25 years of the WHO essential medicines lists: progress and challenges

Lancet. 2003 May 17;361(9370):1723-9. doi: 10.1016/S0140-6736(03)13375-2.


The first WHO essential drugs list, published in 1977, was described as a peaceful revolution in international public health. The list helped to establish the principle that some medicines were more useful than others and that essential medicines were often inaccessible to many populations. Since then, the essential medicines list (EML) has increased in size; defining an essential medicine has moved from an experience to an evidence-based process, including criteria such as public-health relevance, efficacy, safety, and cost-effectiveness. High priced medicines such as antiretrovirals are now included. Differences exist between the WHO model EML and national EMLs since countries face varying challenges relating to costs, drug effectiveness, morbidity patterns, and rationality of prescribing. Ensuring equitable access to and rational use of essential medicines has been promoted through WHO's revised drug strategy. This approach has required an engagement by WHO on issues such as the effect of international trade agreements on access to essential medicines and research and development to ensure availability of new essential medicines.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Consumer Advocacy / trends
  • Forecasting
  • Guidelines as Topic
  • Health Care Reform / trends
  • Health Services Accessibility / organization & administration
  • Health Services Accessibility / trends
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Intellectual Property
  • Models, Organizational
  • Pharmaceutical Preparations / classification
  • Pharmaceutical Preparations / history
  • Pharmaceutical Preparations / standards*
  • Policy Making
  • South Africa
  • World Health Organization* / history


  • Pharmaceutical Preparations