When did medicines become essential?

Expanding access to essential medicines has become one of the most visible challenges of global health delivery. Only a half-century ago, however, the role of medicines in international public health was far less obvious. Indeed, the original 1946 Constitution of the World Health Organization (WHO) barely mentioned medicines. 1 How did access to drugs assume such a central role within global health efforts? The answer is not simply that the drugs of today work better than those of the mid-20th century. When Halfdan Mahler warned the 1975 World Health Assembly of the " urgent need to ensure that most essential drugs are available at a reasonable price " , 2 his words spoke to the changing social and political realities of world health as much as any material shift in epidemiology or therapeutics. Essential drugs depicted a shift in WHO's therapeutic priorities from standard-setting towards the business of " getting drugs into bodies ". 3 When, in 1977, WHO published a list of 186 " essential drugs " defined as " basic, indispensible and necessary for the health of the populations " , 4 this simple act of list-making shifted a set of commodities from the private sphere into a public health commons, and reopened older debates on the relationship between international health and trade that dated back to the original 1948 World Health Assembly. Delegations who had then wished to see WHO " provide essential medical supplies…to countries which do not produce these commodities " were opposed by others insisting that medicines, " like other commodities, should now be obtained through the normal peacetime economic machinery ". Until the mid-1970s, WHO had compromised, working actively to ensure the supply of a few drugs such as chloro-quine, penicillin and streptomycin that were linked to vertical campaigns while leaving the remaining pharmacopoeia to the laws of the market. By the mid 1970s, however, a new majority of decolonized countries called upon the World Health Assembly to improve the supply of medicines for their struggling health systems. Many of these countries' public health budgets were overwhelmed by the cost of importing brand-name drugs, often of dubious quality. 7,8 Medicines subsequently became a key issue in the politics of the new international economic order after the Fifth Conference of Non-Aligned Countries adopted a resolution in Colombo in 1976 arguing that all Member States act en bloc within WHO and the United Nations to …