Which Drugs Should Be on the Essential Medicines List?

Abstract

The World Health Organization (WHO) published its first Essential Medicines List (EML) in 1977, and it is updated biennially. One might reasonably think drugs on the EML are there because they are critical to effective, evidence-based patient care and intervention. One might not reasonably guess, however, that a particular drug's supply chain vulnerabilities that make it a shortage risk would contribute to a drug's listing on the EML. This commentary on a case first describes why the WHO makes the EML and suggests reasons why it might be important to consider a drug's shortage risk when revising and updating it. This commentary also suggests how distinguishing "essential" drugs from "vulnerable" drugs could bolster supply chain resiliency and mitigate drug shortages' disruptions to patient care. CaseDr C is an oncologist at an academic health center who has practiced for 15 years. Dr C's patient is JJ, a child newly diagnosed with cancer. Dr C has now received a second notice from the hospital pharmacy that a standard chemotherapeutic intervention drug, cisplatin, for the treatment of JJ's cancer is in short supply. Dr C starts planning ahead and wonders whether and how to adapt JJ's-and possibly her other patients'-care plan, perhaps by omitting at least one of JJ's chemotherapy cycles or by limiting other patients' access to the drug by modifying their treatment plan so that JJ's care plan is not altered. 1,2 Commentary Suppose Dr C has faced this issue several times before, as shortages of several oncology medications have persisted for decades, 3 and remembers the impacts on patients-and the impacts on her of not being able to provide the best care for her patients-of the shortages of various oncology drugs. She therefore decided to look into the reasons why medicines critical to her patients' treatment regimens are often unavailable. The exact reasons were difficult to find, but she learned that a major reason for shortages in the past was supply chain issues, including problems with manufacturing processes, increased demand, and shortages of the necessary active pharmaceutical ingredients. In the end, though, all that she knows is that the supply chains for numerous cancer drugs need strengthening. They should not be bending or breaking this frequently, to the detriment of her patients, who are among the sickest in