A/HRC/23/42
context of ARV medicines, from 2000 to 2011, market competition induced by a significant
number of generic companies in the market substantially reduced the prices of those
medicines.54 With respect to improving affordability of essential medicines, competitive
public procurement55 and generic substitution56 has also proved successful. The Special
Rapporteur encourages States to enact competition laws and formulate policies for their
effective enforcement in order to ensure affordable prices for essential medicines.
C.
Medicines lists
40.
In order to ensure availability of essential medicines, States should first identify
medicines required to address priority health needs of the population under a national
essential medicines list (NEML). This is consistent with States’ core obligation to provide
essential medicines listed in the WHO Essential Medicines List (EML).57 These include
painkillers, anti-infectives, anti-bacterials, anti-tuberculosis, anti-retrovirals, blood
products, cardiovascular medicines, vaccines and vitamins.58
41.
The NEMLs are based on the rationale that a limited range of priority medicines
contributes to better health care and optimizes the use of financial resources in resourcelimited settings.59 The NEML also serves as a guide for public procurement of medicines
and provides guidance for local production of medicines.60 Notably, in both developed and
developing countries NEMLs are used to guide cost-containment measures for
pharmaceutical expenditures.61
42.
Under the right-to-health framework, the process of selection of essential medicines
should be evidence-based, transparent and participatory. It should also be a part of the
national plan of action on medicines, aimed at ensuring availability and affordability of
medicines. The WHO EML is revised every two years by the Expert Committee on the
Selection and Use of Essential Medicines (the Expert Committee). Revisions should be
based on documentary evidence and include the participation of various groups, such as
pharmaceutical companies and patients’ groups, through a transparent application process.
In contrast, responses to the questionnaire received from States revealed that civil society
and community representatives were often excluded in the process of selecting essential
medicines for NEMLs. Participation by civil society and communities can also contribute
towards providing some evidence of health issues faced by the population.
43.
Inclusion in the WHO EML implies that States should make medicines affordable
for those who need it, including patented medicines. The Special Rapporteur is, however,
aware of concerns about selective practices in including patented medicines in the WHO
EML. In more recent versions of the WHO EML, some expensive patented ARVs, antimalarial and anti-tuberculosis medicines have been included, while such key ARVs as
54
55
56
57
58
59
60
61
Médecins Sans Frontières (MSF), Untangling the Web of Antiretroviral Price Reductions, MSF
Campaign for Access to Essential Medicines, 14th Edition (2011).
Hawkins, “Competition Policy” (see Note 30 above) pp. 5-6.
WHO, “Public-Private Roles in the Pharmaceutical Sector: Implications for Equitable Access and
Rational Drug Use” (see note 39 above), pp. 62-63.
E/C.12/2000/4, para. 43 (d).
See current list at: http://www.who.int/medicines/publications/essentialmedicines/en/
Jonathan D Quick, “Essential medicines twenty-five years on: closing the access gap”, Health Policy
and Planning, vol. 18, No. 1 (2003), pp. 1–3, p. 1.
Medicines: essential medicines, WHO Fact Sheet No. 325, June 2010.
http://www.who.int/mediacentre/factsheets/fs325/en/index.html
Hans V. Hogerzeil, “The concept of essential medicines: lessons for rich countries”, British Medical
Journal, vol. 329 (2004), pp. 1169-1172, p. 1169.
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