when using this method are:
■■ After filling with water, the body of the condom should be tapped
gently to dispel any air bubbles present on the inner surface of the
condom.
■■ Do not apply too much pressure by squeezing too hard. The correct
amount of distension of the filled condom is shown in figures A3.3
to A3.5 in the ASTM Standard (10).
■■ When checking the body of the condom, gently rotate the condom
so that the entire surface is inspected.
■■ When examining the condoms for signs of leakage, ensure that any
water droplets on the outside of the condom are the result of leakage
and not water splashed onto the condom from any external source.
If necessary, gently dry the outside of the condom with a paper
towel and re-check.
8. Visibly open seals (ISO 4074:2015, Annex N)

This test is performed using samples that are drawn for conducting the tests for
Freedom from Holes and Visible Defects.
The individual sealed containers are examined by visual observation for
any visibly open seals. Defects may include improperly formed seals, condoms
getting trapped in sealing area, uneven or very narrow sealing edges leading
to open seals and leakages. However, it should be noted that these packaging
“defects” are not specified in ISO 4074:2015 (6).
It is recommended that the test laboratory has the display of defects
related to visibly open seals to serve as examples of workmanship criteria so
that consistency is maintained in conducting the test. The defective condoms
observed should be preserved for reference.
9. Visible defects (ISO 4074:2015, Annex M and WHO/

UNFPA Technical specifications for male latex condoms)
The test for visible defects is conducted on the same set of samples taken for the
test for Freedom from Holes.
183
After performing the test for visibly open seals, the individual sealed
containers are opened by pushing the condoms to one side of the pack and
opening the seals, taking care that the condom is not damaged by the rough
edges of the seals, nor sharp instruments such as scissors or finger nails. On no
account should any sharp implement (scissors, scalpels, etc.) be used to open the
condom packs. The condoms are unrolled and examined by visual observation
under bright light, which should completely cover all parts of the condom. Visual
defects are classified as Critical and Noncritical defects with corresponding
AQLs of O.4 and 2.5. The section on Workmanship and Visible Defects on
the WHO/UNFPA Specification (6) details the list of Critical and Noncritical
defects. This section also lists minor imperfections, which do not affect the
properties of the condoms, but are considered as potential points for elimination
with appropriate quality improvement projects. Personnel should be trained for
the ability to detect the visible defects and to correctly classify them. Having an
approved workmanship criteria album will be useful to avoid any disputes. It is
recommended to have a display of specific visual defects in the laboratory for
the operators to easily identify and classify the defects.
10. Determination of package seal integrity

Unless specified otherwise in the procurement contract and purchase order, the
Package Integrity test 1 specified in Annex N of ISO 4074:2015 Annex N (6) shall
be used to test package integrity. For condoms intended for distribution to high
altitude regions or to be distributed by air freight, the alternative “dry vacuum
method” described in Annex 2 of the revised World Health Organization/United
Nations Population Fund Technical specifications for male latex condoms (3) may
be specified.
When conducting the test according to the method specified in Annex N
of ISO 4074:215 (6), the following points should be noted:

■■ Working with a vacuum is potentially dangerous. Eye protection
should be used when carrying out this test.
The seal on the individual condom container, whether of the standard foil pack or the “butter dish”
1
container can, at times, be compromised. This can be caused by several factors, including misaligned
sealing jaws, excessive lubricant, a misaligned or poorly rolled condom being trapped in the seal, etc.
In addition, the foil may contain pinholes or, if the information on the foil is stamped on, rather than
ink-jet printed, the stamping may damage the foil. All in all, there are many ways in which the individual
condom container can contain small holes. A consequence of this is that lubricant can leak out and, if
not detected, can contaminate all the other condom containers within the same pack. In addition, a
compromised foil can expose the condom to oxygen which could cause premature degradation. For this
reason, it is necessary to test the integrity of the packages.
184
Annex 6
■■ The vacuum chamber should be closable with an air tight

transparent lid so that the defective packs can be easily observed
during the test.
■■ A vacuum level of 20 ± 5 kPa absolute must be used. That is
approximately 20% of normal atmospheric pressure at sea level.
Unfortunately, some gauges will read from 0 to 100 kPa whilst
others may read from 100 (or −100) to 0 kPa (see figure 3). This can
be confusing. If the gauge reads from 0 to 100, the correct level of
vacuum will be the figure of 20 kPa: if the gauge reads the other way,
the correct vacuum level will be 80 (or −80) kPa (figure 3). In case of
doubt, remember that it is the greater level of vacuum that must be
used. It will typically take at least 20 seconds – often considerably
longer – for a vacuum pump to evacuate the chamber to this level.
Changes in the time taken to reach the desired vacuum level can be
indicative of complications in the test system or an inaccurate level
of vacuum being used.
■■ The water level should be such that the condom packages are at least
25 mm below the surface.
■■ The number of packages in the chamber should be restricted so that
all the packages can be clearly observed.
■■ A dye is often used to help detect leakage into the containers and the
amount used should not obscure observation of the packages.
■■ If a dye is used, it should be easily washable and should not leave
any deposit of colour building up as that would obstruct the
observation of leakages. The vacuum container and the lid should be
maintained clean.
■■ Observe the condom packages as soon as the vacuum pump starts
– do not wait until the specified vacuum level has been reached to
start the observation. By that time, all the air in a defective package
may have been expelled and the stream of bubbles will have ceased.
■■ All of the individual containers must be opened to check for the
presence of water inside. This is where the dye can be helpful, to
distinguish between lubricant and any water that may have entered
the pack.
185
Fig. 3
A pressure gauge reading from −100 to 0 kPa. In this case, the correct vacuum level for
the test would be −80 kPa (red numerals)
References
2. World Health Organization/United Nations Population Fund Prequalification Programme
guidance for contraceptive devices: male latex condoms, female condoms and intrauterine
devices. In: WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-
No. 1025; https://www.who.int/publications-detail/978-92-4-000182-4, accessed 20 May 2020).
3. World Health Organization/United Nations Population Fund Technical specifications for male latex
condoms. In: WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-

4. World Health Organization/United Nations Population Fund Specifications for plain lubricants.
In: WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-fourth report.
https://www.who.int/publications-detail/978-92-4-000182-4, accessed 20 May 2020).
5. ISO/IEC 17025:2017(en). General requirements for the competence of testing and calibration
laboratories. International Standard ISO/IEC 17025. Geneva: International Organisation for
Standardisation, 2017 (https://www.iso.org/standard/66912.html, accessed 21 May 2020).
6. ISO 4074:2015(en). Natural rubber latex male condoms – Requirements and test methods.
International Standard ISO 4074. Geneva: International Organisation for Standardisation, 2015
(https://www.iso.org/standard/67615.html, accessed 21 May 2020).
186
Annex 6
9. ISO 16038:2005(en). Rubber condoms – Guidance on the use of ISO 4074 in the quality
management of natural rubber latex condoms. International Standard ISO 16038. Geneva.
International Organisation for Standardisation, 2005 (https://www.iso.org/standard/ 37078.html,
accessed 21 May 2020).
10. ASTM D3492 – 16(en). Standard specification for rubber contraceptives (male condoms). Active
Standard ASTM D3492/Developed by Subcommittee: D11.40. ASTM International, 2016 (https://
www.astm.org/Standards/D3492.htm, accessed 21 May 2020).
187
Annex 7
Fund guidance on conducting post-market surveillance of
condoms
Background
2019 (1)) stated the following:
Population Fund (UNFPA) and WHO have separated out different aspects
of the current procedure for contraceptive devices and condoms and are
All seven documents were restructured and revised in the first half of
2019, then sent to the Expert Advisory Panel (EAP) and put out for
public consultation in July 2019. The comments received were reviewed
by a group of specialists in October 2019, prior to being presented to
the ECSPP. At UNFPA’s request, the ECSPP focused on the first three
documents (on UNFPA’s Prequalification Programme guidance, condom
quality assurance and specifications for plain lubricants), noting that all
comments have been addressed. It suggested some further minor revisions,
including recommending changes to clarify that, while the specifications
for plain lubricants are principally targeted at procurement agencies, they
may also be used by regulators for public procurement. The next steps for
the remaining four documents include incorporating comments from the
latest consultations and then bringing them back to the ECSPP for possible
adoption at its next meeting in 2020.
189

technical specifications for male latex condoms (3); and
as discussed.
This is one of four remaining working documents in this series.
1. Introduction 191
2. Sampling 191
3. Testing 193
4. Selection of laboratories 194
5. Interpretation of results 194
References 195
190
Annex 7
1. Introduction
Good quality condoms conforming to the World Health Organization (WHO)/
United Nations Population Fund (UNFPA) technical specifications for male latex
condoms (3) have excellent storage properties. The combination of individual
condom packaging, inner boxes and shipping containers is designed to protect
the condoms during shipping and storage. Nevertheless, storage under poor
conditions and/or rough handling during shipping might adversely affect the
properties of the condoms. Exposure to such adverse conditions is potentially
more likely once the condoms have left control of the purchaser and are in the
wider distribution chain. For this reason, periodic surveillance testing of product
recovered from the field is recommended to confirm that the condoms still
conform to the requirements of the World Health Organization/United Nations
Population Fund technical specifications for male latex condoms (3) and ISO
4074, Natural rubber latex male condoms – Requirements and test methods (5).
Surveillance testing may also be conducted to determine if there has been a
significant deterioration in condom properties relative to retained samples kept
under controlled conditions.
It is recommended that prequalified manufacturers conduct periodic
surveillance testing on condoms that are nearing their expiry date and have
been stored in hot regions to support the shelf life claims made on the basis
of real time and accelerated stability studies. Surveillance testing may have to
be undertaken when there are complaints about condoms, particularly if the
complaints are clustered and associated with one specific product or even a
single lot of product. In such cases, sample sizes can be severely limited and it
may be necessary to limit testing to just one property. The selection of sample
sizes for such testing can be challenging and the results may be of limited use if
only a small number of samples are available.
2. Sampling
In order to conduct post-market surveillance testing on male latex condoms, it
might be necessary to recover condoms from any of the following locations:
■■ warehouses;
■■ distribution centres;
■■ wholesalers;
■■ clinics; and
■■ retail outlets.
191
Key issues when recovering samples for surveillance testing are often
the sample size and lot integrity. If single lots are being tested, for example, one
lot each from a number of manufacturers, then ideally the sampling schemes
given in Annex B of ISO 4074 (5) should be used. If possible, samples should
be taken from at least three lots from each manufacturer to give an indication
about lot-to-lot homogeneity. If multiple lots from a single manufacturer are
being evaluated, then the sampling schemes of Annex A of ISO 4074 (5) are
acceptable. If sample sizes are limited then it may be necessary to test only for
selected properties.
Sample only for the tests that are needed to check on the parameters
in question. Obtaining sufficient samples from warehouses, distribution centres
and wholesalers is not usually problematic but sampling from clinics and retail
outlets often means that sample sizes have to be restricted. This may limit the
types and numbers of tests that can be completed. If an adequate number of
samples from one batch is not available at any particular retail outlet or clinic, it
may be possible to obtain more samples of the same batch from a nearby retail
store or clinic in the region.
If sample sizes are restricted, then they should still be selected from
ISO 2859-1, Sampling procedures for inspection by attributes - Part 1: Sampling
schemes indexed by acceptance quality level (AQL) for lot-by-lot inspection –
Amendment 1 (6). Whenever possible, select sampling schemes that have at
least a 95% probability of acceptance if the quality of submitted lots is at the
limit of the specified AQL (refer to tables X-A through to X-R of ISO 2859-1
(6) for the operating characteristic curves and acceptance probabilities of the
sampling schemes). Use sample sizes that are consistent with ISO 2859-1 (6).
Sample sizes that fall between the specified sample sizes in the tables should not
be used (for example, Table II-A) since it may not possible to make a statistically
valid decision about whether or not the product sampled conforms to the
specification. If there are insufficient samples available to use a specified sample

size, the next lowest specified sample size, for which there are enough samples
and corresponding to that AQL, should be used.
For performance requirements, such as burst properties, freedom from
holes and package integrity, avoid zero accept sampling schemes whenever
possible (for example, a sample size of 50 for an AQL of 0.25 with an acceptance
number of 0). These sampling schemes generally have poor operating
characteristic curves which can lead to type I and type II errors (i.e. an incorrect
rejection of a true null hypothesis and failure to reject a false null hypothesis
respectively, or more simply, false positive and false negative results). If forced
to use zero accept sampling schemes, due to a shortage of samples, then be
cautious about any conclusions that are reached.
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Annex 7
At the time of sampling, full details about the lots being sampled,
including the lot numbers, expiry dates and storage conditions, should be noted.
Whenever possible, a sampling agency should be used and samples should be
taken from lots using procedures to ensure the random selection of condoms
from within the lot.
In some cases, it may be necessary to combine samples from more than
one lot in order to achieve an adequate sample size for testing. This should be
regarded as a last resort situation and is best avoided. Full details of the lots
sampled must be recorded and the expiry date noted for each lot sampled. If
possible, samples from the different lots that are to be combined should be kept
separate throughout the testing process in order to facilitate analysis of the final
results. It may be possible, for example, to show that the different lots sampled
have very similar properties and so justify using the overall result as an estimate
of the quality of all of the lots sampled.
If the test laboratory is located some distance from the location at
which the condoms are being sampled, then the transport arrangements needed
to deliver the condoms to the laboratory should be considered. It is essential to
ensure that the condoms will be not be subjected to any adverse conditions in
transit that could affect the results of the tests. Sending samples by air freight
might, for example, compromise the outcome of any testing for package integrity.
The use of data loggers to monitor temperatures during shipment should be
used, particularly if the condoms are being shipped from or through countries
with hot climates.
3. Testing
The primary focus for testing natural rubber latex male condoms should be the
critical performance parameters, i.e. burst properties, freedom from holes and
package integrity. Other properties, such as dimensions, are unlikely to change
during storage or shipping. Burst properties can be evaluated on a variables
basis as well as on an attribute basis (i.e. conformance to the 1.5 AQL for
burst properties). Information about average burst volume and pressure, their
associated standard deviations and the frequency distributions of the results
can be extremely useful in trying to determine if any significant changes have
occurred. Comparisons can be made with the original manufacturer’s data
and the pre-shipment test results. The statistical significance of any changes in
properties can be readily assessed by the t-test or analysis of variance (ANOVA).
Using such methods may be particularly informative in situations where there
are insufficient samples available to make reliable estimates of conformity to the
AQLs on an attribute basis.
193
4. Selection of laboratories
The laboratories used for surveillance testing shall be accredited to ISO 17025
(7) for the tests being carried out. The laboratories should also participate in an
appropriate international inter-laboratory proficiency scheme. Ideally, the same
laboratory that did the original pre-shipment testing should be used. This makes
the comparison of results much easier and more reliable and permits samples
that have been retained under controlled conditions by the test laboratory to be
re-tested if necessary.
For more information about the selection of laboratories, please refer
to World Health Organization/United Nations Population Fund Condom quality
assurance (8).
When selecting test laboratories, consideration should also be given to
any local customs and import restrictions. Some countries have restrictions on
the import of condoms without testing and these rules can even be applied to
samples being imported solely for test purposes. One should confirm with the
laboratory whether or not there are any rules relating to the import of samples for
testing prior to sending the samples.
5. Interpretation of results
Although lot conformity is assessed on an attribute basis, the use of means and
standard deviations whenever possible is recommended. This primarily applies
to burst testing. Trends in burst properties, particularly when compared to
the results from pre-shipment testing, can provide early warning of potential
problems.
Reviewing the burst result histograms can reveal very interesting
information. Bimodal (or even polymodal) distributions of burst pressure and/
or volume are indicators of poor homogeneity within the lot. In some cases,
this might indicate that the product is substandard and/or falsified; for example,
the lot in question may consist of mixed condoms from different lots or even
condoms from different manufacturers. If substandard and falsified medical
product is suspected, then forward all of the details to the manufacturer whose
name is marked on the pack. The manufacturer should be able to determine
the authenticity of the product from the lot number. Producers of substandard
and falsified medical products commonly make small mistakes with labelling
so return samples of the packaging, and any information received, with the
product to the manufacturer for checking. Following confirmation from the
manufacturer that the product is falsified, inform the WHO team working on
substandard and falsified medical products at [email protected].
If regular post-market surveillance testing is being carried out on
products from a specific manufacturer, then analysis of trends over time can
194
Annex 7
provide extremely useful information. Plotting charts, as described in the

document World Health Organization/United Nations Population Fund Condom
quality assurance, Annex 2 (8), for example, is a very powerful method of
identifying any concerning trends in product quality. Early identification of
an unacceptable trend might, for example, permit a manufacturer to carry out
corrective and preventative actions before the product goes out of specification
and lots are rejected. Charts can also be used to identify situations where
manufacturers may have made changes to the product or production processes
and failed to inform the purchaser. Comparing trends for pre-shipment test
results with those from surveillance testing might also identify problems relating
to the shipping and storage of a product.
References
2. World Health Organization/United Nations Population Fund Prequalification Programme guidance
for contraceptive devices: male latex condoms, female condoms and intrauterine devices. In: WHO
Expert Committee on Specifications for Pharmaceutical Preparations: fifty-fourth report. Geneva:
3. World Health Organization/United Nations Population Fund technical specifications for male latex
condoms. In: WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-
4. World Health Organization/United Nations Population Fund specifications for plain lubricants.
In: WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-fourth report.
https://www.who.int/publications-detail/978-92-4-000182-4, accessed 20 May 2020).
6. ISO 2859-1:1:1999/AMD 1:2011(en). Sampling procedures for inspection by attributes - Part 1:
Sampling schemes indexed by acceptance quality level (AQL) for lot-by-lot inspection –
Amendment 1. International Standard ISO 2859-1. Geneva: International Organisation for
Standardisation, 1999/2011 (https://www.iso.org/standard/53053.html, accessed 21 May 2020).
7. ISO/IEC 17025:2017(en). General requirements for the competence of testing and calibration
laboratories. International Standard ISO/IEC 17025. Geneva: International Organisation for
Standardisation, 2017 (https://www.iso.org/standard/66912.html, accessed 21 May 2020).
8. World Health Organization/United Nations Population Fund Condom quality assurance. Geneva:
World Health Organization; 2019 (working document QAS/19.807; https://www.who.int/docs/
default-source/medicines/norms-and-standards/current-projects/qas19-807-condom-quality-
assurance.pdf, accessed 2 February 2021).
195
Annex 8
WHO “Biowaiver List”: proposal to waive in vivo
bioequivalence requirements for WHO Model List of
Essential Medicines immediate-release, solid oral dosage
forms

2. WHO solubility classification for biowaiver 198
3. Scope 199
4. Methodology 199
5. Results 200
References 203
Further reading 204
197

The World Health Organization (WHO) recognizes the possibility to waive in
vivo bioequivalence studies for immediate-release, solid oral dosage forms with
active pharmaceutical ingredients (APIs) belonging to classes I and III according
to the Biopharmaceutical Classification System (BCS), using comparative
dissolution studies as surrogate proof of bioequivalence (1).
The WHO solubility classification, also referred to as the “WHO Biowaiver
List”, is a tool for national regulatory authorities (NRAs) and pharmaceutical
manufacturing companies, suggesting medical products that are eligible for
a waiver from in vivo bioequivalence studies, which are usually necessary
to establish the therapeutic equivalence with the originator (comparator).
For exemption from an in vivo bioequivalence study, an immediate-release,
multisource (generic) product should exhibit very rapid or rapid in vitro
dissolution characteristics that are comparable to those of the reference product.
A risk-based evaluation should also account for the excipients used in the
formulation of the finished pharmaceutical product.
In addition, the present list replaces the existing literature-based
compilation published in 2006 that is reported in the Proposal to waive in
vivo bioequivalence requirements for WHO Model List of Essential Medicines
immediate-release, solid oral dosage forms (3) based on data extracted from
the public domain (i.e. solubility data published by different authors using
inconsistent experimental conditions).
The WHO Biowaiver Project is organized into study cycles. Previous
and current cycles are summarized below in order to provide an overview of the
project development:
■■ 2018: cycle I; also referred to as the pilot phase.
■■ 2019: cycle II.
■■ 2020: cycle III. The new results presented in this updated document
(in Table 1 highlighted in bold) come from cycle III.
2. WHO solubility classification for biowaiver

In 2017, the Fifty-second Expert Committee on Specifications for Pharmaceutical
Preparations (ECSPP) recommended that the WHO Secretariat revise the
existing list using verifiable laboratory data that are generated according to
consistent WHO criteria. Acting on this directive from the ECSPP, the WHO
Secretariat initiated a multicentre research project, the Biowaiver Project, aimed
at experimentally determining the equilibrium solubility profile of medicines
listed in the WHO Model List of Essential Medicines (EML), using a harmonized
approach (4).
198
Annex 8
To classify APIs according to the BCS framework, two critical properties

are usually evaluated: (i) an API’s aqueous solubility; and (ii) its absorption/
permeability. The initial phase of the WHO Biowaiver Project centers on
unambiguous experimental assessment of the solubility parameter, as only
highly soluble APIs are eligible for biowaiver. Once experimental solubility data
are available, the exact BCS-class assignment can be determined by utilizing
quantitative absorption/permeability data. However, since high solubility within
an aqueous environment is a necessary prerequisite for an API to be eligible for
a waiver from bioequivalence studies, the current focus on solubility is justified
to guide the regulatory decision.
The WHO classification should be considered a living document and is
meant to be regularly updated in accordance with new quality requirements and
progress in scientific development.
3. Scope
The aim of the WHO Biowaiver List is to enable an informed decision on whether
or not a waiver from in vivo bioequivalence studies could be granted safely
according to the WHO guidance Multisource (generic) pharmaceutical products:
guidelines on registration requirements to establish interchangeability (1).
The WHO Biowaiver List is expected to promote access to standard
quality essential medicines by shortening the time required develop a multisource
(generic) product supporting an optimized pharmaceutical development.
The WHO Biowaiver List has been recognized by WHO regional and
country offices as a “Global Good”; a normative work essential to strengthening
global health in WHO Member States.
4. Methodology
The WHO Protocol to conduct equilibrium solubility experiments for the purpose of
biopharmaceutics classification system-based classification of active pharmaceutical
ingredients for biowaiver (2) is a tool available to all participants in this research.
It was developed with the purpose of providing a harmonized methodology for
the equilibrium solubility experiments, thereby minimizing the potential source
of variability among centres and studies.
To date, all APIs studied in cycles I, II and III are received as in-kind
donations from pharmaceutical manufacturers supporting WHO in this scientific
work. Equilibrium solubility experiments were conducted by universities, official
national control laboratories, and WHO collaborating centres.
199
5. Results
Table 1 provides an overview of the APIs studied by WHO during cycles I, II
and III. The new APIs studied in cycle III are reported in bold.
Table 1
WHO solubility classification of active pharmaceutical ingredients prioritized from the
WHO Model List of Essential Medicines (3)
Medicine a Therapeutic Indication Highest API PQ WHO

area therapeutic EOI / classifi-
dose (mg) b PQ cation c
aciclovir Antiviral Antiherpes 800 No II/IV*
medicines medicines
amoxicillin Antibacterials Antibiotics 3000 Yes II/IV*
(trihydrate)
azithromycin Antibacterials Antibiotics 2000 Yes II/IV
(dihydrate)
cefixime Antibacterials Antibiotics 400 No II/IV
(trihydrate)
chloroquine Antiprotozoals Antimalarial 1 g salt No I/III
phosphate medicines medicines (= 600 mg
base)
codeine Medicines Opioid 60 No I/III
(phosphate for pain and analgesics
hemihydrate) palliative care
cycloserine Antibacterials Antitubercu 1g Yes I/III

