Essential cancer medicines in the national lists of countries of the WHO South-East Asia Region: a descriptive assessment

Background In 2015, the need for equitable access to cancer treatments in low- and middle incomecountries was underscored by the addition of 16 essential cancer medicines to the 19th World HealthOrganization (WHO) model list of essential medicines (WHO EML). This study assessed the degree towhich this expanded WHO EML from 2015 has influenced inclusion of cancer medicines in the mostrecent national essential medicines lists of the countries of the WHO South-East Asia Region.Methods The inclusion of a selected list of 38 essential cancer medicines in the 2015 WHO EML wasassessed in the most recent national lists of essential medicines from the 11 countries of the WHOSouth-East Asia Region. Additionally, the availability of six essential cancer medicines common tothe national lists of essential medicines from six countries of the WHO South-East Asia Region wasexplored.Results Of the 38 selected essential cancer medicines included in the 19th WHO EML, a mean of 18.0(range 2–33) were included in the national lists of countries of the WHO South-East Asia Region. Ofthe 25 essential cancer medicines included in the WHO EML prior to the 19th revision, a mean of 14.6(range 2–21) were included in national lists; notably fewer of the 13 cancer medicines added in the2015 revision were included: mean 3.4 (range 0–12).Conclusion Compared with the WHO EML, there is a lag in the inclusion of essential cancermedicines in national lists of essential medicines in the WHO South-East Asia Region. Alignment ofessential cancer medicines in national lists of essential medicines among the 11 countries in the regionvaries significantly. These differences may hinder regional strategies to improve access to essentialcancer medicines, such as pooled procurement of selected high-cost medicines. The link between theavailability and affordability of essential cancer medicines warrants further investigation, in the contextof access to medicines for universal health coverage

Approaches to improving access to essential cancer medicines in the WHO South-East Asia Region

The high cancer burden in the World Health Organization (WHO) South-East Asia Region representsnot only a significant cause of death, disability and suffering but also a major threat to development.In 2015, the need for equitable access to cancer treatments was underscored by the additionof 16 cancer drugs to the 19th WHO model list of essential medicines, including three high-costmedicines. This paper explores strategies to improve access, including – but not limited to –managing costs through regional cooperation; coordinated procurement mechanisms; price controls;differential pricing; and licensing agreements. The composition of the region, with small and largepharmaceutical markets with a range of manufacturing capacities and supply-chain issues, offers aunique frame of comparison and consideration for access issues. Different approaches are neededthat are tailored to specific country situations. However, in the absence of global collaborativefunding mechanisms, the region can advocate now, with one voice, for regional action to improve theaffordability and availability of essential cancer medicines and align national cancer-control strategiesto leverage regional strengths. Delays will lead to more premature cancer deaths and morehouseholds in the WHO South-East Asia Region being impoverished through out-of-pocket paymentsfor cancer medicines