WHO Model list of essential medicines: visions for the future.

The first version of the World Health Organization Model list of essential medicines contained 186 medicines in 1977 and has evolved to include 502 medicines in 2023. Over time, different articles criticized the methods and process for decisions; however, the list holds global relevance as a model list to over 150 national lists. Given the global use of the model list, reflecting on its future role is imperative to understand how the list should evolve and respond to the needs of Member States. In 2023, the model list Expert Committee recommended the World Health Organization (WHO) to initiate a process to revise the procedures for updating the model list and the criteria guiding decisions. Here, we offer an agenda outlining priority areas and a vision for an authoritative model list. The main areas include improving transparency and trustworthiness of the recommendations; strengthening connection to national lists; and continuing the debate on the principles that should guide the model list, in particular the role of cost and price of essential medicines. These reflections are intended to support efforts ensuring the continued impact of this policy tool.

La première version de la Liste modèle des médicaments essentiels de l'OMS, publiée par l'Organisation mondiale de la Santé, répertoriait 186 médicaments en 1977 et s'est enrichie jusqu'à en inclure 502 en 2023. Au fil du temps, différents articles ont critiqué ses méthodes et processus décisionnels; toutefois, elle reste importante au niveau mondial, servant de référence à plus de 150 listes nationales. Compte tenu de l'usage international qui en est fait, il est impératif de réfléchir à sa fonction future afin de comprendre comment elle peut évoluer et répondre aux besoins des États Membres. En 2023, le Comité d'experts chargé de la liste modèle a recommandé à l'OMS de se lancer dans la révision des procédures de mise à jour de cette liste, ainsi que des critères appliqués aux décisions. Dans le présent document, nous proposons un programme qui définit les priorités et les perspectives d'avenir pour que la liste fasse autorité. Parmi les principaux domaines abordés figurent l'amélioration de la transparence et de la fiabilité des recommandations, le renforcement des liens avec les listes nationales et la poursuite du débat sur les principes qui devraient orienter la liste modèle, en particulier le rôle joué par les coûts et les prix des médicaments essentiels. Ces réflexions ont pour but de soutenir les efforts permettant à cet instrument politique de conserver son impact.

La primera versión de la Lista Modelo OMS de Medicamentos Esenciales contenía 186 medicamentos en 1977 y ha evolucionado hasta incluir 502 medicamentos en 2023. Con el tiempo, diferentes artículos criticaron los métodos y el proceso de decisión; sin embargo, la lista conserva su relevancia mundial como lista modelo para más de 150 listas nacionales. Dado el uso global de la lista modelo, es imperativo reflexionar sobre su función futura para comprender cómo debe evolucionar la lista y responder a las necesidades de los Estados Miembros. En 2023, el Comité de Expertos de la lista modelo recomendó a la OMS que iniciara un proceso para revisar los procedimientos de actualización de la lista modelo y los criterios que guían las decisiones. En este documento, se ofrece un programa en el que se describen las áreas prioritarias y la visión de una lista modelo oficial. Entre las principales áreas se incluyen la mejora de la transparencia y la fiabilidad de las recomendaciones, el refuerzo de la conexión con las listas nacionales y la continuación del debate sobre los principios que deben guiar la lista modelo, en particular sobre la función del coste y el precio de los medicamentos esenciales. El objetivo de estas reflexiones es apoyar los esfuerzos que aseguren el impacto continuado de esta herramienta política.

Tuberculosis among asylum seekers in Milan, Italy: epidemiological analysis and evaluation of interventions.

In countries of the European Union, tuberculosis (TB) mainly affects marginalised people, including asylum seekers. Migratory flows from high-incidence countries to Italy have increased up to 2017, posing challenges to the national health system. This study sought to assess TB and latent TB infection (LTBI) prevalence among asylum seekers in Milan during the biennium 2016-2017 and to evaluate interventions in place.A two-level active surveillance and screening system was developed for both TB and LTBI. Asylum seekers underwent an initial screening with a tuberculin skin test (TST) and a questionnaire at the receiving sites. At the Regional TB Reference Centre, those with a positive result underwent chest radiography. People aged <35 years with negative chest radiography results underwent further testing by interferon-γ release assay. If results of the assay were positive, LTBI treatment was offered. TB and LTBI prevalence were compared with literature data.A total of 5324 asylum seekers, mostly young (10-39 years; 98%), male (84%) and from sub-Saharan Africa (69%), were enrolled in the study. 69 active TB cases were diagnosed and 863 LTBI-positive individuals were detected. TB prevalence was high (1236 per 100 000 population) and LTBI prevalence was 28%. Despite losses (41%) during the transition from initial screening sites and the diagnostic centre, a good TB cure rate (84%) and optimal LTBI treatment completion (94%) were achieved.Our study shows that TB incidence is high among asylum seekers in Milan and that well-coordinated screening measures are critical for early diagnosis and treatment. It also proves that rolling out successful at-scale interventions for both prophylaxis and disease management is feasible.

Global ecological analysis of COVID-19 mortality and comparison between "the East" and "the West".

Although SARS-CoV-2 was first reported in China and neighbouring countries, the pandemic quickly spread around the globe. This paper explores national drivers of the pandemic and the radically different epidemiology and response in the West and in the East. We studied coronavirus disease (COVID-19) mortality until 31st December 2020, using an ecological study design, considering baseline characteristics and responses that might account for the uneven impact of the pandemic. A multivariable regression model was developed to explore key determinants. Key variables in the West were contrasted with those in the East, and speed of response was examined. Worldwide, 2.24 million COVID-19 deaths were documented in 2020. Western countries reported a median mortality 114 times that of the East (684 vs. 6.0 per million). Significant correlates of mortality in countries with at least 1 million population were median age, obesity prevalence, and democracy index; political stability and experience of SARS in 2002-2003 were protective; health system variables and income inequality were not associated. Outputs of the model were consistent when adjusted for stringency index, timeliness of stay-at-home requirements, and geographical autocorrelation. The West experiences a much higher COVID-19 mortality than the East. Despite structural advantages in the West, delays in national responses early on resulted in a loss of control over the spread of SARS-CoV-2. Although the early success of the East was sustained in the second half of 2020, the region remains extremely vulnerable to COVID-19 until enough people are immunized.

The neglected role of Faith-based Organizations in prevention and control of COVID-19 in Africa.

The COVID-19 pandemic has exposed health system weaknesses of economically wealthy countries with advanced technologies. COVID-19 is now moving fast across Africa where small outbreaks have been reported so far. There is a concern that with the winter transmission will grow rapidly. Despite efforts of African Governments to promptly establish mitigating measures, rural areas, especially in sub-Saharan Africa, risk being neglected. In those settings, faith-based and other non-governmental organizations, if properly equipped and supported, can play a crucial role in slowing the spread of COVID-19. We describe our experience in two rural health facilities in eSwatini and Ethiopia highlighting the struggle towards preparedness and the urgency of international support to help prevent a major public health disaster.