What we measure

The 2021 Index analyses how 20 of the world's largest pharmaceutical companies are addressing access to medicine in 106 low- and middle-income countries for 82 diseases, conditions and pathogens. Find out more about the scope of the Index research.
How we measure

20 of the world's leading pharmaceutical companies

The Index assesses 20 of the world's largest research-based pharmaceutical companies on their actions to improve access to medicine. Collectively, these companies account for 70% of global pharmaceutical revenues. The global pharmaceutical market was worth USD 768 billion in 2016, and is expected to reach USD 1.06 trillion by 2022.

The majority of companies in the 2021 Index have consistently qualified for inclusion since 2008. The companies are selected based on a combination of factors, including market capitalisation and how important their products and pipelines are for people living in low- and middle-income countries. Considering their size, resources, pipelines, portfolios and global reach, these companies have a critical role to play in bringing their products to more people. 

Companies in scope of the 2021 Access to Medicine Index: Pharmaceutical companies that exclusively produce generic medicines remain excluded from the Index in 2021. Generic medicines marketed by the 20 research-based companies or any of their generic medicine subsidiaries in which they have more than 50% ownership are included.

82 diseases, conditions and pathogens

The Index assesses pharmaceutical companies in relation to specific diseases, conditions and pathogens. These diseases are the top access priorities for people living in low- and middle-income countries, as defined by the Access to Medicine Foundation through consultation with experts working in global health. For all types of disease the Index looks at, people in low- and middle-income countries face more than 80% of the global burden.

The disease scope for the 2021 Access to Medicine Index comprises 82 diseases, conditions and pathogens. It covers new products for several emerging infectious diseases, such as COVID-19, and other diseases for which new and more effective products are urgently needed, and for oncology products that are not listed on the WHO Model List of Essential Medicines, among others. All diseases, conditions and pathogens are in scope for all three Technical Areas. 

Diseases where majority of burden rests in LMICs now included
As a new inclusion criteria, the Index now also includes diseases where almost everyone affected lives in low- and middle-income countries (LMICs). This is considered a strong indicator that the availability of suitable treatment options is limited due to a low incentive to invest in pharmaceutical R&D. This change has brought diphtheria, sickle cell disease and yellow fever newly into scope, and has led to tetanus being retained.[1] Specifically, the Index includes diseases where ≥95% of the global DALY burden is in countries in scope, where data is available.

106 low- and middle-income countries

The Index assesses pharmaceutical companies’ actions in countries where better access to medicines is most urgently needed. This set of countries is referred to as the Index’s geographic scope. These countries are home to 77% of the global population, and yet face over 80% of the impact of the diseases in scope. 

Defining the country scope
The country scope is defined in four steps: first, include all countries classified as low-income or lower middle-income based on the latest available World Bank data; second, include all countries defined by the United Nations Development Programme (UNDP) as having either low or medium human development in its Human Development Index (HDI) data; third, include all high development countries with a high inequality-adjusted HDI ratio (HiHDI), as defined by the UN Inequality-Adjusted Human Development Index. This change captures those higher-income countries with significant levels of inequality.; and fourth, include all the Least Developed Countries (LDC) as defined by the United Nations Economic and Social Council (ECOSOC).

​Countries included in the 2020 Access to Medicine Index – 106 Countries: ​The geographic scope has been held constant for the 2020 Index, with the same 106 countries in scope as for the 2018 Index

Wide-ranging product types

The Index assesses pharmaceutical companies' actions in relation to eight product types. The product scope is deliberately broad in order to capture the wide variety of product types available to support the prevention, diagnosis and treatment of the diseases covered by the Index. The Index continues to use the same eight product types within the product scope, as in the last four iterations of the Access to Medicine Index.

8 product types in scope

  1. Medicines 

  2. Microbicides

  3. Therapeutic Vaccines 

  4. Preventive Vaccines 

  5. Diagnostics 

  6. Vector Control Products 

  7. Contraceptive Methods & Devices

  8. Platform TechnologiesÂ