We Love Pharma, courtesy of CDM Worldwide
The pharmaceutical industry gets a bad rap. To listen to the critics you’d think pharmaceutical companies are in the same sleazy category as oil, finance and tobacco companies. But pharmaceutical companies invent life-saving medications, not to mention countless other psychoactive products that many of us enjoy on a recreational basis. Pharmaceutical companies get blamed for fraud, kickbacks, and research deaths, but they never get the credit for oxycontin.
That is why I was thrilled to see that GlaxoSmithKline is sponsoring the prize for the
British Medical Journal
‘s annual
Research Paper of the Year. Sure, the pharma-bashers will whine like infants at the
BMJ’
s decision to brand a medical research prize with the name of multinational drug company, just as they’re whining about an American editor’s decision to re-locate a leading bioethics journal to the Texas headquarters of a
stem cell tourism clinic. These people just don’t get it. This is not about propaganda or corruption. It is about developing innovative medications for diseases that we didn’t even know existed.
In that spirit, my nomination for the GlaxoSmithKline (GSK Research Paper of the Year goes to a ground-breaking article about GSK’s very own antidepressant, Paxil, which was published in the
Journal of the American Academy of Child and Adolescent Psychiatry
. The title of the article is “Efficacy of Paroxetine in the Treatment of Adolescent Major Depression,” but seasoned pharma-watchers know it better as
Study 329. The data behind Study 329 showed that Paxil didn’t actually work in adolescents – that, in fact, it was
no better than a sugar pill. However, as any marketer understands, bad data cannot be allowed to interfere with a good paper. By the time Study 329 appeared in print, GSK had used the magic of biostatistics to transform the raw data into a gleaming advertisement for Paxil. As a result, when FDA eventually decided that Paxil had a few minor side-effects,
such as suicide, Study 329 had already done its work: getting a GSK product into the hands of troubled teenagers. And wait, here’s the beauty part: although the published version of Study 329 was “authored” by leading academic psychiatrists, it was actually
written by a GSK ghostwriter.
Of course, the pharma-bashers have been complaining about Study 329 for years. Some of them even want the journal to retract it. The lead “author” who signed the paper, Martin Keller of Brown University, has been
beaten up by the Senate Finance Committee,
harassed by the New York attorney general, and vilified in the press, all because he put his name on a ghosted article and forgot to report
half a million dollars in pharmaceutical income. To which I say: stand strong, GSK. Ignore the naysayers and the nitpickers. It’s about time you gave these good people some public recognition. Yes, it’s true that Study 329 is eleven years old, but you’re paying the BMJ over $47,000 to
sponsor this prize. Surely they can bend the rules, just this once.
The report in Science Insider said the "60 nanoseconds discrepancy appears to come from a bad connection between a fiber optic cable that connects to the GPS receiver used to correct the timing of the neutrinos' flight and an electronic card in a computer. "
"After tightening the connection and then measuring the time it takes data to travel the length of the fiber, researchers found that the data arrive 60 nanoseconds earlier than assumed," it added.
A study of a new drug for advanced skin cancer has shown it “almost doubles survival times”, BBC News has reported.
The drug, called vemurafenib, was tested in a clinical trial that examined its impact on tumour size and survival in patients with advanced melanoma skin cancer that had spread to other parts of the body. The outlook for this type of cancer is generally poor as it's an aggressive cancer with few treatment options and patients tend to survive for less than a year. Researchers found that approximately half of the patients responded to the drug and that the overall survival rate in these patients was nearly 16 months, on average.
This study provides evidence on the effectiveness of a new drug, vemurafenib, for treating some patients with metastatic melanoma. Because the drug works by targeting a specific genetic mutation, it won’t be suitable for patients who aren’t carrying the mutation, which is found in around half of patients with melanoma that has spread. Additionally, while the drug has been recommended for approval, it hasn't yet been approved for use in Europe; it is unclear at this point if and when it will be available for treatment in the UK, although the National Institute for Health and Clinical Excellence (NICE is said to be currently assessing it.
Where did the story come from?
The study was carried out by researchers from Vanderbilt University, the Hoffman-La Roche pharmaceutical company and other institutions throughout the US and Australia. The research was supported by Hoffmann-La Roche, who are the manufacturers of vemurafenib.
The study was published in the peer-reviewed New England Journal of Medicine.
