E-drug: 11th Model List of Essential Drugs (cont'd)
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Essential drugs: what about AIDS?
The 11th version of the WHO's essential drugs list (published in late
december) is already outdated. The concept of essential drugs has
been paramount to help countries in selecting drugs according to their
efficacy, safety and cost. The idea was that a minimal list of drugs
could solve most health problems. Countries were invited to devote
most of their limited resources to these drugs. In 1977, when WHO
published its first essential drugs list, this was a major step forward.
Year after year the list has been revised in a way that: enhanced the
number of drugs; enhanced the number of drugs considered as
examples of therapeutic groups; enhanced the number of drugs that
can be used only in specialized wards (see the long list of anti-cancer
drugs for example); enhanced the number of patented drugs (higher
priced).
WHO considers that "The concept of essential drugs is
forward-looking. It incorporates the need to regularly update drug
selections to reflect new therapeutic options and hanging unmet
therapeutic needs; the need to ensure drug quality; and the need for
continued development of better drugs, drugs for emerging diseases,
and drugs to meet changing resistance patterns." (quoted from the
EDM policy page on WHO web site).
Well, so what about AIDS, the first cause of death in Africa? The last
revision of the list has included nevirapine for the prevention of
mother-to-child transmission. But WHO says that zidovudine and
nevirapine are included in the list only for this indication. WHO is so
anxious that somebody could use these drugs for adults that this
limitation is written in bold character. There is something more about
AIDS (also quoted from the EDM page): "treatment of sexually
transmitted diseases reduces transmission of the AIDS virus". That's
all... What is the problem with AIDS drugs for WHO? "They are
beyond the budget of most national drugs programs" (quoted from the
11th list).
Well fortunately there is a special UN Agency for AIDS; just visit its
web site these days. They have found a solution for AIDS orphans:
Swiss citizens sent them toys for Christmas. Of course AIDS is not an
easy problem. But WHO will not help in denying its existence.
Pierre Chirac
MSF - Paris
e-mail: pierchir@club-internet.fr
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