The 2024 Access to Medicine Index report reveals that while some pharmaceutical companies have taken meaningful steps to improve equity, affordability and access to medicine in low- and middle-income countries (LMICs), significant gaps still persist in addressing global health inequities.
According to the report despite of the pharmaceutical commodities equity and access progress made during the COVID-19 pandemic, the pace of ensuring universal access and equity change remains inadequate to meet the needs of the world’s poorest populations.
Jayasree K. Iyer, CEO of the Access to Medicine Foundation observed that during the pandemic, several pharmaceutical companies demonstrated their ability to make medicines widely available, signaling a potential shift in how the industry approaches access in LMICs.
However, the latest Index finds that much of this momentum has been lost.
“Despite the progress made, the opportunities to scale access and bridge the health equity gap remain largely untapped,” Jayasree said adding that, “By leveraging proven strategies, innovative approaches, and local partnerships, companies can fulfill their potential in delivering lifesaving treatments to patients wherever they are needed.”
Urgent need to reach routinely overlooked populations
The Index highlights the adoption of Inclusive Business Models (IBMs) by five leading companies – Bristol Myers Squibb, Novartis, Novo Nordisk, Pfizer, and Sanofi.
According to the index these models aim to prioritize low-income and least-developed countries, covering 102 LMICs, including all 48 low-income nations.
While these efforts show promise, their impact remains inconsistent. A key issue is the lack of transparency in reporting patient reach and product delivery outcomes, the report reveals.
“As companies increasingly adopt IBMs, transparent reporting on their progress and patient impact is vital for scaling solutions and closing persistent gaps,” the Index report states.
R&D and Clinical Trials: Glaring Disparities
Another area of concern is the low representation of LMICs in clinical trials. According to the Index, only 43 percent of trials occur across 113 LMICs, with just 3.5 percent in low-income countries.
Pharmaceutical companies play a vital role in fostering local R&D capacity. As patent holders, they are uniquely positioned to collaborate with partners in LMICs to bridge gaps and build clinical trial capabilities in these countries.
Additionally, companies should develop comprehensive access plans that cover a wider range of countries and diseases, focusing on registration, affordability, local partnerships and reliable supply chains.
According to Camille Romero, Research Programme Manager for the Index Pharmaceutical companies often focus on markets where clinical trials are conducted, leaving resource-poor populations underserved.
However, she pointed out an example of positive effort which include Gilead’s trials in Uganda for an HIV prevention treatment and Novartis’s work on new antimalarials in collaboration with the PAMAfrica consortium. These initiatives, however, are the exception rather than the rule.
“Companies must prioritize building local R&D capacity and ensuring trials are inclusive of genetically diverse populations to meet unmet healthcare needs,” Romero said.
Industry needs to recommit to voluntary licensing and technology transfers
Voluntary licensing agreements and technology transfers have proven to be effective tools for expanding access. However, the Index reports a slowdown in such initiatives. Only two new non-exclusive voluntary licensing agreements were finalized during the latest analysis period, compared to six in 2022.
Moreover, technology transfer efforts remain concentrated in upper-middle-income markets, with limited activity in sub-Saharan Africa, except for South Africa.
Only six companies – Boehringer Ingelheim, Gilead, Merck, Novo Nordisk, Pfizer and Sanofi – report having established technology transfer initiatives in this region.
Companies now need to take deliberate steps to not only remain engaged in current efforts, but also to evolve them to encompass a broader range of products, include more countries – particularly in sub–Saharan Africa – and address a wider variety of diseases.
“While individual pharmaceutical companies have advanced their efforts to expand access, overall industry progress remains uneven in key areas. Decisive action is now needed, with the 2024 Index highlighting clear steps companies can take to accelerate broad, impactful change,” Romero observed.
Novartis newly takes the top spot in latest ranking, followed closely by GSK
Despite the challenges, some companies have shown exemplary performance. Novartis ranks first in the 2024 Index, followed closely by GSK, with both companies excelling across Governance of Access, R&D, and Product Delivery. Sanofi, Pfizer, AstraZeneca, and Johnson & Johnson also rank highly.
“The increased emphasis on assessing outcomes has highlighted uneven industry progress,” said Iyer. “Leading companies are making strides, but there is still considerable work to be done.”
The Index calls for decisive action, urging companies to implement scalable, sustainable access strategies that prioritize underserved regions. By improving transparency, expanding R&D efforts in LMICs, and enhancing licensing agreements, the industry can accelerate progress toward global health equity.
“Pharmaceutical companies play a vital role in closing the health equity gap,” Iyer concluded. “The time to act is now, with billions of lives depending on it.”
