AstraZeneca plc

Performance in the 2026 Index

3rd place. AstraZeneca performs strongly overall, driven by particularly strong performance in research and development (R&D). Its large pipeline addressing non-communicable diseases (NCDs) and broad access planning stand out, alongside strong performance in Product Delivery, including registration and access strategies. Performance in Governance of Access is more mixed, with the company ranking around the middle of those assessed by the Index.  

Opportunities for AstraZeneca

Improve the quality and broaden the geographic reach of its access plans for communicable diseases. AstraZeneca has access plans for almost all its late-stage projects. However, plans for communicable diseases are less comprehensive in depth and breadth compared to those for NCDs. It can strengthen its approach by applying the same criteria used in its NCD access plans, including availability, affordability and sustainable supply in low- and middle-income countries (LMICs). For example, it can develop a comprehensive access plan for AZD0292, a monoclonal antibody in Phase II development with activity against P. aeruginosa, including a regulatory strategy informed by disease burden and measures to address affordability challenges associated with introducing this technology in LMICs. 

 Expand access to innovative oncology products in low-income countries (LICs). AstraZeneca has comprehensive access strategies for most of its products targeting NCDs across country income classifications. However, access strategies for its oncology portfolio in LICs remain limited with approaches yet to translate to patient reach. AstraZeneca can build on its existing approaches to expand access to these products, including durvalumab (Imfinzi®), indicated for multiple cancer types; and osimertinib (Tagrisso®), a key lung cancer medicine prioritised for voluntary licensing by public health organisations, through equitable access strategies and/or voluntary licensing. 

 Expand access to newer respiratory medicines in countries with high unmet need. AstraZeneca has established a broad access footprint for mature respiratory products such as budesonide/formoterol (Symbicort®). Building on this foundation, there is an opportunity to extend access to newer therapies in underserved LMICs, particularly formoterol/glycopyrronium bromide/budesonide (Trixeo Aerosphere®; Breztri Aerosphere®) indicated for chronic obstructive pulmonary disease and asthma, registered in 23 countries in scope, and tezepelumab-ekko (Tezspire®) for severe asthma, registered in 15 countries in scope. This could include expanding registration in high-burden markets, alongside measures to address affordability and health system barriers that may limit effective patient access.  

Changes since the 2024 Index

• Signed a strategic memorandum of understanding with Morocco, aimed at advancing public health and scientific research. The agreement focuses on strengthening clinical research, early detection of chronic diseases, artificial intelligence-enabled digital health, workforce training, real-world data use and potential expansion of the Healthy Heart Africa programme.  

• Partnered with the Coalition for Epidemic Preparedness Innovations through an investment of up to USD 43.5mn to evaluate an antibody-based intervention targeting four pandemic influenza strains.  

• In January 2026, announced plans to invest over CNY 100bn (USD 14.5bn) in China by 2030 to expand manufacturing and R&D.  

• Partnered with Aga Khan University Hospital in Nairobi in February 2026 to improve early diagnosis and personalised treatment for breast and ovarian cancer in Kenya. The collaboration focuses on expanding access to affordable BRCA1 and BRCA2 genetic testing.  

• Partnered with Revna Biosciences to advance lung cancer diagnosis in Ghana. Announced in July 2025, this collaboration focuses on improving access to modern technologies to strengthen epidermal growth factor receptor testing capabilities and improve early diagnosis and treatment for patients with non-small cell lung cancer. 

Sales and Operations

Therapeutic areas: Biopharmaceuticals (including cardiovascular, immunology, metabolism, renal and respiratory), immune therapies, oncology, rare diseases, vaccines 

Product categories: Innovative medicines, vaccines 

M&A news: AstraZeneca acquired Fusion Pharmaceuticals for USD 2.1bn in 2024. In 2025, AstraZeneca acquired FibroGen China for USD 160mn, EsoBiotec for up to USD 1bn, SixPeaks Bio for up to USD 300mn and Modella AI for an undisclosed amount. Biotechnologies Inc. For USD 1.2bn; Icosavax for USD 1.1bn; and Amolyt Pharma for USD 1.08bn. 

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Access to Medicine Foundation | accesstomedicinefoundation.org/company/astrazeneca-plc

Sample of pipeline and portfolio assessed by the Index

PIPELINE for diseases in scope

AstraZeneca has 76 R&D projects in scope, 16 of which target priority diseases, including influenza (4) and other prioritised antibacterial resistant infections (4). The remaining 60 R&D projects target other diseases in scope, including cancer (37), kidney diseases (7) and cardiovascular diseases (6). Of its 76 R&D projects, 40 are in late-stage development, with evidence of access planning for 90% (36/40) of these. 

