Treatment and Care

On October 21 2015, the WHO published the full report of the 20th Expert Committee on the Selection and Use of Essential Medicines, including its new Model List of Essential Medicines and a dedicated cancer chapter.

Access to essential medicines is a critical component to be addressed as part of Universal Health Coverage (UHC), particularly with the commitments to noncommunicable diseases (NCDs) contained within the UN Sustainable Development Goals (SDGs).

More than 60% of the world's new cancer cases occur in low- and middle- income countries (LMICs). In spite of the monumental advances in our understanding of systemic therapies for cancer, many LMICs have lacked the bandwidth to develop national cancer formularies and address the complex web of barriers and challenges to achieving the global targets for equitable access to safe, quality and affordable cancer medicines. The WHO Model List of Essential Medicines is an important starting block in addressing these access issues.

Governments of the world have committed to reaching a target of 80% availability of essential medicines and technologies for NCDs by 2025. In order for cancer contributions to this target to be optimal as possible, in 2014, UICC worked with WHO to generate a new methodology for rational selection with the goal of equipping policy makers with the guidance on best select cancer medicines that will have a major impact on patients in their specific national setting. 

Applying the same framework for both, the comprehensive review covered treatment of adult and paediatric cancers, and updates to both the WHO Model List of Essential Medicines (EML) and the WHO Model List of Essential Medicines for Children (EMLc). 

  • See here a downloadable infographic which summarises the process and outputs
  • The methodology is published here
  • The full report is available here

Demonstrating a key win for global oncology, the Expert Committee recommended the addition of 16 new cancer medicines to the EML and 10 new cancer medicines to the EMLc.  These additions broaden the number of treatable cancers from 18 to 29 for adult cancers, and 3 to 10 paediatric cancers. What’s more, the EML had previously simply listed all anti-neoplastics whereas the methodology now emphasises a disease-based approach and includes full briefings on the evidence, capacities, and costs of individual regimens, helping decision makers identify priority medicines to meet their country's health needs. As Margaret Chan, Director General of WHO, highlighted:

"When new effective medicines emerge to safely treat serious and widespread diseases, it is vital to ensure that everyone who needs them can obtain them. Placing them on the WHO Essential Medicines List is a first step in that direction" 

UICC is committed to work with WHO to consolidate this new framework. We are calling on our membership and other interested stakeholders to join our consultation to feed into this next cycle of development and contribute to 2017 decision making. We encourage you to participate by clicking the “join now” button, and to share this link with your networks via blogs, newsletters and other social media. The consultation is now closed.

For more information on submitting proposals for inclusion of new medicines, and changes to or deletion of the currently listed medicines in the 2017 Model Lists, please click here.

Click here to read an example of how essential medicines give a lifeline to people living with cancer.


Recent Updates: Upcoming 69th World Health Assembly

The 69th World Health Assembly (WHA) in May 2016 will discuss topics related to medicines, among others:

  • Addressing the global shortages of medicines,
  • Safety and accessibility of children’s medication, and
  • Comprehensive evaluation of the global strategy and plan of action on public health, innovation and intellectual property.

More about the upcoming WHA can be found at:  http://apps.who.int/gb/e/e_eb138.html


Read further to hear from members of the steering committee who provided expertise for the 2015 list.

What is the role of the WHO Model EML?
Nicola Magrini, Secretary, WHO Expert Committee on the Selection and Use of Essential Medicines
“As the priority health care needs of different populations will and do vary, the WHO Model Lists are intended to serve as a guide for countries in the development of their own national lists of essential medicines: to guide procurement, reimbursement and medicines policy at country level, with the goal of achieving universal health coverage. 

The WHO Model Lists can also be a tool to be used in the regular revision and update of established national essential medicine lists.  As the WHO Model Lists are updated every two years, it would be appropriate for national lists to be updated following a similar time frame to ensure the up to date, relevant recommendations are being considered at country level”.

46 medicines is a lot to have – is there a more essential subset?
Lawrence Shulman, Director, Center for Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania
“The addition of 16 medicines to the previous list of 30 medicines on the WHO EML for cancer in May 2015 represented a major advancement in our approach to the EML.  Medicines were recommended based on disease-based analyses of their impact on survival.  27 diseases were chosen because systemic therapies could impact on the outcome for these patients”. 
 
What are the changes on the children’s list versus the adults list?
Ronald Barr, Professor, Division of Hematology & Thromboembolism, Dept. of Medicine, McMaster University
 “Two main factors contributed to the approval of all medicines recommended for addition to the EMLc – development of proposals according to a rigorous process and co-ordination with colleagues from the provider community for adults. Continuous rather than bi-annual review and consolidation of the EMLs for Children and Adults should lead to further access by children with cancer to Cytotoxic and Adjuvant Medicines”.
               
How does the 2015 list match with the ASCO framework?
Gilberto Lopez, Chief Medical and Scientific Officer, Oncoclinicas do Brasil Group, Johns Hopkins University
“The World Health Organization Essential Medicines List serves as a guide to member nations and healthcare systems around the globe, naming those medications that are fundamental and should be included in all drug formularies. One of the new aspects of the most recent iteration of the WHO EML for cancer is that, just as the ASCO Value framework, it takes in consideration not only each particular drug, but also the specific indication and regimen in which each medication is used, allowing for more clarity on the specific best uses of the anticancer agents included in the list”.