Essential drugs: economics and politics in international health

Abstract

The World Health Organization since the mid-1970s has expanded its activities on essential drugs from a concept to a list to policies, establishing the Action Program on Essential Drugs and Vaccines in 1981. The global social and political environment, especially the emergence of an international consumers movement, created favorable conditions for acceptance of the concept of essential drugs, despite initial resistance by the pharmaceutical industry. The WHO achieved a major accomplishment in getting other organizations to accept the WHO's evolving definition of essential drugs as legitimate. But the relationship between public and private sectors remains a key issue in achieving the objectives of essential drugs policies, an issue the WHO has not fully or directly addressed. Potentials for conflict and collaboration between the WHO and the industry exist around three topics: the extent of regulation, the role of the market, and local production. The case of essential drugs illustrates a new pattern that has emerged for setting the international health agenda, with open participation in international organizations by industry associations and by consumer groups. These changes in the international agenda-setting process influence national policy but still leave difficult problems of implementation at the country level.