PORTFOLIO as selected for analysis by the Index

AstraZeneca has 32 products in scope, including 31 medicines that primarily target NCDs, namely cancer (11), respiratory diseases, such as asthma and COPD (9), and cardiovascular diseases (5). Most of its medicines are on patent (23). Of the 31 medicines in scope, 7 are listed on the WHO EML. In addition, it has 1 vaccine in scope that targets influenza, which is listed on the WHO EML. 

Governance of Access

RANK 12TH, SCORE 3.64

12th place. AstraZeneca is a middle-performing company in Governance of Access. It has clear board-level accountability for access to medicine and robust ethical conduct controls, although it does not disclose whether access objectives are linked to incentives for company leadership. It publicly discloses a systematic approach to measuring patient reach and reports patient reach numbers. Nevertheless, its patient reach target combines product reach and capacity building, limiting assess­ment of product-level reach. 

Has clear board-level accountability for access to medicine via a dedicated Board member responsible for sustainability and access to healthcare. The relevant Board committee oversees access-related strategies and reviews related matters at least annually. AstraZeneca has not disclosed publicly or to the Index whether access-related objectives are linked to senior executive incentives or in-country manager compensation. It provides training, awareness-raising or guidance to employees on the access-to-medicine strategy and activities at least annually.  

Shows strong commitment to responsible sales and promotional practices. AstraZeneca does not disclose the level at which sales targets are set, but incentives are not solely based on sales volume. It has a global policy on ensuring ethical interactions with healthcare professionals. It offers guidance on establishing and documenting a legitimate need for interaction and declares that transfers of value to healthcare professionals (e.g., payments for attending events) are made at fair market value. It publicly discloses information on such payments in countries in scope if required by law or local regulation.

Has a robust set of controls to promote ethical conduct and mitigate risk to ensure that governance efforts are not undermined by non-compliant or corrupt activities. AstraZeneca performs strongly in this respect. It has policies to mitigate non-compliance risks, including processes to ensure third-party compliance with company standards, fraud-specific risk assessments and region or country risk-based assessments. It has a code of ethics guiding employee decision-making and provides related training annually. No breaches in countries in scope were found during the analysis period.  

Publicly supports the Doha Declaration on TRIPS and Public Health. However, AstraZeneca favours the use of alternative avenues ahead of compulsory licensing. It states that compulsory licensing should be considered only when access to patented medicines is critical to maintaining public health, and no appropriate alternative is available.  

Performs well in its approach to measuring and reporting on patient reach. AstraZeneca applies a systematic, company-wide approach across its full portfolio and all markets. It publicly discloses the underlying equation, metrics, assumptions and limitations. It has set a measurable, timebound goal. However, this combines product reach with capacity-building activities, so progress on product-level patient reach cannot be demonstrated. Patient reach is reported publicly at least annually and disaggregated by total reach and underserved populations, in relation to the stated goal, but not by therapeutic area or product. 

Research and Development

RANK 3RD, SCORE 3.29

3rd place. AstraZeneca is among the leading companies in R&D. It has the largest pipeline addressing non-priority diseases in scope, with access plans for nearly all late-stage projects, comprehensive in depth and geographic reach. However, only one of its three late-stage priority disease projects has an access plan, and that plan has limited geographic reach. It discloses anonymised, disaggregated R&D investment data to global health organisations and publicly reports R&D investment by phase of development. 

Average-sized pipeline addressing priority diseases in scope, compared to peers, consisting of 16 projects, with access plans identified for 33% (1/3) of its late-stage R&D projects. AstraZeneca's only access plan covers different access-related components, including registration preparation, supply and demand plans and inclusion of special populations. The plan’s geographic scope, however, is limited.  

Largest pipeline addressing other diseases in scope, compared to peers, consisting of 60 projects, with access plans identified for 95% 12 (35/37) of its late-stage R&D projects. These projects target diseases not currently identified as priorities by global health stakeholders. Access plans are comprehensive in depth and breadth, systematically including registration preparation and equitable pricing plans, with a broad geographic reach.  

Publicly discloses disaggregated R&D investment data for phase of development. In addition, AstraZeneca discloses anonymised disaggregated R&D investment data to Impact Global Health.  

All 5 R&D capacity-building initiatives included for analysis meet all Good Practice Standards (GPS). In 1 initiative, AstraZeneca strengthens Vietnam’s clinical research capacity via collaboration with Ho Chi Minh City University Medical Center by establishing a certified Clinical Research Coordinator training programme to build sustainable local expertise. 

