[Ip-health] Launch of the 6th Access to Medicine Index

Danny Edwards dedwards at accesstomedicinefoundation.org
Tue Nov 20 09:14:00 PST 2018

Dear IP-health colleagues,

I'm emailing to inform you all that the Access to Medicine Index 2018 was
launched today, Tuesday, 20 November. It is now live on our website:

It is the result of two years of methodology review, stakeholder input,
company input, data collection, analysis and writing. Thanks to all those
who contributed to this.

I’ve included a high-level summary of the Index in this mailing, and some
of the headline key findings for this report. Over the coming days I’ll go
into a little more depth on each of the findings via e-drug, and am looking
forward to your responses. As with your work, our insights also work when
they are they are shared and discussed by people working in global health.
I’m happy to respond to any questions about our findings.


   - *Progress since 2016 is led by handful of companies, including in
   pricing and R&D. *All 20 companies are pursuing access initiatives to
   some degree. However, in each area, a handful of companies account for most
   - *Five companies are developing 63% of urgently needed medicines.* This
   type of priority R&D is also concentrated on a small number of diseases:
   malaria, HIV/AIDS, tuberculosis, Chagas disease and leishmaniasis.
   - *Access initiatives for cancer products focus on pricing. *This is the
   first Index analysis of pricing, licencing and donations initiatives to
   improve access to cancer medicines.
   - *53 products are critical candidates for companies’ access
   initiatives. Most have access initiatives, but these are limited in
reach. *The
   Index looked at on-patent medicines and vaccines that are both first-line
   treatments and on the WHO Model List of Essential Medicines

Takeda rises furthest in 2018, jumping ten places to fifth. GSK retains its
position at the top of the Index. Novartis moves into second, ahead of
Johnson & Johnson and Merck KGaA, which complete the group of leaders in

These leaders, together with Sanofi (in 6th), account for 63% of the
priority research and development (R&D) being undertaken.

The Index found that the industry’s engagement in such R&D is focused
overwhelmingly on five diseases, with half of all activity in priority R&D
targeting malaria, HIV/AIDS, tuberculosis, malaria, Chagas disease and
leishmaniasis. All five diseases are the target of global health
initiatives and have international donors behind them. *(NB, priority
research being defined as urgently needed research and specific products
gaps for LMIC contexts as defined by WHO, Policy Cures)*

The analysis indicates that the majority of the priority R&D projects are
being carried out with public sector research organisations. However, some
companies are developing priority products without such facilitation. One
example is Merck KGaA developing tests and treatments for schistosomiasis,
a water-borne parasitic disease that affects around 252 million people. The
concentration in companies and diseases is also seen in other activities
important for access to medicine: for example, small groups of companies
account for the increases in equitable pricing strategies, and in access
planning while products are still in the pipeline.

The Index measures companies in seven areas of corporate behaviour that are
important for increasing access to medicine. Overall, the industry
continues to mature in its approach to access to medicine. Three companies
have set new or strengthened access strategies since the 2016 Index. Five
companies are scaling up commercial models that explicitly view people
living in underserved communities as customers. Companies are also more
transparent about where they have patents in force, which is valuable
information for international medicines procurers. Also, strategies that
set different prices for different segments of a country’s population
continue to become more sensitive to what people can afford.

However, performance continues to lag in some areas. For example, while
companies are refining their pricing strategies to improve the
affordability of more products, they are applying them in comparatively few
countries, mostly emerging markets.  Also, while licensing has enabled the
manufacture and distribution of generic versions of all recommended
treatments for people living with HIV/AIDS, its use remains confined to
that disease and to hepatitis C but could be extended to other diseases.

The companies have more projects in the pipeline that target global health
priorities than they did two years ago. Since the 2016 Index, at least 66
products have moved through the pipeline to reach the market. They are for
14 diseases that the Index covers, with half of them targeting cancers.
Other examples include:

   - Three new pills that each can cure all six major genotypes of
   hepatitis C. Gilead has voluntary licensing agreements in place with 11
   India-based generic pharmaceutical manufacturers which enable the
   manufacture and distribution of two of these products in 105 developing
   countries. (Gilead and AbbVie)
   - A child-friendly chewable form of a tablet for roundworm and whipworm,
   which currently infects an estimated 795 million people. The company has
   pledged a donation programme of 200 million doses per year until 2020.
   (Johnson & Johnson)

Cancer is taking an increasing toll in low- and middle-income countries,
where approximately 65% of cancer deaths now occur. The Index examined
company efforts to increase access to cancer products for the first time
this year, focusing on those that are included on the World Health
Organization (WHO) list of medicines it considers essential for all
healthcare systems. It identified 72 such products. Novartis markets the
largest proportion of these, including half of the cancer products that
have an access initiative attached to them.

Efforts during the R&D phase to plan access initiatives for cancer products
lag far behind those for communicable diseases. Plans are in place for 5%
of candidate cancer products by the time they reach the later stages of
development, compared with 54% for communicable disease pipeline products.

In addition to the launch of Access to Medicine Index 2018, we have also
launched a brand new website. The new website features an extended company
report card section, a comparison hub where you can now directly compare
each company's performance with max. 2 others (NB: the scale varies per
graph as it is set to show the most detail, so bear that in mind when
comparing graphs side by side). There is also a new user-friendly best
practices section: all 45 best and innovative practices can now be
filtered: by region, disease, company,  topic (technical area), disease and
type (best/innovative). We have also made it easier to share the practices,
and for visitors to connect with us about these practices.

Hashtag is #ATMI18

As always we are more than happy to engage on all of our results, respond
to questions, schedule meetings etcetera.

All the best,

Danny Edwards

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