Key Takeaways
- Novartis ranks first, with GSK following closely, yet overall progress in access to essential medicines remains stagnant.
- Only 43% of clinical trials target low- and middle-income countries, leaving billions underserved.
- Urgent action is needed to scale voluntary licensing and equitable access strategies globally.
The 2024 Access to Medicine Index unveils critical insights into how pharmaceutical companies are addressing global health inequities. For the first time, Novartis claimed the top spot, excelling in governance, research, and access strategies. GSK, a consistent leader in prior iterations, ranked second, showcasing exemplary practices in product delivery and licensing initiatives. Sanofi, Pfizer, and AstraZeneca rounded out the top five, demonstrating consistent yet regionally constrained efforts to expand access.
Despite these individual achievements, the Index highlights systemic industry-wide gaps. Nearly two-thirds of assessed products lack comprehensive access strategies for low-income countries. This disparity is particularly striking, as access remains disproportionately skewed toward upper-middle-income countries, with limited advancements in reaching underserved populations. The Index calls for a stronger emphasis on equitable access planning, particularly in regions where healthcare systems are under-resourced and where the burden of disease is greatest.
The report also brings attention to the industry’s declining focus on diseases prevalent in low- and middle-income countries (LMICs). For example, while there has been notable progress in addressing diseases such as HIV and malaria, the number of projects targeting priority R&D gaps has decreased from 367 in the previous Index to 253. This reduction underscores the need for sustained commitment and innovative strategies to address unmet healthcare needs.
Clinical Trials and Licensing Fail to Close the Global Health Divide
A major area of concern in the 2024 Index is the geographic distribution of clinical trials. Out of 685 trials analyzed, only 43% were conducted in LMICs, which house nearly 80% of the global population. This lack of representation exacerbates inequities, delaying the introduction of critical innovations in regions that need them the most. Even among these trials, only 3.5% took place in low-income countries, leaving vast populations excluded from access to life-saving interventions.
Clinical trials are often concentrated in upper-middle-income countries such as China, Brazil, and South Africa, with companies prioritizing markets with higher commercial potential. This trend not only limits access but also creates knowledge gaps in understanding how treatments perform in diverse populations. Expanding clinical trials to include a wider geographic scope and ensuring proportional representation of LMIC populations are crucial steps toward bridging this divide.
Additionally, voluntary licensing—a proven method to ensure affordable and localized access to essential medicines—has seen a troubling decline. Only two new non-exclusive voluntary licenses were issued during the assessment period, marking a significant drop from the six licenses reported in the previous Index. While companies like GSK and Novartis have made strides in licensing and technology transfer, broader participation is needed. For example, seven companies have patented products identified as viable candidates for licensing but have yet to take action.
Technology transfer initiatives also show geographic limitations, with most efforts concentrated in countries like India, Brazil, and China. Sub-Saharan Africa, a region with critical access challenges, remains largely overlooked, with only six companies demonstrating active initiatives there. These gaps in licensing and manufacturing underscore the need for companies to prioritize equitable distribution and local production of healthcare products.
Detailed Insights from the Index
The Index also provides a deep dive into specific strategies and shortcomings, Governance of Access, While 17 companies now demonstrate direct board-level responsibility for access strategies, there is limited progress in integrating these strategies into broader corporate governance. Only about half of the companies publicly report measurable goals tied to their access commitments.
Research and Development, Of the 808 pipeline projects analyzed, only 253 address priority R&D gaps. Diseases such as tuberculosis and malaria remain underfunded, while non-communicable diseases dominate R&D focus, leaving LMICs underserved. Product Delivery, Companies perform well in health system strengthening and product donations but fall short in voluntary licensing and equitable pricing strategies. Notably, 49% of analyzed products remain unregistered in countries with the highest disease burdens.
The Index identifies best practices, such as Sanofi’s Global Health Unit and Pfizer’s Accord for a Healthier World, which aim to expand access to underserved populations. However, the implementation of these models remains limited, with companies struggling to report consistent patient reach data.
Call to Action for the Industry
The 2024 Access to Medicine Index is both a benchmark and a wake-up call. It underscores the potential for pharmaceutical companies to address global health inequities through robust governance, inclusive business models, and scalable access strategies. Yet, the report reveals that many companies remain far from achieving their full potential.
To truly transform global health outcomes, companies must Expand clinical trial representation to include diverse and underserved populations, Accelerate voluntary licensing and technology transfer initiatives, particularly in sub-Saharan Africa and Strengthen access planning to ensure affordable and equitable distribution of innovative therapies. By addressing these gaps, the pharmaceutical industry can move closer to realizing the vision of universal health coverage and equitable access for all.
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