Historically, limited access to medicines was viewed as a problem primarily affecting healthcare systems in the Global South.  However, in recent years this issue has also emerged in the Global North, thus transforming access to medicines into a global concern extending beyond low-resource settings. Moreover, access to medicines is nowadays addressed not just as a moral and public health imperative, but also considered as a matter of health security. Stakeholders in the European Union (EU) and in Africa increasingly call for measures to reduce dependence on Asian markets, thus ensuring health security while also fostering local industrial and economic development.

Last week, the fifth anniversary of the Covid pandemic brought back memories of shortages of essential health products, in Europe and elsewhere. Focusing on our region, EU supply systems were indeed exposed as far more vulnerable than anticipated during the pandemic.  In response, the EU just introduced the Critical Medicines Act “to improve the availability, supply and production of critical medicines within the EU.” The Act comes with a robust set of measures to enhance access to specific ‘critical medicines’. Despite some criticism , it represents an important step forward for the EU.  

Even if primarily focused on the EU, this novel approach may provide valuable guidance for pharmaceutical policies elsewhere. In fact, the goal of diversifying pharmaceutical manufacturing aligns with other initiatives, such as the ones taken by Africa CDC, or efforts to be discussed at the forthcoming WHO World Local Production Forum in Abu Dhabi, April. In preparation of the latter event, the New Partnership for Africa’s Development (NEPAD), in collaboration with Health Action International (HAI), have issued the report “24 Priority Medical Products and Roadmap for Regional Manufacturing in Africa”, to guide investments in pharmaceutical manufacturing across the continent. These recommendations are based on a thorough analysis that considers disease burden, as well as other factors that would make production technically and economically feasible.

As global health researchers, we should however remind decision makers that it’s not just about  safeguarding collective health security, States should also protect the individual right to health. Therefore, any list of critical medicines should “not leave anyone behind”. This requires that criteria for selecting critical and priority medicines consider the complexity of health conditions, especially for vulnerable populations .

We contend here that the essential medicines needed for alleviating pain, for adults and children, should be included in any plans to  improve access. Some of these medicines, like morphine,  are essential but can lead to addiction and/or be abused, and so they are regulated under international treaties and laws. The 68th Commission on Narcotic Drugs, which also took place last week (in Vienna), marked one year since the approval of the (Belgium-sponsored) resolution 67/2 focused on improving access to these essential medicines for children. In these turbulent times, when multilateralism and human rights are at stake (or worse), it was particularly meaningful to stand alongside like-minded organizations and individuals, to advocate for vulnerable children’s right to health and to be pain-free.

Sadly, despite growing attention for access to medicines, there is still a huge neglect of medicines that can relieve human suffering, in all age groups. For instance, it is disappointing  that the EU list of critical medicines includes four injectable forms of morphine but no oral paediatric formulations. And although NEPAD listed sickle cell disease, cancer, and injuries in its priority medical products lists, treatments for severe pain remain overlooked.

While developing policies and making investment decisions to improve access to medicines, we must not forget individual people and their unique needs. Providing the means to alleviate suffering, especially for vulnerable groups like children, should remain at the forefront of our efforts.