Every other year, the World Health Organisation (WHO) rocks the world of healthcare with its release of a list of essential medicines that is made accessible to everyone. It serves as a guide in various countries to increase access to medicines and guide choices about readily available drugs in their respective populations.

The 2017 edition – released just this week – includes recommendations on which antibiotics to be used for common infections, and which ones to preserve for more serious circumstances. Medicines for HIV, Hepatitis C, leukaemia and tuberculosis were also included. A total of 30 new medicines for adults and 25 new medicines for children were added, bringing the total number of drugs on the list to 433.

“These medicines are chosen according to evidence of safety, efficacy and public health relevance. Essential medicines should be available in health systems everywhere, at all times,” said Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation.

Vital changes to antibiotic section

WHO made the biggest antibiotic revision in the list’s 40-year history by introducing three separate categories for antibiotics. The categories – access, watch and reserve – come with recommendations on their use and only apply to antibiotics for the treatment of 21 of the most common general infections. If proven beneficial, future versions of the list could see an extension to other drugs in the treatment of other infections.

Antibiotics in the ‘access’ group are to be available at all times as treatments for a wide array of common infections such as amoxicillin to treat infections like pneumonia. The ‘watch’ group consists of antibiotics that are recommended as first- or second-choice treatments for a few infections. For instance, the use of ciprofloxacin to treat cystitis and upper respiratory tract infections should be severely reduced to prevent future development of resistance. The final group ‘reserve’ includes colistin and some cephalosporins and should be given only when all other alternatives have failed. For example, in life-threatening conditions due to multidrug-resistant bacteria.

Dr Suzanne Hill, Director of Essential Medicines and Health Products said, “The rise in antibiotic resistance stems from how we are using – and misusing – these medicines. The new WHO list should help health system planners and prescribers ensure people who need antibiotics have access to them, and ensure they get the right one, so that the problem of resistance doesn’t get worse.”

Hepatitis C, HIV and leukaemia drugs make the list

The first pan-genotypic hepatitis C treatments to make the list would be Gilead's Epclusa (sofosbuvir and velpatasvir). “Countries without sophisticated diagnostic equipment can actually have an option to move straight to a one treatment approach, even without knowing what types of hepatitis C virus they are dealing with,” said Hill.

Recommendations for tenofovir to stand alone or in combination with emtricitabine or lamivudine for pre-exposure prophylaxis (PrEP) to prevent HIV also made the list. Other notable additions would be Sprycel (dasatinib) and Tasigna (nilotinib) to treat chronic myeloid leukaemia.

Hill explained that some of these drugs might still be out of reach for countries. “Currently, many of these medicines are sold at very high prices, and may be unaffordable for health systems, irrespective of the wealth of the country. The fact that they're not included on the Essential Medicines List sends a strong message to all public health actors that these medicines provide true public health benefits and really should be made available when needed,” she explained.

Skipping out on insulin and new breast cancer treatments

This 40th edition of the list was adapted after the Expert Committee reviewed 92 applications for about 100 medicines. This essentially means that some notable suggestions during the annual World Health Assembly were given the boot. These include new second-line treatments for breast cancer, as those drugs are inaccessible for many women in developing and developed countries.

WHO also rejected a proposal to include long-acting analogue insulin to the list. Health Action international applauded this move stating that this would have “increased pressure on national governments to purchase” those drugs, which are seven to nine times more costly than human insulin “while providing limited added value to users.”

Novo Nordisk, which is one of the companies who proposed the inclusion of this insulin treatment, responded saying, “We know that the aim of the essential medicines list is to bring basic affordable care to the populations."

"Human insulin is the most affordable treatment and we believe it should be made available to as many people who need it especially in developing countries. We do, however, support that better treatment forms are made available over time for the benefit of improving patients’ health outcomes.” MIMS

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