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The 2024 Access to Medicine Index reveals a concerning slowdown in pharmaceutical industry efforts to expand access to medicine for populations in low- and middle-income countries (LMICs). Despite some promising initiatives, the overall performance of pharmaceutical companies has declined compared to the 2022 Index.
Key Findings:
- Novartis Takes the Lead: For the first time, Novartis has claimed the top spot in the Index, surpassing long-time leader GSK, which now ranks second.
- Limited Inclusive Business Models: While some companies prioritize low-income and least-developed countries within inclusive business models (IBMs), implementation remains limited.
- Declining Licensing Momentum: Only two new non-exclusive voluntary licensing (NEVL) agreements were identified in the current period, down from six in 2022.
- Low Representation in LMIC Clinical Trials: Despite LMICs being home to 80% of the global population, only 43% of clinical trials take place in these regions, with just 3.5% in low-income countries.
The Index emphasizes the pharmaceutical industry’s pivotal role in addressing global health inequities. However, progress remains uneven, with large segments of LMIC populations still underserved.
Inclusive Business Models and Reporting Transparency
Encouragingly, five companies – Bristol Myers Squibb, Novartis, Novo Nordisk, Pfizer, and Sanofi – have adopted inclusive business models covering 102 LMICs, including 48 low-income countries. These initiatives aim to improve access to essential medicines but lack transparent reporting on patient reach and outcomes. The Index calls for better transparency to ensure scalability and effectiveness in closing access gaps.
Research and Development Focus Needed
The Index also highlights the need for greater investment in research and development (R&D) for underserved populations. Clinical trials remain heavily concentrated in high-income countries, excluding more genetically diverse populations and limiting access for LMICs. Promising examples include:
- Gilead’s clinical trials in Uganda for lenacapavir, an injectable HIV prevention drug.
- Antimalarial trials conducted by Merck KGaA and Novartis as part of the PAMAfrica consortium.
To bridge these gaps, companies are urged to expand clinical trial representation in LMICs, develop comprehensive access plans, and foster local R&D capabilities through partnerships.
Recommitment to Licensing and Technology Transfers
Voluntary licensing and technology transfers are critical mechanisms for expanding access in underserved regions. However, licensing momentum has waned, with only two NEVL agreements identified in the Index period, despite strong demand for licensing of patented treatments for diseases like cancer. Technology transfer initiatives remain limited to a handful of companies and are concentrated in upper-middle-income markets, leaving sub-Saharan Africa largely underserved.
Industry Rankings and Areas for Improvement
Novartis (1st) and GSK (2nd) led the Index, excelling in all three assessed areas: Governance of Access, R&D, and Product Delivery. High-performing companies Sanofi (3rd), Pfizer (4th), AstraZeneca, and Johnson & Johnson (tied at 5th) demonstrated above-average performance. However, the global decline in company performance underscores the urgent need for decisive action to address health inequities.
A Call to Action
“There are significant opportunities to scale access and bridge the health equity gap for billions globally,” said Jayasree K. Iyer, CEO of the Access to Medicine Foundation. “By using proven mechanisms, innovative approaches, and local partnerships, companies can fully realize their potential in delivering life-saving treatments.”
The 2024 Access to Medicine Index calls on pharmaceutical companies to accelerate efforts in expanding equitable access through better geographic and product coverage, sustainable licensing models, and enhanced clinical trial inclusivity. Only with sustained commitment and innovation can the industry achieve global health equity for the underserved populations who need it most.
