Although disclosure remains comparatively low from this group, it has improved since 2018. The exceptions are Alkem, Hainan Hailing and Sun Pharma. Despite being big producers, they remain unwilling to share data and enable an evaluation of their commitment to limiting AMR.
Cipla, Teva and Fresenius Kabi take the lead, and all stand out for policies that will help ensure their medicines are promoted responsibly. Across all areas evaluated, Mylan and Abbott follow in joint fourth place. Cipla performs strongly in all areas where it was evaluated. It has filed all 10 of its relevant products in countries where need is highest,* takes part in AMR surveillance,** and is one of three companies in 2020 to fully decouple its sales agents’ bonuses from sales volumes, a significant step in mitigating against overselling, particularly as Cipla reports a global antibacterials sales volume of 2-3 billion units.***
Teva is one of the few companies not to use sales agents for antibacterial and antifungal medicines. It reports several strategies to ensure a continuous supply of antibacterials, including its Teva Access Initiative, which aims for a sustainable medicine supply in more countries than it currently does. The third leader in this group, Fresenius Kabi, limits its use of sales-related bonuses for sales agents by selling mainly through tenders without volume-linked bonuses. It has also disclosed guidelines for intensive care units on the appropriate use of its intravenous antibacterials.
Mylan leads the generic medicine manufacturers when it comes to ensuring a continuous supply of medicines. It has a global supply network of over 40 sites, uses dual sourcing and maintains safety and strategic stocks. It also deploys pricing strategies that take socioeconomic conditions into account, reporting that it provided medicines to more than 165 countries in 2018.
Together with Cipla, Abbott outperforms peers in responsible manufacturing. For its own manufacturing sites, Abbott reports a comprehensive environmental risk-management strategy, including ongoing risk assessments and discharge limits for the majority of antibacterials manufactured. Abbott also expects third-party suppliers to follow its supplier guidelines. Along with Cipla, Abbott leads the group in registration filings. Its most widely filed product in this analysis is the antibacterial medicine clarithromycin, used to treat pneumonia, among other infections, which it has filed in 60 high-need countries.