Kishor M. Wasan

In July 2023, the World Health Organization (WHO) released the 23rd Model List of Essential Medicines (EML) for adults and the 9th Model List of EML for children. These lists serve as global references for essential medicines that should be universally available, accessible, and affordable. This editorial explores recent updates to the WHO EML lists, with a particular focus on medicines addressing neglected tropical diseases (NTDs). We discuss the persistent barriers to equitable access, including economic, regulatory, and logistical challenges; highlight global initiatives aimed at improving accessibility; and propose strategies to bridge the gap in essential medicine access. We emphasize the need for international collaboration, increased funding for research institutions, pharmaceutical companies, and global health initiatives to support the development of novel treatments for NTDs, and innovative distribution approaches to ensure these medications reach underserved populations.

In July 2023, the World Health Organization (WHO) released the 23rd Model List of Essential Medicines (EML) for adults and the 9th Model List of EML for children. These lists serve as global references for essential medicines that should be universally available, accessible and affordable. This editorial explores recent updates to the WHO EML lists, with a particular focus on medicines addressing neglected tropical diseases (NTDs). We discuss the persistent barriers to equitable access, including economic, regulatory, and logistical challenges; highlight global initiatives aimed at improving accessibility; and propose strategies to bridge the gap in essential medicine access. We emphasize the need for international collaboration, increased funding for research institutions, pharmaceutical companies, and global health initiatives to support the development of novel treatments for NTDs, and innovative distribution approaches to ensure these medications reach underserved populations.

The COVID-19 pandemic revealed stark inequities in access to life-saving technologies and innovations, particularly for countries in the Global South. While scientific advances were rapid, the benefits of those breakthroughs were not equitably shared, highlighting deep structural imbalances in global health governance. In response, Canadian institutions must lead by example to ensure that future innovations arising from publicly funded research are made equitably accessible. The Global Health Access and Equity Workshop, held in March 2025 by the Neglected Global Diseases Initiative at UBC, convened experts from academia, civil society, and government to identify key barriers and propose a framework for action. This viewpoint outlines the workshop’s vision, summarizes outcomes, and calls for the establishment of a Canadian framework guided by Global Access and Equity Principles (GAEP) to promote health equity globally and fulfill Canada’s moral, scientific, and policy obligations in the post-pandemic era.

Neglected Global Diseases (NGDs) are infectious diseases and other conditions that cause physical and cognitive impairments, contribute to mother and child illness and death, and make it difficult to earn a living, thereby disproportionately affecting the world's poorest populations. They include maternal, infant, and child health conditions, neglected tropical diseases (NTDs), as well as HIV/AIDS, tuberculosis, and malaria. The World Health Organization (WHO) has a list of 21 NTDs that cause substantial illness for more than one billion people globally (1). These diseases thrive in conditions of extreme poverty, areas that generally have unsafe water, poor sanitation, substandard housing, and limited access to health care or essential medicines. In some countries, this includes most rural areas, urban slums, or conflict zones. However, it is increasingly recognized that emerging middle-income countries contain the highest numbers of people affected.NGDs impact daily life for many, predominantly in countries with weak health and social support systems, they cripple families and contribute to the harsh cycle of poverty. While some NTDs are fatal without treatment, most of them are debilitating and stigmatizing. Children are particularly vulnerable. Overall, NGDs cause great suffering and are a leading cause of chronic disability, diminished quality of life, and premature death. Despite their impact, funding for NTDs research and treatment fades compared to "developed world impacted or supported diseases." Unfortunately, particularly in the past 20 years, the development of novel pharmacological targets and new interventions based on these targets to treat NGDs has been limited (2). However, in recent years there has been a resurgence of research in these areas from low-or middle-income countries (LMICs) researchers themselves. Unlike similar Research Topics in this area, the purpose of this Research Topic was to highlight the novel work of LMIC researchers in developing new targets and interventions to treat NGDs.We received five contributions from colleagues highlighting everything from Global Access Principles to research on leishmaniasis.peptides for potential use against malaria and various bacterial, viral, and fungal infections; a portable vaccine cooler; a diagnostic technology to detect severe sepsis; and an SMS Messaging System to monitor and support patients with HIV, TB and COVID-19. The article identified

Visceral leishmaniasis (VL) is a severe and potentially fatal infection, with over 90% of reported cases occurring in East African countries including Chad, Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan, and Uganda, affecting mainly impoverished individuals, and creating a significant economic burden. Currently, the intravenous single-dose liposomal amphotericin B is the first choice for the treatment of VL. Recently, WHO and DNDi have suggested a combination of intravenous liposomal amphotericin B and oral miltefosine as a potential approach to treat VL. However, miltefosine availability is uncertain, and its side effects frequently cause treatment to be discontinued. Furthermore, due to the difficult route of liposomal amphotericin B administration by intravenous infusion, the lack of formulation’s tropical stability, accessibility, injection toxicity, and cost have prevented this injectable formulation of amphotericin B from reaching the most infected populations, particularly the pediatric population. To solve this problem, the development of a solid oral amphotericin B formulation that is cost-effective, safe, tropically stable, and easy to swallow, making it more accessible to children, particularly in rural communities having limited access to medical clinics or trained healthcare professionals is imperative. This viewpoint will discuss the opportunities and challenges of developing an oral amphotericin B formulation for a pediatric population.

