Millions of people today cannot access medicine when they need to. This can be due to price, 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. Further, about 100 million people are pushed into extreme poverty because they have to pay for healthcare. 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.
Achieving universal healthcare is critical to help populations access health services they need without financial constraint. Access to medicines is an important part of this. 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 fallen in recent years 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. To ramp up progress towards these goals, in September 2019, the UN Secretary General called for a Decade of Action to deliver the Global Goals by 2030.
Progress in global health is not inevitable. Non-communicable diseases (NCDs) such as diabetes, cancer and heart disease are a growing challenge due to rapid urbanisation, worsening diets and increasingly sedentary lifestyles, they account for 71% of deaths globally each year, including 15 million people aged between 30 and 69 years, with more than 85% of these so-called premature deaths occurring in low- and middle-income countries. Access to prevention, detection, screening, treatment for NCDs is essential.
In addition, new public health crises have posed further challenges to global health and have put more pressure on already strained health systems and families paying out of pocket for health services. For instance, in 2019 the resurgence of measles was a threat with 6,000 deaths recorded in the Democratic Republic of the Congo by January 2020. Antimicrobial resistance, which already causes more than 700,000 deaths each year worldwide, is growing. A newly emergent coronavirus which causes acute respiratory disease, COVID-19, was identified in Wuhan, China in January 2020, with the World Health Organization declaring a global health pandemic in March 2020. 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, under-five child mortality dropped by 59% between 1990 and 2018. There has been more than a 56% decline in AIDS-related deaths since the peak of the HIV/AIDS epidemic in 2004, and more than half of all people living with HIV/AIDS are accessing antiretroviral therapy. In 2017, 81% of countries had a national action plan addressing cancer, up from 66% in 2013, 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.
Progress is being made against neglected tropical diseases (NTDs), with the number of people requiring treatment and care for NTDs dropping from 2.03 billion to 1.58 billion between 2010 and 2017. The Ebola outbreaks which occurred in the Democratic Republic of the Congo in 2018 were contained more quickly than the 2014-2016 West Africa Ebola outbreak was in part due to quicker response times and the use of novel medicine and vaccine candidates.
New medicines and vaccines also continue to reach the market. Fexinidazole, the first all-oral treatment for sleeping sickness, a neglected tropical disease endemic to Africa, codeveloped by Sanofi and DNDi, was recommended by the EMA in 2018 and approved in 2019 in the Democratic Republic of Congo.
Cancer treatment continues to advance, with personalised therapies promising improved treatment, but also challenges in widespread scale-up. 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. The evolving COVID-19 pandemic has already seen rapid collaboration to develop vaccine candidates.
How to radically ramp up access to healthcare?
How can we radically ramp up access to healthcare worldwide? This 6th Access to Medicine Index shows where pharmaceutical companies are currently focusing their efforts to improve access. The Index is a guide to what is working, and a tool for inspiring further action.
Critical role for pharmaceutical companies
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 evaluated 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.
• The 20 companies in the 2018 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.