hydro losis medicines
chloride
daclatasvir Antiviral Medicines for 60 Yes II/IV **
(dihydro medicines hepatitis C
chloride)
darunavir Antiviral Antiretrovirals 800 Yes II/IV **
(ethanolate) medicines (HIV)
200
Annex 8
Table 1 continued
dexametha (1) Gastro (1) Antiemetic (1) (3) Yes I/III **
sone intestinal medicines 0.5 to
medicines (2) Acute 10 mg a day
(2) Immuno- lymphoblastic depending
modulators leukaemia on the
and anti disease
(2) Multiple
neoplastics being
myeloma
treated (2)
(3) Medicines (3) Medicines 40 mg (4)
for pain and for other 6 mg a day d
palliative common
care (4) symptoms in
Corticosteroids palliative care
for COVID-19 d
(4) Treatment
of patients
with severe
and critical
COVID‑19 d
dolutegravir Antiviral Antiretrovirals 50 Yes II/IV**
medicines (HIV)
efavirenz Antiviral Antiretrovirals 600 Yes II/IV
medicines (HIV)
emtricitabine Antiviral Antiretrovirals 200 mg Yes I/III**
medicines (HIV)
entecavir Antiviral Antihepatitis 1 mg Yes I/III **
medicines medicines
ethionamide Antibacterials Antitubercu 500–1000 Yes II/IV*
losis medicines
furosemide Cardiovascular Medicines 80 No II/IV
medicines used in heart
failure
mefloquine Antiprotozoals Antimalarial 1250 mg Yes II/IV
hydro medicines medicines (as hydro
chloride chloride)
201
Table 1 continued
methyldopa Cardiovascular Pregnancy- 500 mg No I/III
sesqui medicines induced
hydrate hypertension
oseltamivir Antiviral Influenza virus 75 mg (as Yes I/III **
phosphate medicines phosphate)
paracetamol Medicines Non-opioids 1g No I/III
for pain and and non-
palliative care/ steroidal anti-
Antimigraine inflammatory
medicines medicines /
Treatment of
acute attack
primaquine Antiprotozoal Antimalarial 15 Yes I/III
(phosphate) medicines medicines
(curative
treatment of
P. vivax and
P. ovale
infections)
pyrimeth Antiprotozoal Antimalarial 75 Yes II/IV
amine medicines medicines
raltegravir Antiviral Antiretrovirals 400 Yes II/IV**
(potassium) medicines (HIV in
pregnant
women and in
second-line)
rifampicin Antibacterials Antitubercu 750 Yes II/IV
losis/
antileprosy
medicines
sofosbuvir Antiviral Medicines for 400 mg Yes II/IV**
medicines hepatitis C
202
Annex 8
Table 1 continued
tenofovir Antiviral Antiretrovirals 300 Yes I/III**
disoproxil medicines (HIV)
(fumarate)
API: active pharmaceutical ingredient; PQ: prequalification; PQ EOI: expression of Interest for prequalification (2);
WHO: World Health Organization.
a WHO Model List of Essential Medicines (3).
b
According to Summary of Product Characteristics from WHO-PQ or National/Regional Regulatory Authority.
C
According to the WHO guidelines, Multisource (generic) pharmaceutical products: guidelines on registration
requirements to establish interchangeability (1), APIs belonging to classes I and III are eligible for biowaiver.
Once experimental permeability data are available, the exact class attribution will be possible (i.e. either class
I or class III). The present solubility characterization is already sufficient to provide an indication on whether or
not an API is eligible for biowaiver.
d
“Corticosteroids for COVID-19. WHO Living guidance” September 2020) https://www.who.int/publications/i/
item/WHO-2019-nCoV-Corticosteroids-2020.1 (accessed 30 September 2020)
* Change in solubility class compared to WHO 2006 classification.
** APIs characterized for the first time within the WHO Biowaiver Project.
Establishing a new WHO Biowaiver List that is based on unambiguous

verifiable experimental solubility data is a critical project with a tremendous
public health impact on patients; procurement/United Nations agencies; national
and regional regulatory authorities; payers; ethics committees; and manufacturers
worldwide. The involvement and support from WHO stakeholders and partners
is highly encouraged and appreciated.
References
1. Multisource (generic) pharmaceutical products: guidelines on registration requirements to
establish interchangeability. In: WHO Expert Committee on Specifications for Pharmaceutical
Preparations: fifty-first report. Geneva: World Health Organization; 2017: Annex 6 (WHO Technical
Report Series, No. 1003; https://www.who.int/docs/default-source/medicines/norms-and-
standards/guidelines/regulatory-standards/trs1003-annex6-who-multisource-pharmaceutical-
products-interchangeability.pdf, accessed 2 February 2021).
2. Protocol to conduct equilibrium solubility experiments for the purpose of Biopharmaceutics
Classification System-based classification of active pharmaceutical ingredients for biowaiver.
In: WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-third report.
https://www.who.int/publications/i/item/978-92-4-000182-4, accessed 18 November 2019).
3. WHO Model List of Essential Medicines, 21st list. Geneva: World Health Organization; 2019 (https://
apps.who.int/iris/bitstream/handle/10665/325771/WHO-MVP-EMP-IAU-2019.06-eng.pdf?ua=1,
accessed 4 November 2019).
203
Further reading
■■ Guidance for organizations performing in vivo bioequivalence studies. In: WHO Expert
Committee on Specifications for Pharmaceutical Preparations: fiftieth report. Geneva: World
int/docs/default-source/medicines/norms-and-standards/guidelines/regulatory-standards/
trs966-annex9-invivo-bioequivalence-studies.pdf, accessed 18 November 2019).
■■ General background notes and list of international comparator pharmaceutical products. In: WHO
Expert Committee on Specifications for Pharmaceutical Preparations: fifty-first report. Geneva:
who.int/docs/default-source/medicines/norms-and-standards/guidelines/regulatory-standards/
trs1003-annex5-who-list-international-comparator.pdf, accessed 18 November 2019).
■■ Guidance on the selection of comparator pharmaceutical products for equivalence assessment
of interchangeable multisource (generic) products. In: WHO Expert Committee on Specifications
for Pharmaceutical Preparations: forty-ninth report. Geneva: World Health Organization; 2015;
regulatory-standards/trs992-annex8-who-comparators-multisource.pdf, accessed 18 November
2019).
■■ List of international comparator products (September 2016). Geneva: World health
Organization; 2016 (https://www.who.int/medicines/areas/quality_safety/quality_assurance/list_
int_comparator_prods_after_public_consult30.9.xlsx, and WHO list of international comparator
pharmaceutical products and general background notes Annex 5, WHO Technical Report Series
1003, 2017, trs1003-annex5-who-list-international-comparator.pdf, accessed 2 February 2021).
204
Annex 9
Guidelines on the implementation of the WHO
Certification Scheme on the quality of pharmaceutical
products moving in international commerce
1. Introduction 206
2. Background 206
3. Provisions and objectives 207
4. Membership 208
5. Requesting a certificate 210
6. Issuing a certificate 213
7. Notifying and investigating a quality defect 215
References 215
Appendix 1 Model certificate of a pharmaceutical product 218
Appendix 2 Model batch certificate of pharmaceutical products 223
Appendix 3 Glossary 226
Appendix 4 (Draft) model notification to the Director-General of the
World Health Organization 233
205
1. Introduction
The World Health Organization (WHO) Certification Scheme on the quality of
pharmaceutical products moving in international commerce (hereinafter referred
to as the “Scheme”) is an international voluntary agreement to provide assurance
to countries participating in the Scheme about the quality of pharmaceutical
products moving in international commerce. The primary document of the
Scheme is the certificate of a pharmaceutical product (CPP).
2. Background
The Scheme has been in operation since 1969 (World Health Assembly resolution
WHA 22.50) and was amended in 1975 (WHA 28.65), 1988 (WHA 41.18), 1992
(WHA 45.29) and 1997 (WHA 50.3) (1–5). In 2007, the Forty-second ECSPP
discussed and identified a number of perceived problems with the operation of
the Scheme (6).
In 2008, a WHO consultation was held to make recommendations for
consideration during the Forty-third WHO Expert Committee on Specifications
for Pharmaceutical Preparations (ECSPP), taking into account the WHO
working document QAS/07.240 which contains key issues and possible action
(7). The report of the consultation was the working document QAS/08.279 (8).
In light of the changing environment, including the rapid globalization of the
pharmaceutical manufacturing sector, coupled with changes in the make-up of
both the regulators and the groups involved in procurement, the Forty-third
ECSPP endorsed the following recommendations (9):
“1. The WHO Certification Scheme on the quality of Pharmaceutical

products moving in international commerce should be revised.
2. The proposal for revision of the Scheme and modification of the

guidelines should be discussed by the relevant WHO Governing
Bodies – the Executive Board and the World Health Assembly –
and in consultation with WHO’s Legal Counsel.
3. In the interim, a question and answer (Q&A) paper should be
prepared on the function of the Scheme.”
Based on the above recommendations, as an interim measure, a Q&A

document on the function of the Scheme was developed in 2010 and revised in
2015 (10, 11). However, the Scheme has not been revised since 1997.
In 2017, the Fifty-second ECSPP recommended that “the WHO
Secretariat should prepare a proposal for revision of the Scheme for public
consultation” (12).
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Annex 9
The draft working document, which includes the proposed revision of

the Scheme, was prepared by the WHO Secretariat and it was discussed during
an informal consultation that took place from 19 to 20 May 2018.
The draft working document was circulated twice to the Member States
and other interested parties for public consultation to prepare a version of the
working document for endorsement by the Fifty-fifth ECSPP in 2020.
During the revision process, consideration was given to including
reference to the Global Benchmarking Tool (GBT) (13) and the concept of WHO
Listed Authorities (14). However, it was considered that since the GBT details
are still under discussion, it was too early to add it in the Scheme. Additional
wording was instead added to section 2.2 indicating that a Member State or a
regional authority should possess an effective marketing authorization, vigilance
and market surveillance and control systems for pharmaceutical products.
3. Provisions and objectives

3.1 A comprehensive system of certification must be founded on a reliable
system of marketing authorization and independent analysis of the
pharmaceutical product, as well as upon assurance obtained through
independent inspection that all manufacturing operations are carried out
in conformity with accepted norms, referred to as “good manufacturing
practices” (GMP), and also within relevant provisions already approved in
the marketing authorization.
3.2 In 1969, the Twenty-second World Health Assembly, by resolution
WHA22.50, endorsed requirements for Good practices in the manufacture
and quality control of drugs (15) (referred to henceforth as “GMP as
recommended by WHO”). These comprise internationally-recognized and
respected standards that all Member States are urged to adopt and to apply.
These requirements have since been revised several times.
3.3 These standards provide the basis for the the Scheme recommended
initially in resolution WHA22.50 (15). The Scheme is an administrative
instrument that requires each participating Member State or regional
authority, upon application by a commercially interested party, to attest to
the competent authority of another participating Member State or regional
authority that:
■■ a specific product is authorized to be placed on the market within
its jurisdiction or, if it is not thus authorized, the reason why that
authorization has not been accorded;
207
■■ the manufacturing site is subject to inspections at suitable

intervals to establish that the manufacturer conforms to GMP
(16) as recommended by the WHO in accordance with its current
publication;
■■ the actual status of commercialization of the certified product on the
market of the certifying authority, when authorized; and
■■ all product information submitted, including labelling, is currently
authorized by the certifying authority.
Additionally, the Scheme facilitates the exchange of information related to
the investigation of serious quality defects reported in product exported in
accordance with its provisions, reliance on the results of GMP inspections
performed by other authorities, and also on the results of the assessment of
the dossier with the requirements of the certifying authorities.
3.4 The Scheme, as amended in 1975 (17), 1988 (18), 1992 (19) and 1997 (20),
by resolutions WHA28.65, WHA41.18, WHA45.29 and WHA50.3, is
applicable to finished dosage forms of pharmaceutical products intended
for administration to human beings or to food-producing animals.
3.5 Provisions for certification of starting materials (active pharmaceutical
ingredients {APIs} and excipients) for exporting purposes are provided in
separate guidelines (21).
4. Membership
4.1 Any Member State, as well as regional authority that has the legal right to
control the regulation of pharmaceutical products, is eligible to participate
on a voluntary basis in the Scheme as a requesting authority. In order to
participate, a certifying authority should comply, additionally, with the

requirements stipulated in section 2.2. Membership can be voluntarily
withdrawn at any time by written notification to the Director-General
of WHO.
4.2 A Member State or a regional authority intending to become a certifying
member should possess:
■■ an effective marketing authorization, vigilance and market
surveillance and control systems for pharmaceutical products,
including the responsible manufacturers and licensing of
distributors;
■■ GMP requirements, consistent with those recommended by
WHO in accordance with its current publication, to which all
208
Annex 9
manufacturers of finished pharmaceutical products (FPP) are

required to conform;
■■ effective controls to monitor the quality of pharmaceutical products
registered or manufactured within its country or region, including
access to an independent medicine testing laboratory;
■■ a pharmaceuticals inspectorate, operating as an arm of the national
or regional medicines regulatory authority, and having the technical
competence, experience and resources to assess whether or not
GMP and other controls are being effectively implemented, and the
legal power to conduct or to coordinate appropriate investigations
to ensure that manufacturers conform to these requirements by, for
example, examining premises and records and taking samples; and
■■ an efficient surveillance system, administrative capacity and good
regulatory practices compliance to issue the required certificates
efficiently, to detect and institute inquiries in the case of complaint,
and to expeditiously notify WHO and, when possible, the
competent authority in the Member State or region known to
have imported a specific product, or publish the information on
the website about the product that is associated with a potentially
serious quality defect or other hazard in a timely manner.
4.3 Membership as a certifying member and/or requesting member should be
declared by notifying in writing to the Director-General of the WHO of:
■■ its willingness to participate in the Scheme as a certifying member
and/or a requesting member;
■■ any significant reservations it intends to observe relating to this
participation;
■■ the commitment of implementing the WHO guideline ¨WHO
Certification scheme on the quality of pharmaceutical products moving
in international commerce”, the WHO Model Certificates (WHO
template) and provision of the certificates when requested by a
requesting member;
■■ the name and address (including email address, telephone and
website address) of its medicines regulatory authority or other
competent authority;
■■ the commitment to notify any change of the information submitted
related to the certifying and/or requesting member details; and
■■ a declaration to comply with the requirements for a certifying
member as stipulated in section 2.2.
209
4.4 A consolidated list of information on the notification submitted by

Member States and regional authorities in accordance with the provision
in sections 2.3 and 2.5 will be available through WHO’s official website (see
also section 3.3).
4.5 A Member State or regional authority should inform the WHO of any
change of the information notified to the Director-General of the WHO.
5. Requesting a certificate
5.1 Two documents, if available by the certifying authority, can be requested
within the scope of the Scheme:
■■ a certificate of a pharmaceutical product (CPP) and;
■■ a batch certificate of a pharmaceutical product (for more details,
please see sections 3.14 and 3.15 and the Explanatory notes in
Appendix 2).
5.2 The proposed formats for these documents are provided in appendices 1
and 2 of these guidelines. All participating Member States and regional
authorities are henceforth urged to adopt these formats without deletion
in order to facilitate the harmonization and interpretation of certified
information. A CPP with any deleted sections is no longer considered
a “CPP”.
The explanatory notes attached to the two documents referred to above are
very important. Whilst they are not part of the document to be certified,
they should always be attached to the certificate.
5.3 A list of addresses of national and regional authorities participating in the
Scheme that are responsible for the registration of pharmaceutical products

for human and/or veterinary use, together with details of any reservations
they have declared regarding their participation in the Scheme, will be
available on the WHO official website as indicated in section 2.4.
5.4 Each authority should issue appropriate guidelines to all agents responsible
for importing pharmaceutical products for human and/or veterinary use
that operate under its jurisdiction, including those responsible for public
sector purchases, in order to explain the contribution of certification to the
medicine regulatory process and the circumstances in which each of the
two types of documents will be required, the requesting information and
the methodology to follow.
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Annex 9
Certificate of a pharmaceutical product

5.5 The certificate of a pharmaceutical product (CPP) (Appendix 1), issued by
the certifying authority, is intended for use by the requesting authority in
two situations:
■■ when the product in question is under consideration for a marketing
authorization that will authorize its importation and sale, including
the GMP compliance of the manufacturer and information on
the marketing status of a product in the country of the certifying
authority; and
■■ when administrative action is required to renew, extend, modify or
review such a marketing authorization.
5.6 The CPP is intended to facilitate the trade of pharmaceutical products. Its
use should have an impact for regulatory authorities and regional bodies in
terms of quality and time on the assessment of dossiers for the marketing
authorization. The Scheme facilitates reliance among the participating
authorities and its use will enable a timely access to medicines.
5.7 All requests for CPPs should be channeled through the applicant. The
applicant may submit the following information for each product to the
certifying authority:
■■ the marketing authorization number, name and dosage form of
the FPP;
■■ the name and amount of active ingredient(s) per unit dose
(International Nonproprietary Name(s) (INN(s)) where such
exist(s));
■■ the name and address of the marketing authorization holder;
■■ the name and address of the manufacturing site(s);
■■ the unit formulation (complete quantitative composition including
all excipients);
■■ the product information for health professionals, the Summary
of Product Characteristics (SPC), and for the public (patient
information leaflets) as approved by the certifying authority; and
■■ the packaging of the FPP.
The name(s) and address(es) of manufacturing site(s) that could be
submitted to the certifying authority are referred to the FPP, bulk finished
product, solvent and diluents, quality control of the FPP, batch release,
primary and secondary packaging.
211
For the product information to be attached to the certificate, please see

section 4.7.
5.8 The certificate is a confidential document which may be issued by the
certifying authority only with the permission of the applicant or of the
marketing authorization holder.
5.9 The certificate is intended to be incorporated into a marketing
authorization application to the requesting authority. Once prepared, it is
transmitted to the requesting authority through the applicant and, when
applicable, the agent in the importing country.
5.10 When any doubt arises about the status or validity of a certificate, the
requesting authority should request verification of the validity of the
certificate from the certifying authority, as provided for under section 4.8
of these guidelines.
5.11 In the absence of any specific agreement, each certificate will be prepared
always in the working language(s) of the certifying authority. Certifying
authorities are encouraged to issue bilingual certificates, including English
as the second language, if applicable. The applicant will be responsible for
providing any certified translation that may be required by the requesting
authority.
5.12 Since the preparation of certificates imposes a significant administrative
load on certifying authorities, the service may need to be financed by
charges levied upon applicants.
5.13 Additional information is not within the scope of the Scheme. The
certifying authority is under no obligation to supply additional
information.
Batch certificate
5.14 A batch certificate of a pharmaceutical product (Appendix 2) refers to an
individual batch of a pharmaceutical product and is a vital instrument
in the procurement of medicines. The provision of a batch certificate is
usually a mandatory element in tender and procurement documents.
5.15 A batch certificate is normally issued by the manufacturer and must
accompany and provide an attestation concerning the quality and expiry
date of a specific batch or consignment of a product that has already
obtained marketing authorization in the importing country. The batch
certificate shall include all the parameters (attributes), with acceptance
criteria, of the release specification of the pharmaceutical product at
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Annex 9
the time of batch release and the results. In most circumstances, these
certificates are issued by the manufacturer to the importing agent (i.e. the
marketing authorization holder in the importing country), but they must
be made available at the request of – or in the course of any inspection
made on behalf of – the competent authority.
Note: the following are examples of statements and certificates issued in
connection with the Scheme. These are not considered to be part of the
Scheme:
■■ Statement of marketing authorization status of pharmaceutical
product(s) – attests only that a marketing authorization has
been issued for a specified product, or products, for use in the
certifying country or within the jurisdiction of the certifying
regional authority. It is intended for use by importing agents when
considering bids made in response to an international tender,
in which case it should be requested by the agent as a condition
of bidding. It is intended only to facilitate the screening and
preparation of information.
■■ Batch (lot) release certificate (22, 23) – issued by the competent
authority or competent national laboratory in the certifying country
or regional authority, and it refers to the results of a batch or several
batches which comply with established specifications and provisions
to assure the quality, safety and efficacy (QSE) of the concerned
vaccines and vaccine’s individual components, as well as with
WHO’s good manufacturing practices (GMP) for pharmaceutical
products and biological products.
6. Issuing a certificate
6.1 The certifying authority is responsible for assuring the authenticity of the
certified data. Certificates should not bear the WHO logo, but a statement
should always be included to confirm that the document is issued in the
format recommended by WHO.
6.2 When manufacture takes place in a country other than that from which the
CPP is issued, an attestation relevant to compliance of the manufacture
with GMP should still be provided on the basis of inspections undertaken
for registration purposes by the same authority or by another authority.
6.3 When the applicant is the manufacturer of the finished dosage form, the
certifying authority should satisfy, before attesting compliance with GMP,
that the applicant:
213
(a) applies identical GMP standards to the production of all batches of

pharmaceutical products manufactured within the site, including
those destined exclusively for export; and
(b) consents, in the event of identification of a quality defect consistent
with the criteria set out in section 5.1, to relevant inspection
reports being released, in confidence and where possible, to the
requesting authority, should the latter so require.
6.4 When the applicant is not the manufacturer of the finished dosage form,
the certifying authority should similarly satisfy – in so far as it has the
authority to inspect the records and relevant activities of the applicant –
that it has the applicant’s consent to release relevant reports on the same
basis, as described in section 4.3 (b) above.
6.5 Whenever a product is purchased through an intermediary, or when
more than one set of premises has been involved in the manufacture and
packaging of a product, the certifying authority should consider whether
or not it has received sufficient information to satisfy that those aspects of
the manufacture of the product have been undertaken in compliance with
GMP as recommended by WHO.
6.6 The certifying authority should officially stamp and date any certificates
issued or certify using a secure electronic system/electronic certificate
(e-certificate). Every effort should be made to ensure that certificates and
all annexed documentation are consistent with the version of the marketing
authorization operative on the date of issue. Nevertheless, requesting
authorities are discouraged to introduce legalization procedures or any form
of authentication procedures such as notarization, embassy legalization
and apostillation that may cause the undue delay of certificates.
6.7 To avert any potential abuse of the Scheme, to frustrate attempts at

falsification, to render routine authentication of certificates by an
independent authority superfluous, and to enable the certifying authority
to maintain comprehensive records of countries to which certificates have
been issued, each certificate should identify the requesting authority
and be issued in such a way that the authenticity of the certificate can
be verified using appropriate tools, such as, for example, certification and
validation using a secure electronic system.
If requested, an identical copy, clearly marked as a duplicate, may be
forwarded by the certifying authority without any undue delay, ideally
within 20 working days.
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6.8 The certifying authority should establish a standard time frame for the
issuance of certificates, ideally within 30 working days. It should endeavor
to issue a certificate within this period, as soon as the applicant submits
sufficient documents, as requested in section 3.7.
7. Notifying and investigating a quality defect

7.1 Each certifying authority undertakes to investigate any quality defect
reported in a product exported in accordance with the provisions of the
Scheme, on the understanding that:
■■ the complaint is transmitted, together with the relevant facts,
through the requesting authority;
■■ the complaint is considered to be of a serious nature in terms of risk
by the latter authority; and
■■ the defect, if it appeared after the delivery of the product into the
importing country, is not attributable to local climatic or storage
conditions.
7.2 In case of doubt, a participating national or regional authority may request
WHO to assist in identifying an independent quality control laboratory to
carry out tests for the purposes of quality control.
7.3 Each certifying authority undertakes to inform WHO and, when possible,
all national and regional competent authorities of any serious hazard
newly associated with a product exported under the provisions of the
Scheme or of any criminal abuse of the Scheme, or publish the information
on the website about the product. In the case of substandard or falsified
pharmaceutical products, the WHO Global Surveillance and Monitoring
System for Substandard and Falsified Medical Products, should be used
to send the notification to WHO (24). Upon receipt of such notification,
WHO will inform the competent authority as appropriate and/or issue a
WHO Medical Product Alert (25).
7.4 WHO stands prepared to offer advice should difficulty arise in implementing
any aspect of the Scheme or in resolving a complaint, but it cannot be a
party to any resulting litigation or arbitration.
References
1. World Health Assembly resolution WHA22.50 (1969).
215

