What are companies doing to expand access to antibiotics and antifungals in LMICs?

Price caps, donations and voluntary licensing could all be used to help improve access in LMICs
But only one third of products are covered by any access strategy in any of the LMICs in scope

More than 80% of people alive today live in low and middle-income countries
(LMICs). They face some of the highest burdens of infectious diseases, and some of the highest rates of drug resistance, but often do not have access to the medicines and vaccines they need.

Whether they can access these medicines and vaccines depends on several factors, including whether – and how – pharmaceutical companies work to make their medicines and vaccines more available, accessible, and affordable. Across the 17 companies in scope, the Benchmark examined 166 antibacterial and antifungal medicines and vaccines. Looking at these products, the Benchmark considered companies’ efforts to identify the greatest needs for their products, and any gaps in accessibility.

Companies were assessed on how they set prices, both at country level and for different populations within each country. In addition to assessing pricing strategies such as tiered pricing and donations, the Benchmark considered other strategies to expand the accessibility of products. The Benchmark also looked for evidence of patient reach for each access strategy reported by the companies.

Across the 17 companies, the Benchmark identified 166 products, which can be divided into three categories.

Strategies for vaccines vs medicines

When it comes to ensuring access to vaccines rather than medicines, different strategies are commonly used. Many vaccines are purchased in bulk by multilateral organisations on behalf of groups of buyers, usually national governments. The same ‘pooled procurement’ approach is often used for medicines for diseases such as HIV/AIDS, malaria and tuberculosis.

Key questions

What types of access strategies are pharmaceutical companies using?

There are several types of access strategies. Three key strategies are: 1) pricing actions, such as not-for-profit pricing or price caps; 2) voluntary licensing, which can boost competition and supply; and 3) product donations.

Where are access strategies being put into action?

Strategies can be applied either locally, at the national level, or regionally. The Benchmark assesses whether countries with the highest need for better access are being targeted.

Are companies taking account of people’s ability to pay?

Globally, medicine is the largest household expenditure after food. Healthcare costs can push families into bankruptcy. Companies can use a range of measures to assess the affordability of a specific price-point.

Are companies reporting how many patients their strategies are reaching?

Per access strategy, companies should prioritise populations with the biggest need, and monitor their success at reaching patients.

Product and geographic coverage

Most of the access strategies reported focus on a small set of countries and products. Companies need to be more transparent with their strategies and cover a wider range of countries, people, and treatments. Local access initiatives are still driving access overall, and should be sustainable on the long-term.

Affordability

To address affordability more efficiently, companies should look at
implementing price reductions or price segmentation (such as second brand approach, price caps or patient assistance programs) in more countries, especially low-income countries.

Supranational procurement

Access strategies for supranationally procured products are generally better structured and applied more widely. Pentavalent and pneumococcal vaccines, as well as the TB medicines in scope, are procured through organisations including GAVI, The Vaccine Alliance and the GDF Stop-TB partnership and distributed to a wide range of eligible countries.

Donations

Five companies report making donations of their antibacterial and antifungal medicines: GSK, Pfizer, Sanofi, Teva and Viatris. Product donations involve a few Access and Watch antibiotics or antifungals. Product donations continue to play an important role in eliminating, eradicating, or controlling some diseases that affect populations living in LMICs. For people living in poverty, donations may be their only chance of getting access to the treatment they need.

Of the 166 products examined by the Benchmark, 54 are covered by at least one access strategy. A wide range of strategies count towards this figure, including donations, patient assistance programmes, voluntary licensing, tiered and equitable pricing policies.

Many ways for companies to improve local availability, yet few are being used

There are a wide range of tools available to pharmaceutical companies to increase local availability of vital antimicrobials in poorer nations. With each medicine or vaccine, pharmaceutical companies should consider the full range of access strategies in the toolkit to work out what is most useful.

However, as identified in the 2018 and 2020 Benchmarks, companies are making minimal use of the many access strategies in the arsenal. This is the case both in terms of the proportion of products covered by access strategies, and in terms of the countries that are being targeted.

What is the ‘gold standard’ for access strategies?

Companies take a proactive approach and show willingness to reach more people with their medicines and vaccines in LMICs, including countries particularly affected by the relevant disease(s). Companies are using and combining a range of strategies. Access strategies are clear, well described, and detailed – specifying patient and geographic reach, and considering ability to pay where appropriate. Companies commit to longterm access plans.