World Health Organization

Prequalification of Medicines
Manufacturers meeting April 2011
Dr André van Zyl

Head of Inspections vanzyla@who.int

1| Dr AJ van Zyl | April 2011

 WHO GMP
In this presentation:

z Background and Introduction – GMP

– WHO – PIC/S – EU - USA

z Manufacturer survey 2010

z Discussion

2| Dr AJ van Zyl | April 2011

 GMPs

WHO GMP EU and PIC/SGMP

z First WHO GMP published in 1967 z Directives published in 1989

z Revised on an ongoing basis z Other "local" GMP existed well before

– Revisions circulated for comment, this date
informal consultations
– Expert Committee – published in z PIC formed in 1970, PIC/S formed in
TRS 1995

z Main principles z EU and PIC/S GMP similar

z "Supplementary" guidelines z PIC/S GMP based on WHO GMP

z Used in over 100 countries z 39 Participating authorities

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 WHO and PIC/S GMP
WHO GMP PIC/S GMP

z Main principles z Main principles

z Manufacture of sterile medicinal products
z Sterile product manufacture
z Manufacture of biological medicinal products for human use
z Heating, Ventilation and Air Conditioning (HVAC) systems
z Manufacture of radiopharmaceuticals
z Water for pharmaceutical use z Manufacture of veterinary medicinal products other than immunologicals
z Quality Control laboratories z Manufacture of immunological veterinary medical products

z Radiopharmaceuticals z Manufacture of medicinal gases

z Manufacture of herbal medicinal products
z Good Storage Practices (GSP)
z Sampling of starting and packaging materials
z Good Distribution Practices (GDP)
z Manufacture of liquids, creams and ointments
z Good Trade and Distribution Practices (GTDP)
z Manufacture of pressurised metered dose aerosol preparations for inhalation
z Sampling z Computerised systems

z Herbal products z Use of ionising radiation in the manufacture of medicinal products

z Manufacture of investigational medicinal products
z Hazard Analysis and Critical Control Point (HACCP)
z Manufacture of products derived from human blood or human plasma
z Reference standards
z Qualification and validation
z Validation
z Parametric release
z GMP for APIs z GMP Guide for active pharmaceutical ingredients

4| Dr AJ van Zyl | April 2011

 Examples
WHO PIC/S

16.17 Means should be instituted of

indicating failures of equipment or of
services (e.g. water, gas) to equipment.
Defective equipment should be withdrawn
from use until the defect has been rectified.
After use, production equipment should be
cleaned without delay according to detailed
written procedures and stored under clean
and dry conditions in a separate area or in
a manner that will prevent contamination.

16.18 Time limits for storage of equipment

after cleaning and before use should be
stated and based on data.

16.19 Containers for filling should be

cleaned before filling. Attention should be
given to avoiding and removing any
contaminants such as glass fragments and
metal particles.

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 Examples
WHO PIC/S

16.23 3.41

Measuring, weighing, recording, and control Measuring, weighing, recording and control equipment
equipment and instruments should be serviced and should be calibrated and checked at defined intervals by
calibrated at prespecified intervals and records appropriate methods. Adequate records of such tests
maintained. should be maintained.

To ensure satisfactory functioning, instruments

should be checked daily or prior to use for performing
analytical tests. The date of calibration and servicing
and the date when recalibration is due should be
clearly indicated, preferably on a label attached to the
instrument.

6| Dr AJ van Zyl | April 2011

 Survey
z Manufacturer's survey done in 2010 – contracted party
z Limited to identified manufacturers – with prequalified products - majority in India
z Online questionnaire divided into four sections:
1. Previous PQP Experience
2. PQP Service Design (process)
3. PQP Service Delivery (people)
4. Other Aspects of the PQP

z Section 2 (Design) is “custom” to the PQP – developed as a result of a process review with the
WHO PQP Staff and a series of interviews with pharmaceutical manufacturers
– Two multi-item questions for both assessments and inspections
– Two separate multi-item questions each for assessments and inspections respectively

z Section 3 (Delivery) is a widely-applied scale of service quality, SERVQUAL (Parasuraman,

Zeithaml, Berry)1, developed in the 1980’s; refined and applied over past 25 years
– Five separate multi-item questions each for assessments and inspections respectively

z Section 4 is also custom to the PQP and includes advocacy, training and compliance aspects
of the PQP

