[Ip-health] Access to Medicine Index 2014 published today (Monday 17 Nov)

Danny Edwards dedwards at atmindex.org
Mon Nov 17 00:45:55 PST 2014

Dear all, 

I’m sending a note through to inform you all that the Access to Medicine Index 2014 was launched today.

It is now live on our website: www.accesstomedicineindex.org <http://www.accesstomedicineindex.org/> - hashtag is: #atmindex2014.


Following refinements made to our methodology in 2013, and a process of detailed expert review of our research in 2014, we believe this is the Foundation’s clearest ever picture of the pharmaceutical industry’s strengths, weaknesses, progress and struggles regarding access to medicine.

I've included some over the overall rankings and findings below, plus some excerpts from the Patents & Licensing chapter.

GSK is in 1st place for the fourth time, ahead of Novo Nordisk (2nd) and Johnson & Johnson (3rd). The leading group comprises six companies in total, with close scores but different approaches to access to medicine. Some focus on a few specific diseases and target them with deep, comprehensive initiatives. Others adopt wide-ranging, integrated approaches. As a pack, companies are doing more to improve access to medicine, with companies at the bottom continuing to narrow the gap.


* Companies do more to improve access, but progress is uneven

The industry is progressing on several fronts. Regarding patents & licensing and public policy, however, the industry remains static.


* Five companies are developing more than half of pipeline products for developing countries

The top 20 pharmaceutical companies are developing 327 relevant products, with more than half of these products targeting the same five diseases.


* More than half of companies are developing medicines for children

7% of the overall pipeline is devoted to ‘child-size’ medicines, such as liquids, chewable tablets or new formulations.


* Pricing strategies are increasingly tailored

More companies are using commercial pricing strategies that also take socioeconomic factors into account.



The Access to Medicine Index is an independent initiative that ranks the world’s leading pharmaceutical companies according to what they are doing for the millions of people in developing countries who do not have reliable access to safe, effective and affordable medicines and vaccines. It is published every two years.




GSK tops the Index for the fourth time. This is driven by robust performance across most areas, with several innovative practices. It has an innovative business model focused on Africa, a large relevant portfolio, a large share of its pipeline dedicated to relevant diseases, and numerous access-oriented intellectual property sharing partnerships. 

Novo Nordisk has made the most progress, improving in five of the seven areas the Index focuses on. This has resulted in a remarkable leap from 6th to 2nd place, which is partly due to the fact that its access activities are well managed, integrated into its business strategy, and well targeted to local needs. It also applies access-oriented pricing strategies to diabetes products in all Least Developed Countries. Eisai has risen steadily with each Index, and ranks 11th, up four places from 15th in 2012.

Sanofi and Pfizer fell down the rankings most significantly, while Astellas, Daiichi Sankyo and Takeda remain at the bottom of the league.



The industry has stepped up its efforts on several fronts. For instance, it is paying more attention to socioeconomic factors, such as people’s ability to pay, and increasingly tailoring prices within countries.  Since 2012, the number of products in the pipeline appropriate for developing countries has grown by 47. More companies are experimenting with innovative access-oriented business models; three have introduced new models and three have expanded pilots. Companies are granting more licences to developing country companies to make and distribute generic versions of their medicines. Meanwhile, policies and activities to improve access to medicine continue to get better organised. All 20 companies now have some form of board-level representation for access-to-medicine issues, and the number of companies linking performance incentives to access to medicine has more than doubled since 2012. 



However, progress is uneven across the areas of activity that matter, with the industry struggling to perform well in two important areas.

Firstly, nearly all companies (18) have been the subject of settlements or judgements regarding breaches in ethical marketing, bribery or corruption standards or competition laws in the last two years. During the period of analysis there were high-profile allegations of corrupt practices against several companies operating in China. The case against GSK, one of those companies, was settled after the period of analysis, and therefore did not affect its score in the 2014 Index. 

Breaches captured in this Index range from paying or otherwise inappropriately incentivising doctors to prescribe their products, to collusions delaying market entry of generic medicines and misrepresenting the efficacy and safety of their products or those of their competitors. 

The Index’s analysis reveals there is no direct correlation between a company’s size, the breadth of its geographical footprint and its incidence of breaches, which indicates that breaches are not simply a cost of doing business. This evidence raises questions over the commitment and effectiveness of company governance of this area. 

Secondly, companies remain conservative in their public disclosure of where patents are active and when they will expire – information that is very useful to medicine procurers and generics manufacturers. Within the reporting period, no company independently and publicly disclosed patent statuses for products relevant to the Index.




Gilead and GSK lead within this chapter. These companies commit to taking a more balanced approach to IP management, and acknowledge the pressing need for companies to explore new ways of using licensing to improve access to medicine for low income people in middle income countries.



Laggards lack clear commitment Astellas and Takeda occupy the bottom positions. Although Astellas and Takeda have relevant patented products, they do not make the same level of commitment to refraining from seeking or enforcing patents in relevant countries. Neither do they commit to engaging in licensing. They take a comparatively conservative stance on the flexibilities set out in the TRIPS agreement.



Publically, companies generally give only qualified support to the flexibilities intended to protect public health set out in the internationally agreed intellectual property framework. However, even this cautious public stance is undermined by evidence of efforts to lobby against these flexibilities in private.



Since 2012, two more companies have entered licensing arrangements for products for diseases in scope, bringing the total to eight. The Index captured evidence of almost 250 licences relating to diseases in scope. Compared to 2012,

a larger proportion of licences include pro access terms and are publicly available. Innovation is also apparent, with the Medicines Patent Pool playing a key role: for example in the use of tiered royalties in middle-income countries.



The overwhelming majority (93%) of licences identified remain related to antiretrovirals (ARVs) for HIV/AIDS. However, there are early signs that some companies are making steps toward expanding voluntary licensing practices beyond this disease, for example to cytomegalovirus and hepatitis C.

We hope you find the 2014 Index useful in your work, and welcome reactions and views as we head into a round of methodology review in 2016.





Danny Edwards


Access to Medicine Index

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