The World Health Organization has put two abortifacient drugs on its list of essential medicines to offer an alternative to surgical methods that are often used in developing countries.
The WHO holds a list of what it considers essential medicines for developing countries—in other words, medicines that "satisfy the priority healthcare needs of the population" and that are selected on the basis of their efficacy, safety, and cost effectiveness. It will be adding to this list the combination under "close medical supervision" of mifepristone followed, some 36 to 48 hours later, by misoprostol, to induce abortion within nine weeks of pregnancy.
The approval will be of particular benefit to developing countries. Of the 19 million unsafe abortions taking place in the world each year, 18.5 million occur in developing countries. About 68 000 women die each year from unsafe abortion.
"The inclusion of these drugs to the essential drug list is a real addition to the therapeutic alternatives for women who have to undergo abortion, especially in developing countries where surgical facilities are less easily available. We are aware that many women in developing countries die from unsafe abortion, and we are very confident that these medicines will help prevent such unnecessary and tragic death," said Hans Hogerzeil, director of medicines policy and standards at WHO and secretary of its essential medicines committee.
But the addition of the drugs to the list has proved controversial. It is understood that the United States did not support the addition and placed pressure on WHO not to include them, according to a story published in the United Kingdom in the Guardian in (21 April). The publication of the essential medicines list itself, which is reviewed every two years by the essential medicines committee, was believed to have been delayed as a result.
The WHO also recommended that the drugs be used "where permitted under national law and where culturally acceptable," a point added by the WHO’s director general himself.
Dr Hogerzeil said this is the first time this type of language has been used in the essential medicines list, though it is not the first time WHO has used it. For example, similar language was used for emergency contraceptives in emergency health kits in refugee camps.
The combination abortifacient drugs are already registered in nine European countries, including the UK, France, and Germany, as well as the US, Russia, China, Israel, India, New Zealand, and South Africa.
Although the UK’s Family Planning Association welcomed the move by WHO, saying it would provide women with the means to obtain a safe medical abortion, the Society for the Protection of Unborn Children said it "hoped enough cultures rejected the drugs … as they would bring innocent life to an end."
· The WHO has also added methadone and buprenorphine to its essential list for the treatment of heroin addiction. The move is expected to help reduce drug misuse, the spread of HIV, and criminality. The products should be used only within established support programmes, the WHO recommends.
The application for tenofovir, an antiretroviral drug that many non-governmental organisations hoped the WHO would include on the list to treat AIDS, has been suspended, as its manufacturer, Gilead Sciences, would not allow WHO to publish certain data. The application will be reviewed again in 2007.