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 Survey
z A list of potential survey participants was compiled by the WHO PQP Staff using
internal records
– Regulatory Affairs Professionals (assessment of product dossiers)
– Quality Assurance Professionals (on-site inspections)
– Inclusion criterion: participation in the PQP of Medicines 2006 - 2010

z Contact list represents “known population” of manufacturer PQP participants: 75

original contacts; later revised to 62 (30 regulatory, 32 QA)
z Sampling plan: census – all contacts received an e-mail invitation
z All invitations sent by e-mail with two reminders; some follow up telephone
reminders
z 41 completed surveys received by 20 July (66% response rate)
– Surveys oriented toward assessment of product dossiers: 18
– Surveys oriented toward on-site inspections: 23

8| Dr AJ van Zyl | April 2011

 Survey
7.0

6.4*
6.0 6.1
6.0 6.1* 6.1* 6.1*
6.0 5.8 5.8
5.3* 5.3
5.0 5.0* 5.0* 5.0*
Average Rating

4.8*

4.0

3.0

2.0

1.0
Providing clear Providing applicants / Providing a site Providing direct access Providing an efficient
explanations of good manufacturers with inspection plan that to inspectors to process to resolve
manufacturing practice timely announcements includes all the address technical issues and questions
deficiencies observed of inspections information needed to questions or raised during the
during inspection of a prepare for an deficiencies inspection of
manufacturing site inspection manufacturing sites

9| Dr AJ van Zyl | April 2011

 Survey

Question Item Comment

Q7C.1 Providing clear explanations of good manufacturing practice deficiencies Review of pre-qualification dossiers and subsequent responses should be addressed on a fast tract to help the FP
observed during inspection of a manufacturing site manufacturer's.

Q7C.1 Providing clear explanations of good manufacturing practice deficiencies Inspection process is fair and upto the mark.
observed during inspection of a manufacturing site

Q7C.1 Providing clear explanations of good manufacturing practice deficiencies The deficiencies must be evaluated with risk to product , patient and process
observed during inspection of a manufacturing site
Q7D.1 Providing clear interpretation of GMP requirements At least once in 6 months followup audit by QA professional of other organization. example: Mylan labs QA head audit
aurobindo facily or Aurobindo QA head audit Mylan facilty
Q7D.1 Providing clear interpretation of GMP requirements If more training programs for pharmaceutical manufacturers could be organized, it would be much better.

Q7D.1 Providing clear interpretation of GMP requirements I am happy with the way pre-qualification program is conducted. No additional suggestions from me. The process of dossier
evaluation and the process of inspection are transparent and people from WHO are approachable.
Q7D.2 Providing an efficient process to resolve issues and questions raised Interpretation of regulatory guidlines should be clear.
following the inspection of manufacturing sites

Q7D.3 Providing an inspection process that makes efficient use of manufacturers’ should indicate inspection process earlier
time
Q7D.4 The clarity of questions asked during the inspection process 1. Thorough communication with the manufacturers; 2. Interpretation and application of GMP terms.

Q7D.4 The clarity of questions asked during the inspection process On new aspects / updation in expectation of regulatory, site team must be briefed

Q7D.4 The clarity of questions asked during the inspection process We are simultaneously working for compliance with all regulatory authorities. Sometimes we come across discrepancies in
standards of different authorities. At such times we expect guidance from WHO on which standards should be followed so that
we have harmonised standards for all global regulatory authorities. For example guidance on tablets formulations by Dr. Van Zyl
is available, we expect similar guidance for other formulations.
Q7D.4 The clarity of questions asked during the inspection process Some of the questions could be more specific and practical. If the manufacturer's response is not satisfactory, the inspector
should say so on site and, if possible/appropriate, provide some further instructions.
Q7D.5 Including inspectors from your country or region on the inspection team Outof 4 WHO inspcetions, only one tine inspector from our country participated in the audit only for an hour. That's why rated 3.
Need to have firm commitment from Minsitry of Health for auditing facilities along with WHO Geneva auditors. A report from
WHO auditors to ministry of health regarding prsence of local inspector and on his performance may improve this.

