Progress led by handful of companies, including in pricing and R&D
The pharmaceutical industry continues to mature in its approach to access to medicine, with more companies assigning responsibility for access initiatives at the board level, three companies issuing new or strengthened access strategies since the 2016 Access to Medicine Index, and pricing strategies that set different prices for different segments of a country’s population (intra-country pricing) are becoming more sensitive to different population’s abilities to pay.
Many companies have also become more transparent about what products are under patent and where, with 17 out of the 20 now revealing this information. This compares with only four companies in 2016 and one in 2014. This shift has been influenced by years of external pressure and provides much needed clarity for international procurers supplying medicines to low-resource countries.
Core groups of companies account for most activity
All companies assessed are pursuing access initiatives to some degree. However, a handful of them account for the bulk of the activity to address access to medicine in low- and middle-income countries. For instance, the majority of the R&D efforts that the global health community considers a priority is being performed by just five companies, while one-third of such priority R&D is carried by a single company. Meanwhile, the increase identified in segmented pricing is being driven by just five of the companies, as is the application of access plans to candidate products in the pipeline.
These companies aren’t always the same ones in every area important for access to medicine, but those that rank at the top of the Index are consistently among the small group dominating these areas. This reliance on a concentrated group to drive most of the activity makes the access ecosystem fragile; if any of these companies changed direction to focus exclusively on commercial markets in high-income countries, a large proportion of the contributions of the R&D-based industry to access to medicine would be at risk.
Models for good practice emerge
Key areas for access continue to lag behind, however models for good practice have emerged. Only 1 out of 5 candidate products in the late stage of development, across all disease categories, have access plans attached to them, such as registration plans for low- and middle-income countries and commitments to affordability. Nevertheless, five companies now have strong processes for systematically developing access plans. Voluntary licensing is broadly a success story in increasing access to medicine; the full range of antiretrovirals recommended for people living with HIV/AIDS is now available for generic manufacture, whether under patent or not. Nevertheless, licensing remains confined to few diseases (HIV/AIDS and hepatitis C). In addition, less than one-quarter of recently launched products have been filed for registration in the majority of countries the Index identifies as being particularly in need of them.
Disease and country focus
Emerging markets such as China, Brazil and India continue to get significant attention, particularly when it comes to the implementation of segmented pricing and product registration filings, and to transferring knowledge, expertise and other capacities to support the local manufacture of pharmaceutical products. Capacity building initiatives to strengthen health systems and supply chains are particularly concentrated in sub-Saharan Africa. When it comes to specific diseases, malaria, HIV/AIDS and tuberculosis, along with Chagas disease and leishmaniasis, get the most attention when it comes to priority R&D, while products for diabetes, HIV/AIDS, cancer, heart disease and lower respiratory infections are the most frequent targets of registration filings.