[e-drug] Expanding the WHO Model Essential Medicines List (2)

E-DRUG: Expanding the WHO Model Essential Medicines List (2)
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Dear David Hoos, Corey Bills, Aelaf D. Worku

I suggest that you prepare a submission for consideration in the next
review of the WHO Model List.

The revision process is transparent and submissions are invited from
interested people. At the last revision (April 2007) WHO had also
called for submissions or improvements to the review process.

For a summary of the last revision process see E-DRUG archive E-DRUG:
WHO: 15th Essential Medicines Committee meeting 19-23 March, 2007?

In 1977 the first WHO model list of drugs was prepared. According to
Richard Laing et al (Lancet, May 2003)

    The list helped to establish the principle that some medicines were
    more useful than others and that essential medicines were often
    inaccessible to many populations. Since then, the essential
    medicines list (EML) has increased in size; defining an essential
    medicine has moved from an experience to an evidence-based process,
    including criteria such as public-health relevance, efficacy,
    safety, and cost-effectiveness. High priced medicines such as
    antiretrovirals are now included.

There have been 15 revisions of the list published and nearly 200 WHO
member states have adopted medicines lists.

The WHO list is a reference list of essential drugs with information
including:

Core list: minimum drug needs for a basic health care system, listing
the most cost-effective drugs for priority conditions (selected on the
basis of public health relevance and potential for safe and
cost-effective treatment).

Complementary list: essential drugs for which specialised diagnostic or
treatment facilities may be needed.

The list now includes many drugs that did not exist at the time of the
first list. Some were initially too expensive to consider but are now
crucial members of the list. I remember when there was no albendazole
nor praziquantel for example.

The WHO EDL committee does look at new developments, assesses them and
includes them as needed, sometimes as a class representative drug, eg
ACE inhibitor.

regards,

Beverley Snell

*Senior Fellow*
*Essential Drugs and Community Health Specialist*
*Centre for International Health*
*Macfarlane Burnet Institute for Medical Research & Public Health *
*Telephone 613 9282 2115 / 9282 2275*
*Fax 61 3 9282 2144 or 9282 2100*
*email <bev@burnet.edu.au>*
*http://www.burnet.internationalhealth.edu.au*
*GPO Box 2284, Melbourne 3001 Australia*
*Site: Alfred Medical Research & Education Precinct (AMREP),*
*85 Commercial Road, Prahran 3004*
*Time zone: 10 hours ahead of GMT*

E-DRUG: Expanding the WHO Model Essential Medicines List (3)
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Dear Beverly,

There have been two previous communications to the WHO on this topic,
including a December 1, 2006 letter to incoming DG Margaret Chan, and
a March 2, 2007 letter to the WHO Expert Committee on the Selection
and Use of Essential Medicines, both on the Internet here:

http://www.keionline.org/misc-docs/eml2March2007.pdf

The new WHO model EML list ignored both letters.

The proposal is fairly simple. Expand the WHO model EML, by
including a category for products that would be cost effective
treatments for the poor, "if available at generic prices."

In 2007 it is no longer appropriate to take the patented prices as a
binding constraint, when countries are showing they are willing to
issue compulsory licenses to obtain the cheaper generic prices. The
list should reflect this reality. That is the message of the letter
by Hoos, Bills and Worku. It is entirely appropriate to send this
message to the WHA or the WHO EB, since the expert committee is not
interested or responsive on this topic.

regards

Jamie

James Packard Love
Knowledge Ecology International
http://www.keionline.org
james.love@keionline.org
Washington, DC +1.202.332.2670