an Eldis Resource

Twenty-five years after the first model list of essential drugs was published by the World Health Organization (WHO) in 1977, the expert committee met in Geneva from 15 to19 April 2002. This report details the proceedings of the open session and the recommendations of the committee. It includes in annexe the 12th WHO model list of essential medicines.

Issues covered during the meeting include an update on the current situation regarding new procedures for updating and disseminating the model list, development of the WHO model formulary and preparations for the WHO essential medicines library; outstanding technical issues; the format and presentation of the new model list; a number of applications for medicines to be added, including several anti-retroviral medicines for the treatment of HIV/AIDS, and a review of some of its sections. The report includes a summary of the committee’s recommendations and the 12th list in full, along with notes on all inclusions, deletions and additions.

Issues for discussion identified during the open session included:

• Not all the new procedures could be implemented in this first meeting: the practical experience should be evaluated carefully with a view to recommendations for refining procedures for the future.
• The procedure whereby applications for inclusion are submitted directly to the relevant WHO department is flawed. Some WHO departments may be unable or unwilling to process applications for inclusion of some medicines: an additional procedure might be needed for filing applications in such cases.
• Fixed-dose combinations of medicines can be effective but not all combinations offered are logical: applications for their inclusion should be supported by adequate proof of pharmaceutical compatibility and bio-availability.
• A simplified review should be done of medicines considered for deletion. The proposed deletions should be published on the web to invite comments before the decision to delete is taken.
• The current phrasing that ‘essential medicines are selected with due regard to disease prevalence…’ does not adequately cover preventive medicine and family planning items. The wording should therefore be changed.
• Price information is not always easy to obtain: such information should be collected and used with care, and for selection of essential medicines the focus should be on price comparisons within therapeutic categories.

The committee made the following policy recommendations:

• Applications for inclusion could be submitted by any individual or organisation and should be made directly to the Secretary of the Experts Committee, who will submit them to the relevant WHO department if appropriate.
• Decisions to delete a medicine from the list should as far as possible be evidence-based. Separate procedures for deletion were proposed for committee-initiated and applicant-initiated applications.
• Selection criteria should include emphasis on public health relevance rather than disease prevalence, in order to ensure the inclusion of preventive treatments.
• In addition to its current format, the model list should be presented in the five-level Anatomic Therapeutic Classification (ATC) system to allow organisations the option of retaining the old system or changing to the ATC system.
• The name of the expert committee on the use of essential drugs should be changed to the ‘Expert committee on the selection and use of essential medicines’.

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