Essential medicines
Essential medicines are defined by the World Health Organization (WHO) as drugs that meet the priority health care needs of a population. These medications are recognized for their affordability, proven efficacy, and their ability to address common diseases and health conditions. WHO regularly updates its lists of essential medicines for both adults and children, taking into account various factors such as disease prevalence, public health levels, and the economic context of different countries. To be classified as essential, these medicines must be consistently available in adequate quantities and must adhere to safety and stability standards.
The lists are categorized into major groups, including pain relief, infection treatments, cardiovascular medications, and vaccines, among others. WHO also emphasizes the importance of training for healthcare practitioners to ensure safe and effective medication usage. Despite efforts to improve access, challenges persist, especially in developing countries, where issues related to pharmaceutical quality and drug administration remain significant. Recent updates to the essential medicines lists have raised concerns about the inclusion of more expensive and patented medications, leading to discussions about the potential influence of pharmaceutical companies on these important resources.
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Essential medicines
The World Health Organization (WHO), an agency of the United Nations (UN), defines essential medicines as drugs "that satisfy the priority health care needs of the population." WHO maintains regularly updated lists of essential medicines for adults as well as children, and uses a range of criteria to determine which drugs should be included essential. These criteria include affordability, clinically proven efficacy, prevalence rates of specific diseases and health conditions, and overall levels of public health. Thus, essential medicines can be thought of as drugs that are relatively affordable and known to be safe, effective treatments for diseases and health conditions that commonly affect a given population. According to WHO guidelines, essential medicines must be consistently available in sufficient quantities in order for a specific health care system to be considered adequate and functional.
Background
WHO was established in 1948, with a mandate of improving global health care standards and prioritizing the highest possible levels of human health throughout the world. The agency published its first list of essential medicines in 1977, and it updates the list every two years to reflect changing disease prevalence rates and the evolving health care needs of the global population. In addition to releasing regularly updated lists, WHO also encourages UN member countries to maintain their own internal lists of essential medicines, given that disease rates, the prevalence of health conditions, and the general treatment needs of the population differ in varying parts of the world, with a country's relative level of economic development being a key variable. In 2007, WHO separated its standard list into two parts, with one list covering essential medicines for adults, and the other identifying essential medicines for children.
When considering changes to its essential medicines lists, WHO conducts an in-depth review based on research evidence and clinical practice guidelines. Beyond availability and affordability factors, WHO may also consider the drug's stability in various environmental conditions, and whether specialized facilities are required to diagnose the disease or health condition the drug is used to treat. Single-compound drugs, or drugs that contain a single active ingredient, are favored over more complex alternatives whenever possible, except in cases where combination formulations offer a demonstrated benefit over the simpler alternative. Patient demographics, disease prevalence rates, the quality of treatment facilities, and the presence of qualified health care personnel in a given region may also be taken into account.
Beyond publishing lists of essential medicines, WHO also provides procurement and usage guidelines. The agency recommends that essential medicines be procured from reputable manufacturers, so that the health care professionals administering them can be sure the drugs are safe and stable, with predictable effects and side effects. Other safety factors, such as dosage levels and treatment durations, are also a priority of health care education programs. WHO also recommends that health care practitioners receive specific and extensive pharmacology training, and that they regularly update their medicine-related knowledge and skills throughout their careers.
Topic Today
WHO's lists of essential medicines for adults and children were most recently updated in November of 2015. Both lists are separated into broad drug categories, with major categories including anesthetics, pain relievers, allergy medications, poison antidotes, infection treatments, medicines for treating conditions affecting the blood and circulatory system, cardiovascular medications, gastrointestinal medicines, hormones and contraceptives, vaccines, vitamins and minerals, prenatal and neonatal care, and medicines that act on the respiratory system. The list of essential medicines for children includes an expanded list of medicines specifically formulated for treating common childhood and juvenile disorders, while eliminating drugs used to treat conditions that do not affect young people.
WHO's lists of essential medications have been widely adopted as a global standard and are used to inform policy decisions that govern the selection and procurement of medications for publicly funded health care programs. However, low pharmaceutical product quality, the improper use and administration of drugs, and an overall lack of access to essential medications continue to be major problems in developing countries. WHO continues to work with a range of UN and nongovernmental organizations (NGOs), including the United Nations Children's Fund (UNICEF) and the Office of the United Nations High Commissioner for Refugees (UNHCR), among others, in an ongoing effort to make safe, proven essential medicines available to all who need them.
Beyond the inclusion of thirty-six new drugs for adults and sixteen new drugs for children, independent reviews of WHO's most recent lists of essential medicines noted several trends that seem to indicate diversions from the agency's established policies. First, there seems to be a subtle shift away from affordable medications, with expensive and relatively specialized drugs continuing to make their way onto the lists in growing numbers. Historically, WHO has favored drugs with expired patents, but in recent updates, a growing number of patented medications have been included. Patented medications are usually much more expensive than drugs with expired patents.
There is also a growing trend toward including medications that can be used for off-label purposes, which are purposes that are not specifically identified in the drug's registered list of uses. This is thought to be because it is easier for pharmaceutical manufacturers to bring their products to a broader base of patients by encouraging off-label uses than it is to re-register the drug to include new indications. Other reported tendencies include the recommendation of medicines in dosage forms that are not widely available, and the inclusion of drugs that are not subject to strict production and regulatory oversight. In light of these trends, some experts have expressed concerns that major drug companies and pharmaceutical developers have begun to manifest a subtle but perceptible level of influence over WHO's essential medicines lists to further their own financial interests.
WHO prioritizes objectivity and neutrality in its mandate. The prevailing view is that while drug manufacturers may have a vested interest in seeing their products included on the agency's essential medicines lists, their influence on the lists and its updating procedures is, at most, negligible.
Bibliography
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