The World Health Organization (WHO) publishes a list of essential medicines every two to three years, which are considered crucial for providing the global population with safe and effective medicines. This “Essential Medicines List (EML)” is part of WHO’s efforts to improve access to essential medicines worldwide and strengthen health systems in various countries.
The EML is divided into two categories (1. essential medicines for adults and 2. essential medicines for children) and includes a selection of medicines selected based on scientific criteria and needed for the treatment of major health problems such as infectious diseases, cancer, diabetes, and cardiovascular diseases. This list serves as a recommendation for health systems around the world. It aims to facilitate access to important medicines and improve the quality of healthcare, especially in low-resource countries. Despite this claim, so far, the list of essential medicines has not included any medicines for the treatment of multiple sclerosis, which affects about 2.8 million people worldwide.
Three MS drugs on the WHO list
In July 2023, the update of the EML was published, which now includes three drugs that reduce the disease activity and progression of MS – thus filling a gap in the list of essential medicines. The MS drugs Glatirameracetat, Cladribin, and Rituximab were added to the list. These drugs represent treatment options with different modes of administration, different prices (if generics and biosimilars are available), and different recommended uses. If one takes, for example, the current German guidelines for the treatment of MS as a basis, the list contains representatives of the three different efficacy categories (Category 1: Glatitrameracetat, Category 2: Cladribin, Category 3: Rituximab). This should create improved and demand-oriented access to treatment for people with MS worldwide.
Interestingly, Rituximab is not approved for the treatment of MS but was still listed. The WHO argues that there is strong evidence for the efficacy and safety of Rituximab in the indication of MS and given the evidence base and the affordability of Rituximab, also due to the availability of biosimilars, Rituximab was prioritized over approved alternatives.
Overall, the listing of MS drugs is very good news, and it is to be hoped that this will improve the treatment of MS worldwide and that patients in all regions of the world will have access to effective therapy options. If you are interested, you can also read the WHO press release in the original: https://www.who.int/news/item/26-07-2023-who-endorses-landmark-public-health-decisions-on-essential-medicines-for-multiple-sclerosis#:~:text=Medicines%20for%20multiple%20sclerosis%20(MS)&text=Until%20now%2C%20no%20medicines%20for,large%20global%20burden%20of%20MS.
MS sufferers in the global South
On the other hand, we should remember at this opportunity that there is still a great injustice in access to vital medicines, especially in countries of the global South. This is a deeply worrying reality that threatens the lives of millions of people and deepens the social gap between wealthy countries and poorer regions of the world.
In my professional life, I had the chance to get to know other health systems and see the reality of MS care in different countries and thus also the worries and needs of both doctors and patients – it is sometimes hard to bear why, for example, young patients in resource-poor countries, who probably have the same hopes and dreams for their lives as young MS sufferers in Western Europe, much less often receive demand-oriented treatment and yet there is often the risk that they and their families will financially ruin themselves in the effort to receive any therapy. Against this background, the grumbling about the German health system, in which patients have more or less complete and timely access to all pharmacological innovations that are available, is put into perspective.
In my view, it is time for the international community and the civil societies of industrialized nations to make a stronger commitment to combating injustices in access to medicines. This listing of essential medicines is certainly a start, but ultimately it is primarily about strengthening health systems in the global South and creating fair trade conditions.