In 2007, the University of British Columbia (UBC) was the first university in Canada to establish and adopt global access (GA) principles. Toward implementing these principles, UBC then identified a set of strategies for providing affordable access to new UBC-developed technologies throughout low- and middle-income countries and among vulnerable populations. In this perspective, we provide an update of UBC’s progress over the past 15 years made on several technologies that fall under the GA principles. The technologies reported on are wide-ranging, including an oral medication for the treatment of leishmaniasis; peptides for potential use against malaria, and various bacterial, viral and fungal infections; a portable vaccine cooler; a diagnostic technology to detect severe sepsis; and an SMS Messaging System to monitor and support patients with HIV, TB and COVID-19. We identify challenges faced by the researchers in implementing the GA principles for these technologies and potential solutions for overcoming them through creative licensing and partnerships with public and private sectors, governments, local companies, and communities. As the UBC example illustrates, universities across the globe have an opportunity to make a significant social impact on improving global health of vulnerable populations and on supporting local infrastructures for sustaining these improvements.

Although it is commonly accepted that climate change will increase the range and abundance of neglected tropical diseases (NTDs) through increased rainfall and temperature, the role of soil and influence of soil health on this effect is not well understood. We propose that understanding the influence of climate change on the physical, chemical, and biological characteristics of soils can explain how favourable environmental conditions for NTDs and vectors of NTDs to reproduce form. This, in turn, can assist local public health experts in predicting and managing the spread of NTDs. We also suggest that unlike unpredictable climatic factors, soil health can be directly managed through appropriate land use practices. This viewpoint seeks to start a discussion between soil scientists and healthcare professionals on how to achieve common goals and strategies required to manage the spread of NTDs.

Amphotericin B (AmpB) is a polyene macrolide antibiotic used in the treatment of blood-borne parasitic and fungal infections. However, its use, particularly in the developing world, has been limited by dose-dependent kidney toxicity, other systemic-related toxicity issues following injection, the inconvenience of parenteral administration, and accessibility. Oral formulation approaches have focused on the dual problem of solubility and permeability of AmpB, which is poorly water soluble, amphoteric and has extremely low oral bioavailability. Therefore, to enhance oral absorption, researchers have employed micellar formulations, polymeric nanoparticles, cochleates, pro-drugs, and self-emulsifying drug delivery systems (SEDDS). This paper will highlight current uses of AmpB against parasitic infections such as leishmaniasis, preclinical and clinical formulation strategies, applications in veterinary medicine and the importance of developing a cost-effective and safe oral AmpB formulation.

Background There has been much speculation that polyene macrolide antibiotics, such as amphotericin B (AmB) and Nystatin (NYS) may have antiviral activity against several viruses including SARS-CoV-2. Objective The objective of this short communication was to determine the antiviral activity of two polyene macrolides, AmB and NYS, following treatment in kidney cells infected with SARS-CoV-2. Methods A serial dilution of AmB, NYS, and irbesartan (a drug known to bind to the ACE-2 receptor as a positive control) were then added (n=4 at each concentration) to the infected Vero’76 kidney cells in 100 µL media. Cells were also examined for contamination at 24 hours, and for cytopathic effect (CPE) and cytotoxicity (if noticeable) under a microscope at 48 hours. In a second study, AmB and Remdesivir were incubated in kidney cells infected with the virus and inhibition of the virus was determined by an immunoassay. Results and Conclusions Amphotericin B (AmB) showed a significant reduction in the TCID50 titer, with the 50% effective concentration (EC50) of 1.24 µM, which was 2.5 times lower than the cytotoxicity concentration. NYS and Irbesartan both exhibited substantially less active and would not be considered a suitable choice for further investigations. In addition, when measuring viral inhibition by immunoassay, AmB was significantly more potent than remdesivir (EC50 31.8 nM vs. 1.15 µM). Taken together, these preliminary findings suggest that AmB may have significant activity against SARS-CoV-2. However, further cell and animal studies are warranted.