Rediscovering cytisine: Why the WHO’s decision matters for global public health

Recently, the World Health Organization (WHO) announced the inclusion of cytisine in its Model List of Essential Medicines (EMLs). Owing to its efficacy, tolerability profile, and low cost, cytisine represents a valuable addition to the smoking cessation toolkit. This followed approval by the UK MHRA, with regulatory review by the US FDA in process. However, this milestone came over half a century after an initial large-scale randomized controlled trial demonstrated its efficacy. The recognition of cytisine is both a triumph for global health equity and an indictment of the political, economic, and scientific inertia that kept this life-saving treatment in the shadows for more than 50 years. This commentary reviews the history of cytisine, the scientific evidence behind its efficacy, the structural forces that delayed its global recognition, and why its addition to the WHO's EML matters for public health.