What the 4th High-level Meeting (HLM) on NCDs should prioritise when engaging the pharmaceutical industry

Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide, and three-quarters of these deaths occur in low- and middle-income countries (LMICs). Pharmaceutical companies have an essential role to play in inventing and producing life-saving products, and their active involvement is necessary to reach a sustainable solution. As national level delegates come together for the 4th High-Level Meeting (HLM) on NCDs at the United Nations General Assembly (UNGA) in September 2025, they must utilise their position as funders of innovation and as customers or procurers of NCD products to request concrete actions from pharmaceutical companies across the following four themes to facilitate better access to life-saving NCD products:

Clinical trials

Today, innovation for NCDs drives the pharmaceutical business model. Yet these innovations remain geared toward high-income populations, leaving LMICs underserved. The 2024 Access to Medicine Index (Index) finds that less than half of clinical trials conducted by 20 of the largest research-based pharmaceutical companies take place in 113 LMICs, despite these countries being home to nearly 80% of the global population. These companies have the resources, capability and expertise to expand clinical trial conduct in LMICs to improve health equity, by including resource-limited populations and genetically diverse populations. The political declaration must call on pharmaceutical companies to increase the diversity in and uptake of clinical trials in more LMICs to combat the growing burden of NCDs. To facilitate this, governments need to develop policies and invest in strengthening the infrastructure, regulatory and administrative capacity required to address local barriers within the clinical trial landscape in LMICs.

Access plans

Pharmaceutical companies’ research and development (R&D) access plans are essential to ensure that availability, affordability and supply are considered during the product development stage. However, the 2024 Index highlights that while two-thirds of R&D projects analysed target NCDs, only 57% of late-stage R&D projects for NCDs have access plans developed by the companies: fewer and less comprehensive compared to  R&D projects for communicable diseases or neglected tropical diseases. Furthermore, half of the R&D access plans for NCD projects focus solely on registration and cover few countries, mostly upper middle-income countries (UMICs). Companies can plan for many more countries and consider more aspects of accessibility, including affordability, supply and IP management in these R&D access plans. The political declaration must mandate early and comprehensive access planning to reduce time to market in LMICs from product approval. Governments can accelerate this process by signalling clear demand and investing in regulatory capacity, including harmonisation efforts.

Voluntary licensing and technology transfers

Non-exclusive voluntary licensing (NEVL) agreements, especially those supported by technology transfers, can improve sustainable and equitable access to patented essential healthcare products. However, the 2024 Index reveals that only 1 of 27 compounds under NEVL agreements is for an NCD. Although there have been some promising trends in technology transfers for diabetes and cancer products in recent years, these remain limited to UMICs. The political declaration must urge companies to licence their patented NCD products in LMICs specifically those listed in the Medicines Patent Pool's 2024 Prioritisation Report. Simultaneously, companies must expand technology transfers to include a wider range of NCD products and create a more diverse pool of manufacturers in LMICs.

Affordability

High costs for NCD products are one of the leading barriers to access. The 2024 Index reveals that typically companies have more comprehensive affordability strategies for UMICs. While some companies aim to address affordability through their inclusive business models in low-income countries (LICs), most strategies still focus on donations, which do not provide long-term, sustainable access. The political declaration must call on pharmaceutical companies to adopt diverse and tailored access strategies supporting affordability through co-payment models, patient support programmes and microfinancing solutions, or by leveraging second-brand strategies for lower-cost alternatives while maintaining quality and supply to ensure overall affordable access. Governments can support efforts through ensuring incentives, such as demand guarantees; aligning procurement of NCD products with the national health burden and coordinating across procurement systems; and by developing public reimbursement strategies.