Plain Language Summary
Policy commentary on the WHO's 24th Essential Medicines List (2025) inclusion of semaglutide and tirzepatide, analyzing the significance of this landmark decision for global access to GLP-1/GIP agonist therapy, barriers to implementation including cost and healthcare infrastructure, and the persistent challenge of access equity in low- and middle-income countries. Provides a global health policy perspective on WHO EML listing for tirzepatide and semaglutide—framing the listing as a major equity milestone while identifying the implementation challenges that must be addressed to translate EML inclusion into meaningful expanded access for the populations bearing the greatest obesity and diabetes burden.
Abstract
The World Health Organisation (WHO) periodically updates its Model List of Essential Medicines (EML) and Essential Medicines for Children (EMLc) to address evolving global health priorities. The 24th EML and 10th EMLc, released on 5th September 2025, mark a major milestone by expanding access to twenty new medicines for diabetes, cancer, cystic fibrosis, haemophilia, psoriasis, and blood disorders. Notably, the inclusion of glucagon-like peptide-1 (GLP-1) receptor agonists-semaglutide, liraglutide, dulaglutide-and the dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonist, tirzepatide, represents a paradigm shift in the management of type 2 diabetes mellitus (T2DM) and obesity. These agents have demonstrated significant benefits in lowering blood glucose levels, reducing cardiovascular and renal complications, and promoting weight loss in T2DM patients with established cardiovascular disease (CVD), chronic kidney disease (CKD), or obesity. This move aims to bridge the longstanding treatment gap in low- and middle-income countries (LMICs), where high drug costs have limited access to such therapies. Their recognition as essential medicines enables prioritisation of limited resources, facilitates equitable pricing, and supports the development of generics and biosimilars post-patent expiry. This inclusion aligns with Sustainable Development Goal 3.4, which aims to reduce premature mortality from non-communicable diseases (NCDs) by 1/3 by 2030. However, challenges persist, including financial constraints, limited healthcare infrastructure, and risks of irrational use, particularly for obesity alone. Effective implementation through national policies, training, and rational prescribing frameworks is essential to translating this global milestone into tangible public health benefits and to reducing the growing burden of diabetes and obesity worldwide.