6. Forty-second WHO Expert Committee on Specifications for Pharmaceutical Preparations, Geneva
(WHO Technical Report Series, No. 948; 2008 (https://www.who.int/medicines/publications/
pharmprep/OMS_TRS_948.pdf, accessed 2 February, 2021).
7. Proposal for improvement of the WHO Certification Scheme on the quality of pharmaceutical
products moving in international commerce (working document QAS/07.240).
8. Draft report to the Forty-third WHO Expert Committee on Specifications for Pharmaceutical
Preparations. Recommendations for improvement of the WHO Certification Scheme on the
quality of pharmaceutical products moving in international commerce (working document
QAS/08.279) (2008).
9. Forty-third WHO Expert Committee on Specifications for Pharmaceutical Preparations, Geneva
(WHO Technical Report Series, No. 953 {2009}, untitled (who.int), accessed 2 February 2021).
10. WHO Certification Scheme on the Quality of Pharmaceutical Products Moving in International
Commerce: Question and Answers (Q&A) (QAS/10.374, 2010).
11. WHO Certification Scheme on the quality of pharmaceutical products moving in international
commerce: questions and answers (Q&A) (WHO Drug Information, Vol. 30, No. 3, 2016, WHO |
WHO Drug Information, accessed 2 February 2021).
12. Fifty-second WHO Expert Committee on Specifications for Pharmaceutical Preparations (WHO
Technical Report Series, No. 1010 {2018}, WHO | WHO Expert Committee on Specifications for
Pharmaceutical Preparations, accessed 2 February 2021).
13. WHO Global Benchmarking Tool (GBT) for evaluation of national regulatory systems https://
www.who.int/medicines/regulation/benchmarking_tool/en/ Link accessed 23/10/2020.
14. Concept note: A framework for evaluating and publicly designating regulatory authorities as
WHO-listed authorities (QAS/19.808), https://www.who.int/docs/default-source/medicines/
norms-and-standards/current-projects/qas19-808-who-listed-authorities.pdf?sfvrsn=e5b
350f3_2 Link accessed 23/10/2020
15. Quality control of drugs. In: Twenty-second World Health Assembly, Boston, Massachusetts,
8-25 July 1969. Part 1: Resolutions and decisions, annexes. Geneva, World Health Organization;
1969:99-105 (Official Records of the World Health Organization, No. 176).
16. WHO good manufacturing practices: Health product and policy standards. Geneva: World Health
Organization (https://www.who.int/teams/health-product-and-policy-standards/standards-and-
specifications/gmp, accessed 6 February, 2021).
17. WHO Certification Scheme on the quality of pharmaceutical products moving in international
commerce. In: Twenty-eighth World Health Assembly, Geneva, 13-30 May 1975. Part 1: Resolutions
and decisions, annexes. Geneva, World Health Organization; 1975:94-95 (Official Records of the
World Health Organization, No. 226).
18. Resolution WHA41.18 WHO Certification Scheme on the quality of pharmaceutical products
moving in international commerce. In: Forty-first World Health Assembly, Geneva, 2-13 May
1988. Resolutions and decisions, annexes. Geneva, World Health Organization; 1988:53-55
(WHA41/1988/REC/1).
19. Resolution WHA45.29. Proposed guidelines for implementation of the WHO Certification Scheme
on the Quality of Pharmaceutical Products Moving in International Commerce. In: Forty-fifth
World Health Assembly, Geneva, 4-14 May 1992. Resolutions and decisions, annexes. Geneva,
World Health Organization; 1992:155-165 (WHA41/1992/REC/1).
216
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20. Resolution WHA50.3 Guidelines for implementation of the WHO Certification Scheme on the
quality of pharmaceutical products moving in international commerce. In: Forty-fifth World
Health Assembly, Geneva, 5-14 May 1997. Resolutions and decisions, annexes. Geneva, World
Health Organization; 1997:2-3 (WHA50/1997/REC/1).
21. WHO pharmaceutical starting materials certification scheme (SMACS): guidelines on
implementation. In: WHO Expert Committee on Specifications for Pharmaceutical Preparations:
thirty-eighth Report. Geneva: World Health Organization: 2004: Annex 3 (WHO Technical Report
Series, No. 917), ECS cover (7.4mm) (who.int), accessed 2 February 2021).
22. Guidelines for independent lot release of vaccines by regulatory authorities. In: WHO Expert
Committee on Specifications for Pharmaceutical Preparations: forty-seventh report. Geneva:
World Health Organization; 2013: Annex 2 (WHO Technical Report Series, No. 978,).
23. Model Certificate proposed by the WHO National Control Laboratory Network for Biologicals and
published in its second meeting report, 2018: (https://www.who.int/immunization_standards/
vaccine_quality/Report_WHO-NNB2018.pdf?ua=1), accessed 2 February 2021).
24. WHO Global Surveillance and Monitoring System (https://www.who.int/medicines/regulation/
ssffc/surveillance/en/, accessed 2 February 2021).).
25. WHO Medical Product Alerts (https://www.who.int/medicines/publications/drugalerts/en/,
accessed 2 February 2021).).
217
Appendix 1
Model certificate of a pharmaceutical product
Certificate of a pharmaceutical product
This certificate conforms to the format recommended by the World Health
Organization (WHO). It establishes the status of the pharmaceutical product
and of the applicant for the certificate by the national certifying authority in
the country or within the jurisdiction of the regional certifying authority. It is
for a single product only since the manufacturing arrangements and approved
information for different dosage forms and different strengths can vary. (General
instructions and explanatory notes are attached.)
No. of certificate:
Certifying country or regional certifying authority:
Requesting country(countries) or regional authority(authorities):
1. Basic information
1.1. Name: (International Nonproprietary Name (INN)/generic/chemical name);
brand name of the pharmaceutical product as it is declared in the marketing
authorization certificate and used within the territory of the certifying
authority and, if possible, the brand name for the foreign country as
declared by the requester, (if different); and, the dosage form of the finished
pharmaceutical product (FPP):
1.2. Composition: active pharmaceutical ingredient name(s) using if possible,

INNs or national nonproprietary names,. Unit formulation (complete
quantitative composition including all excipients); 1 :
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Annex 9
1.3. Is this product authorized by the certifying authority to be marketed in

the certifying country or within the jurisdiction of the certifying regional
authority? Yes/No (key in as appropriate).
1.3.1 Are there restrictions of the sale, distribution or administration of the
product specified in the marketing authorization? Yes/No (key in as
appropriate). See attached information if Yes.
1.4. Is this product actually on the market in the certifying country or within
the jurisdiction of the certifying regional authority? Yes/No/Unknown
(key in as appropriate).
Sections 2A and 2B below are mutually exclusive, therefore:
■■ If the answer to 1.3 above is yes, continue with section 2A and omit
section 2B.
■■ If the answer to 1.3 above is no, omit section 2A and continue with
section 2B
2. Information on marketing authorization

2.A. Product that is authorized for marketing by the certifying authority.
2.A.1. Number of marketing authorization and date of issue. (Indicate,
when applicable, if the marketing authorization is provisional and the
marketing authorization pathway, e.g. abridged, etc):
2.A.2 Marketing authorization holder (name and address):
2.A.3. Status of marketing authorization holder (one of the options of 3.1,

if manufacturer, or specify the status as importer or any other):
2.A.4. Is a summary basis for approval appended? Yes/No (key in as

appropriate). See attached information if answer is Yes.
2.A.5. Is the attached officially approved product information complete and
consistent with the marketing authorization (such as the Summary
of Product Characteristics – SPC- or similar)? Yes/No/Not provided
(key in as appropriate). See attached information if answer is Yes.
219
2.A.6. Name and address of applicant for the certificate as provided by the
marketing authorization holder, if different:
2.A.7. Web-link to the product marketing authorization information (if

available)
2.B. Product that is not authorized for marketing by the certifying authority.
2.B.1. Applicant for certificate (name and address):
2.B.2. Why is marketing authorization lacking?

Not required/Not requested/Under consideration/Refused/
Withdrawal for commercial reasons/Withdrawal for sanitary
reasons (key in as appropriate)
2.B.3. Reason provided by the applicant for not requesting registration.
(a) The product has been developed exclusively for the treatment
of conditions (e.g. tropical diseases – not endemic in the
exporting country):
(b) The product has been reformulated - please specify:

(c) Any other reason, please specify:
3. Information on manufacturing and inspections

3.1. List of name and address of the manufacturing site(s) and activities:
a) manufacturing of all steps of the finished pharmaceutical product
(FPP);
b) manufacturing the bulk finished product;
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c) manufacturing of solvent and diluents;

d) quality control of the FPP;
e) batch release of the FPP;
f) primary packaging of the dosage form;
g) secondary packaging of the product;
h) other(s) (specify and list in new arrows).
Name of manufacturing site Address Activity
3.2. Does the certifying authority arrange for periodic inspection of the
manufacturing site in which the of the FPP is produced? Yes/No (key in as
appropriate). If not, proceed to question 4.
3.3. Periodicity of routine inspections:
3.4. Has the manufacturer of the dosage form of the FPP been inspected? Yes/
No (key in as appropriate). If Yes, when feasible, insert date of inspection(s)
(dd/mm/yyyy).
3.5. Do the facilities and operations of the manufacturer of the FPP conform to
good manufacturing practices (GMP) as recommended by WHO? 2 Yes/No
(key in as appropriate).
3.6. It is recommended that for products approved, but not manufactured in the
country of the certifying authority, the source of information that assures
the GMP compliance of the manufacturer(es) is declared.
4. Does the information submitted by the applicant satisfy the certifying
authority on all aspects of the manufacture of the product? Yes/No (key in
as appropriate) 3. If the answer is No, please explain:

Address of certifying authority:
221
Telephone number: Website:

Email address:
Name and job title of authorized person:
Validity of the certificate 4 (optional):

Signature:
Stamp and date (electronic whenever possible):
General instructions
Please refer to the guidelines for full instructions on how to complete this form
and for information on the implementation of the Scheme.
Additional sheets should be appended, as necessary, to accommodate
remarks and explanations.
Explanatory notes
1
Details of quantitative composition are preferred but their provision is subject
to the agreement of the marketing authorization holder.
The requirements for good practices in the manufacture and quality control
2
of pharmaceutical products referred to in the certificate, are those included

in the Thirty-second report of the Expert Committee on Specifications for
Pharmaceutical Preparations, WHO Technical Report Series, No. 986, 2014,
Annex 2 (WHO Good manufacturing practices for pharmaceutical products:
main principles). Recommendations specifically applicable to biological
products have been formulated by the WHO Expert Committee on Biological
Standardization (WHO Good manufacturing Practices for biological products,
WHO Technical Report Series, No. 996, 2016, Annex 3).

It is of particular importance when contractors are involved in the
3
manufacture of the product. The applicant should supply the certifying

authority with information in order to identify the contracting parties
responsible for each stage of manufacture of the finished dosage form and
the extent and nature of any controls exercised over each of these parties.
A period of validity can be provided by the authority on the certificate.
4
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Appendix 2
Model batch certificate of pharmaceutical products
Manufacturers/official 1 batch certificate of a pharmaceutical product
This certificate conforms to the format recommended by the World Health
Organization (WHO) (general instructions and explanatory notes are attached).
1. No. of certificate:
2. Importing (requesting) authority:
3. Name: (International Nonproprietary Name (INN)/generic/chemical name);
brand name of the pharmaceutical product as it is declared in the marketing
authorization certificate and, if possible, brand name for the foreign
country, if different.

3.1. Dosage form:
3.2. Composition: Active pharmaceutical ingredient name(s) using, if

possible, International Nonproprietary Names (INNs) or national
nonproprietary names. Unit formulation (complete quantitative
composition including all excipients):

3.2.1 Is the composition of the product identical to that registered
in the country of export? Yes/No/Not applicable (key in as
appropriate) 2
If No: please attach the formula (including excipients) of both
products.
4. Marketing authorization holder 3 (name and address):

4.1 Marketing authorization number 3 :
4.2 Date of issue 3 :
4.3 Marketing authorization issued by 3 :
223
4.4 Certificate of a pharmaceutical product (CPP) number 3,4 :
5. Pharmaceutical product information:

5.1 Batch number:
5.2 Date of manufacture:
5.3 Shelf life (years):
5.4 Contents of container:
5.5 Nature of primary container:
5.6 Nature of secondary container/wrapping:
5.7 Specific storage conditions:
5.8 Temperature range:
6. Quality analysis:

6.1 What specifications apply to this dosage form? Either specify the
pharmacopoeia or append company specifications.5

6.1.1 In the case of a product registered by the certifying country
or regional authority, have these company specifications 5
been accepted by the competent authority? Yes/No (key in as
appropriate)
6.2 Does the batch comply with all parts of the above specifications? Yes/
No (key in as appropriate)
6.3 Append certificate of analysis. Identify and explain any discrepancies

from specifications.
It is hereby certified that the above declarations are correct and that the results of
the analyses and assays on which they are based will be provided on request to
the competent authorities in both the importing and exporting countries.
Name and address of authorized person:
Validity of the certificate 6 :

Telephone number: Website:
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Email address:
Signature of authorized person:
Stamp and date (electronic whenever possible):
General instructions
Please refer to the guidelines for full instructions on how to complete this form
and for information on the implementation of the Scheme.
Additional sheets should be appended, as necessary, to accommodate
remarks and explanations.
Explanatory notes
The certification of individual batches of a pharmaceutical product is only
undertaken on an exceptional basis by the competent authority. Even then, it
is rarely applied other than to biological products, such as vaccines, blood and
plasma derivatives. For other products, the responsibility for any requirement
to provide batch certificates rests with the marketing authorization holder in the
certifying country or within the jurisdiction of the certifying regional authority.
The responsibility to forward certificates to the competent authority in the
importing country is most conveniently assigned to the importing agent.
Any inquiries or complaints regarding a batch certificate should always
be addressed to the certifying competent authority. A copy should also be sent to
the marketing authorization holder.
Strike out whichever does not apply.
1
“Not applicable” means that the product is not registered in the country of
2
export.
All items under 4 refer to the marketing authorization or the certificate of a
3
pharmaceutical product (CPP) issued in the certifying country or within the

jurisdiction of the certifying regional authority.
This refers to the CPP as recommended by WHO.
4
For each of the parameters to be measured, specifications give the values that
5
have been accepted for batch release at the time of product registration.
The validity of the certificate should not be confused with the expiry period of
6
the batch/lot.
225
Appendix 3
Glossary
In order to facilitate understanding, this glossary explains terms in the guidelines
and/or refers to relevant sections. It is considered as supplementary information
and not as being a formal part of the World Health Organization (WHO)
Certification Scheme on the quality of pharmaceutical products moving in
international commerce (hereinafter referred to as the “Scheme”).
abuse of Scheme. Actions addressed to the falsification of the certificates of
the Scheme, its traceability, to issue them by non-authorized authorities or
individuals, and any other activity against the authenticity of the certificates.
active pharmaceutical ingredient (API). Any substance or mixture of substances
intended to be used in the manufacture of a finished pharmaceutical product
(FPP) and that, when used in the production of a pharmaceutical product,
becomes an active ingredient of the FPP. Such substances are intended to furnish
pharmacological activity or other direct effect in the diagnosis, cure, mitigation,
treatment or prevention of disease or to affect the structure and function of
the body.
applicant. The party applying for a certificate of a pharmaceutical product (CPP).
This is normally the agent responsible for importing pharmaceutical products,
the marketing authorization holder or other commercially-interested party. In
all instances, having regard to the commercial confidentiality of certain data,
the certifying authority must obtain permission to release these data from the
marketing authorization holder or, in the absence of a marketing authorization
holder, from the manufacturer.

batch (synonym: lot). A defined quantity of starting material, packaging material
or finished pharmaceutical product (FPP) processed in a single process or a
series of processes so that it is expected to be homogeneous. It may sometimes be
necessary to divide a batch into a number of sub-batches which are later brought
together to form a final homogeneous batch. In the case of terminal sterilization,
the batch size is determined by the capacity of the autoclave. In continuous
manufacture, the batch must correspond to a defined fraction of the production,
characterized by its intended homogeneity. The batch size can be defined either
as a fixed quantity or as the amount produced in a fixed time interval.
batch certificate (synonym: lot certificate). A document containing information,
as set out in Appendix 2 of the guidelines for use, will normally be issued for
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each batch by the manufacturer. Furthermore, exceptionally, a batch certificate

may be validated or issued by the competent authority, particularly for vaccines,
sera and other biological products. The batch certificate travels with every major
consignment as a vital instrument in the procurement of medicines. The
provision of a batch certificate is usually a mandatory element in tender and
procurement documents.
batch number (synonym: lot number). A distinctive combination of numbers
and/or letters which uniquely identifies a batch on the labels, its batch records
and corresponding certificates of analysis, etc.
bulk product. Any product that has completed all processing stages up to, but
not including, final packaging.
certificate of a pharmaceutical product (CPP). A document containing the
information as set out in Appendix 1 of the guidelines that is validated and
issued for a specific product by the competent authority of the issuing country
or regional authority and intended for use by the competent authority in
the importing country/region or, in the absence of such an authority, by the
procurement agency.
certifying authority. This is the competent authority in the Member State and
regional authority that issues certificates. It shall ensure that it possesses the
capacities listed in section 2.2 of the guidelines.
charges for CPPs. Charges levied upon applicants for the issue of a CPP to
be paid to the certifying authority due to the significant administrative load
imposed to these authorities during the service of preparation of certificates.
competent authority. This is the national or regional authority, as identified in
the formal notification to the WHO Director-General, in which each Member
State or regional authority informs WHO of its intention to participate in the
Scheme. The competent authority can issue or receive certificates. The extent
of participation should be indicated in the notification to the WHO Director-
General as stipulated in section 2.3 of the guidelines. WHO makes available a
continuously updated list of addresses of competent authorities and the specific
conditions for participation (see section 2.5 of the guideline).
dosage form (synonym: pharmaceutical form). The form of the completed
pharmaceutical product (e.g. tablet, capsule, elixir, suppository).
expiry date. The date given on the individual container (usually found on the
label) of a pharmaceutical product up to and including the date on which the
product is expected to remain within specifications, if stored correctly. It is
established for each batch by adding the shelf life to the date of manufacture.
227
falsified pharmaceutical product. A pharmaceutical product that deliberately

or fraudulently misrepresents their identity, composition or source. Any
consideration related to intellectual property rights does not fall within this
definition. Such deliberate or fraudulent misrepresentation refers to any
substitution, adulteration, reproduction of an authorized pharmaceutical product
or the manufacture of a pharmaceutical product that is not an authorized
product.
“Identity” shall refer to the name, labelling or packaging or to documents
that support the authenticity of an authorized pharmaceutical product.
“Composition” shall refer to any ingredient or component of the
pharmaceutical product in accordance with applicable specifications
authorized/recognized by a national or regional regulatory authority
(NRRA).
“Source” shall refer to the identification, name and address of the
marketing authorization holder, manufacturer, importer, exporter,
distributor or retailer, as applicable.
A “pharmaceutical product” should not be considered as falsified solely
on the grounds that they are unauthorized for marketing in any given
country.
finished pharmaceutical product (FPP). A finished dosage form of a
pharmaceutical product that has undergone all stages of manufacture, including
packaging in its final container and labelling.
good manufacturing practices (GMP). That part of quality assurance which
ensures that products are consistently produced and controlled to the quality
standards appropriate to their intended use and as required by the marketing
authorization.
importer. An individual or company or similar legal entity importing or seeking
to import a medical product. A “licensed” or “registered” importer is one who has
been granted a licence for such purpose.
importing agents, guidelines for. Guidelines on import procedures for
pharmaceutical products issued for certifying authorities to all agents responsible
for importing pharmaceutical products for human and/or veterinary use that
operate under its jurisdiction, including those responsible for public sector
purchases, to explain the contribution of certification to the medicine regulatory
process and the circumstances in which each of the three types of documents
will be required.
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intermediaries. Intermediaries in the purchasing of pharmaceutical products for

human use. Within the scope of the Scheme, they are responsible for supplying
sufficient information to the national or regional certifying authorities to satisfy
that those aspects of the manufacture of the product, for which the applicant
is not directly responsible, have been undertaken in compliance with good
manufacturing practice (GMP) as recommended by WHO.
international nonproprietary name (INN). The shortened scientific name
based on the active ingredient. WHO is responsible for assigning INNs to
pharmaceutical substances.
manufacture. All operations of the purchase of materials and products,
production, quality control, release, storage, distribution of pharmaceutical
products and related controls.
manufacturer. A company that carries out operations such as the production,
packaging, repackaging, labelling and relabelling of the finished pharmaceutical
product and the issuing of the certification.
marketing authorization. A legal document issued by the competent medicines
regulatory authority for the purpose of marketing or free distribution of a product
after evaluation for safety, efficacy and quality. It must set out, inter alia, the
name of the product, the pharmaceutical dosage form, the quantitative formula
(including excipients) per unit dose (using International Nonproprietary Names
(INNs) or national generic names where they exist), the shelf life and storage
conditions and packaging characteristics. It specifies the information on which
authorization is based (e.g. “The product(s) must conform to all the details
provided in your application and as modified in subsequent correspondence.”).
It also contains the product information approved for health professionals
and the public, the sales category, the name and address of the holder of the
authorization and the period of validity of the authorization. Once a product
has been given marketing authorization, it is included on a list of authorized
products – the register – and is often said to be “registered” or to “have
registration”. Marketing authorization may occasionally also be referred to as a
“licence” or “product licence”.
marketing authorization holder. An individual or a corporate entity being in
possession of a marketing authorization of a pharmaceutical product.
medicines regulatory authority. A national or regional body that administers
the full spectrum of medicine regulatory activities, including at least all of
the following functions in conformity with national or regional medicine
legislation:
229
■■ the marketing authorization of new products and variations of

existing products;
■■ quality control laboratory testing;
■■ the monitoring of adverse drug reactions;
■■ the provision of information on medicines and the promotion of
rational use of medicines;
■■ good manufacturing practice (GMP) inspections and licensing of
manufacturers, wholesalers and distribution channels;
■■ enforcement operations; and
■■ the monitoring of drug utilization.
notarization, embassy legalization or apostillation. Processes of authentication
or legalization of certificates addressed to avert the potential abuse of the
Scheme, to frustrate attempts at falsification, to render routine authentication of
certificates by an independent authority superfluous, and to enable the certifying
authority to maintain comprehensive records of countries to which specific
products have been exported. In addition, this is also for ensuring that certificates
and all annexed documentation are consistent with the version of the marketing
authorization operative on the date of issue. It is considered enough for that goal
that the complete identification of the requesting authority, and the official seal of
the certifying authority (or to certify using a secure electronic system/electronic
certificate) be stamped on each page. These traditional legal methods are highly
discouraged in the context of the Scheme because they have caused undue delays
and have not helped to afford the desired objectives.
pharmaceutical product. Any product intended for human use, or veterinary
product intended for administration to food-producing animals, presented in its
finished dosage form which is subject to control by pharmaceutical legislation
in either the exporting or the importing state and includes products for which
a prescription is required; products that may be sold to patients without a
prescription; biologicals; and vaccines. It does not, however, include medical
devices.
product information. This is the approved product information referred to
in section 3.7 of the guidelines and item 2.A.4 of the product certificate. It
normally consists of information for health professionals and the public (patient
information leaflets) as approved by the related medicines regulatory authority
and, when available, a data sheet or a summary of product characteristics
approved by the medicines regulatory authority.
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Annex 9
production. All operations involved in the preparation of a pharmaceutical

product, from receipt of materials through processing, packaging and repackaging,
labelling and relabelling, to completion of the finished product.
registration (synonym: marketing authorization). See marketing authorization.
As a process, it is any statutory system of approval required at national or
regional level as a precondition for introducing a pharmaceutical product onto
the market. The result of the process could be a certificate of registration or
certificate of marketing authorization.
regional authority. A group of countries in the same geographical region to
achieve an integrated marketing authorization system. A regional authority
that is willing to participate in the Scheme as a certificating member needs to
possess a legal authority stipulated in section 2.2 by itself or through its legal
framework.
reliance. An act whereby a regulatory authority in one jurisdiction may take
into account or give significant weight to work performed by another regulator,
or other trusted institution, in reaching its own decision.
requesting authority. This is the competent authority in the Member State and
regional authority that requests certificates.
specifications. A list of tests, references to analytical procedures and appropriate
acceptance criteria that are numerical limits, ranges or other criteria for the test
described. It establishes the set of criteria to which a material should conform
in order to be considered acceptable for its intended use. “Conformance to
specification” means that the material, when tested according to the listed
analytical procedures, will meet the listed acceptance criteria.
substandard pharmaceutical product. Also called “out of specification”, these
are authorized pharmaceutical products that fail to meet either their quality
standards or their specifications, or both. When the authorized manufacturer
deliberately fails to meet these quality standards or specifications due to the
misrepresentation of identity, composition or source, then the pharmaceutical
product should be considered “falsified”.
summary basis of approval. This refers to the document prepared by some
medicines regulatory authorities that summarizes the technical basis on which
the product has been licensed (see section 4.6 of the guidelines and Explanatory
note 3 of the product certificate contained in Appendix 1).
summary product characteristics (SPC). Product information as approved by
the medicines regulatory authority. The SPC serves as the basis for production
231
of information for health personnel as well as for consumer information on

labels and leaflets of medicinal products and for control of advertising (see also
product information).
References for Appendix 3

