'The list has clearly filled a need. By the end of 1999, 156 countries had a national list of essential medicines; three-quarters of these lists had been revised in the 5 preceding years', WHO's director-general, Gro Harlem Brundtland, told participants of a meeting (Oct 21, Geneva, Switzerland) held to mark the 25th anniversary of the WHO Model List of Essential Medicines.

However, she warned: 'There is now a global cry for equitable access to essential medicines for the prevention and treatment of HIV/AIDS. This also applies for access to other essential medicines, especially those for common childhood diseases, major infectious diseases, and chronic conditions'.

According to WHO, 60% of deaths among the world's population living in poverty are caused by diseases such as malaria and HIV/AIDS.

'95% of world's 33 million people with HIV/AIDS don't have access to life-saving antiretroviral treatment. They die despite the existence of treatments and preventive measures that could protect them', Bernard Pécoul of charity Médicins Sans Frontières (MSF) added.

He praised the addition of 12 antiretroviral drugs to the list recently, but warned that despite a WHO policy change that price should not be a reason for exclusion of a drug from the list, high price remained an obstacle for many new antibiotics-including cephalosporins, quinolones, and macrolides-to be included.

'The list must include these and other new medicines which improve treatment effectiveness and simplify treatment protocols. When people's lives are at risk, WHO and member states have an obligation to impose solutions, even if they contradict the direct interest of commercial entities', Pécoul noted.

One way to increase access to essential medicines in developing countries is to encourage generic competition, according to MSF. For example, as a result of generic competition, the price of HIV triple therapy has dropped to less than US$300 from over $10 000 in May 2002.

Another option is to buy these drugs in bulk, as is done by the Delhi Society for Promotion of Rational Use of Drugs. Since 1996, the society has been buying these drugs in bulk on behalf of state hospitals. As a result, Sangeeta Sharma said, her society receives quotations at 50-80% below the prices given to others and has been able to tackle constant shortages of essential medicines in government hospitals.