Intended for healthcare professionals


Decisions on WHO’s essential medicines need more scrutiny

BMJ 2014; 349 doi: (Published 31 July 2014) Cite this as: BMJ 2014;349:g4798
  1. Corrado Barbui, associate professor of psychiatry,
  2. Marianna Purgato, researcher
  1. 1WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico GB Rossi, Piazzale Scuro 10, 37134 Verona, Italy
  1. Correspondence to: C Barbui corrado.barbui{at}

Global endorsement as a WHO essential medicine is big step. But Corrado Barbui and Marianna Purgato find that the quality of applications for antidepressants and antipsychotics is poor and call on applicants and WHO to raise standards


The World Health Organization produced its first essential medicines list in 1977 in response to a request from member states to help them select and procure medicines for priority healthcare needs.1 2 The list included 208 drugs selected on the basis of their efficacy, safety, availability, ease of use in various settings, comparative cost effectiveness, and public health needs.1 It has been updated every two years since by a WHO expert committee.

The list does not include all effective medicines, the latest medicines, or even all medicines needed in a country; rather, it helps define the minimum needs for a basic health system. Essential medicines include, for example, amoxicillin, diazepam, and haloperidol. WHO suggests that essential medicines should be available within functioning health systems at all times, in adequate amounts, in the appropriate doses, with assured quality, and at a price the individual and the community can afford.2

The effect of the essential medicines list has been remarkable. Conceptually, it has led to global acceptance of essential medicines as a powerful means to promote health equity. Countries are not bound by the list, but it has provided a guide for the development of national, provincial, or state lists and helped promote the development of medicine policies and access initiatives.1 However, our review of medicines for mental disorders in the list raises questions about how decisions are made on what is included.

Getting onto the list

The rules governing the process for inclusion on the list have changed substantially over time. Originally, the expert committee largely decided what should be included. But in 2002, …

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