1. WHO good manufacturing practices for active pharmaceutical ingredients. In: WHO Expert
Committee on Specifications for Pharmaceutical Preparations: forty-fourth report. Geneva, World
Health Organization; 2010: Annex 2 (WHO Technical Report Series, No. 957).
2. WHO good storage and distribution practices for medical products. In: WHO Expert Committee
on Specifications for Pharmaceutical Preparations: fifty-fourth report. Geneva, World Health
Organization; 2020: Annex 7 (WHO Technical Report Series, No. 1025).
3. WHO guidelines on quality risk management. In: WHO Expert Committee on Specifications for
Pharmaceutical Preparations: forty-seventh report. Geneva, World Health Organization; 2013:
Annex 2 (WHO Technical Report Series, No. 981).
4. WHO good manufacturing practices for pharmaceutical products: main principles. In: WHO
Expert Committee on Specifications for Pharmaceutical Preparations: forty-eighth report.
Geneva, World Health Organization; 2014: Annex 2 (WHO Technical Report Series, No. 986).
5. WHO model quality assurance system for procurement agencies. In: WHO Expert Committee
on Specifications for Pharmaceutical Preparations: forty-eighth report. Geneva, World Health
Organization; 2014: Annex 3 (WHO Technical Report Series, No. 986).
6. Resolution WHA70. WHO Member States mechanism on substandard and/spurious/falsely-
labelled/ falsified/counterfeit (SSFFC) medical products, working definitions. In: Seventieth
World Health Assembly, Geneva, 22-31 May 2017. World Health Organization; 2017: Annex 12
(WHA70/2017/REC/1).
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Appendix 4
(Draft) model notification to the Director-General of the
World Health Organization
[Note This Annex 4 is not a part of the “Guidelines on the implementation of the
WHO Certification Scheme on the quality of pharmaceutical products moving
in International commerce”].
The Ministry of Health of the Government of (name
of country) / (name of regional authority) would like to
inform the Director-General of the World Health Organization (WHO) that
(name of country or regional authority) would like
to participate/continue to participate in the WHO Certification Scheme on the
quality of pharmaceutical products moving in international commerce (referred
to henceforth as the “ Scheme”) as a:
Certifying member
Requesting member
Certifying member and requesting member (choose only one).
The Ministry of Health of the Government of (name of

country) / (name of regional authority) hereby confirms
that the competent authority(ies) mentioned in the Attachment to this Annex 2
is(are) the legally established authority(-ies) to regulate/control pharmaceutical
products.
(Only for certifying members)
In addition, we hereby declare that our certifying authority(-ies) in the
Attachment possess(es):
■■ an effective marketing authorization system for pharmaceutical
products, including the responsible manufacturers and licensing of
distributors;
■■ Good manufacturing practices (GMP) requirements, consistent with
those recommended by WHO in accordance with its current
publication, to which all manufacturers of finished pharmaceutical
products are required to conform;
233
■■ effective controls to monitor the quality of pharmaceutical products

registered or manufactured within its country or region, including
access to an independent quality control laboratory;
■■ a pharmaceuticals inspectorate, operating as an arm of the national
or regional medicines regulatory authority, and having the
technical competence, experience and resources to assess whether
or not GMP and other controls are being effectively implemented,
and the legal power to conduct or to coordinate the appropriate
investigations in order to ensure that manufacturers conform to
these requirements by, for example, examining premises and records
and taking samples;
■■ an efficient surveillance system, administrative capacity and good
regulatory practices compliance to effectively issue the required
certificates; to detect and institute inquiries in the case of complaint
and to expeditiously notify WHO and, when possible, the competent
authority in the Member State or region known to have imported a
specific product; or publish the information on the website about the
product that is associated with a potentially serious quality defect or
other hazard in a timely manner.
The Ministry of Health of the Government of (name
of country) / (name of regional authority) would
once more like to express its gratitude to the World Health Organization for this
opportunity to participate/continue to participate in the Scheme.
We also confirm that any change of information in the Attachment will be
promptly communicated to the WHO Secretariat.
Signature Date
Name and title
[STAMP]
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Annex 9
Attachment
Information on certifying/requesting authority(-ies)
Certifying authority Requesting authority Certifying and requesting

authority
(choose only one)
Name of the authority
Address of the authority
Telephone number
Email address
Website address
Reservation as per section 2.3
of the Scheme for posting on
the WHO website (if any)
Other remarks (if any)
(Add tables as necessary)
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Annex 10
Good reliance practices in the regulation of medical
products: high level principles and considerations
Background
WHO supports reliance on the work of other regulators as a general principle
in order to make the best use of available resources and expertise. This principle
allows leveraging the output of others whenever possible while placing a greater
focus at national level on value-added regulatory activities that cannot be
undertaken by other authorities, such as, but not limited to: vigilance, market
surveillance, and oversight of local manufacturing and distribution. Reliance
facilitates timely access to safe, effective, quality-assured medical products
(see section 3. Scope) and can support regulatory preparedness and response,
particularly during public health emergencies.
Good reliance practices (GRelP) are anchored in overall good regulatory
practices (GRP) (1), which provide a means for establishing sound, affordable,
effective regulation of medical products as an important part of health system
strengthening. If implemented effectively, GRP can result in consistent regulatory
processes, sound regulatory decision-making, increased efficiency of regulatory
systems and better public health outcomes. NRAs are encouraged to adopt GRP
to ensure that they are using the most efficient regulatory processes possible.
WHO is establishing and implementing a framework for evaluating
regulatory authorities and designating those that meet the requirements as
“WHO-listed authorities” (WLA) (4). Using the WHO Global Benchmarking
Tool (5) and performance evaluation, WHO will assess the maturity and
performance of a regulatory authority to determine whether it meets the
requirements of a WLA and thereby provide a globally recognized, evidence-
based, transparent system that can be used by NRAs as a basis for selecting
reference regulatory authorities to practise reliance. A list of reference regulatory
authorities is available on the WHO website (6).
In September 2019, WHO held a consultation to solicit input on the
nature, structure and overall content of a document outlining GRelP. The
meeting concluded that the concept note and recommendations on regulatory
reliance principles of the Pan American Health Organization (PAHO) and the
Pan American Network for Drug Regulatory Harmonization (7) should be used
as a basis for the WHO document on GRelP. The high-level document would be
complemented by a repository of case studies, practice guides and examples of
practical application of GRelP.
237
Abbreviations to Annex 10 239

1. Introduction 240
2. Purpose 241
3. Scope 241
4. Glossary 242
5. Key concepts 245
5.1 Reliance versus recognition 245
5.2 Unilateral versus mutual reliance or recognition 246
5.3 Life cycle approach 246
5.4 Risk-based approach 246
5.5 Regional reliance mechanisms 247
6. Principles of good reliance practices 248
6.1 Universality 248
6.2 Sovereignty of decision-making 248
6.3 Transparency 248
6.4 Respect of national and regional legal bases 249
6.5 Consistency 249
6.6 Competence 250
7. Considerations 250
7.1 General considerations 250
7.2 Potential barriers 253
7.3 Enablers 254
8. Conclusions 256
References 257
Appendix 1 Examples of use of reliance 258
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Abbreviations to Annex 10
AMRH African Medicines Regulatory Harmonisation
APEC Asia-Pacific Economic Cooperation
API active pharmaceutical ingredient
ASEAN Association of Southeast Asian Nations
CRP collaborative registration procedure
GRP good regulatory practices
ICH International Council on Harmonisation of Technical
Requirements for Pharmaceuticals for Human Use
IMDRF International Medical Device Regulators Forum
NRA national regulatory authority; for the purpose of this document,
the term also refers to regional regulatory authorities such as
the European Medicines Agency
OECD Organisation for Economic Co-operation and Development
PAHO Pan American Health Organization
PIC/S Pharmaceutical Inspection Convention and Pharmaceutical
Inspection Co operation Scheme
ZAZIBONA Zambia, Zimbabwe, Botswana and Namibia; initial
participants in the Southern African Development Community
collaborative procedure for joint assessment of medicines
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1. Introduction
The United Nations Sustainable Development Goals and the drive for universal
health coverage require that patients have access to quality-assured, effective and
safe medical products. Strong regulatory systems for medical products remain a
critical element of well-functioning health systems and important contributors
to improving access and ultimately achieving universal health coverage.
Establishing and sustaining mature regulatory systems requires adequate
resources, including skilled, capable human resources and a significant
financial investment. The globalization of markets, the sophistication of health
technologies, the rapid evolution of regulatory science and the increasing
complexity of supply chains have shown regulators the importance of
international cooperation in ensuring the safety, quality, efficacy or performance 1
of locally used products. In view of the extent and complexity of the regulatory
oversight required to address these challenges, NRAs must consider enhanced,
innovative, more effective forms of collaboration to make the best use of the
available resources and expertise, avoid duplication and concentrate their
regulatory efforts and resources where they are most needed.
Reliance represents a smarter, more efficient way of regulating medical
products in the modern world. Countries are therefore encouraged to formulate
and implement strategies to strengthen their regulatory systems consistent
with GRP, including pursuing regulatory cooperation and convergence, as
well as reliance. Reliance benefits patients and consumers, industry, national
governments, the donor community and international development partners
by facilitating and accelerating access to quality-assured, effective and safe
medical products.
The use of reliance to enhance the efficiency of regulatory systems has a
long history. The WHO Certification scheme on the quality of pharmaceutical
products moving in international commerce (8), introduced in 1969, is a form
of reliance, as it provides assurance to countries that participate in the Scheme

of the quality of pharmaceutical products. The European Union introduced
the “mutual recognition procedure” for marketing authorizations between its
member states in 1995, and the outcomes of good manufacturing practices
inspections have been shared for years in the context of the Pharmaceutical
Inspection Convention and Pharmaceutical Inspection Co-operation Scheme
(PIC/S) (9) and mutual recognition agreements.
WHO investigated the use of reliance more recently in a survey conducted
on behalf of the International Pharmaceutical Regulators Programme (10). The
“Efficacy” applies to medicines and vaccines and “performance” to medical devices, including in-vitro
1
diagnostics.
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results showed that regulatory reliance is broadly accepted and widely practised
with regard to medical products, especially among well resourced regulatory
authorities. The responses also reflected an evolving situation, with varying
experience and promise in the use of reliance-based approaches. While use of
reliance may be an emerging trend in some regions, the commonly stated goals
are to increase efficiency, help to strengthen regulatory systems and optimize the
use of resources. The results and suggestions from the survey were taken into
account in preparation of this document.
In view of the increasing prevalence and importance of reliance in the
regulation of medical products, Member States have requested WHO to prepare
practical guidance on the topic while ensuring that the approaches meet the
intended objectives. This document and additional guidance that follow are
intended to assist countries in implementing a sound, evidence-based, practical,
effective approach to reliance.
2. Purpose
The purpose is to promote a more efficient approach to regulation, thereby
improving access to quality-assured, effective and safe medical products. The
document presents the overarching principles of regulatory reliance in the
oversight of medical products and use of reliance to enhance the effectiveness
and efficiency of regulatory oversight. It provides high-level guidance,
definitions, key concepts and considerations to guide reliance mechanisms and
activities, illustrative examples of reliance approaches and conclusions. It will be
complemented by a “reliance toolbox”, consisting of practice guides, case studies
and a more comprehensive repository of examples.
3. Scope
The document covers reliance activities in the field of regulation of medical
products (i.e. medicines, vaccines, blood and blood products and medical
devices including in-vitro diagnostics), addressing all the regulatory functions
in the full life cycle of a medical product, as defined in the Global Benchmarking
Tool (5): registration and marketing authorization, vigilance, market surveillance
and control, licensing establishments, regulatory inspection, laboratory testing,
clinical trials oversight and NRA lot release. The document is intended for all
NRAs, irrespective of their level of maturity or resources, and also for policy-
makers, governments, industry, other developers of medical products and other
relevant stakeholders.
The concept of reliance covers all types of medical products and
regulatory activities. Reliance approaches should be given consideration in
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particular for medical products for priority diseases for which there are unmet
medical needs, medical products to be used in public health emergencies or
during shortages and also for orphan and paediatric medical products.
4. Glossary
Definitions are essential to ensure a common understanding of concepts and
clarity in interpreting guidance on reliance. In addition to the definitions
provided below, reference is made to the WHO document on good regulatory
practices (1), which includes definitions of harmonization, convergence and
other relevant terms.
Abridged regulatory pathways. Regulatory procedures facilitated by reliance,

whereby a regulatory decision is solely or partially based on application of
reliance. This usually involves some work by the national regulatory authority
(NRA) that is practising reliance (see section 5.4 Risk-based approach). It is
expected that use of reliance in these pathways will save resources and time
as compared with standard pathways, while ensuring that the standards of
regulatory oversight are maintained.
Assessment. For the purpose of this document, this term covers any evaluation
conducted for a regulatory function (e.g. evaluation of a clinical trial application
or of an initial marketing authorization for a medical product or any subsequent
post-authorization changes, evaluation of safety data, evaluation as part of an
inspection).
Equivalence of regulatory systems. Implies strong similarity between two

regulatory systems, as mutually established and documented through objective
evidence. Equivalence can be established using criteria and approaches such
as similarity of the regulatory framework and practices, adherence to the same

international standards and guidelines, experience gained in use of assessments
for regulatory decision making, joint activities and exchanges of staff. It is
expected that equivalent regulatory systems will result in similar standards and
levels of regulatory oversight or “control”.
International standards and guidelines. For the purpose of this document, the
term includes relevant WHO standards and guidelines and any other relevant
internationally recognized standards (e.g. International Organization for
Standardization or pharmacopoeial standards) and guidelines (e.g. International
Council on Harmonisation of Technical Requirements for Pharmaceuticals for
Human Use [ICH] or guidelines of the Pharmaceutical Inspection Convention
and Pharmaceutical Inspection Co operation Scheme [PIC/S]).
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Mutual recognition agreement. According to a definition issued by the

Organisation for Economic Co-operation and Development (OECD), a mutual
recognition agreement is:
a principle of international law whereby states party to mutual
recognition agreements recognize and uphold legal decisions
taken by competent authorities in another member state. Mutual
recognition is a process which allows conformity assessments
(of qualifications, product…) carried out in one country to be
recognized in another country (2).
Recognition. Acceptance of the regulatory decision of another regulator or
trusted institution. Recognition should be based on evidence that the regulatory
requirements of the reference regulatory authority are sufficient to meet the
regulatory requirements of the relying authority. Recognition may be unilateral
or mutual and may, in the latter case, be the subject of a mutual recognition
agreement.
Reference regulatory authority. For the purpose of this document, a national or
regional authority or a trusted institution such as WHO prequalification (WHO
PQ) whose regulatory decisions and/or regulatory work products are relied
upon by another regulatory authority to inform its own regulatory decisions.
Regional regulatory system. A system composed of individual regulatory
authorities, or a regional body composed of individual regulatory authorities,
operating under a common regulatory framework but not necessarily under
a common legal framework. The common framework must at least ensure
equivalence among the members in terms of regulatory requirements,
practices and quality assurance policies. The system or regional body may
have enforcement powers to ensure compliance with the common regulatory
framework.
Reliance. The act whereby the regulatory authority in one jurisdiction takes
into account and gives significant weight to assessments performed by another
regulatory authority or trusted institution, or to any other authoritative
information, in reaching its own decision. The relying authority remains
independent, responsible and accountable for the decisions taken, even when it
relies on the decisions, assessments and information of others.
Sameness of product. For the purpose of this document, sameness of product
means that two products have identical essential characteristics (i.e. the product
being submitted to the relying authority and the product approved by the
reference regulatory authority should be essentially the same). All relevant
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aspects of drugs, medical devices and in vitro diagnostics, including those

related to the quality of the product and its components, should be considered
to confirm that the product is the same or sufficiently similar (e.g. same
qualitative and quantitative composition, same strength, same pharmaceutical
form, same intended use, same manufacturing process, same suppliers of
active pharmaceutical ingredients, same quality of all excipients). Additionally,
the results of supporting studies of safety, efficacy and quality, indications
and conditions of use should be the same. The impact of potential, justified
differences should be assessed by the manufacturer (for the purpose of this
document, manufacturer also means marketing authorization holder) and the
relying national regulatory authority (NRA) in determining the possibility of
using foreign regulatory assessments or decisions.
Stringent regulatory authority. A regulatory authority which is: (a) a member
of the International Council for Harmonisation of Technical Requirements for
Pharmaceuticals for Human Use (ICH), being the European Commission, the
US Food and Drug Administration and the Ministry of Health, Labour and
Welfare of Japan also represented by the Pharmaceuticals and Medical Devices
Agency (as before 23 October 2015); or (b) an ICH observer, being the European
Free Trade Association, as represented by Swissmedic, and Health Canada (as
before 23 October 2015); or (c) a regulatory authority associated with an ICH
member through a legally-binding, mutual recognition agreement, including
Australia, Iceland, Liechtenstein and Norway (as before 23 October 2015) (3).
Work-sharing. A process by which NRAs of two or more jurisdictions share
activities to accomplish a specific regulatory task. The opportunities for work-
sharing include joint assessment of applications for authorization of clinical
trials or marketing authorizations, joint inspections for good practices, joint
post marketing surveillance of the quality and safety of medical products, joint
development of technical guidelines or regulatory standards and collaboration

on information platforms and technology. Work-sharing also entails exchange
of information consistent with the provisions of existing agreements and
compliant with each agency’s or institution’s legislative framework for sharing
such information with other NRAs. A joint activity is a form of work-sharing
whereby a regulatory task is conducted by two or more NRAs in collaboration
in order to share their assessments, benefit from each other’s expertise and
discuss any shortcomings of the data evaluated. For example, a joint assessment
is a procedure in which the same application is submitted simultaneously to
two or more NRAs so that they conduct their evaluations in parallel and share
their scientific assessments (e.g. the different modules for quality, nonclinical
and clinical data can be assigned to different NRAs for review). The NRAs
participating in a joint assessment can combine their lists of questions or
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deficiencies to the manufacturer and base their respective independent

regulatory decisions on the outcome of these assessments. Similarly, a
joint inspection is one in which two or more NRAs share the activities and
assessments performed during an inspection.
5. Key concepts
Fig. 1 illustrates some of the key concepts explained in the document, notably
how NRAs can gain efficiency in regulatory operations and how to avoid
duplication by using reliance approaches.
Fig. 1
Key concepts of reliance
5.1 Reliance versus recognition

Reliance may take many forms and be applied to varying degrees in recognizing or
taking account of the assessments, decisions or other authoritative information of
other authorities and institutions. Recognition may be seen as a special and more
formalized approach to reliance, whereby one regulatory authority recognizes
the decisions of another regulatory authority, system or institution, obviating
additional regulatory assessment to reach its own decision. Recognition usually
requires formal and binding legal provisions.
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5.2 Unilateral versus mutual reliance or recognition

Reliance and recognition may be unilateral, for example, when a country chooses
to rely on or formally recognize an assessment from another country unilaterally
and without reciprocity. In other cases, mutual recognition may be based on
binding mutual agreements or treaties negotiated at the level of governments.
Such agreements take considerable time and resources to set up, as the regulatory
systems involved must be mutually assessed and shown to be equivalent before
agreement can be reached. A demonstration of the equivalence of regulatory
systems is usually a prerequisite for mutual reliance or recognition. Work-sharing
and joint activities are examples of mutual reliance.
5.3 Life cycle approach

The concept of reliance for regulation of medical products should be applied
throughout the life cycle of medical products and in all regulatory functions (see
3. Scope). While reliance approaches are widely used for the initial authorization
of medical products, they should also be used for vigilance and other post-
authorization activities (e.g. post approval changes, inspections and lot release),
in view of the substantial regulatory resources required for evaluating safety
and post-approval changes during a product’s life cycle. Review of post approval
changes to a product that was approved by a different authority may present
challenges. Assuring “sameness of product” (see 4. Glossary) is essential for the
use of reliance. If an NRA has relied on another NRA’s assessment for its initial
approval, use of similar reliance measures for post approval changes and vigilance
activities is beneficial, as long as the sameness of the product from the initial
authorization is maintained. This also avoids the situation in which different
changes are accepted in originating and in receiving countries over time.
5.4 Risk-based approach

Each NRA should define its own strategy for an appropriate risk-based approach
to reliance, which includes factors such as the type and source of products
evaluated, the level of resources and expertise available in the NRA, the public
health needs and priorities of the country and opportunities for reliance. Using
marketing authorization as an example, four different reliance based regulatory
pathways and levels of reliance could be envisaged, with increasing degrees of
assessment by the relying NRA:
■■ verification of sameness of the medical product to ensure that it is
the same as that assessed by the reference regulatory authority
(see section 7.1.4 Sameness of a product in different jurisdictions).
Sameness should always be verified in any of the reliance approaches
listed here.
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■■ confirmation of the applicability of the assessment outcomes of

another authority for regulatory decision making in the national
context, for example, in terms of legal and regulatory settings,
benefit–risk assessment, co-morbidities, unmet medical needs,
risk management plans and any quality-related specificities such
as climatic zones for product stability. In case of differences, such
as in target population, epidemiology and other features of the
disease, medicines used concomitantly and other factors that can
substantially affect the benefit–risk profile of a medicine, as well
as quality parameters, especially in relation to the stability under
different climatic conditions, appropriate evidence should be
provided by the manufacturer.
■■ abridged assessment of data on quality, safety and efficacy or
performance, taking into account information in the assessment
reports of the reference regulatory authority; and
■■ joint assessment or work-sharing between two or more regulatory
authorities. This may take various forms, including a primary review
by one authority followed by a joint assessment session to finalize
the report and comments or distribution of the modules (quality,
non-clinical and safety or efficacy) between the authorities.
Regardless of the approach, it is expected that the timelines will be shorter
than the standard timelines and resources will be used more effectively when
reliance is used. The reduction in timelines will depend on the level of reliance
and any additional assessment required locally. It is important that the timeline
established for reliance procedures should be sufficient for the relying authority
to properly review the assessment of the reference authority and perform the
necessary local assessments, including of local labelling, product sameness and
the applicability of the data to the country.
Similar reliance-based regulatory pathways can be used for other
regulatory functions, such as inspection, lot release or import testing.
5.5 Regional reliance mechanisms

In some regions, medical products can be assessed centrally in a regional
regulatory system. In some regional reliance mechanisms, the regional decision
is binding on the member states (e.g. European Union). In others, regional
decisions are recommendations that member states take into consideration when
making national regulatory decisions (e.g. the Southern African Development
Community collaborative procedure ZAZIBONA [Zambia, Zimbabwe, Botswana
and Namibia; initial participants in the Southern African Development
Community collaborative procedure for joint assessment of medicines], the Gulf
Health Council and the Caribbean Regulatory System).
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6. Principles of good reliance practices

In developing a strategy on the use of reliance in regulatory functions and
activities, an NRA should consider the needs and characteristics of the national
health and regulatory systems. A decision to practise reliance should consider
existing capacity, regulatory systems’ needs, the availability of an authority on
which the NRA can rely with confidence and how reliance could complement
the capacity to increase efficiency and make optimal use of resources. Reliance
is not a lesser form of regulatory oversight but rather a strategy for making the
best use of the available resources in any setting. This would allow the allocation
of resources to other regulatory functions, such as in-country vigilance and
post authorization activities, thereby increasing the effectiveness of local
regulatory oversight. In addition, reliance can result in more evidence-based,
better-quality decisions.
The following principles are meant to complement and extend the basic
principles of GRP. They are based on the principles presented in the concept
note and recommendations on regulatory reliance principles of PAHO and the
Pan American Network for Drug Regulatory Harmonization (7).
6.1 Universality
Reliance applies to all NRAs, irrespective of their levels of maturity or resources.
Lack of resources or capacity are not the exclusive drivers for reliance. Different
NRAs use reliance for different reasons. Some use it to increase or build in-
house capacity when there is the requisite expertise but not enough to perform
their regulatory work as efficiently as they would like. Others use reliance to
gain expertise that they do not have locally. Reliance is relevant for all resource
settings.
Sovereignty of decision-making
6.2
The decision to practise reliance and how best to do so rests with the national
health regulatory authority. Reliance does not imply dependence; it is not an
agency out-sourcing its decision-making authority or responsibility. In applying
reliance in daily practice, NRAs maintain independence, sovereignty and
accountability in regulatory decision-making.
6.3 Transparency
Transparency is a key enabler to adopting new, more efficient ways of conducting
regulatory operations, both locally and internationally. NRAs should be
transparent about the standards, processes and approaches they adopt in
implementing reliance measures. The basis and rationale for relying on a specific
entity should be disclosed and fully understood by all parties. NRAs should
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engage with all stakeholders, including industry, to ensure the appropriateness

and awareness of reliance processes.
Furthermore, NRAs should conduct transparent regulatory operations
and decision-making, not only as a fundamental principle of GRP but also to
build trust and maximize opportunities for cooperation and reliance as part of
a shared regulatory community responsibility. Transparency measures should
be encouraged through the publishing and sharing of regulatory information
to facilitate information exchange among NRAs. NRAs that seek to act as
reference agencies are encouraged to issue public assessment reports in a
common language to document their regulatory decisions. Relying NRAs
should use such reports as the primary source of information for assessments.
If no public assessment reports are available or when additional information
of a confidential nature is required, the manufacturer should provide an
assessment report when available to them. If the relying NRA requests non
public assessment reports from a reference agency, they may be provided with
the consent of the manufacturer, if necessary.
6.4 Respect of national and regional legal bases

