A/61/338 51. Medicines must also be of good quality. If rejected in the North because they are beyond their expiry date and unsafe, medicines must not be recycled to the South. Because medicines may be counterfeit or tampered with, States must establish a regulatory system to check medicine safety and quality. Combating discrimination, inequality, vulnerability 52. A national medicines policy must be designed to ensure access for vulnerable individuals and disadvantaged groups, including women and girls, ethnic minority and indigenous populations, people living in poverty, people living with HIV/AIDS, internally displaced people, the elderly, people with disabilities, prisoners and others. 53. This preoccupation with vulnerability and disadvantage arises from two of the most fundamental principles of international human rights law: non-discrimination and equality. Importantly, these twin principles do not always demand equal treatment; on the contrary, they sometimes require a State to take measures in favour of disadvantaged individuals and communities. Although closely linked to the ethical concept of equity, the principles of non-discrimination and equality have the advantage of being reinforced by law and accountability mechanisms. 54. In relation to access to medicines, non-discrimination and equality have numerous implications. For example, a State is obliged to establish a national medicine supply system that includes programmes specifically tailored to reach the vulnerable and disadvantaged. It is also required to tackle the cultural, social and political factors that inhibit vulnerable groups’ access to health care generally and to medicines in particular. So far as possible, data must be disaggregated to identify vulnerable groups and monitor their progress towards equal access (see E/CN.4/2006/48, from para. 62). In relation to medicines, how is progressive realization to be measured and monitored? What are the obligations of immediate effect? 55. The right to the highest attainable standard of health — and thus access to medicines — is subject to progressive realization and resource availability, in accordance with article 2, paragraph 1, of the International Covenant on Economic, Social and Cultural Rights. Put simply, progressive realization means that a State is required to be doing better in five years time than it is doing today, while resource availability means that what is required of a developed State is of a higher standard than what is required of a developing State. 56. This has a number of important implications. For example, States need appropriate indicators and benchmarks so they know whether or not they are progressively realizing the right to health (see human rights-based approach set out in E/CN.4/2006/48). But it also has an important qualification: the right to health includes some core obligations of immediate effect, without which the right would be largely deprived of its raison d’être.40 For example, States have an immediate obligation to avoid discrimination and also to make certain pharmaceuticals — known as “essential medicines” — available and accessible throughout their jurisdictions.41 These core obligations of immediate effect are not subject to progressive realization. 14 06-51997