WHO Adds Breakthrough Cancer and Obesity Medicines to Essential List; India Faces Crucial Decision on National Adoption

The World Health Organization (WHO) has released a landmark update to its Model Lists of Essential Medicines (EML), marking a significant shift in global public health strategy. The 24th edition of the EML for adults and the 10th edition for children now include crucial new treatments for cancer, diabetes, and obesity, as well as for conditions like cystic fibrosis and hemophilia. This move serves as a global recommendation, putting pressure on member nations, including India, to consider incorporating these life-saving therapies into their national health policies.

The WHO’s Landmark Additions

The revised lists, which are referenced by over 150 countries for their public procurement and reimbursement schemes, are designed to address the most urgent health challenges facing the world today.

New Cancer Treatments: Recognizing cancer as the second leading cause of death globally, the WHO Expert Committee has focused on expanding access to advanced cancer treatments. The new additions include powerful PD-1/PD-L1 immune checkpoint inhibitors, a class of immunotherapy drugs that enable the body’s own immune system to fight cancer. Pembrolizumab was added as a first-line therapy for metastatic cervical, colorectal, and non-small cell lung cancers, with atezolizumab and cemiplimab listed as therapeutic alternatives. The committee’s recommendation is particularly impactful as it is based on a rigorous criterion: only medicines proven to extend a patient’s life by at least 4-6 months are considered.
Essential Diabetes and Obesity Medicines: In a major move to tackle the intertwined epidemics of diabetes and obesity, the WHO has added a new class of medicines known as glucagon-like peptide-1 (GLP-1) receptor agonists. The list now includes semaglutide, dulaglutide, liraglutide, and the dual agonist tirzepatide. These drugs are specifically recommended for adults with type 2 diabetes who also suffer from heart or kidney disease and obesity. The inclusion redefines these medicines as essential tools for managing severe chronic conditions, not just as lifestyle drugs.

Will India’s National List of Essential Medicines (NLEM) Follow Suit?

The WHO’s list is a powerful guiding document, but its adoption is not automatic in India. The country maintains its own National List of Essential Medicines (NLEM), last updated in 2022, which dictates drug procurement, public hospital stocking, and most importantly, price regulation by the National Pharmaceutical Pricing Authority (NPPA). The Ministry of Health, along with committees like the Indian Council of Medical Research (ICMR) and the Standing National Committee on Medicines (SNCM), will now undertake a detailed, evidence-based review of the WHO’s recommendations.

The path to inclusion for these new medicines in India’s NLEM is likely to be a mixed one, with affordability being the primary determining factor.

Challenges for High-Cost Cancer Drugs: The addition of cancer immunotherapies like pembrolizumab poses a significant financial challenge. A single dose of this drug can cost lakhs of rupees, making it a difficult proposition for India’s public healthcare system, which is designed to serve a vast, low-income population. While the clinical benefit is clear, the high cost could place an enormous strain on government schemes like Ayushman Bharat. The government may have to choose between negotiating with pharmaceutical companies for steep price cuts or waiting for patent expiry and the availability of affordable biosimilars to make these drugs financially viable for the masses.
A Clearer Path for Diabetes and Obesity Medicines: The case for adopting GLP-1 agonists is far more compelling. India has a massive and growing burden of both diabetes and obesity. The WHO’s decision to classify these drugs as essential, particularly for high-risk patients, aligns perfectly with India’s public health priorities. The key to their potential inclusion lies in their cost-effectiveness. The patent for some of these drugs, such as liraglutide, has already expired, allowing Indian pharmaceutical companies to produce more affordable generic versions. This makes large-scale procurement and distribution through public healthcare channels a more realistic possibility. The WHO’s endorsement could also help reframe these drugs as a medical necessity rather than a luxury item, ensuring they are accessible to patients who need them most.

In conclusion, the WHO’s latest EML update provides India with a crucial benchmark for expanding access to new, life-saving medicines. While the inclusion of cutting-edge, high-cost therapies will require careful consideration and strategic planning, the path is open for India to adapt these global standards and ensure its national health policy truly leaves no one behind.