Reliance practices should be coherent with national and regional legal
frameworks and policies on medical products, supported by clear mandates
and regulations that ensure efficient implementation of reliance as part
of government policy on good regulation. The reasons for adopting such
legal frameworks should be the efficiency and capacity to be gained and not
minimization of resources for regulatory functions. Use of reliance does not
obviate the need for a capable local regulatory authority; on the contrary, it
should be used to maintain and build local capacity for regulatory decision-
making. When regulations do not make explicit provision for the application
of reliance, it may be adopted through interpretation of existing regulations,
if the legal framework does not explicitly preclude application of reliance
approaches by the NRA. Reliance can be implemented through policy change,
as long as it is broadly consistent with national legislation. If application of
reliance is prohibited, revision of the legislation should be considered within a
reasonable timeframe.
6.5 Consistency
Reliance on an assessment or decision from another authority should be
established for specific, well-defined categories of products and processes. The
scope of regulatory activities in which reliance may be practised should be clearly
defined, and the practise of reliance should be transparent and predictable. Thus,
reliance should be expected to be applied consistently for products and processes
in the same categories.
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6.6 Competence
Implementation of reliance approaches requires that NRAs have the necessary
competence for critical decision-making. Introduction of the reliance approach
usually requires the involvement of senior regulatory staff, managers and
experts who are competent to make the best use of foreign information in the
local context. NRAs should maintain the appropriate scientific expertise of their
staff for activities in which they do not apply reliance, such as monitoring local
adverse events, market surveillance and control, national labelling and product
information activities and for oversight of locally manufactured products.
Equally, the authorities being relied upon should have and maintain
competence and operate within a robust, transparent regulatory system based
on international standards and guidelines, as well as GRP, and a well-functioning
quality management system (11). Competence may be benchmarked through
transparent processes for developing trust and building confidence in the
reference authorities.
7. Considerations
A number of considerations can guide reliance approaches and facilitate their
implementation. These include general aspects, barriers that NRAs may have
to overcome and enablers for implementing reliance approaches. The non-
exhaustive list of considerations below will be further elaborated in case studies,
practice guides and the reliance repository.
Reliance is encouraged in any setting when supported by a common
legal or regulatory framework in a regional regulatory system, by bilateral
agreements, by mutual recognition agreements or on a purely voluntary,
networking or ad-hoc basis. It is recommended that reliance be based on the
original assessment. In some cases, however, it may be based on a decision made
by reliance on another assessment.
7.1 General considerations

7.1.1 Reliance anchored in a national regulatory authority strategy
Application of reliance should have not only a legal basis that supports or at
least does not preclude it (see section 6. Principles of good reliance practices)
but should also be anchored in high-level national policy and the NRA strategy
endorsed by senior management. This is necessary to provide a mandate for,
direction to and expectations of NRA staff, to guide them in their daily work.
The strategy should be detailed in procedures and integrated into processes to
ensure the maximum benefits. It should include a sustainable funding model
when implementing reliance, so that it does not negatively impact the financial
sustainability and competence of the NRA. The strategy should be published
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in order to make it accessible and understandable to external stakeholders.

Implementation of reliance should be supported by training and periodic
reviews to ensure that the standards are being maintained, to assess whether the
objectives are being met and to revise it when warranted.
NRAs that practise reliance should establish and publish a list of reference
regulatory authorities, with the criteria used in identifying them. They should
decide and establish the criteria they will use for selecting reference authorities,
such as application of international standards, long standing recognition in the
international community, proximity and commonality of medical products.
To qualify reference regulatory authorities or specific oversight of a regulatory
function, an NRA may refer to an assessment by an independent organization
(e.g. WHO benchmarking, WHO-listed authority, International Organization for
Standardization accreditation, the Medical Device Single Audit Program, PIC/S).
WHO encourages NRAs to monitor and evaluate the impact of regulatory
reliance, including its benefits, in their country and region and to share their
experiences with other regulatory authorities. When possible, the impact should
be measured specifically, and the NRA should establish the metrics they will
use to measure the impact of using reliance in regulatory decision-making and
the time for conducting the assessment. The metrics may include costs saved,
efficiency in the number of products reaching the market or time to market, and
redirection of scarce resources to areas of higher regulatory risk. NRAs should
consider methods for sharing best practices and experience in establishing
reliance arrangements in international forums for regulation of medical products
to increase understanding of the opportunities and challenges of reliance, subject
to agreement with the other party(s) involved and information disclosure
requirements.
7.1.2 Cultural change

Use of reliance approaches means moving to a more innovative, effective way of
working, based on trust and relying on the outputs of other NRAs. The benefits
must be understood and supported at operational level, and the staff who are
expected to implement reliance approaches must contribute to their development.
This will require engagement, willingness, effective preparation, messaging and
support from management and peers on the importance of reliance in better
addressing workload pressures without minimizing the rigor of regulatory work
or losing scientific or regulatory competence or capacity. Use of assessments and
information from other trusted regulatory authorities can help build capacity and
competence (e.g. through exposure to the reviews and decisions of the reference
authority, networking, twinning, staff visits and exchanges). Furthermore, as
effective use of such information in the local context requires skill, ability and
experience, the skill set and competence necessary to practise reliance will have
to be developed in the NRA workforce.
251
Senior management, reviewers, inspectors and other staff should build

confidence and trust in the work done by other NRAs or trusted authorities.
This will take time and require a change in the culture of the relying NRA. The
experience of regulatory authorities and systems that already practise reliance
should be leveraged to promote acceptance and avoid pitfalls. Trust should also
be built with the public, health care professionals and the industry by assuring
them that reliance offers more efficient regulatory oversight.
7.1.3 Flexibility in approach: “one size doesn’t fit all”

In accordance with the principles outlined above, reliance strategies should
be tailored to the needs of the national health and regulatory systems. NRAs
may choose to rely on others in routine regulatory oversight and/or in special
circumstances, such as a public health emergency. Reliance offers flexibility
to NRAs. When adopting reliance, whatever the approach, the NRA should
consider its capacity, establish clear goals and efficient processes and ensure that
the standards and criteria are transparent and well established.
7.1.4 Investment of resources and time in implementing reliance

As stated above, reliance should increase the efficiency of a regulatory system in
a country or region. Nevertheless, implementation of reliance approaches will
first require investment of resources and time for activities such as legislative
changes, preparation of guidance documents and approaches, pathways and
processes, building confidence by preparing parallel or joint reviews supported
by staff exchanges, training staff, dialogue with industry and other stakeholders
and establishment of or access to information-sharing platforms, communication
links and networks with other NRAs.
7.1.5 “Sameness” of a product in different jurisdictions

A critical aspect of the application of reliance is verification of the “sameness”

of a medical product (see 4. Glossary and section 5.4 Risk-based approach) in
different jurisdictions. Reliance can be practised only if the NRA that intends
to use a foreign assessment as the basis for its own assessment and regulatory
decision making has the assurance that the medical product being assessed is
essentially the same as the one submitted to the reference NRA. The role of the
manufacturer is essential to confirm the sameness of a product and to provide the
same documentation to different NRAs, except for additional country-specific
information submitted for review, such as product stability data according to the
stability zone and the local product label. The manufacturer should confirm in
the application that the product is the same and that the application contains
essentially the same information, taking into consideration any potential
national requirements. If the application is not submitted simultaneously to the
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agencies, the manufacturer should highlight any new information about the
product acquired since the application was submitted to the reference agency,
with the corresponding assessment.
7.1.6 The role of industry

Industry plays a crucial role in successful use of reliance mechanisms by
NRAs. While industry widely supports reliance as a concept and practice
that can increase efficiency, it must have clear guidance on its application and
see meaningful benefits. Industry support and stringent adherence to the
factors that validate the reliance process are essential for filing applications in
several countries or regions to ensure the sameness of products submitted to
reference regulatory authorities and relying NRAs. They should share complete,
unredacted information.
Review and discussion of pilot programs to quickly adapt and improve
guidance will be key to benefit from key learnings and improve implementation.
Collaboration and dialogue among all stakeholders participating in regulatory
reliance activities will help to create and build trust, which is the foundation of
regulatory reliance. Transparent publication of an NRA’s reliance framework
and strategies, including the metrics used and benefits achieved, will encourage
industry to support and promote the reliance approach.
7.1.7 Reliance in a public health emergency

In case of a public health emergency, reliance approaches are even more
essential and should be given more importance in order to accelerate access to
the medical products required.
7.2 Potential barriers

7.2.1 Lack of political will
Lack of political will and government support can make it difficult for NRAs
to implement or facilitate reliance in their daily practice, even if a legal basis is
established that supports (or does not preclude) reliance and if NRAs support
reliance as a strategy and approach.
7.2.2 Lack of accessible information and confidentiality of information

Lack of access to complete assessments of reference regulatory authorities can
be a major barrier to effective reliance. Reference regulatory authorities should
make their assessments and other regulatory information publicly available.
Non-public regulatory reports might be available directly from the manufacturer
when the company is able to access these reports from the reference regulatory
authority. If this is not possible, the relying NRA should approach the reference
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regulatory authority. In these cases, arrangements among NRAs on the exchange

of confidential information would facilitate the reliance process.
Sensitive, non-public information in unredacted assessment or
inspection reports can also be shared between regulatory authorities upon
request. This may include confidential commercial information, trade secrets or
personal information. In some circumstances, the sharing of such information
may require the consent of the manufacturer. Sharing of personal information
may also require consent from individuals in order to comply with data
protection regulations. Given the sensitivity of such non-public information,
NRAs may require that confidentiality agreements be signed that govern the
exchange, management and disclosure of such information to ensure that
the confidentiality of the information is protected by the relying NRA. Such
information should always be exchanged through secure channels or on
information-sharing platforms.
7.2.3 Other barriers

Additional potential barriers include issues such as lack of a common language,
difficulties in or the cost of translation, differences in national regulatory
requirements and evidentiary standards, lack of regulatory alignment of product
risk classifications, inconsistent practices regarding modifications to medical
devices (including in-vitro diagnostics), the lack of acceptance of foreign clinical
data and real world evidence, the level of detail in regulatory reports, different
levels of competence and, as previously noted, internal resistance and insufficient
knowledge of the reference regulatory authority and how it operates. All such
factors should be considered in developing appropriate reliance strategies, as will
be further elucidated in the additional guidance documents to follow.
7.3 Enablers
7.3.1 Trust
Trust is a critical element, as reliance requires confidence that the regulatory
outcome is based on strong regulatory processes and standards and is, thus,
trustworthy. Consequently, initiatives to foster trust among regulatory authorities
are essential. Trust develops with increasing familiarity and understanding of what
is behind regulatory outputs. Confidence can be built throughout the organization
by sharing information, including the standards applied to regulatory decisions,
working together and learning each other’s ways of working, which then leads to
effective use of reliance in regulatory work. Trust can be built in phases, starting
with exchange of assessment reports and moving to work-sharing or joint
assessments. Regulatory authorities may consider initiating reliance processes
with applications for medical products of lower risk.
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In addition, industry and other stakeholders must trust regulatory

authorities, for example, to respect the confidentiality of information.
7.3.2 Convergence and harmonization

Convergence and harmonization of requirements, standards and guidelines are
important enablers of regulatory cooperation and reliance. The more similar
requirements, standards and guidelines are, the greater the opportunity for
collaboration and reliance. Use of the ICH Common Technical Document
(CTD) and the electronic CTD (eCTD) as a common format for regulatory
submissions around the globe is one example of how harmonization can
facilitate and enable reliance.
Differences in standards and practices, however, do not prevent one
authority from relying on another, particularly when the relying authority has
limited capacity and expertise. The system on which an NRA relies should
be at least equivalent to or superior to the standards it applies. As a matter of
good practice, NRAs should rely on assessments or decisions from reference
regulatory authorities that apply international standards and guidelines.
7.3.3 Information-sharing and dialogue among regulators

Information-sharing is an essential part of reliance, and NRAs are encouraged
to share information and good practices with other NRAs. Increasing dialogue
among regulators is seen in the growing number of international initiatives such
as the International Pharmaceutical Regulators Programme and in networks for
sharing regulatory information and work such as the Pan American Network
for Drug Regulatory Harmonization, the Southeast Asia Regulatory Network,
regulatory networks in the Regional Economic Communities under the African
Medicines Regulatory Harmonisation (AMRH) Initiative and the Association of
Southeast Asian Nations (ASEAN) Pharmaceutical Products Working Group,
the International Coalition of Medicines Regulatory Authorities, the Caribbean
Community and Common Market’s (CARICOM) Caribbean Regulatory System,
the Western Pacific Region Alliance of NRAs for Medical Products and others,
which greatly facilitate reliance.
Scientific and technical events, such as the International Conference of
Drug Regulatory Authorities, ICH and PIC/S, are platforms for disseminating
regulatory information and for building knowledge and trust among NRAs.
7.3.4 Economic or legal integration

When there is economic or legal integration in a region or a group of countries,
reliance is facilitated and strengthened by the existing mutual provisions. Examples
are the Asia–Pacific Economic Cooperation (APEC), ASEAN, CARICOM, the
European Union, the Eurasian Economic Union, the Gulf Cooperation Council,
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the Pacific Alliance, the Regional Economic Communities in Africa and the
Southern Common Market (MERCOSUR).
7.3.5 Engagement of stakeholders

All relevant stakeholders, including industry, health care professionals, policy-
makers and the public, should be engaged and informed in order to increase
their understanding and acceptance of reliance approaches and the clear benefits
they present for all parties. Communication and engagement with stakeholders
should be tailored to each target audience.
8. Conclusions
Reliance is being practised by a growing number of regulatory authorities as
a means of improving the effectiveness and efficiency of regulation of medical
products. It allows NRAs to make the best use of resources, build expertise and
capacity, increase the quality of their regulatory decisions, reduce duplication
of effort and, ultimately, promote timely access to safe, effectiveand quality
assured medical products. Adoption of reliance measures whenever possible,
in a well structured framework underpinned by national or regional policies
and strategies, will allow regulators to focus their resources on activities that
contribute to public health that cannot be undertaken by others.
Reliance represents a “smarter” form of regulatory oversight, based on
constructive regional and international collaboration, that will facilitate and
promote convergence and the use of common international standards and
guidelines, resulting in more predictable, faster approval to improve access to
quality-assured medical products for patients worldwide.
Reliance does not represent a less stringent form of regulatory oversight
or outsourcing of regulatory mandates, nor does it compromise independence.
On the contrary, a decision to “regulate through reliance” is the hallmark of a

modern and efficient regulatory authority.
NRAs are encouraged to include reliance-related provisions as part
of their flexible regulatory pathways, and reliance should be considered in all
regulatory functions of the life cycle of a medical product, as appropriate.
The principles and considerations presented in this document should
be considered in implementing regulatory reliance frameworks or strategies.
Effective implementation of reliance will benefit not only NRAs but also patients,
health care providers and industry.
While reliance may be viewed as particularly useful for low-resourced
regulatory authorities, it is equally relevant for well-resourced NRAs. Reliance
is an approach to be used by all NRAs and should therefore become an integral
part of regulatory operations.
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References
1. Good regulatory practices: guidelines for national regulatory authorities for medical products.
Draft working document. Geneva: World Health Organization; 2016 (https://www.who.int/
medicines/areas/quality_safety/quality_assurance/QAS16_686_rev_3_good_regulatory_
practices_medical_products.pdf?ua=1, accessed 29 January 2021).
2. Definition of a mutual recognition agreement. Paris: Organization for Economic Co-operation and
Development; 2020 (https://www.oecd.org/gov/regulatory-policy/irc6.htm, accessed 29 January
2021).
3. Definition of stringent regulatory authority. In: WHO Expert Committee on Specifications for
Pharmaceutical Preparations: fifty-first report (WHO Technical Report Series, No. 1003). Geneva:
World Health Organization; 2017:34–5 (https://www.who.int/medicines/areas/quality_safety/
quality_assurance/expert_committee/trs_1003/en/, accessed 29 January 2021).
4. Policy evaluating and publicly designating regulatory authorities as WHO-listed authorities.
Draft working document. Geneva: World Health Organization; 2019 (https://www.who.int/
medicines/areas/quality_safety/quality_assurance/QAS19_828_Rev1_Policy_on_WHO_Listed_
Authorities.pdf, accessed 29 January 2021).
5. WHO Global Benchmarking Tool (GBT) for evaluation of national regulatory systems. Geneva:
World Health Organization; 2020 (https://www.who.int/medicines/regulation/benchmarking_
tool/en/, accessed 29 January 2021).
6. A framework for evaluating and publicly designating regulatory authorities as WHO-listed
authority, Interim list of national regulatory authorities. Geneva: World Health Organization; 2020
(https://www.who.int/medicines/regulation/wla_introduction/en/, accessed 29 January 2021).
7. Pan American Health Organization, Pan American Network for Drug Regulatory Harmonization.
Regulatory reliance principles: concept note and recommendations. Ninth Conference of the
Pan American Network for Drug Regulatory Harmonization (PANDRH) (San Salvador, 24 to 26
October, 2018. Washington DC: Pan American Health Organization; 2019 (https://iris.paho.org/
handle/10665.2/51549, accessed 29 January 2021).
8. The WHO Certification Scheme on the Quality of Pharmaceutical Products Moving in International
Commerce. Geneva: World Health Organization; 2020 (https://www.who.int/teams/regulation-
prequalification/pharmacovigilance/certification-scheme, accessed 29 January 2021).
9. History of PIC/S. Pharmaceutical Inspection Convention and Pharmaceutical Inspection Co-
operation Scheme; 2020 (https://picscheme.org/en/history, accessed 29 January 2021).
10. Outcome of WHO survey on reliance. International Pharmaceutical Regulators Programme; 2019
(http://www.iprp.global/news/outcome-who-survey-reliance, accessed 29 January 2021).
11. WHO guideline on the implementation of quality management systems for national regulatory
authorities. In: WHO Expert Committee on Specifications for Pharmaceutical Preparations:
fifty‑fourth report (WHO Technical Report Series, No. 1025). Geneva: World Health Organization;
2020: Annex 13:273–327 (https://www.who.int/publications/i/item/978-92-4-000182-4, accessed
29 January 2021).
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Appendix 1
Examples of use of reliance
Regulatory reliance can take many forms and encompasses a wide range of
regulatory approaches and practices that involve two or more regulatory
authorities. It may be limited to a discrete regulatory process or function or
comprise the full scope of regulatory functions throughout the life cycle of a
medical product. Many examples around the world illustrate current use of
reliance and the diverse ways in which NRAs leverage the work of others. The
examples below illustrate the points raised in the GRelP, to show use of reliance
in different regulatory functions. The list is not exhaustive but an illustration
of current global practices in reliance. It may be replaced in the future by a
comprehensive repository of reliance approaches to be established as a part of
a toolbox of GRelP.
A1. Clinical trials

Work-sharing in the assessment of clinical trials is being used in some regions,
such as the Voluntary Harmonisation Procedure in the European Union (1)
and the African Vaccine Regulatory Forum (AVAREF) (2). By assessing clinical
trial applications together, NRAs and, in some cases, ethics committees in
different countries can benefit from the assessments performed by the different
participating countries with a view to facilitating and ensuring the robustness of
the clinical trials application assessment process across countries. The AVAREF
platform has been instrumental in building the expertise and capacity of
regulators and ethics committees, promoting the use of international standards
and expediting clinical trial assessments and decisions for medical products
of high public health interest in both emergency and other circumstances. A

guideline and a platform for joint assessment of applications for clinical trials
as well as guidelines for site inspections for good clinical practices have been set
up to facilitate product development, regulatory decision-making and access to
promising new medical products (3).
A2. Marketing authorization

A2.1 Abridged regulatory pathways with reliance
for initial marketing authorization
Several procedures are available through regulatory authorities or the WHO
prequalification programme for use of an abridged regulatory pathway by
a relying NRA. The European Union Article 58 (also referred to as European
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Union Medicines for all) (4), the Swissmedic Marketing Authorisation for
Global Health Products (5) procedures and the WHO collaborative procedure
(CRP) for accelerated registration (CRP) (6) are three examples of abridged
regulatory pathways in which reliance is used to facilitate the registration of
medical products.
The European Union Article 58 and the Swissmedic Marketing
Authorisation for Global Health Products not only facilitate national registration
but also provide an opportunity for experts from NRAs to both observe and
participate in assessment and scientific advice procedures, thus building their
capacity and establishing confidence in the processes.
The CRP facilitates the assessment and accelerates national registration
of WHO-prequalified medical products and medicines approved by a stringent
regulatory authority. The CRP provides unredacted reports on the assessment,
inspection and performance evaluation (in the case of in-vitro diagnostics)
upon request (and with the consent of the manufacturer) to participating NRAs,
primarily in low- and middle-income countries. The procedures are detailed in
WHO guidelines, which also include guidance on how NRAs can make the most
efficient use of the reports in reaching their own decisions, as participating NRAs
are expected to reach a decision on marketing authorization within 90 calendar
days (regulatory time). The CRP has been successful in both accelerating
decisions in countries and building the capacity of regulatory authorities.
The WHO certificate of a pharmaceutical product (CPP) is also used as
a reliance tool, in lieu of full or partial assessment for marketing authorization
(7). NRAs are encouraged to consider use of electronic CPP. These certificates
are being used in lieu of a full or partial review, accelerating assessment in
many countries such as Benin, Bolivia, Cameroon, Congo, Cuba, Curaçao
(Netherlands), Guinea, Haiti, Honduras and Hong Kong (China).
A2.2 Quality information

Many NRAs, and the WHO Prequalification programme, recognize certificates
of suitability for monographs in The European Pharmacopoeia (8) for active
pharmaceutical ingredients (APIs) as validation of the quality of a certain
API. Some countries also recognize confirmation of API prequalification
by the WHO Prequalification programme for APIs (9). These two examples
provide assured mechanisms of reliance and also reduce the documentation
requirements for countries that rely upon or recognize those certificates. When
a certificate of suitability for the monographs of The European Pharmacopoeia
or confirmation of prequalification of an API is issued, the receiving NRA need
not duplicate the API assessment but can focus on sections not covered by
either document.
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A2.3 Work-sharing
The Australia–Canada–Singapore–Switzerland United Kingdom ACCESS
Consortium (10) was formed in 2007 by “like-minded” medium-sized regulatory
authorities to promote work sharing for greater regulatory collaboration and
alignment of regulatory requirements. The ACCESS Consortium explores
opportunities to share information and work in areas such as biosimilar
products, complementary medicines, generic medicines, new prescription
medicines, medical devices and information technology. The Consortium
capitalizes on each country’s strengths, addresses gaps in science, knowledge
and expertise and leverages resources to expedite risk assessment, while
maintaining or raising quality and safety standards. The Consortium builds
on international networks, initiatives and mechanisms to advance work- and
information-sharing throughout the life cycles of health products.
A2.4 Joint assessments

Joint assessments can be beneficial to NRAs by spreading the workload, building
capacity through broader experience and expertise and helping to build trust
in each other’s assessments and decision making processes. Similarly, industry
can benefit from a common review and a single set of questions, saving
both resource and time as compared with separate interactions. In view of
these benefits, several joint assessment initiatives have been introduced into
regional regulatory networks, sometimes driven by the higher-level priorities
of economic blocs seeking to create common markets. Examples of joint
assessment initiatives include those in the Regional Economic Communities
in Africa (East African Community (11)), ZAZIBONA (12) in the Southern
African Development Community, the Economic Community of West African
States/West African Health Organization (13)) and the ASEAN Joint Assessment
Coordinating Group (14).
A2.5 Unilateral recognition

The Mexican Federal Commission for Protection against Sanitary Risk
unilaterally recognizes marketing authorizations from certain reference
regulatory authorities (15).
A2.6 Mutual recognition

