Pediatric formulations in national essential medicine lists: A cross-sectional study

Camila Heredia¹Moizza Zia Ul Haq¹Bernadette Cappello²Farihah Malik²Martina Penazzato²Lorenzo Moja²Navindra Persaud^1,3*

• ¹Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
• ²World Health Organization (Switzerland), Geneva, Geneva, Switzerland
• ³Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Background: Children need specialized medicine formulations for proper dosing, safety, and adherence. The World Health Organization developed a pediatric essential medicines list prioritising pediatric formulation. Given global commitment by countries to children health, we expected national lists similarly prioritizing pediatric medicines and formulations. We assessed the extent to which national lists include medicines for children. Methods: We used a global essential medicines database to collect data on national lists identifying pediatric lists and formulations. Six key therapeutic areas were selected a priori to present granular data. Data were categorized by country characteristics and income levels. Results: Our study found that most countries do not include pediatric formulations in their Essential Medicine Lists (EMLs), especially high-income European countries. Of the 22 countries that do, most list medicines for infections, antiretrovirals, and cancer, but gaps exist for antitrypanosomal, antileishmanial, and antihepatitis treatments. Paracetamol had the most diverse formulations. Additionally, differences were found between national and WHO EMLs, with some countries listing fewer medicines overall, though some countries included more treatments for HIV and hepatitis than the WHO EMLc.In many countries, it is unclear which medicines for children are prioritized, if any. The problem is particularly acute in high-income countries. Misalignments between national lists and the World Health Organization are common. There is little evidence that countries are adequately implementing medicines policies for youth.