A research programme by the Access to Medicine Foundation

The context

Millions of people today cannot access medicine when they need to. This can be due to high prices, to empty pharmacy shelves, or other factors. Find out more about the situation and how the Index stimulates pharmaceutical companies to help turn it around.

How can progress in access to medicine be sustained?

The constitution of the World Health Organization (WHO) asserts that all people have the right to the highest attainable standard of health, yet access to medicine continues to be out of reach for an estimated two billion people. New and complex health challenges continue to emerge, demanding sustained commitment and deeper cooperation across the ecosystem of global health stakeholders, as well as wider adoption of proven solutions. 

Increasing access depends on a range of factors and involves action from a variety of parties. The pharmaceutical industry, in collaboration with the global health community, plays a critical role in responding to defined priorities for global health, developing much-needed innovative products, expanding access to those products that already exist and forging new partnerships to promote sustainable, long-term access to medicines.

A healthcare worker in Ghana uses Novartis' telemedicine platform during a consultation with a young mother.

Global health challenges are evolving

The growth in development aid for health has slowed since 2010 as donor government budgets have tightened. This is particularly concerning for low-income countries that rely heavily on aid to provide health services to their populations. Low-income countries are being hit the hardest: in these countries, government health expenditure as a percentage of GDP has been in decline in recent years, resulting in more needing to be done with less. In 2015, the UN agreed the Sustainable Development Goals, including global health targets such as the elimination of major disease epidemics and the reduction in the burden of childhood obesity.  

Progress in global health is not inevitable. In 2017, improvements in the global mortality rate was less pronounced than in earlier years; in some countries, mortality rates are stagnating or worsening. In 2017, non-communicable diseases (NCDs) accounted for 73.4% of deaths, an increase of 22.7% since 2007. The rise is due, in part, to rapid urbanisation, worsening diets and increasingly sedentary lifestyles.

Meanwhile, the scale of antimicrobial resistance, which already causes more than 700,000 deaths each year worldwide, is growing. In addition, new public health crises have posed further challenges to global health and put more pressure on already strained health systems and families paying out of pocket for health services. For instance, new Ebola outbreaks occurred in the Democratic Republic of Congo in 2018. They were contained more quickly than the 2014-2016 West Africa Ebola outbreak was, in part due to quicker response times and the use of innovative medicine and vaccine candidates. Yet, infections were confirmed in high-conflict areas, creating significant new challenges for health services. Also in 2018, just weeks after 47 African governments pledged to end cholera outbreaks by 2030, Zimbabwe declared a state of emergency due to a cholera outbreak. To help address current and future global health issues, governments and regulators – as well as stakeholders from the public and private sectors – need to develop, support and implement innovative practices to reach more people in need.

Progress is being made

Despite significant global health challenges, milestones have been reached. These demonstrate that effective approaches are being developed and applied and exemplify the impact that international collaboration and coordination can have on the health of billions. For example, child mortality dropped by almost 50% between 1990 and 2013. There has been a 48% decline in AIDS-related deaths since the peak of the HIV/AIDS epidemic in 2005, and more than half of all people living with HIV/AIDS are accessing antiretroviral therapy. In 2015, 71% of countries had a national action plan addressing cancer, up from 50% in 2010, and WHO member states endorsed a set of measures in 2017 to improve cancer control. Vaccine campaigns are enabling movement towards elimination of polio in Haiti, meningitis in 26 countries in sub-Saharan Africa and hepatitis B in China. New global health conventions and commitments – including the 2017 London Summit on Family Planning and the 2018 UN High Level Meeting on Ending Tuberculosis, as well as the UN High-Level Meeting on Non-Communicable Diseases – are helping to set additional priorities, with the goal of inspiring global action. 

Recent innovations

New medicines and vaccines also continue to reach the market, including new treatments that make country-by-country elimination of hepatitis C now possible. Immunotherapy has become a clinically validated treatment for many cancers, contributing to a 23% reduction in cancer mortality since 1991 in the United States. Collaboration to limit antimicrobial resistance is also strengthening, with multiple initiatives established in recent years, such as the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) and the Global Antibiotic Research and Development Partnership (GARDP) in the field of R&D. New vaccine developments are helping countries to better prepare for and respond to future disease outbreaks, including Ebola.

