Vanderbilt University Medical Center

Improving global health by Repurposing Essential Medicines Internationally (Remedi) Highly Ranked

Take Action

Connect with us

To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

The World Health Organization (WHO) Essential Medicines List (EML) defines minimum acceptable availability of 376 safe, affordable medicines. Over 150 countries use the EML to guide treatment decisions. However, its utility is hindered - the number of diseases addressed is limited and pathways to spread information are under-powered. As a result, billions of people in low- and middle-income countries (LMICs) have inadequate access to treatments for serious illnesses. Our program, Remedi, will uncover additional uses of EML medicines, and catalyze the EML’s global reach by enhancing its format, accessibility, and health worker awareness. We will make better use of what we have. We will systematically curate, validate, share, and locally implement existing and new therapeutic uses, prioritizing the most prevalent medicines for diseases with the highest current and projected future burden, affecting the most vulnerable and marginalized. Hundreds of millions of people will benefit from medicines already in local pharmacies.

Problem Statement

Some medicines are designated so crucial to basic health that the WHO posts them on an Essential Medicines List, garnering global attention. The problem is, the EML’s utility is hindered by the narrow range of diseases addressed (just 200 out of 7,000 human diseases) and lack of a dedicated driving force behind its distribution and dissemination. This problem exists because: 1) There are few incentives to pursue new uses of generic EML medicines. 2) When evidence exists for a new therapeutic use of an EML medicine, it does not rapidly or reliably make it to country-specific EMLs and therefore does not reach pharmacists, community health workers, and patients. 3) The WHO EML is static/non-interactive and does not itself facilitate country-specific adaptations or health worker awareness. Massive numbers of patients are impacted by this problem, which is further exacerbated because poorer populations are more vulnerable to both communicable and non-communicable diseases and have worse disease progression and severity. As one example, N-acetylcysteine (on EML for acetaminophen toxicity), has been found to prevent bronchiectasis attacks, but few community health workers know to address these breathing difficulties with something already available at pharmacies. Our leverage point is the creation of an expanded armamentarium based only on existing essential medicines, because their global use is relatively high: 90% of all medicines prescribed in LMICs are on EML. By finding many additional uses and generating substantially higher awareness among targeted practitioners, pharmacists, and health workers, we offer a powerful, pragmatic way to effect change.

Solution Overview

EML medicines hold tremendous untapped potential yet the information contained is limited and difficult to fully engage with. We help resolve the problem by first methodically identifying and validating new therapeutic uses for EML medications. Repurposing works; it is a proven method requiring no further hypothesis testing. Given the sizeable set of medicines, we prioritize those already available to treat diseases with largest current and projected global burden affecting vulnerable and marginalized individuals. We will work with local/governmental community health organizations to validate new uses when necessary. Then, the deliverable will be an evidence-based expansion to a user-friendly, customizable “pocket” version of the EML that describes and systematically rates evidence for new therapeutic uses of EML medications. We will make it easy to find and use the needed information. Finally, we will share new uses with national health authorities and community health workers and will measure progress via countries’ adoption of new uses using our internationally recognized information management system as a platform for bi-directional transmission of data. Dissemination will occur in a country-specific context, with ‘warm handoffs’ occurring via health workers or health ministries, depending on each country’s needs and assets. Patients could then immediately be treated with a drug already in stock at their local pharmacy. Accounting for variability in medicine availability/usage, and estimating the populations impacted, calculations show we will impact hundreds of millions of people in need over the grant period. Many people in LMICs for the first time will have options for treating serious diseases.

+ Read More

More Solutions Like This

Highly Ranked

Diseases and conditions

Task Force for Global Health

End Child Leprosy by 2030: Break Transmission and Eliminate Stigma

Brazil, India, Indonesia, Nepal, Tanzania, Bangladesh, Ethiopia, Mozambique, Nigeria

Diseases and conditions

Cerebral Palsy Foundation

National Cerebral Palsy Early Detection Initiative for High Risk Infants

United States

Diseases and conditions

Ezintsha, sub-division of Wits Health Consortium (Pty) Ltd

Halving chronic disease-related deaths using science-guided health technologies

South Africa, Sub Saharan Region