Essential Medicines – 35 years+ now
Successes, Challenges and Outlook
Pharmaceuticals and Global Health:
Inequalities and Innovation in the 21st Century
University of Sussex
19th July 2013
Krisantha Weerasuriya MD FRCP PhD
Department of Essential Medicines and Health Products
World Health Organization
Essential Medicines and Health Products (EMP)
Essential Medicines - History
• Essential Medicines Concept – 1975
• First Expert Committee on Selection of Essential Medicines
and First WHO Model List – 1977
• Second Committee – Selection and Use of Essential
Medicines
• List revised every 2 years by Expert Committee
• Essential Medicines List for Children (EMLc) – 2007
• 18th List released in July 2013 after Expert Committee
meeting in April 2013
Essential Medicines and Health Products (EMP)
Essential Medicines are …
The concept of essential medicines
A limited range of carefully selected essential medicines leads to better
health care, better drug management, and lower costs
Definition of essential medicines
Essential medicines are those that satisfy the priority health care needs of
the population
Selection of essential medicines
Selected with due regard to disease prevalence, evidence on efficacy and
safety, and comparative cost-effectiveness.
Continuity, Sustainability
From 1977 – Revised every 2 years, 18 Lists
374 medicines in 18th List (April 2013)
The first list was a major breakthrough in the history of medicine,
pharmacy and public health – Medicines sans Frontiers
Essential Medicines and Health Products (EMP)
The Essential Medicines Target
National list of
essential medicines
Registered medicines
All the drugs
in the world
Levels of
use
S
CHW
S
dispensary
Health center
Hospital
Referral hospital
Private sector
Department of Essential Medicines and Health Products
Essential
TBS 2012Medicines and Health Products (EMP)
Supplementary
specialist
medicines
Essential Medicines – in countries …
• Over 100 countries have National Essential Medicines Lists
based on WHO EML
• When revising National Lists, medicines on WHO list will be
taken into account
• Multilateral agencies (World Bank, GFATM, Unicef, UNFPA) base
their medicines procurement on WHO/National EML
• Donations of medicines – is the medicine in the National List, if
not in the WHO List
Essential Medicines and Health Products (EMP)
Essential Medicines – Successes
• A universally accepted concept
• Wide adoption in in low and middle income countries
• Even wider implementation in High Income Countries –
really ??!!
• An official list for training, supply, reimbursement or
related health objectives. They maybe state / provincial
lists instead of or in addition to national lists.
• Process has been robust – Declarations of Interests in the
Technical Report itself
• Is a strategy that has explicitly embedded health care
needs and cost-effectivenes in health care system
Essential Medicines and Health Products (EMP)
Essential Medicines – Challenges
• A concept and list ahead of necessary infrastructure
in the LMICS and ahead of the political will necessary
to implement it in HICs
• Is a strategy that has explicitly embedded health care
needs and cost-effectiveness in health care system
• Quality of medicines
• Once accepted, is it strong enough to withstand the
influences?
• Necessary expertise in countries to adapt the WHO
List to a National List
• Is it suitable for "forward guidance" to new medicines
development for the pharmaceutical industry?
Essential Medicines and Health Products (EMP)
Health Technology Assessment (HTA)
• Health technology assessment is a multi-disciplinary field
of policy analysis that examines the medical, economic,
social and ethical implications of the incremental value,
diffusion and use of a medical technology in health care.
(Does the medicine/ technology give value for money?)
• Why now?
• Governments facing funding problems in health care
• National Institute of Clinical Excellence premier example
(UK) –(NICE International)
• CHOosing Interventions that are Cost Effective (WHOCHOICE)
• HTA will be a partner in Selection of Essential Medicines
Essential Medicines and Health Products (EMP)
Essential Medicines – Outlook
• Good – promising future!
• HTA will be a strong partner in future but expertise ?
• Universal Health Coverage – the major focus post 2015
Millennium Development Goals
What will be the medicines delivered as part of UHC?
• Defining what it useful for Health Care Systems –
"Forward Guidance" – is it a better strategy than the
"Market", for Medicines Development?
• Not only new medicines but better formulations of
existing ones – "heat stable oxytocin"
• Serving health care needs rather than developing
"Blockbusters"?
Essential Medicines and Health Products (EMP)
Essential Medicines – Conclusion
• Discovery Science makes the Headlines
Delivery Science saves the Lives
Dr Margaret Chang, DG WHO
• Essential Medicines has exploited existing medicines to
deliver enormous improvements in the health
• In the future, can the Essential Medicines Concept also
guide to what the needed medicines are?
• It would be advancing from influencing access, to
improving innovation.
Essential Medicines and Health Products (EMP)