Two decades of progress, a defining moment for access

Our benchmarking has helped catalyse change, and we have seen notable progress. Companies have moved from treating access as a largely philanthropic issue towards taking a more strategic approach. Today, access now has a greater place within business operations and in boardroom discussions.

But there is still much more to do. Despite the wider range of products now available in LMICs, access is still patchy and large gaps remain. Worrying geopolitical headwinds also threaten to derail progress. Nationalist pressures are pushing companies to look inwards to their home markets, while drastic cuts in international aid budgets are jeopardising funding for the vital infrastructure needed to distribute life-saving therapies and vaccines.

We have reached an inflection point. In the face of these challenges, leaders of the world’s major pharmaceutical companies need to redouble their commitment to getting products to the people who need them most. 

The industry has plenty to offer. Better and more convenient products in late-stage development for conditions such as hepatitis B, sickle cell disease, HIV, drug-resistant malaria, as well as a vaccine to protect mothers and babies from group B streptococcus (GBS), could improve millions of lives. 

It is encouraging that 68% of late-stage pipeline candidates are now covered by an access plan, more than triple the proportion in 2018. However, these plans vary in how fully they ensure availability, affordability and supply in LMICs. 

As non-communicable diseases (NCDs) such as diabetes, cancer and cardiometabolic diseases take a growing toll, treatments for these conditions are gaining greater attention. But access efforts for NCDs focus primarily on upper-middle-income countries and rarely extend to low-income populations.

In cancer, for example, companies are acting earlier to make innovative products available: 65% of oncology pipeline candidates are now covered by an access plan. Yet the geographic reach of these plans remains narrow, leaving far too many cancer patients in low-income countries behind.

When it comes to diabetes, treatment in developed markets is being revolutionised by GLP-1 medicines. Given how prevalent the condition is in LMICs, these products – including oral formulations in place of injections – could also play a huge role in transforming lives in LMICs. Unfortunately, access plans in diabetes fall short on both equitable pricing measures and the level of registrations in low-resource settings.

Looking back, there is plenty to celebrate in the progress of the last two decades – and plenty to build on for the future. We have learnt a great deal about how to make access work, including the fact that no single approach can solve health inequity. It requires a combination of different tools, from commercial and non-commercial schemes to voluntary licensing and technology transfers.

The Index is a rare example of a successful non-financial incentive system that has helped change industry behaviour. It provides the evidence and practical solutions needed to build on progress made and translate it into greater impact at scale. Pharmaceutical companies must also keep doing their part, breaking down access barriers to make the promise of scientific innovation a reality for all.

Jayasree K. Iyer 

Chief Executive Officer, Access to Medicine Foundation