Providing a population with safe, effective, good quality drugs at the least possible cost is a major pharmaceutical policy challenge. Many innovations have been tried to increase access to essential drugs.¹ Economic criteria are not yet widely used to formulate and apply pharmaceutical policies; and when they are, their use is generally confined to keeping prices as low as possible. However, pharmaceutical supply is complex and requires a broader economic analysis. Decisions need to be made about purchase strategy and organizational arrangements, and not simply about the less costly of two alternatives. Therefore, pharmaceutical policy-makers should possess some competence in economics, in spite of the fact that the economic characteristics of drugs vary from one to another and there is no fully fledged theory or reliably tested economic instrument to ensure that this sector is properly regulated.

¹ The WHO Expert Committee on the Use of Essential Drugs defines essential drugs as “those that satisfy the health care needs of the majority of the population” [The use of essential drugs. Seventh report of the WHO Expert Committee. Geneva, World Health Organization, 1997 (WHO Technical Report Series, No. 867)]. More than 70 countries now have national drugs policies based on the concept of essential drugs; within the context of their national health policies, these countries each maintain a list of essential drugs.

Notwithstanding the above definition, many countries also use a classification system (known as the VEN classification) to set priorities for the selection, procurement and use of drugs according to their health impact. The VEN classification, which is described in more detail on page 10, assigns drugs to one of three categories:

V: vital drugs
E: essential drugs
N: non-essential drugs.

Each of these categories may be on a country’s essential drugs list. Drugs for minor illnesses assigned to the non-essential category may still be on the list but may be considered a lower priority for procurement than drugs in the other two categories.

This book uses the term “essential” in two ways - both to describe drugs on an essential drugs list and to describe the second category of drugs in the VEN classification. In each case the context identifies the usage for the benefit of readers.