The BBC covered this research appropriately, emphasising the positive results but also highlighting that the drug had yet to be approved in the UK and wouldn’t be suitable for all patients with metastatic melanoma. The broadcaster also reported on some of the limitations of the research methods.
What kind of research was this?
This was a phase II clinical trial that examined how effective a drug called vemurafenib was at inducing a clinical response and its impact on overall survival in a set of patients with metastatic melanoma. Malignant melanoma is a relatively rare but aggressive type of skin cancer that can be particularly hard to treat when caught at an advanced stage. All of the patients in the trial carried a specific genetic mutation called the “BRAF V600 mutation”, which leads to the abnormal activation of an enzyme involved in cell growth and death. Previous research indicates that vemurafenib blocks the action of this enzyme.
Phase II trials are designed to assess the effects of new drugs in highly controlled settings. These trials don’t normally employ a group of control patients receiving other forms of treatment, and so generally can’t be used to tell how a new drug compares against standard or existing treatments. These types of control-group comparisons are usually performed in phase III trials. Phase II trials are, however, a key part of the development of new drugs, and are used as a confirmatory step before a drug can be given to wider research populations.
Media coverage of this trial has compared the survival rates of patients receiving vemurafenib with those seen in general patients with metastatic melanoma, rather than patients directly involved in the study. While such comparisons are useful for readers to understand more about the drug, formal scientific comparisons of different treatments have to account for a range of important factors, such as patients’ medical histories or how advanced the cancer is when treatment is started.
What did the research involve?
Researchers enrolled 132 patients with stage IV metastatic melanoma (stage IV cancer means it has spread to other parts of the body, such as the lungs or liver . They all carried a form of BRAF V600 genetic mutation. All patients had previously been treated for the disease, and they all received the same dose of the drug vemurafenib twice a day. The patients stopped taking the drug if they experienced unacceptable side effects or if their disease progressed.
The patients underwent tumour imaging (either magnetic resonance imaging (MRI or computed tomography (CT at the beginning of the study and every six weeks thereafter. Researchers used these scans to assess any changes in tumour size and response to the treatment.
Researchers then analysed the data to determine the proportion of patients who responded to treatment.
What were the basic results?
The patients were followed up for an average (median of 12.9 months. The researchers found that:
- Overall, 53% of patients showed some reduction in the size of their tumour measured at the start of the study.
- Among those that responded, eight patients achieved a complete response (6% of the total study group , and 62 patients (47% achieved a partial response (47% of the total study group .
- Of the patients who responded to treatment, 23 (33% of responders maintained that response at the end of the study.
- The median duration of response was 6.7 months (95% CI 5.6 to 8.6 months .
- Median overall survival was 15.9 months (95% CI 11.6 to 18.3 months , and 62 patients (47% were still alive at the end of the study.
- The overall survival rate at six months was 77% (95% CI 70% to 85% , at twelve months was 58% (95% CI 49% to 67%, and at eighteen months was 43% (95% CI 33% to 53% .
Most patients experienced at least one side effect due to the study drug. The most commonly reported side effects were joint pain, rash, fatigue, sensitivity to light and hair loss. Four patients (3% stopped taking the drug due to side effects. One patient died due to a rapid progression of the melanoma along with kidney failure; the researchers said this may have been related to taking vemurafenib but this was not certain.
How did the researchers interpret the results?
The researchers concluded that vemurafenib effectively targets metastatic melanoma tumours in patients with BRAF V6000 mutations, and that response rates are higher than those seen with other treatments.
Conclusion
This study has shown that patients with a specific mutation and advanced metastatic melanoma have a high response rate to a new drug, vemurafenib. Currently, treatment options for people with metastatic melanoma can involve chemotherapy, radiotherapy or immune therapies, but even with treatment the outlook is usually poor once their cancer has spread. Often, people with late-stage disease may be enrolled in clinical trials such as this to try and find more effective treatments.
Researchers say that the long follow-up of their study provides initial evidence on the overall survival of patients receiving this drug, something that phase III studies have so far not been able to demonstrate.
Researchers point out, however, that patients do develop resistance to vemurafenib, and that further research is needed to determine how this occurs.
Previous studies have shown that patients with metastatic melanoma have an average survival rate of 6 to 10 months, as mentioned in some news coverage. However, it is difficult to compare this estimate to survival times seen in the current study, as the patient populations may be different. For example, it’s unclear whether these studies enrolled patients with the same genetic mutation, or how survival may be different between those with and without the mutation.
