E-DRUG: Expanding the WHO Model Essential Medicines List
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[Here is a proposal for a fundamental discussion of the role of the WHO Model Essential Medicines List.
WHO's rationale behind its Model EML is given at http://www.who.int/medicines/services/essmedicines_def/en/index.html
The latest copy (15th edition) of the WHO Model list is at http://www.who.int/entity/medicines/publications/EML15.pdf
The last "full" report of the WHO Expert Committee (TRS 933) is at:
http://mednet3.who.int/EML/expcom/expcom15/others/TRS933SelectionUseEM.pdf
Previous minutes of the WHO Expert committee are at:
http://mednet3.who.int/EML/expcom/expcom.htm
WB]
Dear Pharmacy, Public Health, Medical Students and Faculty,
The following is a letter we are circulating for signatures, asking the WHO to expand it's essential medicines list, to include a category for products that would be included, "if available at generic prices."
Right now, there are only 16 patented medicines on the EML, all but two of which are for treatment on one disease -- AIDS. We want to give this letter to members of the WHO's governing body the week of May 14. If you are willing to sign, send your name and medical school affiliation to:
fix.the.who.eml@gmail.com
Please circulate for signatures until May 12, 2007.
Open Letter to the World Health Organization Intergovernmental Working Group on Public Health, Innovation, and Intellectual Property
We, the undersigned students and faculty of pharmacy, public health and medicine, are writing to request a specific reform in the composition of the World Health Organization's (WHO) Essential Medicines List (EML).
This reform is necessary to implement the mandate set out in a variety of World Health Assembly resolutions concerning the need to expand access to medicines. We are deeply familiar with the importance of medications in safeguarding the health of patients. New drugs continue to elevate the standard of care for countless diseases and extend and improve lives. Ensuring that our future patients and patients everywhere, have access to these medications is of the utmost concern. To this end, we applaud the February 7, 2007 statement of WHO Director General Dr. Margaret Chan that "WHO unequivocally supports the use by developing countries of the flexibilities within the TRIPS agreement that ensure access to affordable, high quality drugs."
We are concerned, however, that the WHO's EML does not fully reflect this support. WHO evaluates whether medicines are sufficiently cost effective for inclusion in the list on the basis of current market prices, ignoring lower generic prices available to countries that employ patent flexibilities supported by WHO. As a result, of the 312 medicines on the list, only 16 are newer patented drugs, including 14 for the treatment of AIDS. Not a single patented drug for a non-communicable disease is included –not for cancer, not for diabetes, not for ischemic heart disease. This is despite the fact that non-communicable diseases are the leading cause of mortality in low-income countries, and that many new drugs offer substantial improvements in the treatment of non-communicable disease.
The existence of a WHO "Essential Medicines List" which does not contain a single patented medicine for non-communicable diseases provides rhetorical cover for those who oppose public health exceptions to patent laws and who argue that patients in developing countries should not expect treatment for "Western" diseases. The current list also offers little guidance to developing countries exploring legal, WHO supported options for obtaining drugs at lower cost.
For these reasons, we ask the WHO Intergovernmental Working Group on Public Health, Innovation and Intellectual Property to support a change in the EML that is consistent with WHO's support for the use of TRIPS flexibilities.
As proposed in a March 2, 2007 request by Knowledge Ecology International, the WHO EML should include a category for medicines that would be included in EML "if available at generic prices." This change in the EML list would avoid sending mixed signals on the legitimacy of patent flexibilities and the medical importance of patented drugs. It would provide developing country Health Ministries with invaluable information to more effectively negotiate drug prices and make informed decisions on the use of compulsory licensing. Finally, such a list would no longer exclude many of the most effective drugs for millions of patients in developing countries who suffer from non-communicable diseases.
As teachers and students of medicine and health, we are firmly committed to the WHO's mission of "the attainment by all peoples of the highest possible level of health." Creating an EML that supports developing countries striving to achieve the highest standard of care for all patients would be a vital step towards achieving that goal. We urge the Intergovernmental Working Group to incorporate this proposal into its Global Strategy and Plan of Action.
David Hoos, MD, MPH
Associate Professor of Epidemiology
Mailman School of Public Health
Columbia University
Corey Bills
Medical Student
University of Chicago Prizker School of Medicine
Aelaf D. Worku
Medical Student
The Mount Sinai School of Medicine