The European Union is an example of highly integrated regulatory cooperation,
and its many regulatory pathways depend heavily on work-sharing, recognition
and other forms of reliance. The approval of medicines is based on a single
assessment system, so that an assessment report from any agency in the
European Union network can be used as a basis for reliance by other regulators.
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In this case, a strong, common legal framework and harmonized regulatory

standards shared by all European Union countries has enabled and facilitated
reliance and recognition (16).
A3. Post-approval changes

In accordance with the same principles as for initial marketing authorization,
reliance can also be applied broadly in assessing post-approval changes already
approved by NRAs considered to be reference authorities. In the case of CRP,
for example, WHO informs the participating NRAs about any variations in
prequalified products approved by the WHO Prequalification team (6).
The Health Sciences Authority in Singapore applies a verification route
with shortened times for approving post-approval changes to quality and
product labels, to increase leverage of reference agencies’ assessments, minimize
duplication of effort and increase efficiency as part of work that includes
effective life cycle management of registered therapeutic medicinal products. To
qualify, the proposed changes must be identical to those approved by one of the
Authority’s five reference agencies, with proof of the approval and the approved
product label of that reference agency (17).
A4. Testing and lot release

A4.1 Network of Official Medicines Control Laboratories
The network of official medicines control laboratories supports regulatory
authorities in controlling the quality of medicinal products on the market.
Collaboration within the General European Official Medicines Control
Laboratories Network (GEON) (18) makes the best use of resources by pooling
resources and avoids duplication of work and testing. Some of the main goals
of the GEON are to ensure mutual recognition among its members of tests
conducted by national official medicines control laboratories, coordinate
activities among official medicines control laboratories and facilitate sharing of
knowledge and work.
A4.2 Lot release and quality monitoring of vaccines

and other biological products
Launched in 2017, the WHO National Control Laboratory Network for
Biologicals (WHO-NNB) (19) brings together national control laboratories and
NRAs of vaccine-producing and vaccine recipient countries, WHO contract
laboratories, manufacturers’ associations, WHO regional offices and other
stakeholders, including donors. WHO-NNB ensures effective use of global
resources by providing a platform and infrastructure for collaboration and
exchange of information on quality and technical aspects. Its main objective
261
is to facilitate access to and the availability of prequalified vaccines (and other

biotherapeutic products) through reliance on batch releases by NRAs and
national control laboratories that are members of WHO-NNB, thereby reducing
redundant testing and encouraging more cost–effective testing and more effective
regulatory oversight.
A5. Pharmacovigilance
Exchanges and sharing of data are critical in pharmacovigilance. More than
100 Member States share data on the safety of medical products in the WHO
database of individual case reports of safety, VigiBase, developed and maintained
by the Uppsala Monitoring Centre (20). Member States use this database (and
thereby each other’s data) as a single source of pharmacovigilance information
to confirm and validate any signals of adverse events associated with medicines
and vaccines that they have observed. In Regulation EU No 1235/2010 (21),
the European Union introduced the concept of a supervisory authority for
pharmacovigilance, to be responsible for verifying on behalf of the Union
that the marketing authorization holder for a medicinal product satisfies the
pharmacovigilance requirements as per European Union legislation.
Countries in the Region of the Americas have been preparing joint
assessments of periodic safety updates and risk management plans. Coordinated
by Health Canada, pairs of countries have completed evaluation reports for
several products. The reports are made available on a regional platform with
access restricted to the pharmacovigilance focal points of the NRAs.
A6. Inspections
Governments and NRAs in various regions have made mutual recognition
agreements so that they can rely on each other’s inspections, avoiding duplication
of work and making the best use of resources. These include agreements between
the European Union (22) and Australia, Canada, Japan, Switzerland and the USA
and ASEAN mutual recognition agreements (23).
PIC/S is a non-binding, informal cooperative arrangement among
regulatory authorities in the field of good manufacturing and good distribution
practices of medicinal products for human or veterinary use and, more recently,
also in good clinical and good vigilance practices (24). Its aim is to facilitate
cooperation and networking among competent authorities and regional and
international organizations, thus increasing mutual confidence in inspections.
PIC/S has issued guidance on inspection reliance, outlining a process for desk-
top assessment of compliance with good manufacturing practices (25). Reliance
is an important aspect of desktop assessments of compliance with relevant good
practice guidelines and requirements, as described in WHO guidance (26).
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The OECD operates a system for mutual acceptance of data in the

assessment of chemicals (including pharmaceuticals), in which data generated
in any member country in accordance with OECD test guidelines and the
principles of good laboratory practice are accepted by any other member
country for assessing products for the protection of human health and the
environment (27).
A7. Examples of medical devices

Reliance is prevalent in the regulation of medical devices, including in-vitro
diagnostics. For example, the Medical Device Single Audit Program (28) was
developed under the auspices of the International Medical Device Regulators
Forum (IMDRF). Under this Program, the regulatory authorities of Australia,
Brazil, Canada, Japan and the USA have pooled their resources into a robust
system of oversight by third party auditing organizations, which, in turn,
audit the quality management systems of medical device manufacturers. The
Program permits an auditing organization to conduct a single regulatory audit
that satisfies the requirements of the regulatory authorities that participate
in the Program. The pooled resources are used to establish and maintain
oversight of auditing organizations, resulting in more effective use of limited
regulatory resources. A single audit programme allows regulatory authorities to
leverage resources efficiently and to streamline the regulatory process without
compromising public health and to promote better aligned, more consistent
regulatory requirements.
The IMDRF has also issued guidance for exchanges of information
on the safety of medical devices among participating NRAs (29). The system
reports incidents that represent a serious threat public health beyond national
borders. The IMDRF provides consistent terminology for reporting and coding
adverse events for categorized reporting (30).
These activities are just two examples of the work of IMDRF in
harmonization, convergence and reliance in the area of medical devices. Other
examples are optimizing standards for regulatory use (31), essential principles
of the safety and performance of medical devices (32) and requirements for the
competence, training and conduct of regulatory reviewers (33).
In Singapore, medical devices and in vitro diagnostics that have been
authorized through specific pathways in Australia, Canada, Europe, Japan or
the USA are eligible for abridged evaluation. To qualify, the proposed intended
use must be identical to that approved in the reference country. Typically the
documentation includes proof of approval from the reference regulatory
authority and summary technical documents to satisfy requirements for
supporting documentation (34). Additionally, Australia recognizes registrations
and certifications from notified bodies designated by the medical device
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regulators of Health Canada, European member states, the Pharmaceuticals and

Medical Devices Agency of Japan, the US Food and Drug Administration and
organizations participating in the Medical Device Single Audit Program (35).
A8. Examples of public health emergencies

WHO developed the “emergency use assessment and listing” mechanism as a
risk-based procedure for assessing and listing unlicensed vaccines, therapeutics
and in-vitro diagnostics for use primarily during public health emergencies
of international concern but also in other public health emergencies when
appropriate.
PAHO has developed guidance for NRAs and regulatory systems on
practical ways of implementing reliance for emergency use of medicines and
other health technologies in a pandemic (36).
References to Appendix 1
1. Clinical trials facilitation groups. Guidance document for sponsors for a voluntary harmonisation
procedure (VHP) for the assessment of multinational clinical trial applications. Heads of
Medicines Agencies; 2016 (https://www.hma.eu/fileadmin/dateien/Human_Medicines/01-About_
HMA/Working_Groups/CTFG/2016_06_CTFG_VHP_guidance_for_sponsor_v4.pdf, accessed 29
January 2021).
2. The African Vaccine Regulatory Forum. Brazzaville: World Health Organization Regional Office for
Africa; 2020 (https://www.afro.who.int/health-topics/immunization/avaref, accessed 29 January
2021).
3. GCP inspection guide. Joint review guideline. In: AVAREF tools. Brazzaville: World Health
Organization Regional Office for Africa; 2020 (https://www.afro.who.int/publications/avaref-
tools, accessed 29 January 2021).
4. Human regulatory. Marketing authorisation. Medicines for use outside the European Union.
European Medicines Agency. Amsterdam. European Medicines Agency; 2019 (https://www.ema.
europa.eu/en/human-regulatory/marketing-authorisation/medicines-use-outside-european-
union, accessed 29 January 2021).

5. The Swissmedic Marketing Authorisation for Global Health Product (MAGHP) Procedure. Bern:
Swissmedic; 2017 (https://www.swissmedic.ch/swissmedic/en/home/about-us/development-
cooperation/marketing-authorisation-for-global-health-products.html, accessed 29 January
2021).
6. Collaborative procedure for accelerated registration. Geneva: World Health Organization,
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(TPB-GN-005-005). Chapter H. Minor variation (MIV) application submission. Singapore: Health
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20. VigiBase. Uppsala: Uppsala Monitoring Centre; 2020 (https://www.who-umc.org/vigibase/

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2010 amending, as regards pharmacovigilance of medicinal products for human use, Regulation
(EC) No 726/2004 laying down Community procedures for the authorisation and supervision
of medicinal products for human and veterinary use and establishing a European Medicines
Agency, and Regulation (EC) No 1394/2007 on advanced therapy medicinal products. Off J Eur
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25. Guidance on GMP Inspection Reliance. PIC/S; 2018 (https://picscheme.org/docview/2475,
26. Guidance on good practices for desk assessment for compliance with good manufacturing
practices, good laboratory practices and good clinical practices for marketing authorization of
medical products. In: WHO Expert Committee on Specifications for Pharmaceutical Preparations:
fifty-second report (WHO Technical Report Series, No. 1010). Geneva: World Health Organization;
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current-projects/trs1010-annex9--desk-assessment.pdf 29 January 2021).
27. Mutual acceptance of data (MAD). Paris: Organisation for Economic Co-operation and
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htm, accessed 29 January 2021).
28. Medical device single audit program (MDSAP). Silver Spring (MD): Food and Drug
Administration; 2020 (https://www.fda.gov/medical-devices/cdrh-international-programs/medical-
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29. Medical devices: post-market surveillance: national competent authority report exchange
criteria and report form. Singapore: International Medical Device Regulators Forum; 2017 (http://
www.imdrf.org/docs/imdrf/final/technical/imdrf-tech-170921-pms-ncar-n14-r2.pdf, accessed
29 January 2021).
30. IMDRF Adverse Event Terminologies Working Group. IMDRF terminologies for categorized
adverse event reporting (AER): terms, terminology structure and codes. Singapore: International
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tech-200318-ae-terminologies-n43.pdf, accessed 29 January 2021).
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of medical devices and IVD medical devices. Singapore: International Medical Device Regulators
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33. IMDRF Good Regulatory Review Practices Group. Competence, training, and conduct
requirements for regulatory reviewers. Singapore: International Medical Device Regulators
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pandemic (e.g. COVID-19). Washington DC: Pan American Health Organization; 2020 (https://iris.
paho.org/handle/10665.2/52027, accessed 29 January 2021).
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Good regulatory practices in the regulation of medical
products
Background
A fundamental role of government is to protect and promote the health and safety
of the public, including by delivering health care. A well-functioning health care
system requires available, affordable medical products that are safe, effective and
of assured quality. As medical products are essential in the prevention, diagnosis
and treatment of disease, the consequences of substandard and falsified medical
products can be life threatening. This is a concern, as users of medical products
are not usually in a position to judge their quality. The interests and safety of the
public must therefore be entrusted to a regulatory body or bodies that ensure that
only products in legal trade are available and that marketed products are safe,
perform as claimed and are of assured quality.
The regulation of medical products has become increasingly complex
with the globalization of product development, production and supply and
the rapid pace of technological and social change in the context of limited
financial and human resources.The importance of robust regulatory systems
was recognized by the Sixty-Seventh World Health Assembly when it endorsed
resolution WHA 67.20, Regulatory system strengthening for medical products.
The resolution notes that “effective regulatory systems are an essential
component of health system strengthening and contribute to better public
health outcomes”, that “regulators are an essential part of the health workforce”
and that “inefficient regulatory systems themselves can be a barrier to access to
safe, effective and quality medical products” (23).
A sound system of oversight requires that regulatory authorities be
supported by an effective framework of laws, regulations and guidelines and
that they have the competence, capacity, resources and scientific knowledge to
deliver their mandate in an efficient and transparent manner. The extent to which
a regulatory framework fulfils its policy objectives depends on the quality of its
development and implementation. GRP are critical to efficient performance of
a regulatory system and, consequently, to the public’s confidence in the system,
while also setting clear requirements for regulated entities. A sound regulatory
framework, including international norms and standards, and the recruitment
and development of competent staff are necessary but not sufficient conditions
to ensure “good oversight”. All individuals in regulatory authorities should be
guided by GRP in setting appropriate requirements and formulating decisions
269
that are clear, transparent, consistent, impartial, proportionate, timely and based
on sound science. Regulated parties and other stakeholders also play important
roles in ensuring a clear, efficient regulatory environment so that quality-assured
medical products are available to patients.
Acknowledgements 271
Abbreviations to Annex 11 271
Executive summary 271
1. Introduction 273
2. Purpose 273
3. Scope 273
4. Glossary 274
5. Objectives 276
6. Key considerations 276
7. Overview of a regulatory system for medical products 277
7.1 Components of the regulatory framework 277
7.2 Components of a regulatory system 279
8. Principles of good regulatory practices 282
8.1 Legality 283
8.2 Consistency 284
8.3 Independence 286
8.4 Impartiality 287
8.5 Proportionality 288
8.6 Flexibility 290
8.7 Clarity 292
8.8 Efficiency 294

8.9 Transparency 297
9. Enablers of good regulatory practices 299
9.1 Political and government-wide support 299
9.2 Effective organization and good governance supported by leadership 300
9.3 Inter- and intra-organizational communication, collaboration and coordination 300
9.4 A robust, well-functioning quality management system 300
9.5 Sufficient, sustainable financial resources 300
9.6 Competent human resources 301
9.7 Organizational ethics and values 301
9.8 Science- and data-driven decision-making process 301
10. Implementing good regulatory practices 301
References 302
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Acknowledgements
WHO acknowledges all the authors, stakeholders and organizations who
contributed to the preparation of this document.
Abbreviations to Annex 11
APEC Asia–Pacific Economic Cooperation
ASEAN Association of Southeast Asian Nations
GRP Good regulatory practices
OECD Organisation for Economic Co-operation and Development
Executive summary
A fundamental role of government is to protect and promote the health and
safety of the public, including providing health care. A well-functioning health
care system requires available, affordable medical products that are safe, effective
and of consistently assured quality.
The medical products sector is one of the most regulated of all industries,
because of the impact of the diverse range of medical products on health, the
difficulty in assessing their quality, safety and efficacy or performance 1 and
the complexity of their development, production, supply and surveillance. It is
therefore essential that the interests and safety of the public be entrusted to a
regulatory body responsible for ensuring that only products in legal trade are
available and that marketed products are safe, perform as claimed and are of
assured quality.
Regulatory authorities have a duty to ensure that they regulate in a
manner that achieves public policy objectives. A coherent legal framework
should be established and implemented that provides the required level of
oversight while facilitating innovation and access to safe, effective and good-
quality medical products. The framework should also have the necessary
flexibility and responsiveness, particularly for managing public health
emergencies, addressing new technologies and practices and promoting
international regulatory cooperation.
Governments incur costs by establishing and maintaining regulatory
systems to protect and promote the health of their citizens. Regulated parties
incur costs in complying with regulations. Inefficient regulatory systems, however,
Medicines and vaccines: efficacy; medical devices including in-vitro diagnostics: performance
1
271
have impacts on the health system, with potentially significant implications for
morbidity and mortality, health care costs and the economy.
A sound legal framework, adoption of international norms and standards
and recruitment and development of competent staff are necessary but not
sufficient conditions to ensure “good regulatory oversight”. These measures must
be combined with good regulatory practices (GRP) that guide all individuals
in organizations entrusted with regulating medical products in formulating
decisions that are clear, transparent, consistent, impartial, proportionate, timely
and based on sound science and legislation.
GRP can be defined as a set of principles and practices applied to the
development, implementation and review of regulatory instruments – laws,
regulations and guidelines – to achieve public health policy objectives in the
most efficient way. Successful application of GRP is the hallmark of a modern,
science-based, responsive regulatory system in which regulations are translated
into desired outcomes. GRP provide a means of establishing and implementing
sound, affordable, efficient regulation of medical products as an important part
of health system performance and sustainability.
This document is intended to present Member States with widely
recognized principles of GRP derived from an extensive review of public
documents issued by governments and multilateral organizations as well as many
consultative workshops, benchmarking exercises and interactions with Member
States. The nine principles presented in this document – legality, consistency,
independence, impartiality, proportionality, flexibility, clarity, efficiency and
transparency – are relevant to all authorities responsible for the regulation of
medical products, irrespective of their resources, sophistication or regulatory
model. Regulated parties and other stakeholders also have important roles to play
in achieving an efficient regulatory environment.
GRP serve as a basis for guidance documents on best regulatory practices.
The body of WHO guidance documents is intended to provide regulatory
authorities with comprehensive guidance for improving their performance.

This document will be supplemented by practical guides and tools designed to
facilitate implementation of GRP.
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1. Introduction
This document responds to requests from national authorities responsible for
regulation of medical products (see 4. Glossary) for guidance in addressing
common gaps in regulatory practices identified during benchmarking exercises.
The document draws on documents published by multilateral bodies such as the
Asia-Pacific Economic Cooperation (APEC) (10), the Organisation for Economic
Co-operation and Development (OECD) (11, 12), the World Bank (13) and the
Association of Southeast Asian Nations (ASEAN) (14), as well as guides published
by a number of governments. The document also takes account of earlier WHO
documents that touch on aspects of GRP (15–22) and of WHO experience in
applying the WHO Global Benchmarking Tool (GBT) and promoting the
principles of good regulatory practices (GRP). Proper implementation of GRP
through GRP enablers across the regulatory system (see 4. Glossary) can result
in desired regulatory outcomes and impact.
2. Purpose
This document presents the high-level principles of GRP. They are intended
to serve as benchmarks and thereby guide Member States in applying good
practices in regulation of medical products. This document is also meant to
guide Member States in prioritizing the functions of their regulatory system
according to their resources, national goals, public health policies, medical
products policies and the medical product environment. This “principles-
based” document will be supplemented by practical guides and tools to facilitate
implementation of GRP by organizations responsible for the regulation of
medical products. This basic document is complemented by related guidance
on best regulatory practices, including good governance practices (24), good
reliance practices (25), good review practices (26) and quality management
systems (see 4. Glossary) for national regulatory authorities (NRAs) (27).
The group of documents is intended to provide regulatory authorities with
comprehensive guidance on improving performance.
3. Scope
This document presents principles and considerations in the development and
use of the regulatory instruments that underpin regulatory activities. Broader
practices and attributes are presented that define well-performing regulatory
systems for medical products.
The document is relevant to all regulatory authorities, irrespective of
their resources, maturity or regulatory model. High-level GRP principles are
273
equally applicable to supranational (e.g. regional), national and subnational

regulatory systems, and systems in which several institutions are charged
with regulating certain products or activities in a country or jurisdiction. The
document is also intended for a number of related audiences: institutions and
policy-makers responsible for formulating health policies, laws, regulations
and guidelines; institutions that, together, form national or supranational
systems for regulation of medical products; and regulatory networks and parties
affected by or otherwise interested in regulatory frameworks, such as industry
or other developers of medical products.
4. Glossary
The definitions given below apply to the terms as used in this document. They
may have different meanings in other contexts. Readers are also encouraged to
consult related WHO guidance for more complete definitions relevant to best
regulatory practices (see References).
Co-regulation. A system of shared regulatory responsibilities in which an
industry association or professional group assumes some regulatory functions,
such as surveillance and enforcement or setting regulatory standards.
International standards and guidelines. For the purpose of this document,
the term includes relevant WHO standards and guidelines and any other
relevant, internationally recognized standards (e.g. International Organization
for Standardization or pharmacopoeial standards) and guidelines (e.g. the
International Council on Harmonisation of Technical Requirements for
Pharmaceuticals for Human Use or guidelines of the Pharmaceutical Inspection
Convention and Pharmaceutical Inspection Co-operation Scheme).
Medical product. For the purpose of this document, the term includes medicines,
vaccines, blood and blood products and medical devices, including in-vitro
diagnostics.
Public health emergency. The condition that requires a governor to declare a
state of public health emergency, defined as
an occurrence or imminent threat of an illness or health condition,
caused by bioterrorism, epidemic or pandemic disease, or (a)
novel and highly fatal infectious agent or biological toxin that
poses a substantial risk of a significant number of human fatalities
or incidents or permanent or long-term disability.
The declaration of a state of public health emergency permits a governor to
suspend state regulations and change the functions of state agencies (1).
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Quality management system. An appropriate infrastructure comprising the

organizational structure, procedures, processes, resources and systematic actions
necessary to ensure adequate confidence that a product or service will satisfy
given requirements for quality.
Recognition. Acceptance of the regulatory decision of another regulator or
other trusted institution. Recognition should be based on evidence that the
regulatory requirements of the reference regulatory authority are sufficient to
meet the regulatory requirements of the relying authority. Recognition may
be unilateral or mutual and may, in the latter case, be the subject of a mutual
recognition agreement.
Regulatory convergence. A voluntary process whereby the regulatory
requirements in different countries or regions become more similar or “aligned”
over time. Convergence results from gradual adoption of internationally
recognized technical guideline documents, standards and scientific principles,
common or similar practices and procedures or the establishment of appropriate
domestic regulatory mechanisms that align with shared principles to achieve a
common public health goal (2).
Regulatory cooperation. A practice among regulatory authorities for efficient
and effective regulation of medical products. May be practised by an agency,
an institution or a government. The formal mechanisms include creation
of joint institutions, treaties and conventions such as mutual recognition
agreements, while less formal mechanisms include sharing information, scientific
collaboration, common risk assessment, joint reviews and inspections and joint
development of standards. May also include work with international counterparts
to build regulatory capacity or provide technical assistance, thus contributing to
improvement of international regulatory governance practices (3–6).
Regulatory harmonization. A process whereby the technical guidelines of
participating authorities in several countries are made uniform (7).
Regulatory impact analysis. Process of examining the probable impacts of a
proposed regulation and of alternative policies to assist the policy development
process (8).
Regulatory stock. Collection or inventory of accumulated regulations.
Regulatory system. The combination of institutions, processes and the
regulatory framework with which a government controls particular aspects of
an activity (9).
Reliance. The act whereby a regulatory authority in one jurisdiction takes
into account and gives significant weight to assessments by another regulatory
275
authority or trusted institution or to any other authoritative information in

reaching its own decision. The relying authority remains independent, responsible
and accountable for the decisions taken, even when it relies on the decisions,
assessments and information of others.
5. Objectives
GRP ensure sound, effective regulation of medical products as an important
part of health system performance and sustainability. If they are implemented
consistently and effectively, they can result in higher-quality regulation, better
regulatory decision-making and compliance, more efficient regulatory systems
and better public health outcomes. They help to ensure that regulatory systems
remain up to date as the technologies and systems in which they are used
continue to evolve. In an increasingly complex, interconnected regulatory
environment, GRP also promote trust among regulatory authorities and other
stakeholders, such as industry, academia, research centres and health care
professionals and thereby facilitate international cooperation and the adoption of
more effective and efficient approaches to ensuring the quality, safety and efficacy
or performance of medical products in the global regulatory community. The
ultimate aim of GRP is to serve and protect public health and patients’ interests,
with respect for all applicable ethical principles.
6. Key considerations
The medical products sector is one of the most regulated of all industries because
of the impact that the diverse range of medical products can have on health and
society, the difficulty in assessing their quality, efficacy or performance and safety,
lessons learnt from public health tragedies and the complexity of developing,
producing, supplying and monitoring medical products to ensure that they

consistently perform as intended. Many countries therefore have increasingly
sophisticated sets of laws, regulations and guidelines to control all aspects of the
life cycle of medical products.
In providing the necessary regulations and tools for fulfilling publicly
entrusted mandates, regulatory authorities have a duty to ensure that they regulate
in a manner that achieves public policy objectives. They must therefore establish
and implement a coherent regulatory framework to provide the required level of
oversight and control while facilitating innovation and access to safe, effective
and high-quality medical products. They must also build the necessary flexibility
and responsiveness into the regulatory framework, particularly for managing
public health emergencies (see 4. Glossary), addressing new technologies and best
practices and promoting international regulatory cooperation (see 4. Glossary).
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Increasingly, policy-makers and regulatory authorities are adopting

modern models of regulation that are responsive to resource constraints
while meeting the challenges posed by scientific development, globalization,
rising public expectations and public health emergencies. Weak or inefficient
regulatory systems can limit access to safe, effective and, high quality medical
products and pose a threat to public health. As countries strengthen their
regulatory capacity, they must ensure that their regulatory systems are science-
based, that they adhere to international standards and guidelines and that
their approach leverages the work of other, trusted regulatory authorities and
institutions when possible. To this end, countries are encouraged to formulate
and implement policies and strategies that promote international collaboration
(23), convergence, harmonization, information- and work-sharing and reliance
(see 4. Glossary) as part of GRP (25). WHO is establishing a framework for
evaluating NRAs and regional regulatory systems and for designating those that
meet the requirements of WHO listed authorities (28).
Regulatory control of medical products to protect public health is
fully acknowledged, as noted above. The issue is how to regulate effectively,
efficiently and transparently, such that the interests of the health care system
are served. Consistent application of GRP in all aspects of oversight is essential
in ensuring that those interests are served and in providing the foundation
for a well-performing, respected regulatory system. GRP are principles and
practices applied to the development, implementation and review of regulatory
instruments – laws, regulations and guidelines – in order to achieve public health
policy objectives in the most efficient way. GRP instil a culture of best practices
among institutions responsible for regulatory oversight to ensure that regulation
is fairly, consistently and effectively applied.
7. Overview of a regulatory system for medical products