This study adds to the mounting evidence of the effectiveness of vemurafenib as a treatment of metastatic melanoma with BRAF V600 mutation. While this phase II study cannot directly demonstrate effectiveness compared to standard care, an additional phase III study has been conducted that randomised patients to receive vemurafenib or standard therapy. This study was stopped before it was complete, as an interim analysis indicated that vemurafenib significantly improved patients' progression-free survival and six-month survival, compared with standard care. At this point, all of the participants were given the new drug.
All in all, this is very promising research for the treatment of an aggressive cancer for which there are few existing options. At present the drug has been recommended for approval by the European Medicines Agency, and is currently being evaluated by NICE for use in the UK.
Analysis by Bazian
Links To The Headlines
Skin cancer drug hopes raised by study. BBC News, February 23 2012
Links To Science
Sosman JA, Kim KB, M.D., Schuchter L et al. Survival in BRAF V600 Mutant Advanced Melanoma Treated with Vemurafenib. New England Journal of Medicine 2012; 366:707-714
“Heart attack symptoms differ in women,” BBC News has today reported. The broadcaster says that women having a heart attack are less likely to experience chest pain, compared with men.
A heart attack can cause a range of different symptoms, from crushing chest pains to tingling in the limbs, and feelings of breathlessness or nausea. Given the variations in possible symptoms, US researchers set out to examine just how common chest pain and discomfort is for each gender, and whether it indicate an increased risk that a patient might die. To do so, they examined records on more than 1 million US men and women who suffered from a heart attack between 1994 and 2006. The researchers looked for links between gender, symptoms and death rates.
Overall, 42% of men with a heart attack reported chest pain, compared with 30.7% of women. Further calculations revealed that the younger a woman was, the higher the chance she would not experience chest pain.
The results from this large pool of subjects helps demonstrate that although we perceive chest pain to be the key symptom of a heart attack, it isn't always present. People may also experience any combination of symptoms without any pain at all, such as shortness of breath, sweating and nausea. Although the study suggests that a heart attack without any pain (in the chest, arm, neck or jaw may be slightly more common in women than men, raising awareness of the different possible signs of a heart attack is important for both sexes, so that when a heart attack is suspected people can receive emergency medical assistance as quickly as possible.
Where did the story come from?
The study was carried out by researchers from Watson Clinic and Lakeland Regional Medical Center, Lakeland, Florida and various other academic and health institutions in the US. It was funded by Genentech, a company specialising in pharmaceuticals and biotechnology. The study was published in the peer-reviewed Journal of the American Medical Association (JAMA .
What kind of research was this?
This was a cohort study that aimed to examine whether there is any difference between the heart attack symptoms experienced by men and women. The researchers conducting the study also looked at whether the relationship with gender is influenced by age, and whether there is any association between these factors and the risk of death while in hospital following a heart attack.
This sort of study can tell us how common it is (the prevalence for men and women to experience a heart attack (known medically as a “myocardial infarction” with or without chest pain symptoms. The research drew its subjects from a large, nationwide registry of heart attack patients called the National Registry of Myocardial Infarction. This would be a valuable source to use in a prevalence study, as its size and widespread use mean we can be fairly sure that the people within this study would be representative of all those who experience a heart attack. However, it can tell us little more than prevalence figures. For example, it can’t tell us the reasons for differences in symptoms between men and women.
What did the research involve?
The National Registry of Myocardial Infarction is reported to be the largest registry of its kind in the world, featuring records on more than 2 million patients with a heart attack admitted to 1,977 participating hospitals between 1994 and 2006. A diagnosis of a heart attack was based on clinician assessment and supporting information from investigations (such as heart attack markers on blood tests, electrocardiogram [ECG] evidence and autopsy findings . The researchers’ analysis excluded records from patients who were transferred to other hospitals, and patients who did not have complete records on gender, age or symptoms at the time they were first given medical attention. This left just over 1 million patients in their study, 42.1% of whom were women.
The researchers say that the only symptom recorded in the registry was the presence or absence of chest pain or discomfort. This pain could include:
- any symptom of chest discomfort, sensation of pressure, or tightness
- pain in the arms, neck or jaw
The symptom was classed as present or absent before admission, during admission or at both times. People who were classed as having chest pain may or may not also have experienced additional symptoms such as shortness of breath, nausea or vomiting, heart palpitations, faintness or collapse. People who experienced any of these symptoms but without pain were simply classed in the "no pain" group and no further recording was made of the individual symptoms these people actually experienced. Therefore, the study can only tell us how many people experienced "pain" or "no pain"; it can’t tell us what the people without pain experienced instead (for example, how many were admitted with breathing difficulties, or following a collapse .
