The World Health Organization (WHO) has updated its lists of essential medicines and diagnostics in a bid to expand access to affordable treatments for individuals worldwide.
WHO Director-General Tedros Adhanom Ghebreyesus asserted in a statement that “around the world, more than 150 countries use WHO’s Essential Medicines List to guide decisions about which medicines represent the best value for money, based on evidence and health impact.” Essential medicines, as defined by the WHO, are “those that satisfy the priority health care needs of the population.”
The updated list adds 28 medicines for adults and 23 for children, expanding the number of medicines included in the list to 450. “While this figure may seem high, it corresponds to a fraction of the number of medicines available on the market,” the WHO said in a press release. “By focusing the choices, WHO is emphasizing patient benefits and wise spending with a view to helping countries prioritise and achieve universal health coverage.”
“For India, the inclusion of cancer tests is of particular significance. India loses 700,000 lives to cancer every year. One issue driving the country’s high death toll is the fact that many individuals with cancer do not consult a doctor before their condition has progressed to the advanced stage…Early testing for these conditions could go some way towards facilitating early diagnosis, thereby improving survival outcomes.”
The updated essential medicines list incorporates five new cancer therapies and two immunotherapies with the potential to improve outcomes in those with advanced melanoma, whose beneficiaries enjoy survival rates of up to fifty percent. The medicines list also tackles strokes with the inclusion of new oral anticoagulants; biologics for chronic illnesses including rheumatoid arthritis and inflammatory bowel disease; and heat-stable carbetocin for preventing postpartum haemorrhage – an alternative to the standard therapy of oxytocin.
On diagnostics, the WHO makes tackling cancer a priority with an emphasis on tests to ensure timely diagnosis. As such, it includes tests for twelve cancers in the list as well as anatomical pathology to be made available in specialised labs.
For India, the inclusion of cancer tests is of particular significance. India loses 700,000 lives to cancer every year. One issue driving the country’s high death toll is the fact that many individuals with cancer do not consult a doctor before their condition has progressed to the advanced stage. The tests recommended by the WHO include cancers with high prevalence in India, including breast, cervical, colorectal, and liver cancer. Early testing for these conditions could go some way towards facilitating early diagnosis, thereby improving survival outcomes.
As well as cancer, the diagnostics list tackles anaemia; sickle cell disease; thyroid dysfunction; and a number of infectious diseases including cholera, dengue fever, and the Zika virus. Many of these conditions are common in India. Anaemia, for example, affects 39.86 percent of people including 51 percent of women between the ages of fifteen and 49. Dengue is endemic throughout all 35 states and union territories. In recent years, several outbreaks of the Zika virus have been reported including a large-scale breakout in Rajasthan last year.
“India is a country where out-of-pocket spending on healthcare typically reaches astronomical levels. Such expenditure accounts for more than 67 percent of the country’s total healthcare spend, driving tens of millions into poverty on an annual basis. Addressing lack of availability to essential medicines is a key way of improving access to healthcare.”
The WHO is keen to emphasise that its essential medicines list should act as guidance for countries in developing lists of their own. India’s equivalent list is the National List of Essential Medicines (NLEM), first prepared and released in 1996 and revised numerous times since. The NLEM has included 384 drugs whilst the government has been in the process of updating the list since last year. The WHO’s updated list ought to offer guidance towards updating the list, especially given the spotlight it casts on conditions that take a toll in the country. The input of stakeholders representing “medicines, medical devices, medical disposables and consumables, hygiene and other healthcare products” is also being solicited by the government.
India is a country where out-of-pocket spending on healthcare typically reaches astronomical levels. Such expenditure accounts for more than 67 percent of the country’s total healthcare spend, driving tens of millions into poverty on an annual basis. Addressing lack of availability to essential medicines is a key way of improving access to healthcare, with government initiatives rolled out in recent years targeting this issue.
As well as the Pradhan Mantri Jan Arogya Yojana (PMJAY) or Ayushman Bharat, which provides free health insurance coverage to poor families, the government has also rolled out the Pradhan Mantri Bhartiya Jan Aushadhi Pari Yojana Kendra (PMBJPK) initiative, wherein affordable medicines can be purchased from government-run stores. Earlier this year, Prime Minister Narendra Modi credited the scheme with reducing the costs of 850 medicines to rates that were up to ninety percent cheaper than market prices. The Jan Aushadhi kendras where the medicines are sold currently number at around 5,050. The Centre plans to introduce 2,500 more stores by next year and intends to eventually establish one kendra for every block.
However, for these schemes to be a success, the availability of essential medicines must be guaranteed. In recent years, research has suggested a shortage of essential medicines in both privately-run and government-run dispensaries. In light of the rollout of government initiatives targeting issues of access to healthcare and medicines, further investigation is needed to ensure that beneficiaries are enjoying expanded access not only to healthcare but to high-quality healthcare. This includes medicines deemed essential by both the Indian government and the WHO to treat a broad plethora of ailments. Without this goal being met, the target of ‘health for all’ is likely to remain a distant reality.