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Two billion people still lack medicines access. Is the industry doing enough?

Published on 22/12/15 at 08:26am
The Index measures pharma companies efforts to provide medicines to people all over the world

“We have a mission to encourage the pharmaceutical industry in improving access to medicine for the two billion people who still don’t have access to the medicines they need,” Jayasree Iyer, the Access to Medicine Foundation’s new executive director, tells

The organisation is gearing up to the release of its Access to Medicine Index 2016. The Netherlands-based Foundation is funded by – amongst others – the Bill and Melinda Gates Foundation and the UK Department for International Development. A key part of its work in raising awareness of and affecting change in access issues is production of the Index, which independently ranks leading pharma companies’ efforts in this field.

Published every two years since 2008, the Index is based on 83 indicators, covering a range of factors across seven weighted technical areas: access to medicine management, market influence and compliance, R&D, pricing, manufacturing and distribution, patents and licensing, capacity building and product donations. It encompasses as well as four strategic pillars: commitments, transparency, performance and innovation.

The next edition will be published late next year, and this time will put an even greater emphasis on companies’ performance, increasing the pillar’s weighting from 40-50%, with the intent of recognising pharma firms that have acted on their stated commitments.

A good ranking for a pharma company in the Index can generally be attributed to a strong research pipeline, pricing strategies targeting the poor, IP management which stimulates competition, and constant innovation. Companies receive an overall score and placing based on such criteria.

In the 2014 Index GSK came out on top for the fourth time, followed by Novo Nordisk and J&J, while Daiichi Sankyo and Takeda trailed in 19th and 20th places respectively. However it should be recognised that to make the competitive top 20 at all is no insignificant achievement.  

Iyer explained that the Foundation applies a three-part model to the Index in its efforts to encourage increased access, which includes: consensus-building with stakeholders who wouldn’t necessarily collaborate on this topic, such as including patient organisations, governments, investors, pharma industry leaders and academics; encouraging competition between pharma companies in increasing access and achieving a better ranking; and dissemination of best practices in increasing access.  

Engagement with pharma

An important part of the Foundation and Iyer’s work is in encouraging pharma companies towards improving their access efforts: something she had been active in independently with various companies and public-private partnerships prior to joining the foundation two and a half years ago. This gave her a good understanding of the current landscape and clear targets to work towards as executive director.

“I came in with the goal of stimulating companies to do more. I have been a negotiator between companies and others independently, so I know the intentions of several members of the industry are good and intended to create solutions, but to stimulate that you need a level of internal motivation, bringing back value to the pharma industry, yet showing a balanced approach recognising that there are bad practices that need to be ironed out and good ones that must be encouraged,” she explains.

“As soon as the latest index is launched, you begin to create the change for the next round, identifying opportunities in the index that you can get people to work on. The idea is to empower a company to see that there are certain gaps that are industry-wide, and as a company, you are interested in being champion of this particular space. You have certain unique things in your portfolio, or the expertise to solve some of these problems: here’s a chance to step up.”

Companies are of course, always keen to place well, and the Foundation will engage with them when they question their ranking or even ask for advice on how to improve. As yet, no company comes close to the highest possible score of five; in 2014, GSK scored 3.3, so there is plenty of room for improvement.

“All the companies want to know why they ranked where they did, and if they are not in the top 20, then they are asking if they were, where they would be, so the constant discussion we have with companies is on why they stand where they do. Companies may be happy with parts of it, but they all have something to work on. Being number one in one Index does not guarantee you will stay there. For all companies, there is still a way to go.” 

Room for improvement

What are some of the areas in which pharma companies are struggling? The Foundation’s data suggests that progress has been static on certain access issues, as Iyer explains: “I think there are still a range of areas in addressing affordability, in solving some of the key business model issues in the areas of corruption and bribery which the industry has been struggling with. We’ve identified corruption and bribery on competition laws, on marketing and competition laws, which are areas when almost all the companies have been struggling in recent years.

“We’ve also identified areas like pricing, where the number of products that companies are actually addressing affordability can still be improved, because we have only found evidence of credible pricing strategies and adequate tailoring of strategies in a third of the products.”

Despite this, she does recognise progress, and crucially, a willingness from pharma to act. It is Iyer’s belief that “the industry as a whole has come a long way on access and it has become a key priority in a lot of companies.” However, she also pointed out that progress varies substantially between companies in terms of their stature and to what extent their leadership supports the access cause, and the access teams – if the company indeed has one. It is also a question of whether their portfolios, expertise and experience in some of the countries that the Foundation prioritises are “where they need to be.”

“The areas of price and manufacturing distribution and of research and development are where the industry has most to offer, as innovators, developers and sellers of key products,” she adds, “although it is a little away from their traditional business model to do some of this work.”

Aside from dialogue with industry, another important factor is engagement with governments, and Iyer says it is paramount that governments throw their weight behind mechanisms like the Index to encourage the industry towards positive change and positive solutions. Thankfully, as executive director, she has of late been afforded greater access to such decision-makers. Also key is the Foundation’s support of infrastructure development, capacity building and capability advancement in developing locations – where access remains a particular concern.

Progress since Index 2008

Seven years is a long time in the pharmaceutical industry and this can also be said of disease itself, which can shift the priorities in terms of medicines access. Iyer explains: “The medicines landscape has shifted since 2008, when the onus on HIV/AIDS was even stronger, as well as tropical diseases. More recently, the priority has shifted towards non-communicable diseases and antibiotic resistance – and we see companies responding to this.”

With this in mind, what of the 2016 Index? Can we expect to see any particular companies climb the ranking or indeed lose ground? While she has some pharma companies in mind, the executive director says it is a question of waiting for the data next year.

She comments: “It is such a competitive landscape that we always see companies rising and falling. The message we put forward is that just doing nothing in a two year cycle is one way to fall back. And it is not always about brand new ideas, but about crystallising some of the steps you have made and making steps within existing programmes. When we engage with companies, we see all of them acting on our work and trying something, and on some of the international calls for action on affordability. They are aware of these issues and some companies are working on these harder than others. We will see movement in the next Index, but it is hard to name names at the moment.”

The early part of 2016 is already shaping up to be a busy time for the Foundation. On the agenda for the New Year is a trip to Japan to meet with leaders of the four pharma companies currently in the current top 20 to discuss their ranking. This will be followed by the busy period of collation of data for the 2016 Index. For the first time, this will be followed early 2017 by the seminal Access to Vaccines Index, for which the methodology has just been published. This new Index will specifically address access to vaccinations and will follow a separate set of criteria to the standard Index. The Foundation says that “by uncovering what is working, where and why, the [vaccines] Index can help to build inclusive vaccine markets that also reach the poorest and most remote communities.”

While there is still much more that can be done, it is encouraging to know that the industry is becoming increasingly receptive to the work and insights of organisations like the Foundation, and gives hope that in years to come, there may be a meaningful reduction in the two billion figure of those in the world who lack access to the medicines they need.

Iyer concludes: “By 2020, I hope that we will have made big steps in improving on some of the key challenges that we have already identified with affordability, really addressing companies’ business models to make access a core part of their strategies. The collaboration between the industry and other stakeholders is improving and I hope that becomes the norm. Setting the right targets and reaching the right people is critical. 2020 seems a long way away, but it is in fact very close, and I hope companies can use their best offerings, their portfolio products and their expertise now towards these goals.”  

Joel Levy

2014 Access to Medicine Index

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