Appropriate Access & Stewardship

Read the findings from the 2020 AMR Benchmark on access strategies for antibacterial and antifungal products in LMICs from eight large research-based companies and nine generic medicine manufacturers, as well as stewardship initiatives.

On-patent products are registered in few LMICs

Out of 39 on-patent antibacterial and antifungal products assessed, 24 are registered in at least one country where better access is urgently needed (termed access countries); but only 9 in more than 20 access countries.

Off-patent products are not widely available

Over 10% of off-patent products are not registered in even one access country. For a further 30%, it is unknown if these products have been registered in any access countries.

Companies address pricing in different ways

Most companies report that they apply a diverse range of pricing strategies to relevant on- and off-patent products, ranging from tiered pricing, tenders to licensing agreements.

Companies prevent falsified medicines

Companies' supply strategies mostly report aim to prevent the production or supply of falsified medicines: e.g., auditing warehouses or track-and-trace coding.

Older antibiotics are not widely supplied

While most companies manufacture one or more 'forgotten antibiotics' - older, but still useful antibiotics - less than half are supplied to access countries.

Companies share AMR surveillance results

Publicly sharing AMR surveillance results is common practice for the majority of companies involved. Yet one company, Pfizer, shares raw data as well as results.

Companies aim to prevent overselling

Almost half of the companies take steps to promote their medicines responsibly, while six companies show best practice by not by not actively promoting such medicines or fully decoupling sales agents’ bonuses from volumes.

Companies avoid conflicts of interest

The majority of companies are involved in AMR educational programmes aimed at healthcare professionals. Most companies aim to mitigate conflicts of interest that may arise from providing information about how their products should be used.

Product packaging improved for correct use

Some companies report adaptations in their brochures and/or packaging to improve likelihood of appropriate use, and so limit AMR. Language is the most common adaptation.

Context

Rising antimicrobial resistance (AMR) poses twin challenges: excess and access. The rise of AMR is being accelerated by excessive or inappropriate antibacterial and antifungal use (stewardship), while millions of people currently live without reliable access to such products. Both issues are closely interlinked as the need to enhance access where necessary must be balanced with that of ensuring optimal and appropriate use. 

Pharmaceutical companies can influence both access and stewardship. To ensure access, they can put in place strategies, relating to product registration, affordability and improving supply chains. Regarding stewardship, the role for pharmaceutical companies spans a range of areas such as surveillance and ensuring sales practices take account of the risks of overuse and misuse. 

What sets the two company groups apart?

Large R&D-based companies: Portfolios include vaccines and on-patent products; companies take more diverse steps in access and stewardship
The eight companies in this group have at least 598 relevant products, including the 39 on-patent products evaluated in the registration and pricing analyses. On-patent products are not being registered particularly widely (only nine, mainly vaccines, are filed in more than 20 out of 102 access countries). These companies account for six of the 10 off-patent medicines evaluated that are being registered in more than 20 access countries. On affordability, large research-based companies generally report a more diverse range of pricing strategies than generic medicine manufacturers. They are also slightly more likely to be involved in AMR surveillance (6/8 companies), and often publish results in open-access journals. On responsible promotion, three companies from this group either do not promote antimicrobial medicines, or fully decouple its sales incentives from sales volumes (Johnson & Johnson, Otsuka and Shionogi).

How the large R&D-based companies compare
Three companies take the lead among the large R&D-based companies: GSK, then Pfizer and Johnson & Johnson. All three are registering products in some countries where need is high. GSK stands out with multiple strategies to ensure products are in continuous supply. Pfizer leads on AMR surveillance, publishing raw data.

Generic medicine manufacturers: Larger portfolios, all off-patent medicines; most companies take some steps, with less variation in the group
The nine companies in this group have at least 855 relevant products. They account for around half of the off-patent products that are being registered in more than five access countries* (19 out of 36 products), but a lower proportion of those products being filed in more than 20 access countries (four out of 10 products). Compared to large research-based companies, a smaller proportion of these companies use pricing strategies to address affordability. They use a less diverse range of strategies, often applying for tenders. When it comes to stewardship, four of the nine companies in this group engage in educational programmes for healthcare professionals.  On responsible promotion, two companies from this group either do not promote antimicrobial medicines, or fully decouple sales incentives from sales volumes (Cipla and Teva).

How the generic medicine manufacturers compare
Among the generic medicine manufacturers, Cipla is in front, ahead of Teva, then Fresenius Kabi. All three are registering off-patent medicines in some countries where needed. Cipla and Teva both show best practice in responsible promotion in different ways. Mylan and Fresenius Kabi both use several measures to mitigate conflict of interest in educational programmes for healthcare professionals.

In this Research Area, the AMR Benchmark uses global antibiotic sales volumes to inform its selection of companies to analyse. The scale of these companies’ sales volumes suggests that their policies and practices can likely have a significant impact on AMR. 


Explore the results

Research & Development

Read what the 2020 AMR Benchmark found when it analysed the R&D pipelines of eight large research-based companies and 13 pharmaceutical SMEs. It has mapped their medicine and vaccine projects targeting priority bacterial and fungal pathogens.

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Responsible Manufacturing

Read the results of the 2020 AMR Benchmark analysis into how eight large research-based companies and nine generic medicine manufacturers aim to minimise the risk that antibacterial discharge released from factories contributes to AMR.

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Appropriate Access & Stewardship

Read the findings from the 2020 AMR Benchmark on access strategies for antibacterial and antifungal products in LMICs from eight large research-based companies and nine generic medicine manufacturers, as well as stewardship initiatives.

Learn more

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View our detailed overview of each company’s performance

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