List of Essential Medicines

List of Essential Medicines
Name	Essential Medicines List
Caption	Cover of the 2023 WHO Model List of Essential Medicines
Publisher	World Health Organization
Published	1977 (first edition)
Media type	Digital and print report
Subject	Public health, Pharmacology
Genre	Medical guideline

List of Essential Medicines. The List of Essential Medicines is a crucial public health tool compiled by the World Health Organization to guide countries in selecting the most important medications for their health systems. First conceived in 1977, it identifies medicines that satisfy the priority healthcare needs of a population, emphasizing those that are safe, effective, and cost-efficient. Its adoption and adaptation by national governments significantly influence drug procurement, health policy, and the global fight against diseases like HIV/AIDS, malaria, and tuberculosis.

History and development

The concept was pioneered following the World Health Assembly in 1975, with the first Model List published in 1977 under the leadership of then-Director-General Halfdan Mahler. Its creation was influenced by earlier efforts in countries like Norway and was a direct response to the Alma Ata Declaration which championed primary health care. Key figures in its early development included pharmacologists like Jonas Salk and institutions such as the Harvard Medical School, which contributed to evidence-based selection methodologies. The list has evolved from a simple compendium to a dynamic guideline, reflecting advances from the Human Genome Project and challenges posed by events like the COVID-19 pandemic.

Selection criteria

Medicines are selected based on rigorous review of their efficacy, safety, and comparative cost-effectiveness within therapeutic categories. The process involves the WHO Expert Committee on the Selection and Use of Essential Medicines, which evaluates data from clinical trials, such as those conducted for artemisinin-based therapies, and considers disease prevalence from global reports on non-communicable diseases. Factors like stable supply chain logistics, appropriate dosage form availability, and alignment with international treatment guidelines, like those from the Centers for Disease Control and Prevention, are paramount. The criteria deliberately avoid promoting specific pharmaceutical companies or proprietary brands.

List contents and organization

The list is structured into core and complementary sections, organized by therapeutic categories such as antimicrobials, cardiovascular drugs, and mental health medications. It includes classic agents like penicillin and morphine, as well as newer additions like direct-acting antivirals for hepatitis C and biologics for rheumatoid arthritis. Specific sections address medicines for children, based on the separate WHO Model List of Essential Medicines for Children, and for specific conditions managed in programs like the President's Emergency Plan for AIDS Relief. Each entry specifies the preferred active pharmaceutical ingredient and key dosage forms.

Impact and usage

Over 150 countries have created national essential medicines lists, influencing formularies for systems like the National Health Service in the United Kingdom and insurance schemes in Thailand. It guides procurement for major agencies including UNICEF and the Global Fund to Fight AIDS, Tuberculosis and Malaria, shaping markets for vaccines and treatments. The list has been instrumental in increasing access to antiretroviral therapy across Sub-Saharan Africa and in standardizing emergency kits used by Médecins Sans Frontières. Its principles underpin essential medicine laws in nations from India to South Africa.

Updates and revisions

The list is revised approximately every two years by the WHO Expert Committee, which meets in Geneva. Recent updates have added medicines for multiple sclerosis, new insulin analogs, and novel oral anticoagulants following reviews of data from the European Medicines Agency and the Food and Drug Administration. The revision process considers submissions from member states, research from the Cochrane Collaboration, and recommendations from technical groups like those for the End TB Strategy. A major review occurred in 2021 to address therapeutics for the COVID-19 pandemic.

Criticisms and controversies

Criticisms include perceived delays in listing new, costly breakthrough therapies for diseases like cancer, often due to debates over cost-effectiveness versus innovation, as seen with certain immunotherapy drugs. Some argue the process can be influenced by political pressures from entities like the World Trade Organization regarding patent laws and generic drug production. Controversies have arisen over the inclusion and then removal of medicines like ketamine, due to its dual use and scheduling under the International Narcotics Control Board. Debates continue on balancing comprehensive listings with the practical realities of health system financing in low-income countries.

Category:World Health Organization Category:Medical lists Category:Pharmaceutical policy