Technical consultation: Nutrition‐related products and the WHO Model List of Essential Medicines: practical considerations and feasibility

“The World Health Organization (WHO) recommended the approval of the draft 13th General Programme of Work 2019-2023 (GPW13) by the Seventy-first World Health Assembly. The GPW13 is focused on three interconnected strategic priorities to ensure healthy lives and promote well-being for all at all ages: advancing universal health coverage, addressing health emergencies and promoting healthier populations. It is estimated that half of the world’s population cannot obtain essential health services. Universal health coverage means that all people receive the quality health services they need without suffering financial hardship. These include public health services designed to promote better health, to prevent illness, and to provide treatment, rehabilitation and palliative care of optimal quality. Appropriate access to affordable and quality-assured medicines, vaccines and health products (including diagnostics and devices, blood and blood products, and nutrition-related products) is part of universal health coverage.

Access to nutrition-related products may be improved by including them in the WHO Model of Essential Medicines List (EML), a core element of universal health coverage. Alternatively, some of these products may be registered as food for special medical purposes.

Over the past years new nutrition-related products used in the public health and clinical interventions have been developed to prevent and treat undernutrition (i.e. ready-to-use therapeutic foods (RUTFs), therapeutic-formula diets (F75 & F100), iron-containing multiple micronutrient powders, vitamin and mineral supplements).

Undernutrition such as wasting, stunting and micronutrient deficiencies, increases risk of morbidity and to early deaths for mothers, infants and young children, and impaired physical and mental development in the young. Around 45% of deaths among children under 5 years of age are linked to this form of malnutrition. WHO guidelines recommend the use of RUTFs and F75 / F100 as part of the management of severe acute malnutrition, while other nutrition-related products (i.e. multiple micronutrient powders for point-of-use fortification of foods, iron plus folic acid supplements) are recommended for the prevention of nutritional anaemias.

A proposed strategy to improve the access of nutrition-related products to the target population in need is to make them part of the WHO Model List of Essential Medicines. The WHO Department of Essential Medicines and Health Products define essential medicines as those that satisfy the priority health care needs of the population. Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford.

The WHO Model List of Essential Medicines serves as a guide for the development of national and institutional essential medicine lists and is updated and revised every two years by the WHO Expert Committee on Selection and Use of Medicines. In 2017, an application to include RUTFs in the EML was made by a nongovernmental organization. This application was reviewed and the Committee agreed on the need to improve the access of RUTFs at country level for the outpatient treatment of severe acute malnutrition. The Committee considered that including RUTFs in the EML might carry implications to comply with stringent requirements for medicines or pharmaceutical products in some countries and manufacturing sites, and recommended WHO to conduct a comprehensive evaluation of the benefits and trade-offs associated with the potential listing of nutrition-related products in the EML.

The WHO Department of Nutrition for Health and Development, in collaboration with the Department of Essential Medicines and Health Products are convening the technical consultation: “Nutrition-related products and the WHO Model List of Essential Medicines: practical considerations and feasibility” to identify the criteria that define a nutrition-related product to be considered as candidate for inclusion in the EML and to determine the advantages, disadvantages and trade-offs that would result from the inclusion of RUTFs and other nutrition-related products in the EML.