Working to improve access to MS treatments in low-resource settings
In December 2022, the Multiple Sclerosis International Federation (MSIF) applied to add MS treatments to the World Health Organization’s Essential Medicines List (EML). This was the result of many years of effort from MS experts across the globe, who undertook a rigorous review of all the disease-modifying therapies (DMTs) for MS to develop recommendations for the application.
The EML has a key role in improving access to medicines globally, as a tool for awareness-raising and advocacy. If this application is successful, it will formally acknowledge MS as a global health concern, and put it higher on the agenda of the WHO and individual countries.
MSIF's application to add MS treatments to the World Health Organization’s Essential Medicines List (EML) is now publicly available ⧉ on the WHO website.
MSIF's Application
Further information
Multiple sclerosis and disease-modifying therapies
Multiple sclerosis (MS) is the most common non-traumatic cause of neurological disability in young adults, with prevalence rates increasing globally. Early, adequate control of disease activity with disease modifying therapies (DMTs) can delay the progressive phase of the disease, preventing accumulation of disability and prolonging the ability of people with MS to remain active and employed with enhanced quality of life.
Without access to early or effective treatment, individuals with MS are at high risk of hospitalisation due to acute disease exacerbations, accelerated time to disability progression and decreased life expectancy.
What is the WHO Essential Medicines List and why is it important?
The WHO Essential Medicines List (EML) has a key role in improving access to medicines globally. Essential medicines are those that are needed as a minimum to satisfy the priority health care needs of a population. There are currently no treatments for MS on the WHO EML.
Listing MS DMTs on the WHO EML creates a tool for awareness-raising and advocacy. It is a WHO-level stamp of approval, moving the conversation from whether MS DMTs should be made available to how to make them available in low-resource settings. Importantly, the listing of any MS DMTs on the WHO EML will formally acknowledge MS as a global health concern, and put it higher on the agenda of the WHO and individual countries.
Proposal for inclusion of three disease-modifying therapies for multiple sclerosis
Though several applications to consider MS treatments for the EML have been submitted to the WHO, including the MSIF 2019 application, none have been successful to date. At present there is no section of the EML dedicated to MS and no DMTs indicated for MS are listed on the WHO EML with MS as an indication. This is indicative of a disparity and treatment gap between high-income countries (HICs) and low-and middle-income countries (LMICs).
The Intersectoral Global Action Plan (IGAP) on epilepsy and other neurological disorders (IGAP)
In May 2022, the Intersectoral Global Action Plan (IGAP) on epilepsy and other neurological disorders (IGAP) was adopted at the Seventy-fifth World Health Assembly, endorsed by 194 member states, and committed WHO to prioritise neurological conditions over the next decade. This application will act as a catalyst for international, national, and local efforts to improve access to treatment for MS in line with the goal of the IGAP.
Extract from the IGAP: “Essential medicines have a crucial role for both the prevention and treatment of neurological disorders. For example, medicines for multiple sclerosis exist that slow disease progression and improve the quality of life for many people, but their availability and affordability are limited in low- and middle-income countries.”
This application has been prepared independently but with regular contact and consultation with Tarun Dua (Head) and Nicoline Schiess (Technical Officer) from WHO Brain Health Unit, Mental Health and Substance Use Department. Nicoline Schiess has participated as an observer on the MSIF Essential Medicines Panel throughout the process, and the application has been shared twice for comments with the Brain Health Unit.
24th Expert Committee on Selection and Use of Essential Medicines
The WHO Model Lists of Essential Medicines are updated every two years by the Expert Committee on Selection and Use of Essential Medicines. The current versions, updated in September 2021, are the 22nd Essential Medicines List (EML) and the 8th Essential Medicines List for Children (EMLc).
The meeting of the 24th WHO Expert Committee on the Selection and Use of Essential Medicines will be held at WHO Headquarters, Geneva, from 24 to 28 April 2023 to revise and update the WHO EML and the WHO EMLc.
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