Rational Selection of Essential Medicines Tim Reed World health Assembly May 2014

Acknowledgements Hans Hogerzeil, University of Groningen Declaration of interest: No funding from private sector, participation at WHA funded by DFID and EU; HAI receives funding from WHO from time to time.

Outline Essential Medicines List (EML) Concept How EML transposes into access EML as a component of Universal Health Coverage (UHC) Challenges that remain for a new EML chapter

Essential Medicines Concept Essential medicines are those that satisfy the priority health care needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford. Crucial component of a functioning and sustainable health system It is a Health Technology Assessment

Essential Medicines Concept Services Patented (single-source) 98% of medicines on WHO Model List of Essential Medicines are off- patent 85% of the access problem can be solved with generic medicines What about changing LMIC epidemiology? What about the 15%? Access Generic name GenericBranded genericMedicines

Access to essential medicines, within one hour’s travel from home, at an affordable price Reality of morbidity and access in low resource settings Keep hearing that we have made significant strides in access to medicines, and we have, but …. Access

Access to medicines for the Poor WHO, Lauridsen/Hogerzeil (1987 – 2002) The poor have remained poor

Access Three dimensions of Universal Access

Challenges that Remain for the EML The epidemiological transition in LMICs brings about new challenges for the EML Cost of new therapies Cost effectiveness as a core criteria? Placement on the EML will give leverage to use mechanisms for price reduction Welcome a consultation on the future of the EML as a contribution to Universal Health Coverage