Cancer is the second leading cause of mortality globally - but the likelihood of a better outcome and quality of life increases with timely diagnosis and access to proper treatment. Despite the global need for essential cancer medicines, nearly all countries are struggling with issues of access, availability and affordability of medicines for cancer treatment.
Ensuring the availability of medicines – chemotherapy, immunotherapy, antibiotics, pain relief medications, etc – requires strong government commitment and a range of activities that guarantee financing and an effective procurement system and supply chain.
Establishing a comprehensive National List of Essential Medicines (NEML) tailored to the needs of the population is key to improving the availability and affordability of cancer medicines.
In 1975 the World Health Assembly requested WHO to create a guidance tool that would help member states in selecting and procuring quality medicines. The first WHO Model List of Essential Medicines list (WHO EML) was published two years later, establishing a guiding principle that some medicines were more useful than others and that these medicines were often not available to all who needed them. Selection of these medicines was initially opinion-based, relying on a physician’s experience in treating patients; now the list is based on an approach grounded in scientific evidence.
Essential medicines are defined as those that “satisfy the priority health care needs of the population” and selected with regard to their public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness. They are intended to be available within the context of functioning health systems in adequate quantities, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford. 
In 2015, UICC convened experts to review the cancer medicines listed on the WHO EML. As a result, the methodology for the selection of essential cancer medicines was revised to propose medicines based on specific regimens for specific cancers, which would make it easier for policymakers to identify cancer medicines relevant for their national disease burden. Using this process, the WHO EML was further updated, with the addition of cancer medicines in 2017 and 2019.
The selection of essential medicines is one of the core components of a national medicines policy. The WHO EML serves as a model to help countries prioritise what is included in their NEMLs for public procurement.
A NEML can decrease barriers to access by maintaining focus on a limited list of medicines. However, lists are not always updated in a timely manner. An analysis of 135 NEMLs in 2016, found that of the 25 cancer medicines on the 2013 WHO EML and 16 added in 2015, a median of 17 and 3 appeared in NEMLs respectively.
The addition of a medicine on the NEML is a crucial step towards ensuring its availability. These lists should be updated at regular intervals.
View the step by step process countries can use in revising their NEMLs:
Establishing a NEML is crucial; however, additional steps must be taken to overcome barriers and ensure access to medicines. These barriers include the pricing and quality of medicines, procurement and supply chain issues, diagnostic capacity, infrastructure and the lack of adequate human resources.
These challenges are increasingly being raised in discussions between policymakers, civil society and the pharmaceutical industry, as governments move towards Universal Health Coverage.
Building on this momentum, UICC was instrumental in bringing the cancer community together for an open, inclusive, constructive, and evidence-based dialogue about how to pursue solutions collectively to improve access to cancer medicines, for the wellbeing of patients and sustainability of cancer care and health systems.
Members can pursue this issue and encourage governments and policymakers to ensure the implementation of an evidence-based NEML, in alignment with the WHO Model List of Essential Medicines, as a first step in improving access to cancer medicines.
WHO Essential Medicines and Health Products: https://www.who.int/medicines/en/
The list of national essential medicine lists by countries: https://www.who.int/selection_medicines/country_lists/en/
WHO Fair pricing forum: https://www.who.int/medicines/access/fair_pricing/en/
Essential medicines for universal health coverage: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31209-6/fulltext
 25 years of the WHO essential medicines lists: progress and challenges https://apps.who.int/medicinedocs/documents/s17543en/s17543en.pdf
 Shulman LN, Wagner CM, Barr R, et al. Proposing essential medicines to treat cancer: methodologies, processes, and outcomes. J Clin Oncol. 2016; 34:69–75.
 Robertson J, Barr R, Shulman LN, Forte GB, Magrini N. Essential medicines for cancer: WHO recommendations and national priorities. Bulletin World Health Organization. 2016;94:735–742.