Statistical analyses were used to look at the presence or absence of chest pain or discomfort in relation to gender and age, with participants principally grouped according to whether they were older or younger than 65. The analyses were adjusted for the patients’ existing characteristics, such as their cardiovascular risk factors and their cardiac and general medical histories.
What were the basic results?
Women experiencing a heart attack were, on average, significantly older than men (73.9 years old compared with 66.5 years old . More men than women presented with the symptom of chest pain or discomfort (42.0% vs. 30.7% .
Further statistical analyses revealed that the younger a woman was, the slightly higher the odds that her heart attack would have presented without pain:
- A woman aged under 45 was 30% more likely than a man of the same age to experience a heart attack without chest pain (OR 1.30, 95% CI, 1.23 to 1.36 .
- A woman aged 45 to 54 was 26% more likely (OR 1.26, 95% CI, 1.22 to 1.30 .
- A woman aged 55 to 64 was 24% more likely (OR 1.24, 95% CI, 1.21 to 1.27 .
- A woman aged 65 to 74 was 13% more likely (OR 1.13, 95% CI, 1.11 to 1.15 .
- A woman of 75 or older was only 3% more likely than a man of the same age to experience a heart attack without pain (OR 1.03, 95% CI, 1.02 to 1.04 .
The researchers found that 14.6% of women and 10.3% of men died in hospital following their heart attack. Overall, there was a significant relationship between gender, symptoms, age and risk of death (mortality . When looking at trends in mortality by age-group, the researchers found that mortality tended to be higher among younger women (aged 54 or younger who presented without chest pain than among men of a similar age who presented without chest pain.
Over the age of 54 the absence of chest pain was no longer associated with a greater risk of death for women compared with men (in other words, men and women without chest pain were at equivalent risk of death , and at the age of 65 and over women who presented without chest pain were actually less likely to die in hospital than men of a similar age and presentation.
How did the researchers interpret the results?
The researchers concluded that in the national registry of patients hospitalised with heart attack, women were more likely than men to present without chest pain. They also said that men and women differ in how frequently they present without chest pain, and that the associated differences in heart attack mortality were “attenuated with age”. In other words, older men and women had fewer differences between each other in their presentation and mortality rates.
Conclusion
This study gives us an indication of the proportion of men and women who do or don’t experience chest pain or discomfort during a heart attack and whether this could be a potential indicator of a patient being at increased risk of death. That the data was taken from a large population registry of over 1 million people makes it a valuable source of information and we can be fairly confident that it’s representative of the general US population who would present to hospital with a heart attack.
The primary result of this study is that slightly more women than men experience heart attack without pain: 42% compared to 30.7% of men. However, it is not possible to say from this study why patients do or don’t experience chest pain. The researchers say that further studies into this would be necessary.
The study also found a trend for heart attack without pain to be more common among younger women than in younger men, but the difference between the two genders diminished with each increasing age category. Women aged under 45 were 38% more likely than men of the same age to experience a heart attack without symptoms, while women between the ages of 65 and 74 were only 13% more likely to. The researchers noticed a trend for higher mortality among younger women who presented without chest pain compared with younger men who presented without chest pain, but the associations within each age-group were not all large enough to be statistically significant. It's also worth noting that analyses of younger women with heart attacks involved smaller groups of women: around three-quarters of all women in this registry were over 65 when they had their heart attack, and the average age was 73.9. Analyses of smaller numbers of people may be less robust than those of larger numbers.
The results from this large cohort help to raise awareness among the general population that although we perceive chest pain to be the key symptom of a heart attack, this is not always the case. Although chest pain is a characteristic symptom during a heart attack (sometimes described as a heavy, crushing, pressing or squeezing pain , not all patients will experience it. Some people may feel pain, tingling or discomfort in one or both arms, the throat, jaw or back in addition to pains in the chest; and others may experience pain in only these locations with no pain in the chest. Sometimes the chest pain may only be mild discomfort and it may feel like heartburn. Other common symptoms that may be experienced – either with or without pain – are feeling short of breath, sweaty and clammy, feeling sick, or feeling faint or collapsing. Sometimes a heart attack can happen with no symptoms at all.
