What is the WHO-UMC Causality Assessment?

The WHO-UMC (World Health Organization-Uppsala Monitoring Centre) Causality Assessment is a vital framework used to evaluate the likelihood that a specific drug, vaccine, or other medical intervention has caused an adverse event. Developed through a collaboration between the World Health Organization (WHO) and the Uppsala Monitoring Centre (UMC) in Sweden, this system plays a crucial role in pharmacovigilance and drug safety monitoring worldwide.

The importance of the WHO-UMC Causality Assessment lies primarily in its contribution to ensuring drug safety and efficacy. It helps in discerning whether reported adverse effects are due to the product itself or are coincidental occurrences. This assessment is pivotal not only for patient safety but also for maintaining public trust in pharmaceutical products and vaccination programs. By accurately identifying adverse drug reactions (ADRs), health authorities can take appropriate measures such as updating drug labels, restricting drug use, or even withdrawing a drug if necessary.

How does the WHO UMC Causality Assessment work?

The process of the WHO UMC causality assessment typically involves the following steps:

Data collection: The first step is to gather comprehensive information about the suspected adverse drug reaction. This includes details about the patient's medical history, concurrent medications, timing of the event in relation to drug exposure, clinical presentation of the reaction, laboratory findings, and any other relevant factors.

Medical Literature Review: Healthcare professionals may review published literature, case reports, clinical trials , and pharmacovigilance databases to gather additional evidence about similar adverse events associated with the suspected drug.

Determine whether causality criteria is applicable: The WHO UMC causality assessment uses specific criteria to evaluate the causal relationship between the drug and the adverse event.

a. Temporal Relationship: Assessing the temporal association between drug exposure and onset of the adverse event. A close temporal relationship suggests a higher likelihood of causality.

b. Known Pharmacological Effects: Considering whether the adverse event is consistent with the drug's known pharmacological effects or mechanisms of action.

c. Exclusion of Alternative Causes: Ruling out other potential causes or confounding factors that could explain the adverse event, such as concomitant medications, underlying medical conditions, or environmental factors.

d. Relationship: Evaluating whether there is a dose-response relationship between drug exposure and the severity or likelihood of the adverse event.

e. Rechallenge Information: Assessing whether the adverse event recurs upon re-administration of the suspected drug, which can provide additional evidence of causality.

Causality Assessment Categories: Based on the evaluation of these criteria, the WHO UMC causality assessment categorizes the causal relationship into different categories:

a. Certain: The adverse event is highly likely to be caused by the drug, with strong evidence supporting the causality

b. Probable/Likely: There is a high likelihood that the drug caused the adverse event, although some uncertainty or alternative explanations may exist.

c. Possible: The drug could have contributed to the adverse event, but other factors or confounders cannot be ruled out.

d. Unlikely: here is little evidence to suggest a causal relationship between the drug and the adverse event.

e. Conditional: More information is needed to assess the causal relationship definitively.

Documentation and reporting: The results of the causality assessment are documented in pharmacovigilance services reports, regulatory affairs submissions, and medical records. This information is crucial for risk assessment, signal detection , regulatory decision-making, and patient safety monitoring.