Definitions are essential for a common understanding of concepts. While
more terms are defined in the Glossary, the terms “regulatory framework”,
“legal framework”, “regulatory authority”, “regulatory system” and “regulatory
outputs” are explained below to ensure proper understanding of their use in
this document.
7.1 Components of the regulatory framework

In this document, the terms “law” and “regulation” are used to describe the
components of the legal framework (binding legislation). Other terms may be
used in some jurisdictions, such as “act” instead of “law” or “ordinance” instead
of “regulation”.
277
Laws generally define the roles and responsibilities of institutions, in this

case, a regulatory authority, ministry of health or other relevant organizations.
They define the products, persons and activities that are to be regulated and state
what is permitted and what is not. More importantly, laws authorize an institution
to make lower-level (or subordinate) regulations.
Regulations are a diverse set of instruments by which governments place
requirements on enterprises and citizens. Regulations usually state at high level
the conditions to be met and the requirements defined in laws. For instance, a law
may prohibit the manufacture, importation or sale of a medical product in the
absence of specific authorization, while regulations would set out the conditions
for obtaining authorization, such as the provision of certain types of information
(the results of non clinical testing and clinical trials, data on manufacturing and
control) that allow the regulatory authority to establish the quality, safety and
efficacy or performance of a medical product.
Guidelines (and other guidance documents) provide further detail on how
the regulated stakeholders can comply with laws and regulations. Guidelines may
also provide details of the processes of enforcement of the respective legislation
(laws and regulations). Within a regulatory framework for medical products,
such documents are usually non-binding and are generally more detailed and
scientific in nature. They are thus appropriate for describing the approaches
that are generally considered suitable for satisfying regulatory requirements but
unsuitable for inclusion in legislation.
Fig. 1
Architecture of a regulatory framework
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Annex 11
7.2 Components of a regulatory system

A regulatory authority is a public institution(s) or governmental body or
bodies authorized by law to exercise independent regulatory oversight
over the development, production, marketing and surveillance of medical
products. Although the term implies that a single organization is responsible
for all regulatory functions, these functions may be undertaken by one or
more institutions that report to the same or a different senior official. The
regulatory authority plays a critical role in ensuring the quality, safety, efficacy
and performance of medical products and also the relevance and accuracy of
product information.
The regulatory framework is the collection of laws, regulations,
guidelines, guidance documents and other regulatory instruments through
which a government and a regulatory authority control particular aspects of a
specific activity.
The legal framework is the part of the regulatory framework that contains
binding pieces of legislation, such as laws and regulations.
Regulatory outputs are the results or products of the regulatory authority,
such as reports of inspections and assessments, decisions and product labels.
The term regulatory system is used to describe the combination of
institutions, processes, regulatory framework and resources which, taken
together, are integral to effective regulation of medical products in a country or
multi country jurisdiction. GRP should be considered and applied to the whole
regulatory system.
Fig. 2 illustrates the principles and enablers of GRP and the components
of a regulatory system.
279
280
Fig. 2

Principles and enablers of good regulatory practices (GRP) and components of a regulatory system
Annex 11
In the overall regulatory system, three components (inputs) contribute

most to regulatory functions and activities: (i) the regulatory framework,
composed of the legal framework (laws and regulations), guidelines and other
guidance documents; (ii) regulatory institutions, which may be represented
by one or more entities, including the NRA, the national control laboratory,
pharmacovigilance centres and research ethics committees; and (iii) all types
of resources, including human and financial, infrastructure and equipment
and information management systems. The regulatory outputs depend on the
functions and activities concerned (e.g. regulatory and marketing authorization,
inspection and assessment reports). The concepts and principles of GRP apply
to the overall regulatory system, as explained above. For application and
implementation of GRP, several enablers are essential (see section 9. Enablers
for Good Regulatory Practices). When the principles of GRP are properly
implemented through the enablers, the desired regulatory outcome and impact
can be achieved.
WHO classifies the spectrum of regulatory activities for medical
products into seven common regulatory functions, which are applicable to all
medical products: clinical trials oversight, marketing authorization, vigilance,
market surveillance and control, licensing of establishments, regulatory
inspection and laboratory testing (29). In addition, a number of non common
functions apply to certain medical products, such as official lot release of
vaccines and other biologicals.
The term regulatory authority implies that a single organization is
mandated to perform all regulatory functions. This is not always the case.
For example, different organizations may be legally responsible for regulating
medicines and vaccines and for medical devices. Even when one body is
responsible for all regulatory functions, aspects critical to certain functions may
lie outside its authority, such as those performed by surveillance or vigilance
centres that have formal relations with the authority; these include activities such
as collecting reports on adverse events, surveillance for substandard and falsified
medical products and monitoring advertising. Certain regulatory functions
may be undertaken by third parties, as in the case of auditing organizations for
medical devices. In order to ensure a comprehensive and efficient regulatory
system, clear roles, responsibilities, processes and communication channels must
be established among the different organizations responsible for performing
regulatory functions.
Regulatory activities may also be undertaken at supranational (e.g.
regional), national or subnational level. Examples include supranational
evaluation of certain products for the purpose of granting marketing
authorization that is valid for several countries or inspections of certain
manufacturing sites for medical products for good manufacturing practices at
national level.
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8. Principles of good regulatory practices

There is no universal model for regulation of medical products. Each approach
reflects national health policies and priorities, national socioeconomic
development, the availability of resources and infrastructure, the health
system, the national legal system, research and development capacity and local
production capacity. Nonetheless, as in other regulated sectors, there is growing
international consensus on best practices to be applied in regulation of medical
products.
A review of public documents on GRP (10, 13, 14, 30) reveals common
practices that should be adopted by all institutions responsible for or
involved in regulation of medical products. These principles apply equally
to the development and implementation of regulatory oversight and to daily
regulatory business. GRP are guided by overarching principles. Nine principles
are listed in Table 1 and described below, with considerations relevant to
regulation of medical products. The principles, practices and examples will
be further elaborated in supplementary guidance that will complement
this document.
Table 1
Principles of good regulatory practices
Legality Regulatory systems and the decisions that flow from them must
have a sound legal basis.
Consistency Regulatory oversight of medical products should be consistent
with existing government policies and legislation and be applied
in a consistent and predictable manner.
Independence Institutions that execute regulation of medical products should be
independent.
Impartiality All regulated parties should be treated equitably, fairly and
without bias.
Proportionality Regulation and regulatory decisions should be proportional to risk
and to the regulator’s capacity to implement and enforce them.
Flexibility Regulatory oversight should not be prescriptive but rather be
flexible in responding to a changing environment and unforeseen
circumstances. Timely responsiveness to a specific need and in
particular to public health emergencies should be built into the
regulatory system.
Clarity Regulatory requirements should be accessible to and understood
by users.
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Table 1 continued
Efficiency Regulatory systems should achieve their goals within the required
time and at reasonable effort and cost. International collaboration
promotes efficiency by ensuring the best use of resources.
Transparency Regulatory systems should be transparent; requirements and
decisions should be made known, and input should be sought on
regulatory proposals.
8.1 Legality
Regulatory systems and the decisions that flow from them must have a sound
legal basis.
Key elements:
• The regulatory framework should provide the necessary authority, scope and
flexibility to safeguard and promote health.
• Delegation of power and responsibilities to various levels of the regulatory system
should be clear and explicit.
• Regulatory frameworks should support and empower regulatory authorities to
contribute to and benefit from international cooperation.
• Systems should be in place to ensure that regulatory decisions and sanctions can
be reviewed.
• The regulatory framework should clearly define the scope and lines of authority
of the institutions that form the regulatory system to ensure its integrity.
• The regulatory authority must be held accountable for its actions and decisions to
the public, those regulated and the government within a legal framework.
The principle of legality requires that a regulatory system be structured

such that all regulatory actions and decisions are based on clear legal authority,
thus respecting the “rule of law”.
A regulatory body exists to achieve objectives deemed by the government
to be in the public interest. It must operate within and in accordance with the
powers conferred by the legal framework (31). The law or act that establishes
the regulatory authority should clearly state the objectives of the enabling
legislation, the powers of the authority, the scope of the products and general
activities that the authority is mandated to regulate and the provisions for
making regulations.
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Delegation of power and responsibilities to different levels of the

regulatory system should be explicit and clear. When more than one institution
or level of government is involved in regulating medical products, the functions
and responsibilities of each should be clear and complementary, and the
processes for communication and coordination among them should be defined
(see section 8.2 Consistency).
As cooperation among regulatory authorities is essential to manage
increasingly complex and cross jurisdictional issues, a modern legal framework
for medical products must support and encourage all forms of cooperation,
including convergence, harmonization, information- and work-sharing, reliance
and recognition (see 4. Glossary). Ideally, this is stated explicitly in provisions
of laws and/or regulations, with operational detail provided in policies and
procedural guidance. A legal framework should at least not prohibit all forms
of regulatory cooperation, such as the use of assessments and decisions of other
trusted regulatory authorities and institutions in conducting its own work.
Cooperation does not alter the sovereign responsibility and accountability of
each regulatory authority to protect the health and safety of its citizens but allows
the exchange of good practices and may save resources and avoid duplication.
Legislation must be in place to control and perform all the required
regulatory activities under common and non-common regulatory functions.
Policies, guidelines and procedures cannot compensate for the absence of
legislation. A legal framework should ensure the integrity of the regulatory
system by providing clear authority, scope, power, roles and responsibilities to
the institutions that form the system. Conflict in organizational authority or
responsibilities should be avoided.
All regulatory authorities must be accountable to the public, the bodies
they regulate and the government for their actions and decisions as part of good
governance and accountability. In the context of GRP, regulatory authorities
are accountable when they are: (i) responsible for acting according to certain
standards and commitments, (ii) answerable for their actions and (iii) willing to
face the consequences when standards or commitments are not met.
Regulatory actions and decisions should be consistent with the authority
and controls provided for by the legal framework. Processes should therefore be
in place for review of regulatory decisions, including internal appeals and judicial
appeal of the decisions of regulators, such as on the grounds of procedural
fairness and due process, in addition to scientific and administrative grounds.
8.2 Consistency
Regulation of medical products should be consistent with government policies
and legislation and be applied consistently and predictably.
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Key elements:
• The regulatory framework for medical products should fit coherently into the
national legal and policy framework.
• New regulations should complement, and not conflict with, existing regulatory
instruments.
• Regulatory requirements should be implemented and enforced consistently for
all medical product sectors and stakeholders.
Regulation of medical products must be performed in the context of

and in ways coherent with the national legal framework, general government
policies and public health policy objectives. It should also be coherent with any
treaties, conventions and regional or international agreements to which the
country is a party as well as any supranational legislation that affects constituent
member states.
Any overlap or conflict with existing laws and regulations should be
avoided, as this causes confusion, duplication of mandates and unnecessary
regulatory work and increases the likelihood of noncompliance. Manufacturers
(for the purpose of this document, manufacturers also means marketing
authorization holders), importers, distributors and other stakeholders should
be able consistently to identify the responsible authority in laws and regulations.
Consistency is particularly important when regulation of medical products
is decentralized, for instance, with central and state or provincial authorities.
Effective systems should be in place for consultation, cooperation and
coordination among the different levels of government to promote national
uniformity of regulatory requirements while respecting local responsibilities.
All regulatory functions and activities should be efficiently integrated to ensure
the uniformity of the regulatory system. Similar considerations apply when
more than one institution or department at the same level of government is
responsible for different, or the same, regulatory functions and products
– a situation that is not uncommon. Unclear or conflicting mandates and
requirements create complex regulatory systems and challenge effective
communication and coordination. In all instances, formal mechanisms for
proper coordination should be established during the drafting and execution
of regulatory instruments and the operations of bodies charged with the
regulation of medical products.
Consistency in regulatory actions and decisions is ensured when the
same or similar circumstances lead to the same or a similar outcome. It is
therefore important that the regulatory system build an institutional memory,
by recording decisions, to ensure similar, fair treatment in future situations.
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Regardless of differences in technology, the level of regulatory oversight in

relation to the risk posed by different types of medical products and regulated
entities (manufacturers, importers and distributors) must be consistent.
Consistency is upheld when the regulatory framework provides for impartial
appeal of regulatory decisions. The enforcement of such appeals and corrective
measures should also be consistent among sectors.
Consistency is also ensured by sufficient, clear regulatory guidance,
based, when possible, on international guidelines; orientation and training
programmes for staff; and regular, transparent interactions with regulated
parties and other stakeholders (e.g. industry associations, patients, health care
professionals associations and other relevant government institutions). These
are mechanisms for improving process and for the identification and resolution
of issues.
Application of a well-functioning quality management system that
covers all regulatory activities (33) is critical for regulatory consistency. This
includes adoption of a process approach, involving systematic definition and
management of regulatory processes and their interactions to achieve the
intended results in accordance with the quality policy and strategic direction of
the organization.
Performance-based indicators, internal reviews and external audits may
also be important in ensuring consistency in the application of regulations and
regulatory operations.
8.3 Independence
Institutions responsible for regulation of medical products should be independent.
Key elements:
• The regulatory system must operate, and be seen to operate, in an independent

and authoritative manner, discharging its duties independently from politicians,
government and regulated entities.
• Regulatory activities and decisions should be free of improper and undue
influence of stakeholders.
• Appropriate funding and clear funding processes are essential.
• The independence of the leadership should be established to ensure
independent behaviour during and after employment.
According to an OECD publication entitled Creating a culture of

independence (32):
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Regulatory agencies (authorities) often find themselves under

various pressures from different stakeholders and interest groups
which can subject them to different forms of influence. To ensure
they conduct their activities correctly and achieve the right policy
outcomes they must take on board legitimate interests and protect
themselves from inappropriate or undue influence.
Good governance and anti-corruption measures (24) should be built
into the regulatory framework to obviate actual or perceived conflicts of interest,
unfounded bias or improper influence by stakeholders (also known as “regulatory
capture”). To maintain public confidence, the regulatory authority must operate,
and be seen to operate, independently, authoritatively and impartially and
to discharge its duties independently of the regulated entities (e.g. researchers
and industries).
When regulators are funded by fees, an appropriate cost-recovery
mechanism is essential to set the “right” fee and to avoid a regulator that is
under-funded, captured by industry or undermined by the executive. It may be
easy to influence a regulator that is funded from general government revenues
by reducing its resources. Annual appropriations make it easier to influence a
regulator than multi annual appropriations, which are less susceptible to short-
term shocks, such as political or electoral imperatives. Adequate safeguards can
protect the budget from being used to unduly direct the regulator.
The nomination and appointment of the regulator’s leadership should be
based on transparent and accountable processes. Clear rules to avoid conflicts
of interest should be in place to ensure independent behaviour during and after
employment.
8.4 Impartiality
All regulated parties should be treated equitably, fairly and without bias.
Key elements:
• Regulatory activities and decisions should be free of conflicts of interest or
unfounded bias.
• The regulatory system must operate impartially.
• The regulatory authority should not be engaged in the activities it regulates nor be
hierarchically subordinate to the institutions that perform the regulated activities.
• Regulatory decisions should be based on science and evidence, and the decision-
making process should be robust, according to defined criteria.
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Regulatory instruments must be written such that the regulatory

activities and decisions made on the basis of such instruments are legitimate,
evidence-based and ethical. Public and private bodies and domestic and foreign
entities should be regulated equitably, with the same principles and framework,
to ensure competitive neutrality.
The regulatory authority must operate impartially, discharging its
duties independently of the regulated entities (see section 8.3 Independence).
This principle extends to researchers and other experts sitting on scientific and
advisory committees that make recommendations to the regulatory authority
on regulatory policy or the authorization of medical products. Declarations of
interest must be completed and reviewed, and rules for withdrawal should be
defined before discussions in order to maintain the integrity and impartiality of
the committee and its recommendations.
The regulatory authority should not be engaged in the activities it
regulates nor be hierarchically subordinate to the institutions that perform the
regulated activities, including the procurement of medical products by a ministry
of health or other government institution.
Regulatory activities and decisions should be based on science and
evidence and be predictable. While good regulatory judgement and discretion are
necessary in enforcement, actions and decisions should be based on regulatory
requirements and on the evidence for or the circumstances of the situation (see
also sections 8.2 Consistency and 8.6 Flexibility).
Regulators should avoid actual or perceived influence and be open and
transparent about their decisions and decision-making process. The scientific
and technical basis for regulatory oversight should be objective and accessible.
Public consultation and transparency throughout decision making should ensure
impartiality, better regulatory outcomes and greater public confidence in the use
of regulated products.
8.5 Proportionality
Regulatory oversight and regulatory decisions should be proportional to the risk
and to the regulator’s capacity to implement and enforce the decisions.
Key elements:
• Regulatory oversight should be adequate to achieve the objectives without being
excessive.
• Regulatory measures should be proportionate to the risk of the product or activity
or service.
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Box continued
• Regulations should not exceed the national capacity to implement and enforce
them.
• Assessment of medical products should be based on a benefit–risk evaluation
and continuous monitoring of the benefit–risk profile in a robust vigilance system.
The principle of proportionality demands that an action not exceed what

is necessary to achieve the intended objective. This principle should be applied
to all elements of a regulatory system. Regulation should be created only when
necessary and should be adequate for the aim and not excessive. The content and
form of regulation should be appropriate to both the issue being addressed
and the risk it poses. For instance, extensive pre-clinical and clinical studies
are necessary to ensure the safety and efficacy of a new medicine for marketing
authorization, whereas studies such as of in-vivo bioequivalence or, when
appropriate, in-vitro studies are sufficient for generic medicines.
Regulatory enforcement and inspection regimes should also be
proportionate to the risk and severity of an infraction in order to reduce or
mitigate the health risk posed by the infraction. A proportionate, risk-based
approach allows the regulator to allocate resources where the need is greater.
It also ensures that the cost of complying with a regulation is proportionate
to the nature of the risk. For instance, the frequency of inspections could be
determined in part by a manufacturer’s history of compliance.
The principle of proportionality also applies to the policies and processes
by which regulations are made. Regulation-making should be flexible and
proportionate to the complexity and/or impact of the problem that it is to
address. For instance, a rigorous cost–impact analysis may be required for a new,
complex regulatory framework, whereas a more pragmatic approach could be
used for simple regulations or when the policy alternatives are limited.
Regulation should not exceed national capacity to implement and
enforce it.
If there are no strategies, facilities and resources for implementation
and enforcement, legislation on its own will achieve nothing. A
law with modest aims and objectives that is properly enforced
is preferable to a more comprehensive one that cannot be
implemented (21).
Furthermore, lack of resources or ability to implement and enforce
represent a liability for governments.
Assessment of medical products should be based on a benefit–risk
evaluation based on the evidence submitted on the quality, safety and efficacy
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or performance of the product. All the demonstrated benefits of the medical

products should be weighed against the identified risks. Regulatory systems
should include appropriate surveillance or vigilance to monitor the benefit–risk
profile and to take any actions required.
8.6 Flexibility
Regulatory oversight should be flexible in order to respond to a changing
environment and unforeseen circumstances.
Key elements:
• The regulatory system, including its frameworks, should provide sufficient
flexibility to reflect or respond to changes in the regulated environment, such as
evolving science and technology.
• The regulatory system should be prepared to provide timely responses to urgent
situations such as public health emergencies and shortages of medical products.
• The language of regulation should reflect performance when possible, allowing
for alternative approaches to achieve the same result.
• The regulatory system should provide the flexibility for applying good judgement.
Flexibility is essential to ensure that regulatory frameworks and

regulatory systems remain “fit for purpose”. The design and use of regulatory
instruments must therefore be appropriate. A meaningful, understandable,
enforceable regulatory framework should contain sufficient detail to ensure
clarity. It should also allow flexibility to respond to new technologies and
innovation and to changes in the regulated environment and to ensure a timely
response to unforeseen public health threats. Flexibility in regulatory oversight

should be risk-based and should not compromise the quality, safety, efficacy or
performance of a product (28).
Responsiveness is an extended principle of flexibility. It represents the
possibility of responding more rapidly than usual in certain circumstances. For
example, an expedited response or review might be necessary in a public health
emergency.
Responsiveness is time-bound and temporary, as it is necessary in
urgent situations such as a public health emergency, serious shortages of a
medical product with no alternative, an unmet medical need or rare disorder
and medical products for compassionate use or donation. Regulatory systems
should be well prepared and have the necessary regulatory instruments to
respond to and manage such situations. The NRA should have flexible and
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expedited development programmes or review processes to accelerate the access

to patients by approval of innovative products for serious, life threatening and
rare diseases and to address unmet medical needs. Flexible and responsive
provisions are critical for ensuring that the authority can make decisions based
on the best available science and on benefit–risk considerations, often in the
face of less than complete information (e.g. compassionate use, emergency use
authorization or listing). Lack of the necessary regulatory tools and flexibility
can be a real, significant impediment to ensuring public safety, particularly
during public health emergencies.
When regulatory responsiveness is essential, a regulatory authority
should consider prioritizing its activities through a risk-based approach. The
involvement of policy- and decision makers and regulatory collaboration and
coordination within the international regulatory community significantly
contribute to regulatory responsiveness.
The aim of flexibility and responsiveness in regulatory frameworks
should be to accommodate the evolution of science and technology. The
language of the regulations that support laws is usually based on performance
rather than being prescriptive (15), thus allowing regulated parties to use
alternative approaches to achieve the same outcome.
Guidelines and other guidance documents are the most detailed, most
flexible and most amendable regulatory instruments. These attributes ensure
that the regulatory framework can respond to new risks in a timely manner and
allow for possible use of advances in regulatory science and technology for a
future medical product. Unlike laws and regulations, guidelines in themselves
usually do not have the force of law; however, guidelines are very effective if
appropriately anchored in the regulation and used to describe how compliance
with the regulation may be achieved. They should also allow for other, justified
approaches to compliance. Alternative approaches to the principles and practices
described in guidance may be acceptable, provided they are adequately justified.
The flexibility and amendable attributes of guidelines are lost if such detailed
texts become part of regulation.
For science that is evolving rapidly but not sufficiently mature to justify
regulatory guidelines, lists of “points to consider” can provide useful principles-
based guidance and definitions for promoting best practices, a common
regulatory understanding and international convergence and prepare the ground
for eventual guidelines. International guidelines and standards should always
be considered in developing new guidance documents, and regulators should
support international harmonization and convergence. National requirements
beyond international standards should be well justified.
The regulation of medical products is complex and evolving. New
technologies and practices will continue to pose challenges to regulatory systems
and redefine the boundaries of what can and should be regulated. Before
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developing regulations to address new technologies or address certain practices,

regulators should have the necessary regulatory flexibility to interpret existing
legislation and regulations appropriately. It should be possible to revise or
withdraw a regulation or guideline when it is no longer required.
8.7 Clarity
Regulatory requirements should be accessible to and understood by users.
Key elements:
• Regulatory instruments should be written in language that is understood by users.
• The terminology should be defined and consistent with international norms
when possible.
• Consultation, education and training in new requirements contribute to
clarification and compliance.
• Guidelines and good guidance practices are instrumental to proper interpretation
of regulations.
• The process and basis for taking regulatory decisions and enforcement actions
should be clear.
Compliance with and consistent application of regulatory requirements

