WHO Expands 2025 Essential Medicines List, Adding Life-Saving Cancer and Diabetes Treatments
Switzerland: The World Health Organization (WHO) has released the executive summary report of its 25th Expert Committee meeting on the Selection and Use of Essential Medicines, held from May 5 to 9, 2025, in Geneva. These updates to the Model List of Essential Medicines (EML) and the Model List of Essential Medicines for Children (EMLc) are designed to address critical global health challenges, including the impacts of climate change, the escalating burden of chronic diseases, and cancer.
The overarching goal is to foster greater equity and access to life-saving treatments worldwide. The Model Lists serve as a crucial guide for countries and regional authorities to adapt for their national essential medicines lists, aiming to improve access, promote rational prescribing, and lower healthcare costs.
The Expert Committee's diligent review of 59 applications, including proposals for new medicines, indications, and formulations, culminated in significant revisions. Ultimately, the Committee recommended adding 20 new medicines to the EML and 15 to the EMLc, bringing the total number of medicines (including fixed-dose combinations) to 523 on the EML and 374 on the EMLc. This dynamic revision process also involved adding new indications for existing medicines, incorporating new formulations, and recommending the deletion of some medicines and formulations that were either no longer appropriate, unavailable, or posed environmental concerns.
10 Key Takeaways from the WHO Essential Medicines List Updates (2025):
1. Expanded Lists & Dynamic Revisions: The EML now totals 523 medicines (up from 502 in 2023) and the EMLc 374 (up from 361 in 2023), reflecting continuous adaptation to evolving health needs.
2. Environmental Stewardship: Halothane was removed from both lists due to its significant environmental impact as a potent greenhouse gas and ozone-depleting substance. New guidance was also issued to prioritize point-of-care cylinders for nitrous oxide to minimize waste.
3. GLP-1 Agonists for Diabetes with Comorbidities: Medicines like semaglutide, dulaglutide, liraglutide, and tirzepatide were added to the EML as add-on therapy for adults with type 2 diabetes who also have established cardiovascular disease (CVD) or chronic kidney disease (CKD) AND obesity (BMI ≥ 30kg/m2). However, they were not recommended for obesity without these specific comorbidities due to limited long-term safety and cardiovascular outcome evidence. The Committee acknowledged high costs but emphasized fostering competition through biosimilars.
4. Strategic Cancer Immunotherapy: Immune checkpoint inhibitors such as pembrolizumab, atezolizumab, and cemiplimab were included for specific metastatic cancers like non-small cell lung cancer, colorectal cancer, and cervical cancer. Strategies were outlined to improve access, including aggregating procurement of a single molecule (pembrolizumab) across multiple indications to influence price negotiations and encourage biosimilar entry.
5. Cystic Fibrosis Breakthroughs: The combination therapy elexacaftor + tezacaftor + ivacaftor and single-agent ivacaftor were added for treating cystic fibrosis in eligible patients aged 2 years and older. The Committee recognized their significant benefits but also noted high costs and the hope for generic development.
6. Enhanced Haemophilia Care: Emicizumab was added for haemophilia A, alongside recombinant coagulation factors VIII and IX. Due to its high price, the Committee suggested prioritizing emicizumab for patients with factor VIII inhibitors in resource-limited settings.
7. New Vaccines for Public Health: The lists were expanded to include vaccines for Ebola, Mpox, Hepatitis E, maternal Respiratory Syncytial Virus (RSV), and Malaria, aligning with WHO Strategic Advisory Group of Experts (SAGE) recommendations.
8. Methylphenidate for ADHD Not Recommended: The Committee did not recommend methylphenidate for Attention-Deficit Hyperactivity Disorder (ADHD) in children and adolescents, citing "limitations in the available evidence for benefits and safety of long-term use" and concerns about health system capacity in low- and middle-income settings for appropriate diagnosis and management.
9. AWaRe Antibiotic Classification Review: A comprehensive review of the AWaRe (Access, Watch, Reserve) antibiotic classification system and its definitions was requested to be considered by the 2027 Expert Committee, deferring immediate reclassification requests.
10. Triple Fixed-Dose Antihypertensives: Triple fixed-dose combination (FDC) antihypertensive formulations were added to the EML for patients with uncontrolled blood pressure on dual therapy or those at high risk (e.g., with diabetes, kidney disease, cardiovascular disease), aiming to improve adherence and simplify treatment.
These updates highlight the WHO's ongoing commitment to ensuring essential medicines meet global priority healthcare needs, balancing clinical efficacy and safety with critical considerations of affordability, access, and environmental impact.
Reference:
The selection and use of essential medicines, 2025: report of the 25th WHO Expert Committee on Selection and Use of Essential Medicines, executive summary. Geneva: World Health Organization; 2025. https://doi.org/10.2471/B09544. Licence: CC BYNC-SA 3.0 IGO.