Although the study suggests that a heart attack without pain (chest, arm or jaw may be slightly more common in women than men, raising awareness of the different possible symptoms of a heart attack is equally important in both genders, so that emergency medical assistance can be sought as quickly as possible if heart attack is suspected.
Links To The Headlines
Heart attack symptoms 'differ in women'. BBC News, February 22 2012
Women more likely to have deadly 'silent' heart attacks. The Daily Telegraph, February 22 2012
Links To Science
JAMA Press Release: Younger Women Have Symptoms Other Than Chest Pain and An Increased Risk of Dying After Heart Attack. February 21 2012
UN Population Fund
Burundi
23 Mar 2012
VACANCY NO.: Job ID 1940
CLOSING DATE: 23 March 2012 (5.00 p.m. New York time
POST TITLE: Technical Specialist (MH/RHCS
CATEGORY: ICS-11 (equivalent to P-4
POST NUMBER: New
DUTY STATION: Bujumbura, Burundi
POST TYPE: Non-Rotational
DURATION: One year (renewable 1/
ORGANIZATIONAL UNIT: Burundi Country Office, ARO
BACKGROUND INFORMATION:
Burundi is one the African Countries where maternal morbidity and mortality is a major health concern. According to results of the last DHS and Census, the maternal mortality ratio (MMR was estimated at 866 deaths per 100000 births. In addition, the health system is registering a weak contraceptive prevalence rate (18% and the presence of a skilled attendant at birth is estimated at 60 percent of the deliveries. The HIV prevalence rate remains high (3,58% with a feminization of the infection (4,02% .
Burundi has suffered repeated waves of intense conflict since independence. Thirteen years of ethnically fuelled civil war have weakened the country’s health care system, including the service provision of reproductive health care system, care for victims of sexual violence and HIV/Aids prevention. Also, as a stream 2 country implementing the RHCS Global Program, the CO will be strongly involved into interventions aiming to strengthen the national health system, the health procurement system through advocacy and Policy Dialogue, technical support including monitoring and evaluation, capacity building, management, coordination partnerships development and knowledge sharing on RHCS.
ORGANIZATIONAL SETTING:
The Technical Specialist post is located in the UNFPA Burundi office in Bujumburae. S/he reports to the Representative, who provides overall direction and supervision, and works in close collaboration with the Johannesburg sub-regional office and the Technical Division. The technical Specialist is part of a team and works in an integrated manner with the programme and operation staff. S/he will ensure technical and programmatic support, in accordance with the principles of result based management and good governance to reinforce the quality of the maternal health programme.
DUTIES AND RESPONSIBILITIES:
The Technical Specialist will have the responsibility for health system strengthening and financing for the promotion, design, monitoring and evaluation, equitable access of RH commodity for all sectors, including supply management system. She/he will provide technical advice and support to RH/FP planners, policy makers, programme managers and service providers on national policies and programmes in the field of Reproductive Health. This will include conducting relevant research, analysis and training to improve knowledge sharing. The incumbent will contribute to an enhancement of national capacity to mobilize and obtain social and political support for national policies and programmes in the field of Reproductive Health.
POLICY, ADVOCACY AND RESOURCE MOBILIZATION
• Provide technical assistance to develop the MDG5 component of the United Nations Development Assistance Framework (UNDAF , the UNFPA Country Programme and annual work plans. • Support national implementing partners in advocacy activities for inclusion of RH/RHCS in SWAPs, PRSPs and health sector reforms • Assist and advise the country office in financial resource mobilization for MNH • Advice the country office and national counterparts on integrated approaches to improve reproductive health, in particular to (i Maternal Health, (ii Family planning (including Condom programming • Reinforce and advise staff and national partners on effective supply chain management, including information management, forecasting, distribution and information systems. • Provide technical assistance to national counterparts in the costing and effective implementation of the national reproductive health action plan. • Assist and advice the country to address the urgent need for skilled health workers, particularly midwives • Assist and advise the country to eliminate obstetric fistula • Assist and advise the country to address the financial barriers to access, especially for the poorest • Provide technical assistance to strengthen the national health information system, and monitoring and evaluation.
