On Essentiality and the World Health Organization's Model List of Essential Medicines

Victoria A Marks,Stephen R Latham,Sandeep P Kishore

doi:10.1016/j.aogh.2017.05.005

Abstract

BackgroundIn 1977 the World Health Organization created its first Model List of Essential Medicines—a list designed to aid countries in determining which medicines to prioritize on their National Essential Medicines Lists. In classifying drugs as “essential,” the World Health Organization has historically stressed drugs' ability to meet priority health needs of populations and cost. ObjectivesIn this paper we trace the fluctuations in the application of cost and priority status of disease as criteria for essential medicines throughout the reports published by the WHO Expert Committee on Selection and Use of Essential Medicines since 1977. MethodsWe analyzed essential medicines lists published on the World Health Organization website since 1977 for trends in criteria concerning cost and priority status of disease. Where, available, analyzed the World Health Organization Expert Committee analysis rationalizing why certain medicines were or were not added and were or were not removed. ResultsThe application of the criteria of cost and priority status of essential medicines has fluctuated dramatically over the years. ConclusionsThe definition of essential medicines has shifted and now necessitates a new consensus on normative definitions and criteria. A more standardized and transparent set of procedures for choosing essential medicines is required.

Highlights

The World Health Organization (WHO) currently defines essential medicines as “those that satisfy the priority health care needs of the population”[1] and describes the criteria for their selection as “disease prevalence and public health relevance, evidence of clinical efficacy and safety, and comparative costs and cost-effectiveness.”[1]. These standards for defining and selecting an “essential medicine” are quite general; their application to particular cases has been unpredictable in recent years
We analyzed each of these lists, as well as the reports released by the WHO Expert Committee on Selection and Use of Essential Medicines rationalizing all additions and deletions from the list
When the WHO first published its list, it stated that affordability was considered a “major selection criterion.”[2]. This criterion included “cost comparisons between drugs”[2] and “the cost of the total treatment”[2] for a given drug; for example, a low-cost, efficacious drug that requires constant monitoring to prevent side effects may be expensive in a country where such maintenance is difficult

Summary

Introduction

The World Health Organization (WHO) currently defines essential medicines as “those that satisfy the priority health care needs of the population”[1] and describes the criteria for their selection as “disease prevalence and public health relevance, evidence of clinical efficacy and safety, and comparative costs and cost-effectiveness.”[1] These standards for defining and selecting an “essential medicine” are quite general; their application to particular cases has been unpredictable in recent years. Developed in 1977, this list was created to serve as a guideline for the National Essential Medicines Lists for countries globally. 1977 the World Health Organization created its first Model List of Essential Medicinesda list designed to aid countries in determining which medicines to prioritize on their National Essential Medicines Lists. In classifying drugs as “essential,” the World Health Organization has historically stressed drugs’ ability to meet priority health needs of populations and cost

Objectives

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Results

Discussion

Conclusion