Critical role for pharmaceutical companies

In 2018, the need for all stakeholders to take action on access to medicine remains clear, with each having their own roles and responsibilities. This includes the scientific research community, local governments, public health and regulatory agencies, overseas development agencies, philanthropists, multi-lateral agencies and the non-profit sector including product development partnerships. Pharmaceutical companies, with the resources and the knowledge to develop and supply new medicines at scale, have a responsibility to ensure these are made available to people regardless of their socioeconomic standing. Pharmaceutical companies have the power to address affordability by refining their access strategies; and the ability to strengthen supply chains and support healthcare infrastructures. Considering their size, resources, pipelines, portfolios and global reach, these companies have a critical role to play in improving access to medicine.

The 20 companies in the 2018 Index account for approximately 70% of global pharmaceutical revenue. In 2016, global pharmaceutical sales were USD 768 billion, and are expected to reach USD 1.06 trillion by 2022 (growing 6.5% year on year). The global market for anti-infectives is projected to grow by 5.1% between 2016 and 2022 to USD 90.9 billion. Emerging economies accounted for 25% of global spending on pharmaceuticals in 2015, and is expected to account for 25% by 2020. The size of the pharmaceutical market in low-income countries is comparatively stable. 

Key pharma market stats

• The 20 companies in the Index account for 70% of global pharmaceutical revenues.
• Global pharmaceutical sales are projected to grow to USD 1.06 trillion by 2022.
• Emerging economies accounted for 25% of global spending on pharmaceuticals in 2015.

Pharmaceutical companies manufacture almost all medicines and vaccines available today. The industry continues to consolidate, particularly in anti-infectives. In 2018, for example, Novartis ended its antibacterial research (licensing three projects), following a similar decision by AstraZeneca, and Sanofi outlicensed the development of its anti-infective medicines.

The Access to Medicine Index

For a decade, the Access to Medicine Index has worked to stimulate change within pharmaceutical companies. The Index analyses 20 of the top research-based pharmaceutical companies in low- and middle-income countries and ranks them according to their efforts to improve access to medicine. It identifies best practices, highlights where progress is being made and uncovers where critical action is still required. In this way, the Index provides an incentive and a guide for pharmaceutical companies to do more for people who still lack access to medicine. 

Over the past decade, the Access to Medicine Foundation has developed a robust process for building consensus among a wide range of stakeholders on what society expects of pharmaceutical companies regarding access to medicine in low- and middle-income countries. These expectations are then translated into metrics that form the basis of the methodology for the Access to Medicine Index. The Index methodology is updated every two years in line with developments in access to medicine following a wide-ranging multi-stakeholder dialogue coordinated by the Access to Medicine Foundation. The dialogue involves NGOs, governments, the industry and multilateral organisations, in order to build consensus on how and where pharmaceutical companies can and should be improving access to medicine. 

How the Index responds to global challenges

As a result, the Index methodology has evolved continually since the first Access to Medicine Index was published in 2008. For example, the disease  scope has been adjusted in line with changing views on which diseases should be prioritised for improving access to medicine. In 2008, the Index focused mainly on neglected tropical diseases as defined by WHO, expanding to include high-burden diseases, including non-communicable diseases, in 2010. The latest refinement in this direction is the inclusion of cancer in the 2018 Access to Medicine Index. The geographic scope has also been refined, to ensure it covers countries where greater access to medicine is needed most. Many countries have moved into higher World Bank classifications over the lifespan of the Index: 72% of the world’s poor now live in middle-income countries. To adapt to these demographic changes, the 2014 Index adopted measures of human development and inequality in its country inclusion framework, to bring some higher-income countries with high levels of inequality into the scope of the Index. At the same time, company business models are also evolving and accounting for a growth in the middle class in, for example, emerging markets. The Index continues to raise the bar, measuring companies on their ability to both increase access for the new middle classes, as well as to ensure the most marginalised populations are not left behind.  

The 2018 Index measures 20 companies. The methodology comprises 69 indicators and covers 106 countries and 77 diseases, conditions and pathogens. The Foundation will use this latest Index to provide guidance to pharmaceutical companies on where the priorities lie and how they can improve current practices with the many solutions and opportunities identified in the Index.



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View our detailed overview of each company’s performance in the Index, including breakdowns of their product portfolios and R&D pipelines.