Less than half of key products are covered by pharma companies’ access strategies in poorer countries
Access strategies with the biggest potential impact on access to medicine are strategies that aim to make products affordable for all patients across the income pyramid. The 2021 Index finds that many of the world’s poor countries still do not benefit significantly from pharma companies' access strategies.
Many of the world’s poor countries still do not benefit significantly from access strategies being implemented by the world’s largest pharmaceutical companies. The 2021 Access to Medicine Index shows that less than half of key products controlled by 20 large companies are being offered through access strategies in countries classified by the World Bank as either lower middle income countries (LMICs) or low income countries (LICs). The shortfall is particularly acute in LICs, which are most consistently overlooked by companies despite being home to almost 700 million people.
The Index looked at 199 medicines, vaccines, diagnostics and vector control products. These constituted those products that are considered essential for a well-functioning healthcare system and for which large companies hold a controlling position regarding access – determined either through patents or their dominance of the market. In such situations, the responsibility is with companies to facilitate access through measures such as equitable pricing, voluntary licensing and, for the most vulnerable populations, through product donations.
Low coverage across product categories
Currently, only 13% of critical products (8/60) that need to be administered by healthcare professionals (HCPs) – including, for example, injectable treatments for cancer – are covered by access strategies in at least one LIC. For self-administered medicines – which are often pills – the figure is 26% (24/94).
In LMICs, these proportions jump, to 42% (25/60) for HCP-administered products and 43% (40/94) for self-administered ones. Further up the income ladder, the picture is better, with approximately half of products covered by an access strategy in at least one upper middle income country (UMIC).
Worryingly, however, 42% of the HCP-administered and self-administered products analysed did not have evidence of access strategies in any of 106 countries in scope (64/154 products in total). This reveals a widespread lack of consideration for how people living in these countries will gain access to these products, which are largely controlled by the pharmaceutical companies in question.
Products that are procured through international agreements, where governments pool their purchasing power, are best served by access strategies. LICs are typically covered by international agreements, driven by organisations such as Gavi, the Vaccine Alliance. Further, four out of five of these products are also offered by the companies to countries outside of these agreements on pro-access terms.
How far do access strategies reach?
Data on the extent to which access initiatives helped medicines reach more patients was supplied by 11 of the 20 companies, and covers only a few products. This suggests a gap in knowledge and transparency in how to reach the millions of people without access to medicine.
In all cases, the greatest reach is achieved in UMICs. Among HCP-administered medicines, the numbers of people who benefited from access strategies for oncology treatments ranges between 100 and 31,000 patients, while for asthma it is 100 to 10,000, and for ischaemic heart disease and stroke less than 100 to 238,000. Access strategies for self-administered therapies reach more patients – ranging from 100 to approximately 1.65 million in the case of diabetes and 1,000 to 70,000 for hypertensive heart disease.
The examples of access strategies captured in this analysis clustered around the same emerging markets, particularly China, Brazil and Mexico. Among LMICs, the examples cluster around India, Philippines and Egypt. Among LICs, Uganda, Ethiopia and Nepal stand out from a much thinner line-up.
Which companies stand out?
A few companies stand out for their consistent use of access strategies across the products analysed. These include Novartis, which exhibits leading practice across HCP- and self-administered products, as well as those procured at a supranational level by organisations such as UNICEF and Global Fund. Other stand-outs identified in the Index include Pfizer, for self-administered products; Takeda for HCP-administered products; and GSK, Johnson & Johnson and Sanofi for supranational products. The majority of the HCP-administered products with access strategies (78%) are also supported by capacity building, although once again those initiatives largely overlook LICs. For most of these products, specialist capacities, expertise or equipment is needed to make the diagnosis, select the right treatment and monitor outcomes and side effects.
Novartis exhibits leading practice across HCP- and self-administered products, as well as those procured at a supranational level by organisations such as UNICEF and Global Fund.
What next? Robust strategies with wide geographic scope are key to improving access at scale
A lot more still needs to be done. Solving the access to medicine problem is fundamentally a question of taking action at scale: industry needs to reach more people with more products across a wider range of the world’s poorest countries.
Current industry access arrangements do not go far enough, and many of the world’s most vulnerable patients are still not receiving the life-saving medicines they need, especially in LMICs and LICs. Future strategies need to be more transparent and cover a wider range of countries, people and treatments.
While a 10-year analysis of Index trends published in 2019 found there had been an increase in access and affordability strategies by pharma companies, it is clear that progress is still only gradual. For example, many companies remain reluctant to enter into voluntary licensing arrangements, even for countries where they do not have a presence. Such licensing agreements currently remain confined to medicines for HIV and AIDS, hepatitis C, and now COVID-19. Since 1977, the World Health Organization has worked with more than 150 LICs and LMICs to develop Essential Medicines Lists (EMLs) – vital tools for ensuring universal health coverage, which is one of the UN’s Sustainable Development Goals. However, access to many of the newer and more expensive products on these lists will ultimately be determined in large part by industry action, underscoring the need for pharma companies to expand their use of access strategies to more products and countries.