Pharma companies inch forward in integrating access to medicine into business practices
Pharmaceutical companies continue to inch forward when it comes to embedding access to medicine into business practices in low- and middle-income countries. There are signs of progress in how they are integrating access to medicine into governance structures, R&D processes and monitoring efforts. Yet efforts to address access to specific products still remain focused on a few countries.
The most notable progress is in planning ahead during R&D to make future products accessible: eight companies are developing approaches for systematically ensuring all R&D projects are paired with plans to increase access in poorer countries soon after launch (these have yet to be applied across late-stage projects). The industry has stepped up efforts to understand the outcomes of their access-related activities, and more companies are evaluating initiatives to build local capacity and strengthen health systems than in 2018. All 20 companies have now set specific goals and targets for improving access, and more companies are deploying business models that explicitly include people at the base of the income pyramid. There is also movement in responsible promotional practices, with three additional companies adopting rewards schemes that decouple sales agents’ incentives from sales targets only (now 12 companies).
Health system strengthening efforts improve
Nearly all companies have stepped up their efforts to strengthen local health and pharmaceutical capacity. Collectively, they have been engaging in more and better-quality initiatives to build R&D or supply chain capacities, or strengthen health systems, than in 2018. However, activities continue to focus on a subset of countries. Manufacturing initiatives are mainly focused on emerging markets such as China, India and Brazil, whereas supply chain and health system strengthening initiatives are mainly in sub-Saharan Africa.
When it comes to specific actions to improve access to individual products, there is less evidence of progress or good performance. Less than half of late-stage R&D projects are so far covered by an access plan, while efforts to improve access to existing products, for example through equitable pricing, voluntary licensing or product donations, remain limited to a narrow range of countries. Almost 42% of the 154 products analysed did not have evidence of access strategies in any of 106 countries in scope.
Actions for specific products lag
Where products are paired with access strategies, low-income countries* are most consistently overlooked, despite being home to approximately 700 million people. The countries that are most often targeted are generally wealthier, namely Brazil, China, India and Mexico. Furthermore, there typically remains a large gap between the first time a product is registered anywhere, and its first registration in a low- or middle-income country. Voluntary licensing remains limited to a few products targeting a few diseases, such as HIV/AIDS and hepatitis C.
R&D dominated by cancers and COVID-19
As in 2018, a handful of diseases are the main focus of companies’ R&D activity. Cancers dominate the pipeline for non-communicable diseases, accounting for more than two thirds of projects. Among infectious diseases, HIV and AIDS, tuberculosis and malaria once again receive most attention, with COVID-19 newly joining the group in 2020. These account for more than half of projects in the communicable disease pipeline. In the same period, projects targeting neglected tropical diseases decreased from 90 to 86, while R&D targeting maternal and neonatal health conditions such as neonatal sepsis and maternal haemorrhage increased, but only slightly, from 9 projects to 11, accounting for just 1% of R&D projects.
R&D targeting coronaviruses surged in 2020
R&D targeting coronaviruses surged in 2020, from zero projects in 2018 to 63 projects, reflecting a clear and vigorous response to the COVID-19 pandemic. However, the other 15 emerging infectious diseases (EIDs) in scope receive very little R&D attention, despite being identified by WHO and Policy Cures Research as posing an epidemic or pandemic risk. The 20 companies are not developing any products for 10 of the 16 EIDs listed as priority.
As in 2018, a small group of companies account for the bulk of the R&D projects that the global health community considers a priority. GSK, Johnson & Johnson, Merck,** Eisai and Pfizer account for 56% of such projects. Looking beyond projects that target established priorities, the 20 companies are developing 440 R&D projects with evidence of offering a clear public health benefit to patients in LMICs, led by AstraZeneca, Bristol Myers Squibb and Johnson & Johnson.
*Low-income countries (LICs) as classified by the World Bank.
**Merck KGaA (Darmstadt, Germany)