Shifting mindsets to improve access to medicine

What levers need to be pulled to improve access to medicine worldwide? Jayasree K. Iyer shares ideas that would lead to more people accessing the medicine they need.

When I took on the leadership of the Access to Medicine Foundation from Wim Leereveld, our long-time CEO and founder, the first order of business was to carve the Foundation’s path for the years ahead. To balance my ideas, as well as the evidence we already had on the influence of our work, I wanted to hear first-hand what value we bring to people.

We also discussed many inspiring ideas – mindset shifts – that would improve access to medicine. I want to share some of them with you. Some ideas will be familiar, while others may be new. I hope they provide food for thought and inspiration to engage with our work in new ways.

It is vital to empower companies’ internal access teams

This is not only a question of numbers – of extra employees, of budgets – or of board-level discussions about access. It’s about a broader alignment between the core business and a company’s access-to-medicine initiatives. It’s clear that a company cannot do all it can for global health if its access programmes are managed from an isolated corner of the organisation.

As the Foundation, we have been talking to access teams from many different companies, to understand how they get results internally. To have an honest conversation about what a pharma company can actually do to improve access, internal change-makers must break through the usual hierarchies, roles and norms. You need discussions within and between different teams – from R&D, from sales, from compliance. It’s about ensuring innovation does not only happen in access programmes and capacity building, but in all corners of the organisation, from product development, to medical affairs, to investor relations.

CEOs and investors need to regularly talk about access

Pharma CEOs and investors rarely talk to each other about access to medicine. And yet, regularly bringing access to medicine into shareholder discussions – whether as opportunities, material issues, or as responsibilities – can help create a group of like-minded shareholders and CEOs. The outcome would be long-term access programmes with shareholder buy-in that are both sustainable and that deliver on the bottom line. In our discussions with company shareholders, including with our signatory investors, we are making a start. Multiple pharma CEOs welcome this.

Health systems and pharma markets must be grown simultaneously

There is universal agreement on the need to develop local health systems. The burning question, as ever, is “How?”. Clearly, governments must prioritise healthcare. And local pharmaceutical markets must be grown at the same time. In all my discussions, particularly with senior government figures, there was agreement that a sound regulatory environment, robust pharmaceutical policies and embedded performance management systems are essential. The African Leaders Malaria Alliance, for example, is leading the way in key areas, such as HIV/AIDS, malaria, and maternal & child health.

Private sector players must also lend their expertise. Not only the big pharma companies, but also local healthcare companies, banks, logistics firms and so on. To achieve universal health coverage, we need to collectively address incentives for innovation and guarantee a sustainable, reliable supply of affordable healthcare products and services. At the Access to Medicine Foundation, our analysis has revealed examples of how pharma companies are taking action. We need equivalent insight into how other players are stepping up.

Don’t lock your people and technologies away

When pharmaceutical companies exit a therapeutic area, it’s no surprise that they begin winding down efforts to address access there. Nevertheless, I know from our research that some companies find new ways to keep contributing. They continue to respond to urgent needs by participating in problem-solving discussions, or by continuing to send staff and technologies to the field, so that their brains and years of experience are not “locked away” but can be put to good use. That’s just good practice.

Make the impossible into a development issue

Some are arguing for cancer, mental health conditions and other non-communicable diseases to be placed higher up the development agenda. In response, time and again, I hear the same fatalistic language used to talk about these diseases. But there is also an enlightened few saying that, with all the excellent work that has gone into HIV/AIDS prevention and treatment, malaria healthcare, vaccination programmes and other initiatives, we already have a fantastic framework and expertise on developing health systems, building local infrastructure and capacities, and on driving innovation in products and solutions that can all be applied to address these NCDs.

Some organisations (the WHO, the World Bank, Grand Challenges Canada, Amref, to name a few) are already doing great work here. It’s only the lack of experience and outreach among those of us not directly involved that makes progress seem impossible. Quite simply, it’s not, and we can’t afford to think otherwise.

The elephant in the room – our broken pricing model for innovative medicines

We all know it – the pricing model for medicine is fundamentally flawed, if not actually broken. Billions of people have only a limited ability to pay for medicines. Even narrow attempts to provide universal health coverage puts a too-big strain on populations, their governments and on innovation pipelines. Let’s stop re-stating the problem over and over again from different sides. There are some great new ideas on the table. It really is time for companies and for their shareholders to start talking solutions as well. There are signs that some companies are moving on this and I see a drive inside certain companies for change.

In November, we will launch the next Access to Medicine Index. It will once again analyse how the top 20 pharmaceutical companies address some of the most pressing access-to-medicine challenges of our time. This will kick-start a new phase of activity for us, when we start using our latest findings to spark change in the industry. We will reach out to the many people working to raise the bar when it comes to access. Throughout this phase, I will be thinking hard about how best to leverage these ideas and bring modern medicine within the reach of everyone.

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