Q7D.5 Including inspectors from your country or region on the inspection team Inconsitencies between Inspectors style and willingness to understand different interpretations of GMP and means of achieving
the same needs to be addressed

10 | Dr AJ van Zyl | April 2011

 Survey: Comments in responses

z Providing clear explanations of GMP deficiencies observed

during inspection of a manufacturing site
– Review of dossiers and subsequent responses should be addressed on fast
track
– Inspection process is fair and up to the mark
– Deficiencies must be evaluated with risk to the product, patient and process

z Providing clear interpretation of GMP requirements, resolving

issues and clarity of questions
– Satisfied. Transparent
– If response is not clear on site (following inspectors questions) - then should
say so on site and provide some suggestions
– Inspectors inconsistent in willingness to understand different interpretations
of GMP s

11 | Dr AJ van Zyl | April 2011

 Survey: Comments in responses
7.0

6.3* 6.3* 6.2

6.0 6.1* 6.0
5.7 5.8
5.6 5.5*

5.0 5.1*
5.0*
Average Rating

4.7* 4.7*
4.3
4.2
4.0

3.0

2.0

1.0
Providing clear Providing an efficient Providing an inspection The clarity of questions Including inspectors
interpretation of GMP process to resolve process that makes asked during the from your country or
requirements issues and questions efficient use of inspection process region on the
raised following the manufacturers’ time inspection team
inspection of
manufacturing sites

12 | Dr AJ van Zyl | April 2011

 Survey: Comments in responses
50%

40%

30%

20%

10%

0%
1 2 3 4 5 6 7
Í Less Stringent --- More Stringent Î

WHO GMP vs US CFR and EU GMP: Interclarity Research & Consulting, Inc.

13 | Dr AJ van Zyl | April 2011

When asked how strongly they agree or disagree with the statement "WHO GMP requirements are more
stringent than EU or US FDA GMP requirements", the majority of manufacturers indicated that they were more
stringent.

Comment

It is quite descriptive and elaborative. Interpretation of WHO guidelines are very easy compared to others.Even minute
points covered in WHO GMP.
The sampling plan and protocols should be made more strict.
Such as provisions about sampling and the approval of changes etc.
WHO is specififying, how to perform the activities alongwith scientific rationale and explanations.
The inspection takes a long time, it covers a wide range of areas
The requirement of EU / MHRA is more as compared to WHO, it need to be harmonise
Sometimes they ask us to perform certain studies thrice which are not required by any other regulatory bodies
Regarding the aspects of safety and effectiveness
very specific like one batch vs 3 batch requirement for filling
eg. conducting all ID tests on each container even if a robust ID test is available for each container.
The guidance are more detailed, specific and useful such as Guidance on HVAC & Water System
All are respected.
Again this is a general comment where the guideline points are interpreted differently and understanding of the
inspectors whrere guideline are general.
Each and every points of the WHO guideline are covered while the inspection & suggesions were provided with
observations for compliance & suffieicnet time is give implementaion of corrective actions. All supporting documents were
also required for compliance to closure of audit.
accelerated Stability data requirement is 6months in case of WHO and where as 3months with USFDA. Validation
data of three batches is a part of PQF. where as one batch and a commitment in USFDA.
The way WHO regulations are laid out and implemented, takes into account best of both EU and US FDA GMP
requirements. It covers overall GMP, products and processes.
The WHO requires 100% sampling from each container of a raw materia's lot when received for manufacturing a
formulation even if the vendor is validated.
It focuses more on the operational levels, not just paper work or procedures evidence. It also emphysizes detailed
practice and skills/capbility of employees.

14 | Dr AJ van Zyl | April 2011

 Comments (WHO GMP more stringent)
z Quite descriptive and elaborate. Interpretation of WHO GMP is very easy compared to others. Even minute points are
covered in WHO GMP
z Guidances are more detailed, specific and useful such as HVAC and Water
z WHO guidelines take into account the best of EU and FDA. It covers overall GMP, products and processes
z WHO explains how to perform activities alongside with scientific rationale and explanations
z Sampling
– The sampling plan and protocols should be made more strict
– Provisions about sampling and the approval of changes
– WHO requires 100% sampling from each container even if the vendor is validated
– Asking all ID tests on each container even if a robust ID test is available
z Inspections take a long time and cover a wide range of areas
z It focuses more on operational levels not just paper work or procedure evidence
z The requirement of EU / MHRA is more compared to WHO - need to harmonize
z They ask us to perform some studies thrice while others don't
z Very specific like asking 3 batches for filing
z Regarding safety and effectiveness
z Accelerated stability data required for 6 months where FDA requests 3 months. Validation of three batches opposed
to one batch data (FDA)
z Guidelines are general and different interpretations by inspectors

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 The way forward…

z Invite comments from the floor

z Discussion
z List recommendations

z WHO Procedure:
z Secretariat will take it to the Expert Committee
z Discussion, recommendation: Action if needed
z Revision, comment, informal consultation, Expert Committee

16 | Dr AJ van Zyl | April 2011