Making medicines essential: The emergent centrality of pharmaceuticals in global health

Expanding access to pharmaceuticals has become one of the most visible aspects of twenty-first century global health practices, as evidenced by the moral urgency of antiretroviral rollout and the pressing call for new drugs for neglected diseases. However, the role of prescription drugs in public health was far less obvious to the framers of international health organizations only a half-century ago. This article examines the evolving role of pharmaceuticals in global health practices by charting the emergence of the category of ‘essential medicines’: initially a list of 186 drugs first defined by the World Health Organization (WHO) in 1977 to be ‘basic, indispensable, and necessary for the health of the population’, and subsequently expanded by actors beyond the WHO including NGOs, pharmaceutical companies and the broader financial community. This apparently simple act of list-making worked to transport a set of commodities from the private, commercial sphere into a public health commons, and sparked a series of methodological, logistical and political controversies over the winnowing of ‘essential’ from ‘inessential’ that collapsed evidentiary, regulatory, participatory and market terms into a single process. To ask ‘what practices render a medicine essential?’ is therefore to address the shifting ecology of knowledge governing global health today.