It is time to accelerate access

Despite some modest progress, this 9th Access to Medicine Index finds the potential for improved access is still far from realised and the pace of change is slow. Coverage remains patchy and many populations – especially those in the poorest countries – are still largely overlooked.

Companies could do a lot more to scale up their initiatives to make lifesaving treatments accessible and affordable everywhere they are needed. Until that happens, many essential medicines and healthcare products will remain out of reach for billions of people living in low- and middle-income countries (LMICs).

For the past two decades, my team has been tracking the pharmaceutical industry’s contribution to global health and benchmarking leading players based on clear deliverables. The latest scorecard shows a new company now leading the pack, but while there have been advances at an individual level, the overall performance of the industry still falls short. No company is yet meeting its full potential and those at the bottom have much work to do.

This report highlights the practical steps that companies should now take to give more people in LMICs the affordable medicines they need – from vaccines against infections to treatments for diabetes and cancer. By following these recommendations, companies and the partners they work with have the power to transform lives and strengthen global health security.

A top priority must be an increased focus on reach – in other words, making sure medicines are not only available but are getting to those who need them. Although there is a promising trend for more companies to prioritise low-income and least developed countries within their inclusive business models, progress in delivering on commitments to reach patients in these settings is limited. In addition, many companies do not consistently report the number of patients they are reaching, or which products have been delivered.

More attention also needs to be paid to research and development – especially the worryingly low representation of resource-poor populations in clinical trials. Less than half of all clinical trials are currently conducted in any LMICs, even though these countries are home to nearly 80% of the global population. This matters because pharmaceutical companies prioritise market access in countries where clinical trials are conducted, while the concentration of research in high-income countries risks excluding more genetically diverse populations living elsewhere.

Finally, the industry needs to recommit to scaling up global availability of key essential medicine, using voluntary licensing and technology transfers – both tried-and-tested tools for maximising the local availability of medicines across large swathes of the world. It is concerning that the pace of non-exclusive voluntary licensing (NEVL) agreements has recently stalled, even though multiple patented products have been identified as potential candidates. Technology transfers, meanwhile, remain concentrated in a few upper middle-income markets, with very few such initiatives in sub-Saharan Africa where shortfalls in local supply are critical.

The need for equitable access to medicines has never been more urgent, given the increasing burden of non-communicable diseases around the world, the rise of resistance infections and the threat of further pandemics. Innovative medical treatments can help address these challenges and radically improve global health – but they must be made available to all.

Jayasree K. Iyer

CEO, Access to Medicine Foundation