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Prices of cancer, diabetes, antimicrobials, antifungal drugs and tobacco cessation medicines may decline in India with the World Health Organization (WHO) including these drugs in the new edition of its Model Lists of Essential Medicines and Essential Medicines for Children published on Friday.

Antimicrobial drugs and those for fungal diseases such as mucormycosis surged during the pandemic, especially in the second wave. WHO’s updated essential medicines’ list includes 20 new medicines for adults and 17 for children and specifies new uses for 28 already-listed medicines.

WHO said high prices for both new, patented medicines and older medicines such as insulin continue to keep some essential medicines out of reach for many patients.

WHO’s model lists of essential medicines refer to those medicines that satisfy the priority healthcare needs of most of the population.

WHO noted that diabetes is spreading faster in low- and middle-income countries.

“Too many people who need insulin encounter financial hardship in accessing it or go without it and lose their lives. Including insulin analogues (an altered form of insulin) in the essential medicines’ list, coupled with efforts to ensure affordable access to all insulin products and expand use of biosimilars, is a vital step towards ensuring everyone who needs this life-saving product can access it," said Dr Tedros Adhanom Ghebreyesus, director-general, WHO.

As per International Diabetes Federation, 463 million people have diabetes globally with 88 million people in South-east Asia. Of this, 77 million are in India with 8.9% prevalence of diabetes in the population.

WHO noted that insulin production is concentrated in a small number of manufacturing facilities, and three firms control most of the global market. The lack of competition has led to high drug prices that are prohibitive for many people and health systems, it said.

“Inclusion in the list means that biosimilar insulin analogues can be eligible for WHO’s prequalification programme; WHO prequalification can result in more quality-assured biosimilars entering the international market, creating competition to bring prices down and giving countries a greater choice of products," said WHO.

Public health experts in India appreciated the move.

“Overall, this step of the WHO is welcome, specifically in relation to availability of life and heart saving SGLT2 inhibitor drugs at primary level. However, decision of provision of insulin analogues at primary levels is intriguing because these cost 2-5 times more than regular insulin and add nothing to efficacy in lowering blood sugar, apart from lower tendency to cause hypoglycemia. At primary level (and at all levels), low-cost regular insulins work as effectively as any highly publicized expensive insulins," said Dr Anoop Misra, chairman at Fortis-C-DOC and president of Diabetes Foundation (India).

In the case of cancer treatment, four new drugs were added to the model lists—Enzalutamide as an alternative to abiraterone for prostate cancer; Everolimus for subependymal giant cell astrocytoma (SEGA), a type of brain tumour in children; Ibrutinib, a targeted medicine for chronic lymphocytic leukaemia; and Rasburicase for tumour lysis syndrome, a serious complication of some cancer treatments.

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