CAPACITY DEVELOPMENT AND PARTNERSHIPS
• Maintain and foster partnerships with UN agencies and other partners in the technical area of RH, and RHCS for advancement of knowledge. Carry out joint assessments and projects, formulate recommendations on potential critical maternal health issues and provide advice in respect to MDG targets • Provide technical assistance to national partners to scale-up quality health services to ensure universal access to reproductive health, including family planning, skilled attendance at delivery, emergency obstetric and newborn care • Identify, develop and/or adapt training materials and manuals in substantive areas • Strengthen the capacity of national institutions in the areas of needs assessments, resource mobilisation and monitoring and evaluation
EVIDENCE AND KNOWLEDGE DEVELOPMENT AND DISSEMINATION
? Analysis and synthesis trends and research in the area of RHCS and Maternal Health in Cote d’Ivoire to produce technical knowledge ? Advocate for the incorporation of evaluation results and lessons learned in the updating of strategies and approaches in order to improve the effectiveness of UNFPA operations ? Contribute to the successful execution of impact evaluations. Provide support in developing a prioritized operational research agenda for UNFPA ? Promote UNFPA’s comparative substantive role and specific contribution in the changing development agenda
TECHNICAL REPRESENTATION
? Represent UNFPA on substantive issues and support advocacy for RH, and RHCS in international, governmental, U.N., and other policy and technical meetings and seminars ? Collaborate with UN agencies, academia, professional societies, and act as focal point for inter-agency working groups in the substantive area ? Act as the CO’s focal point for RHCS and Maternal Health. Carry out other duties as may be required by UNFPA Representative.
CORE COMPETENCIES:
? Values/Guiding principles; ? Performance management; ? Developing people/Coaching and Mentoring & Fostering Innovation and Empowerment; ? Working in Teams; ? Self-management/Emotional Intelligence; ? Communication; ? Appropriate and Transparent Decision Making; ? Analytical and Strategic Thinking and Results Orientation/Commitement ot Excellence ? Knowledge Sharing/Continuing Learning
FUNCTIONAL COMPETENCIES:
? Conceptual innovation in the provision of technical expertise ? Leveraging the resources of national governments and partners/Building strategic alliances and partnerships ? Job knowledge/Technical expertise
QUALIFICATIONS:
? Advanced university degree in any of the following - public health, medicine, social sciences, pharmacy, business or other related fields. The degree must be directly related to the substantive area identified in the job description of the post. A course in logistics, essential drugs, health system strengthening and financing and MIS is a plus. ? 7 years of increasing responsibilities in managing RH or health programmes with direct experience relating to supply management systems, of which at least five years national and/or international experience in advising on RH commodities, health systems and supply management. ? Extensive knowledge of supply management: forecasting, warehousing, distribution, transportation and logistics information systems. ? General knowledge of the principles and operational aspects of integrated RH/MH care. ? Familiarity with UN development programmes and working procedures, especially UNFPA policies and programming procedures, an asset. ? Fluency in French. Good command of oral and written English is required.
UNFPA provides a work environment that reflects the values of gender quality, teamwork, respect for diversity, integrity and a healthy balance of work and life. We are committed to maintaining our balanced gender distribution and therefore encourage women to apply.
We offer an attractive remuneration package commensurate with the level of the position. The package includes a competitive salary plus housing allowance, home leave, health insurance and other benefits.
1/ No expectancy of renewal in accordance with UN Staff Regulations 4.5
UNFPA has established an electronic application management system. This allows applicants to create a candidate profile, which can be updated regularly and submitted for more than one vacancy.
Download the Step by Step Guide to Applying in the E-Recruit System of UNFPA at
http://www.unfpa.org/employment/application_guide.doc. Please print out the Guide for your reference during the registration and application process.
Notice: There is no application, processing or other fee at any stage of the application process. UNFPA does not solicit or screen for information in respect of HIV or AIDS and does not discriminate on the basis of HIV/AIDS status.
Notice to applicants: In accordance with the rules of the United Nations, persons applying to posts in the international Professional category, who hold permanent resident status in a country other than their country of nationality, are required to renounce such status upon their appointment. Exceptions to this rule are very limited and can be made only for: (a stateless persons; (b newly appointed staff members who have applied for citizenship by naturalization, when such citizenship will be granted imminently; (c acting staff members in the General Service and related categories with permanent residency status, on promotion to the Professional category; (d staff members appointed under a temporary appointment. Please understand that UNFPA is not in a position to provide advice on or assistance in applying for any citizenship.
*This is a project-funded post.
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