Product Delivery

RANK 7TH, SCORE 3.18

7th place. AstraZeneca performs well in Product Delivery. It registers newer products in more coun­tries than peers on average. It implements comprehensive access strategies and reports outcomes for both healthcare practitioner (HCP)-administered and self-administered products. However, coverage in low-income countries remains limited. All manufacturing capacity-building and health system strengthening initiatives meet all GPS. 

Registers newer products* in more countries (14) than its peers on average. AstraZeneca’s products are also, on average, registered in more countries with the highest burden of disease (3) compared to peers. For 4/10 of the products assessed, there is evidence of registration in LICs. Osimertinib (Tagrisso®), indicated for lung cancer, is its most widely registered product, totalling 50 countries, an increase of 8 countries since the previous Index. It reports engaging in national reliance registration pathways to facilitate registration for several of its products.  

*Products that received their first marketing authorisation within the last 5 years. 

Not eligible for assessment of supranational access strategies because none of its products in scope are supranationally procured. 

Comprehensive access strategies and outcomes reporting for its HCP-administered products, with limited coverage in LICs. AstraZeneca reports access strategy examples across all 3 country income classifications (upper-middle-income countries (UMICs), LMICs, LICs) for 1 product, while for the other 4 products analysed it reports examples across UMICs and LMICs only.  Strategies are comprehensive; the company has achieved or is working towards public reimbursement in most countries to cover the majority of the population. For 3 products, in UMICs and LMICs, it also implements patient assistance programmes to provide additional financial support. For all of the strategies analysed, it provides evidence of health system strengthening initiatives, including HCP training and patient education. Outcomes are tracked and shared for the majority of the strategies; for 4 products, the company reported an increase in the number of patients reached.  

Comprehensive access strategies and outcomes reporting for its self-administered products, but limited coverage in LICs. For all 5 products analysed, AstraZeneca reports access strategies in UMICs and LMICs. These strategies are comprehensive, with public reimbursement achieved for the majority of the examples, complemented by pricing and non-pricing initiatives to improve affordability and access. AstraZeneca reports working on access strategies in LICs for 4 products; however, evidence of implementation and supply during the period of analysis was identified for only 2. For most of the assessed strategies, it tracks and reports the number of patients reached. 

Publicly commits not to file for or enforce patents on all products in 80 countries in scope. This applies to all LICs and LDCs, as well as the majority of LMICs and UMICs. AstraZeneca publicly discloses the list of countries to which this commitment applies.  

Publicly discloses product patent status for countries in scope. AstraZeneca publicly discloses patent information for its products on its website. The information published includes brand name, nature of the patent, patent number, expiry date and jurisdiction.  

Does not engage in non-exclusive voluntary licensing for products in scope.  

All 3 manufacturing capacity-building initiatives included for analysis meet all GPS. For example, AstraZeneca is transferring technology for formulation, fill and finish and packaging of cardiovascular medications rosuvastatin (Crestor®) and candesartan cilexetil (Atacand®) to Algerian manufacturer AT Pharma. It has also invested in a facility upgrade at AT Pharma.  

2 of the 3 supply chain capacity-building initiatives included for analysis meet all GPS. For example, AstraZeneca is partnering with WeConnect International to support suppliers in Kenya, Nigeria, Mexico, China and India. It is providing mentorship in procurement readiness, quality-system improvements, sustainability capability development and revenue-growth targets.  

All 5 health system strengthening initiatives included for analysis meet all GPS. For example, together with health tech partner Qure.ai, AstraZeneca is embedding AI tools for chest X-ray risk assessments to help reduce diagnostic delays, support earlier detection and improve triage in low-resource and high-volume settings in 11 countries in scope.  

Newly engaged in 2 IP-sharing agreements with public research institutions to accelerate drug development. In 1 agreement, with a public research institution, AstraZeneca provides access to its diverse compound library for high-throughput screening to identify novel USP17 inhibitors for lung cancer. The company remains engaged in existing agreements.  

Fulfils all 3 mechanisms to ensure continuous supply in LMICs and is involved in local manufacturing at its own sites in countries in scope and demonstrates involvement in technology transfers (TTs). These TTs are designed to improve patient access, including ongoing support to the manufacturer. For example, AstraZeneca is involved in manufacturing capacity building and TT to enable local pharmaceutical production and supply of innovative medicines in Algeria. 

Has a policy for reporting substandard and falsified medicines in countries in scope. AstraZeneca reports cases to the national or local regulatory authorities within 5 days and to WHO Rapid Alert if required. It provides evidence of shortened timeframes for reporting cases that only require visual inspection for confirmation.  

No evidence of inclusive business models that meet all inclusion criteria.  However, AstraZeneca’s Cancer Care Africa demonstrates approaches that facilitate access for populations often not addressed by the company’s existing business models.