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What makes an essential medicine? WHO’s new list focuses on antibiotic resistance, adds expensive drugs, and downgrades Tamiflu

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3044 (Published 07 July 2017) Cite this as: BMJ 2017;358:j3044
  1. Michael McCarthy, journalist, Seattle
  1. mxmc{at}mac.com

The focus on efficacy rather than affordability in WHO’s decisions highlights that the essential medicines list is aimed at both rich and poor countries, writes Michael McCarthy

The latest version of the World Health Organization’s model list of essential medicines, released on 6 June 2017, has added 30 drugs for adults and 25 for children, bringing the total number of drugs listed to 433. It has also specified new uses for nine previously listed products and lowered the status of oseltamivir (Tamiflu), moving it from its “core” list to its “complementary” list.

The antiviral was added to the list in 2009 for the treatment of pandemic influenza. It has been downgraded after the committee reviewed evidence that indicated that the drug has little effect on clinical outcomes.

Some of that evidence came to light as the result of a four and a half year campaign by The BMJ for the drug’s manufacturer to release data from clinical studies that it had not published (bmj.com/Tamiflu). A review of that data published in The BMJ found that although the drug shortened the duration of symptoms in adults for about a day, it did not reduce the number of people admitted to hospital or rates of complications.1

In WHO’s new listing, oseltamivir’s use is restricted to severe illness caused by confirmed or suspected influenza virus infection in critically ill hospital patients. The committee said that unless new information supporting the use of oseltamivir for seasonal and pandemic outbreaks is provided, it may consider deleting oseltamivir from the list.

Peter Doshi, assistant professor of pharmaceutical health services research at the University of Maryland School of Pharmacy in Baltimore and one of the authors of The BMJ review, said the committee’s decision was a signal to the drug’s manufacturer, Roche, to provide more data …

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