Abstract
In this study, we compared the pharmaceutical items, their numbers, and therapeutic categories listed in the
essential medicines lists of various countries to examine policies for securing pharmaceuticals within the context
of establishing pharmaceutical supply systems and national security policies. This study is a comparative survey
based on publicly available information from the essential medicines lists of Japan, the United States (US), the
European Union (EU), the World Health Organization (WHO), Thailand, and China, published between 2018 and
2023. Although the criteria for selecting essential medicines lists vary across the countries studied, 25 items were
designated as essential medicines across Japan, the US, EU, WHO, Thailand, and China within the Japan List of
Essential Medicines, accounting for 5.3% of Japan’s essential medicines list. The number of overlapping medicines
between the lists of each country was determined, and the precision, recall, and F1 scores were calculated. The
highest F1 score (consistency) was observed between China and WHO. Comparison of the US, EU, WHO, and CH
against Japan and comparison of WHO, China and Thailand against the US as the baseline yielded F1 score below
0.2, indicating that the Japan and the US List of Essential Medicines have low level of consistency with the others.
Regarding the characteristics and selection criteria of the medicines included in the essential medicines lists,
Japan, the US, and the EU all focus on the continuity of pharmaceutical supply. However, Japan’s selections are
based on requests from Japanese medical societies. In the US, medicines are designated as those used in acute
care settings for conditions that immediately threaten life or as those required for patients to continue outpatient
treatment. The EU evaluates medicines based on the diseases they target and the availability of alternatives.
WHO focuses on medicines that are the most effective, safe, and cost-effectiveness for priority diseases in
developing countries. Thailand emphasizes medicines available at reasonable prices for representative diseases,
while China prioritizes medicines that meet healthcare needs, can be stably supplied, and are provided at
appropriate prices. The Japan List of Essential Medicines and the US List of Essential Medicines exhibit high
degree of heterogeneity compared with the NLEMs of the other countries, reflecting its unique selection process.
This makes international coordination challenging from the perspective of securing pharmaceuticals. Moving
forward, if Japan and the US aim to pursue international cooperation in pharmaceutical security, it will need to
revise its list of essential medicines and actively work to ensure that the medicines Japan and the US deem
necessary are recognized by other countries.
