Translating the essential drugs concept into the context of the year 2000.

The WHO Essential Drugs List (EDL) was first published in 1977. It must continue to be adapted to a changing world with new drugs, new indications and new diseases. Médecins sans Frontières is concerned that the eleventh list is outdated. The EDL should be stricter about its inclusion of first-line drugs and price should not be a criterion for excluding drugs from the list. Second-line drugs are complementary and their inclusion would in no way undermine the essential drugs concept. The EDL should be updated regularly and in a transparent manner, by an independent panel of experts chosen for their competence. Decisions regarding the inclusion of drugs in the list should be evidence-based, and the evidence should be available to the panel of experts long before their final sessions on updates to the EDL. The WHO not only has the challenge of defining a EDL that addresses today's epidemiological reality, but also a responsibility to assist countries in gaining access to these treatments.