ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This commentary argues to refocus the WHO Model List of Essential Medicines on the needs of low and middle-income countries, reiterating the original goals of the process to promote equitable access to medicine and improve health globally.

The World Health Organization (WHO) Model List of Essential Medicines, first published in 1977, is designed to promote equitable access to essential medicines that address the priority health needs of populations. It includes medicines selected based on public health relevance, evidence of efficacy and safety, and cost-effectiveness. The list has become a critical tool in guiding national medicine policies and universal health coverage and Is now incorporate into the national essential medicine list of over 150 countries.

The model list is specifically intended to present evidence-based comparisons of safety, efficacy and cost effectiveness, focusing on value for money and supporting procurement and reimbursement decision. In the last decade, there has been a rise in applications to include expensive and highly specialized medicines, especially those requiring advanced healthcare infrastructure with upper-middle and high-income countries adapting the essential medicine concept to define reimbursement. This trend challenges the relevance of the list for low and middle-income countries (LMICs), which may not have the resources to provide these medicines sustainably. Medicines included in the list should be those that offer high public health value, particularly in LMICs. WHO should prioritize medicines that are of high public health relevance to LMICs and refine its guidelines for submitting price and cost-effectiveness data, ensuring they are applicable to LMICs. The inclusion of medicines for rare diseases or those requiring sophisticated diagnostic capabilities should be reconsidered unless these medicines are essential and can be sustainably provided in these settings.

The authors advocate for a realignment of the WHO Model List of Essential Medicines to better serve the needs of LMICs, emphasizing the importance of equity, efficiency, and relevance in medicine selection. The WHO is encouraged to maintain its role in providing global guidance while ensuring that its recommendations are practical and actionable for countries with limited resources.

References: 1. World Health Organization. The selection of essential drugs, including the first Model List of Essential Drugs. 1977. Technical Report Series.2. Perehudoff K, Toebes B, Hogerzeil H. A human rights-based approach to the reimbursement of expensive medicines. Bull World Health Organ 2016;94:-6. doi: 10.2471/BLT.15.166371 pmid: 27994287