and processes require a clear understanding of what is expected. Both the
regulator and the regulated party should understand the conduct that is expected
and the consequences of non-compliance.
Proposed regulatory instruments should be written in language that
can be understood by the intended users. This will require collaboration with
legal personnel in considering the objectives of the legal instrument, the

intended audience, other stakeholders who may be impacted and feedback from
internal and external consultations, including subject matter experts. Drafting
of instruments in clear, unambiguous, precise language in a form consistent
with other laws and regulations reduces possible disputes or misinterpretation
and promotes compliance. Meetings between NRAs and regulated entities can
be helpful in clarifying the application of guidance and cases in which there is
no guidance.
As an initial step, an authority that is drafting medical product
regulations should conduct a review to identify unclear areas and resolve any
inconsistencies in the regulation itself or with other regulations. This step also
provides an opportunity to review the “regulatory stock” – the accumulated
body of applicable regulations (see 4. Glossary) – to identify whether updating
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and better integration of regulatory requirements are necessary to eliminate

inconsistencies, redundancy and complexity or to adapt to new requirements.
Interested parties, including the public, should be informed of and
contribute to regulatory development and regulatory impact analysis (see
4. Glossary) in order to improve the quality and language of a regulatory
instrument, ensuring clear understanding of what is intended and increasing
the likelihood of buy-in and future compliance. The means by which interested
parties can contribute should be made clear.
Regulatory impact analysis is valuable for systematic assessment of
the expected effects of regulatory proposals. It is usually undertaken by policy
analysts in the regulatory departments, agencies or ministries that are sponsoring
the proposal, primarily to assist decision-makers in considering a proposal.
The product of a regulatory impact analysis is a document that summarizes
the regulatory proposal, possible alternatives and the aspects and impacts of
implementing the proposal.
Terms should be defined in order to avoid ambiguity or misinterpretation.
When possible, they should be consistent with established international norms,
standards and harmonized guidelines. As noted previously, international standards
and guidelines (see 4. Glossary) are particularly important vehicles for promoting
common regulatory language, convergence and international cooperation.
The principle of clarity is also applicable to regulatory and administrative
guidelines, which are instrumental for interpreting and providing operational
clarity to regulations. Guidelines should be developed according to good
guidance practice to ensure that they are written clearly and concisely and
are consistent with other guidelines and the underlying regulations. Standard
templates and formats, style guides, editors, experts in the regulatory framework
and users’ feedback obtained with established tools (e.g. forms, webinars,
institutional polls) should be used.
Draft guidelines, like regulations, should be submitted for internal and
external consultation to confirm that the language is clear or requires revision to
improve comprehension. Plain language and simple sentence structure should
be the goals, with illustrative examples when possible. Education, awareness
sessions and training, with clear timelines for adoption of new regulations and
guidelines, should be considered for ensuring clarity and compliance when
introducing or amending regulations and guidelines, particularly when they
are complex.
Regulations and supporting guidelines should be reviewed periodically
to ensure that they reflect the authority’s current practices and expectations,
are adapted to scientific and technological developments and are aligned with
current international standards and guidelines, when applicable. Review and
revision of a guideline should include consideration of the consequential changes
in other guidelines, which should be revised simultaneously.
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The process and basis for taking regulatory decisions and enforcing
them should be clear and accessible to those directly impacted or otherwise
affected (see section 8.9 Transparency).
In summary, clarity is essential in all aspects of regulatory oversight
(requirements, procedures, decisions and communications) if regulatory
programmes are to have the desired effect.
8.8 Efficiency
Regulatory systems should achieve the intended results within the required time
and at reasonable effort and cost.
Key elements:
• Efficient regulatory systems achieve the intended public health goals.
• A sound regulatory framework, competent staff and effective use of resources and
information from other authorities are the key elements of an efficient regulatory
system.
• Policy-makers should seek the most efficient, least burdensome means of
achieving their regulatory purposes and confirm effectiveness after
implementation.
• The total burden and resources required for cumulative regulation should be
evaluated.
• Regulatory authorities should continually explore ways of improving efficiency in
fulfilling their mandate.
• Alignment of regulatory requirements with those of other countries and
international collaboration promote efficiency.
• Regulated entities contribute critically to the efficiency of regulatory systems.
• The efficiency of regulatory instruments and regulatory operations should be

assessed with performance-based indicators.
An efficient regulatory system must be based on science and evidence

and the principles of risk assessment and management and embed a strategy of
international regulatory cooperation into daily business. A regulatory system
in which sound decisions cannot be made in a timely, consistent fashion is not
effective. Its efficiency depends not only on sufficient resources but also on the
type of resources and their effective use, irrespective of size. In this context, lack
of integrity in the overall regulatory system is a barrier to regulatory efficiency.
Regulatory systems with fewer resources can be as effective as those
with more resources if they use a risk-based approach, take advantage of the
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work and decisions of other regulatory authorities and focus their resources
on essential, value-added activities that can be provided only by the regulatory
authority (26).
Regulatory oversight cannot be considered efficient if it creates unjustified
barriers to access, trade or international regulatory cooperation. Successful
establishment of effective regulatory control on medical products depends on a
number of factors, as previously described, including:
■■ analysis of options, including the results of consultations with
stakeholders, as regulations are more likely to be effective if those
who are impacted have provided input;
■■ regulations that are proportional to the perceived risk, encourage
innovation and pose no unnecessary barriers to trade (e.g. sample
testing at import); and
■■ early planning for implementation and for the practicalities of
future enforcement. Application and enforcement should not be
after-thoughts.
In developing new regulatory instruments and analysing their impact,
the regulatory authority should develop “strategies for education, assistance,
persuasion, promotion, economic incentives, monitoring, enforcement, and
sanctions” (34). The authority should decide which compliance strategies to
establish and whether consumer awareness and market forces can reasonably
be used, in addition to the threat of penalties. The role of civil society in
monitoring adherence to regulation should also be considered. Co-regulation
(see 4. Glossary) may be considered in certain circumstances. In such situations,
a government issues regulations and enters into a non-statutory agreement
with a body (e.g. industry or professional health care association) to develop
and administer a compliance programme. When a government works with and
through such a body in regulating the activity, it does not delegate its oversight
of the activity.
Regulatory authorities may also consider use of third parties to conduct
their activities. This model is prevalent in the regulation of medical devices,
such as use of recognized auditing organizations to audit manufacturers’ quality
management systems to ensure that they are of an international standard and
respect applicable regulatory requirements. Regulatory resources are used
to establish and maintain oversight of audit organizations, resulting in more
effective use of limited resources (35).
A government incurs costs by establishing and maintaining regulatory
systems. Industry and other regulated parties incur costs in complying with
regulations, such as undertaking studies, preparing application dossiers,
maintaining records and paying fees – the cost of doing business. Additional
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costs accrue in inefficient regulatory systems. If the cost of complying with a

regulation is disproportionately high, companies may decide not to develop
a product and/or commercialize it in a particular market. For instance, a
mandatory requirement to conduct local clinical trials as a condition for
marketing authorization could be a disincentive to entering that market,
particularly if trials conducted elsewhere reflect the patient profiles of the
intended market and demonstrate the safety and efficacy of the product.
Similarly, long and/or unpredictable times for product review result in lost
revenue and unnecessary delays in the availability of products for patients, with
potentially significant negative implications for morbidity, mortality, health
care costs and the economy. Healthy economies require healthy people.
Inefficiency also results in a negative impact on a regulatory authority’s
resources, reputation and job satisfaction and increases the time spent
addressing complaints about performance. Regulatory frameworks that reflect
the principles of proportionality, flexibility and consistency are more likely to be
efficient, as they allow resources to be allocated to the regulatory activities that
most need them.
International collaboration. Regulatory frameworks that are consistent and

aligned with those of other countries and regions encourage the necessary
investment to bring appropriate, affordable products to that market. Internationally
consistent frameworks also enable the regulatory authority to participate in
work sharing networks and other forms of regulatory cooperation (including
convergence, harmonization, information- and work-sharing, reliance and
recognition). When properly anchored in the regulatory framework, reliance on the
work of other authorities eliminates or reduces inefficient duplication of regulatory
evaluations of medical products and inspection or audit of facilities. International
collaboration thus facilitates access to medical products for all.
Regulatory authorities should continually explore means of improving

their efficiency while maintaining standards for evaluating the quality, safety and
efficacy or performance of medical products. This could include introduction
or refinement of good review practices (28) and a quality management system
(28); greater, more effective use of information technology; consultations with
industry, health care professionals and patients on common deficiencies and
how best to address them; risk-based criteria for scheduling and conducting
inspections; addressing gaps in guidance; performance measurement; and – as
noted above – regulatory cooperation and reliance (26).
Industry also contributes critically to the efficiency of regulatory
systems. For example, high-quality applications for marketing authorization
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reduce the overall review time by reducing the number of review cycles.
Similarly, a manufacturer with a good compliance record should not require the
same frequency or depth of inspection as a poorly performing manufacturer.
Consultations and training can effectively complement enforcement in achieving
the desired level of compliance.
In a regulatory impact analysis, policy-makers should seek the most
efficient, least burdensome means of achieving their regulatory purposes at a
minimum reasonable cost. A regulatory approach should include consideration
of the total burden and resources required for cumulative regulation.
Periodic performance assessments should be conducted to evaluate the
actual efficiency of regulatory instruments to ensure that the foreseen benefits
are realized and, if so, the direct and indirect costs.
8.9 Transparency
Transparency is the hallmark of a well-functioning regulatory system and is
essential for building public trust and enabling international cooperation.
Key elements:
• Transparency requires investment and a culture of openness, supported by
government policy, commitment and action.
• Stakeholders should be consulted in the development of new or revised regulatory
instruments.
• Regulatory requirements, processes, fees, assessments, decisions and actions
should be as accessible as possible.
• The policies of the regulatory authority with respect to disclosure should be
consistent with national laws on access to information.
The WHO Constitution states “Informed opinion and active co-operation

on the part of the public are of the utmost importance in the improvement of
the health of the people.” Transparency is in the interests of patients, consumers,
governments, health care workers and manufacturers, as it increases public trust
and confidence in the regulation of medical products. Transparency in regulatory
requirements and actions results in better informed decisions about investment
in the public and private sectors and discourages discriminatory, corrupt or
abusive practices.
With transparency, all affected and potentially interested parties –
domestic, foreign, public and private – have a meaningful opportunity to be
informed of new or amended regulations and guidelines and to make their
297
views known before they are enacted. With transparency, once medical product
regulations and guidelines are adopted, they are readily available and accessible
to stakeholders and the general public. Relevant laws, regulations and guideline
documents should be posted on the authority’s website. Additionally, national
industry and professional associations often work with regulatory authorities to
disseminate new regulatory texts or to provide opportunities for exchanges of
relevant information.
The assessments (positive and, when possible, negative), decisions and
actions of the regulatory authority should be documented and made publicly
available, with the rationale for the decisions, ideally by issuing a public
assessment report. This information is important to a range of stakeholders,
including industry, researchers, health professionals, patients and consumers,
who use the information for various purposes. It is also essential for building
trust and confidence in the regulatory system.
Regulated parties should be able to access the full reports of a product
assessment or site inspection that pertains to them. This not only provides
insight into the basis for comments and decisions but is also educational, helping
to improve regulatory compliance and the quality of future submissions. This
practice can also be beneficial to the regulatory authority by fostering a culture
of transparency and accountability at operational and management levels.
Furthermore, it can lead to higher-quality reports by ensuring that they clearly
explain how such assessments led to decisions. The manufacturer should be given
the opportunity to redact any trade secret or confidential personal or commercial
information before publication.
Transparency requires investment and a culture of openness, which, in
turn, should be supported by government policy, commitment and action. While
not all regulatory authorities may be able to implement the full range of measures
for an optimally transparent regulatory system, a step wise approach can be
adopted. Given the prevalence of smart devices and the Internet, an up-to-date,
searchable public website could be established and maintained that contains

basic information such as:
■■ the roles, responsibilities, organization and contact information of
the regulatory authority;
■■ access to the laws, regulations, guidelines and procedures necessary
to satisfy regulatory requirements and improve the efficacy, safety
and quality of medical products;
■■ a searchable registry of approved, suspended and withdrawn
products;
■■ product information for health care professionals and patients;
■■ the licensing status of manufacturing sites;
298
Annex 11
■■ health advisories, safety information, alerts on quality or on

substandard or falsified medical products, advisory notices, recalls
and other time-sensitive information of public health interest;
■■ performance targets and results and annual reports;
■■ proposed new regulatory instruments, including periods for
comment and how to provide input; and
■■ public assessment reports and reports of facility audits or inspections.
The findings of all audits or oversight reviews of the performance and
functioning of the regulatory authority should be made public. Such reviews
are important elements of public accountability, as are reports of performance
against targets and annual reports.
In fulfilling their responsibilities, regulatory authorities will create or
access proprietary or confidential information. Examples include identifiable
personal information from clinical trials or reports of adverse events, trade
secrets or confidential commercial information such as specifications of medical
product compounds or materials or manufacturing processes. Measures should
be established to prevent the disclosure of such information, with a mechanism to
address disputes about the proprietary nature or confidentiality of information.
In general, national laws and regulations should favour transparency
and public access to both the process and the criteria of regulatory decision-
making. The disclosure policies of a regulatory authority should be consistent
with national laws on public access to government information or “freedom of
information”. Procedures and contact points for obtaining information held by a
regulatory authority should be accessible and clear.
Transparency enables adoption of new, more efficient ways of conducting
regulatory operations. It is incumbent upon regulators to practise transparency
in regulatory operations and decisions, not only as a fundamental principle of
GRP but also to build trust and maximize opportunities for cooperation and
reliance as part of the shared responsibility of the regulatory community.
9. Enablers of good regulatory practices

An enabling environment facilitates successful implementation of GRP. Some
elements are described below.
9.1 Political and government-wide support

Sustained support at the highest political and government levels, including
policy-makers, is essential for proper implementation of the concept and
principles of GRP. GRP should form an integral part of all government policies
on regulatory systems and be backed by strong political support.
299
9.2 Effective organization and good governance

supported by leadership
The structure and line of authority among and within all institutions in the
regulatory system should be well defined. The integrity of the overall regulatory
system is critical to the efficient performance of each of its constituent
institutions. If more than one institution is involved in the regulatory system,
the legislation or institutional regulation should provide for clear coordination
and no overlap of regulatory activities. Leadership is critical for setting and
realizing the organizational vision, mission, policies and strategies, which in turn
significantly contribute to organizational efficiency.
9.3 Inter- and intra-organizational communication,

collaboration and coordination
Adequate, effective communication plays a fundamental role in the exchange
of information within and outside the institutions that form the regulatory
system. When regulatory authorities communicate regularly, both internally
and externally, they remain more transparent and accountable. Communication
of correct information prevents potential misunderstandings and dissemination
of misleading information to patients and the public. Communication is a
powerful tool for collaboration and coordination with relevant national and
international stakeholders, which leads in turn to efficient use of resources and
better regulatory outcomes.
In view of their responsibilities, regulatory authorities should have the
personnel, infrastructure and technical tools adequate for the performance of
their tasks. Coordination may be facilitated by communication technologies
and efficient, rapid information-sharing, which will result in fewer gaps and less
duplication of effort.
9.4 A robust, well-functioning quality management system

A quality management system (28), which includes application of quality risk
management principles, makes the decisions of regulatory authorities more
credible and their operations more stable and consistent. A quality management
system contributes to systematic planning, control and improved quality in all
processes in regulatory functions and ensures a comprehensive approach.
9.5 Sufficient, sustainable financial resources

Investment in a regulatory system is critical to a well-functioning health care
system. Adequate financial resources to fulfil its regulatory mandate effectively
and to improve the performance of regulatory activities continuously are essential
300
Annex 11
for the independence, impartiality, consistency and efficiency of a regulatory

system. The financial resources of all institutions of the regulatory system should
be sustainable, apart from donations from donors or philanthropic entities.
9.6 Competent human resources

An array of technical and scientific knowledge and skills of regulatory staff
contribute to the development, implementation and maintenance of an effective
regulatory system for medical products. Policies and measures for personal
and career development (e.g. training programmes, competitive remuneration
schemes) are critical for regulatory authorities to attract competent staff and
retain them in the service.
9.7 Organizational ethics and values

Regulatory personnel should abide by organizational ethical principles and
values and show professionalism. All regulatory staff should be made aware of
and be trained in the ethical principles and values of the regulatory authority
(e.g. a code of conduct). A system should be established, within or outside
the regulatory system, for managing departures from organizational ethics
and values.
9.8 Science- and data-driven decision-making process

Regulatory decisions and decision-making should be based on scientific
foundations and accurate data rather than intuition or arbitrariness. Science-
based decisions provide for consistent, predictable regulatory outcomes.
Adherence to international standards and guidelines is a key enabler of science
based regulatory decision-making.
The enablers listed above are not effective when present individually.
Rather, they work in harmony in the application and implementation of GRP. For
example, sufficient, sustainable financial resources contribute to the recruitment,
development and maintenance of competent human resources. Similarly,
financial resources should be managed according to good governance practices.
10. Implementing good regulatory practices

WHO Member States are encouraged to implement GRP in their regulatory
systems with due consideration of the realities of their legal and regulatory
systems. Transparent, predictable processes should be used to ensure high-
quality regulatory oversight that achieves the intended objectives while
minimizing negative impacts and costs. At the same time, regulatory systems
should be sufficiently flexible for the processes to be applied proportionately
301
to the scope, magnitude and complexity of the issue. Sustained support at the
highest levels, with adequate resources, is essential.
Further guidance will be issued to assist Member States both in
establishing new regulatory systems for medical products and in updating
existing ones.
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28. Policy evaluating and publicly designating regulatory authorities as WHO-listed authorities.
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304
SELECTED WHO PUBLICATIONS OF RELATED INTEREST
The World Health Organization was established in 1948 as a specialized agency of the
United Nations serving as the directing and coordinating authority for international
health matters and public health. One of WHO’s constitutional functions is to The International Pharmacopoeia, tenth edition.
provide objective and reliable information and advice in the field of human health, a 2021 (online)
responsibility that it fulfils in part through its extensive programme of publications. WHO Expert Committee on Specifications for Pharmaceutical Preparations
Fifty-fourth report.
The Organization seeks through its publications to support national health strategies
WHO Technical Report Series, No. 1025, 2020 (xiv + 325 pages)
and address the most pressing public health concerns of populations around the world.
To respond to the needs of Member States at all levels of development, WHO publishes International Nonproprietary Names (INN) for pharmaceutical substances
practical manuals, handbooks and training material for specific categories of health Cumulative List No. 17 2018 (available on CD-ROM only) and Cumulative List
workers; internationally applicable guidelines and standards; reviews and analyses of No. 18 2021 (available as searchable pdf – in preparation)
health policies, programmes and research; and state-of-the-art consensus reports that The selection and use of essential medicines
offer technical advice and recommendations for decision-makers. These books are Report of the WHO Expert Committee (including the 21st WHO Model List of
closely tied to the Organization’s priority activities, encompassing diseases prevention Essential Medicines and the 7th WHO Model List for Children),
and control, the development of equitable health systems based on primary health WHO Technical Report Series, No. 1021, 2019 (xxxviii + 639 pages)
care, and health promotion for individuals and communities. Progress towards better
WHO Expert Committee on Biological Standardization
health for all also demands the global dissemination and exchange of information
Seventy-first report
that draws on the knowledge and experience of all WHO’s Member countries and the
WHO Technical Report Series, No. 1028, 2020 (xi + 101 pages)
collaboration of world leaders in public health and the biomedical sciences. To ensure
the widest possible availability of authoritative information and guidance on health
matters, WHO secures the broad international distribution of its publications and
encourages their translation and adaption. By helping to promote and protect health
and prevent and control disease throughout the world, WHO’s books contribute to
achieving the Organization’s principal objective – the attainment by all people of the
highest possible level of health.
The WHO Technical Report Series makes available the findings of various international
groups of experts that provide WHO with the latest scientific and technical advice
on a broad range of medical and public health subjects. Members of such expert
groups serve without remuneration in their personal capacities rather than as
representatives of governments or other bodies; their views do not necessarily reflect
the decisions or the stated policy of WHO. To purchase WHO publications, please
contact: WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27,
Switzerland (tel. +41 22 791 3264; fax: +41 22 791 4857; email: [email protected]; Further information on these and other WHO publications can be obtained from
http://www.who.int/bookorders). WHO Press, World Health Organization, 1211 Geneva 27, Switzerland
www.who.int/bookorders
tel.: +41 22 791 3264; fax: +41 22 791 4857; email: [email protected]
1033
1033

The Expert Committee on Specifications for Pharmaceutical
Preparations works towards clear, independent and practical

standards and guidelines for the quality assurance of
medicines and provision of global regulatory tools. Standards
are developed by the Expert Committee through worldwide
consultation and an international consensus-building
process. The following new guidance texts were adopted and
recommended for use:
on Specifications
Guidelines and guidance texts adopted by the Expert Committee
on Specifications for Pharmaceutical Preparations; Points
for Pharmaceutical
to consider when including Health Based Exposure Limits
(HBELs) in cleaning validation; Good manufacturing practices:
water for pharmaceutical use; Guideline on data integrity;
Preparations
WHO/United Nations Population Fund recommendations
for condom storage and shipping temperatures; WHO/United
Nations Population Fund guidance on testing of male latex
condoms; WHO/United Nations Population Fund guidance Fifty-fifth report
on conducting post-market surveillance of condoms; WHO
“Biowaiver List”: proposal to waive in vivo bioequivalence
requirements for WHO Model List of Essential Medicines
immediate-release, solid oral dosage forms; WHO Certification
Scheme on the quality of pharmaceutical products moving
in international commerce; Good reliance practices in
the regulation of medical products: high-level principles WHO Technical Report Series
and considerations; and Good regulatory practices in the
regulations of medical products.
All of the above are included in this report and recommended
for implementation.
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WHO Expert Committee on Specifications for Pharmaceutical Preparations

WHO Expert Committee

WHO Expert Committee

This report contains the views of an international group of experts and

© World Health Organization 2021

FEFO first expiry-first out

MSC maximum safe carryover

QRM quality risk management

SPC summary of product characteristics

Initiative, Geneva, Switzerland

The main session of the Fifty-fifth Expert Committee on Specifications for

Dr Daisaku Sato, Tokyo, Japan

Dr Mingzhe Xu, Beijing, China

Representation from intergovernmental organizations 3

International Atomic Energy Agency (IAEA)

State actors (pharmacopoeias) 4

Pharmacopoeia of the Republic of Korea

World Health Organization 5

Representation from WHO Regional Offices 6

Introduction and welcome

I. Expert Committee on Specifications for Pharmaceutical

II. Update on new guidelines, norms and standards

III. Technical agenda topics of the Fifty-fifth Expert Committee

ingredients (APIs), finished pharmaceutical products (FPPs),

IV. Points of discussion

■■ The accessibility of ECSPP’s work. Participants expressed their

Election of chairpersons and rapporteurs

Participation in Expert Committee on Specifications

c. closed sessions, for agreeing to ECSPP recommendations and for

The next IMWP meeting was to be hosted by the Mexican Pharmacopoeia

It is progressing slowly, with only 14 classes completed so far. The

3.2 Quality assurance terminology

3.3 Guidelines and guidance texts adopted by the Expert

4.1.1 Final report on phase 9

in identifying and investigating problems of quality and to take corrective

4.1.2 Update on phase 10

5.2 General chapters

The existing chapter is based on the corresponding internationally harmonized

5.2.2 General identification tests

5.2.3 Test for histamine-like substances

The ECSPP reviewed the revisions and discussed whether, in

5.3 General monographs for dosage forms

5.3.2 Liquid preparations for oral use

5.4 Specifications and draft monographs for medicines, including

Dexamethasone sodium phosphate

Remdesivir intravenous infusion

Laboratory investigations are due to start soon; and both monographs

5.4.2 Antiviral medicines, including antiretrovirals

5.4.3 Medicines for tropical diseases

5.4.4 Medicines for maternal, newborn, child and adolescent health

Estradiol valerate and norethisterone injection

Pharmacopoeial Specifications for Medicines in 2019 and 2020. After laboratory

health perspective and addressing known deficiencies in quality. The concept

5.5 Update on the virtual informal consultation on Screening

44 monographs and general texts under development for The International

7.1.2 Good manufacturing practices for