After years of advocacy for access planning, there has been a shift in pharmaceutical company policy, said Jayasree Iyer, executive director of the Access to Medicine Foundation.
The index notes the details of these access plans, and how they will accelerate the speed at which future vaccines and other medicines are accessible in low- and middle-income countries.
“It’s not coincidental,” she said in an interview with Devex about the results of the index. “It’s strategic.”
The COVID-19 pandemic has raised awareness of inequitable access, and Iyer said the Access to Medicines Foundation hopes investors will have questions about the 2021 index during these earnings calls.
This conversation has been edited for length and clarity.
“Even in light of COVID-19, there were very few commitments from the pharmaceutical industry last year.”— Jayasree Iyer, executive director, Access to Medicine Foundation
Since 2018, engagement in systematic access planning has increased from one company, to now 40% of companies in the index. How has the pandemic helped to drive this shift, and what are some of the other factors that led to this move toward access plans?
I do think COVID-19 has led to more awareness, not only in the industry, but in the partners around the industry. Even investors have started understanding the need to invest in global health issues and infectious diseases, because they've lost money in all sectors because of this pandemic. I think the ecosystem the industry operates in has become much more aware of the urgency of innovation, the urgency of access, and the need for equitable access.
But the problem is, even in light of COVID-19, there were very few commitments from the pharmaceutical industry last year, in terms of how the industry on its own would ensure global access to people living in low-income countries. Access planning has been an agenda that people like us have been pushing forward, together with a few important donors like the Wellcome Trust and the Gates Foundation. They have been including access considerations in contracts, so when you receive funding, you have to demonstrate that eventually the product will be made available in resource-poor settings.
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I think it's a combination of a few donors driving that agenda and the industry’s experience with access planning with neglected tropical diseases and some of the “big three” diseases — malaria, HIV, tuberculosis — that have made some of the pharmaceutical industry leadership teams realize “Okay, we have to do something about ensuring our products are being made available in low-income markets.”
That, and the instability and expense associated with some of the high-income markets has driven some companies to think, “Okay, can we not start looking at our research and development portfolio differently to make sure that it's more available for global markets?”
So we've got companies like Sanofi, AstraZeneca, GlaxoSmithKline. They’ve been growing their emerging market revenue stream quite significantly over the last year. That concerted effort to say, “Our business is not only the U.S. and Europe. Our business is global,” has played a very strong role in this.
The moment COVID-19 started affecting rich nations and poor nations, most in the industry realized, “There is going to be a paying market available for this.” So it fell closer to some of the broader vaccine work for the industry.
“There's still a lot of companies, mostly at the bottom of the index, who still heavily rely on a business model ... centered on the U.S. market and the European market paying premiums.”—
Pfizer made the most progress in the index, rising from the bottom half of the ranking to the top 5. Can you expand on the reasons for this progress at Pfizer?
When the new CEO took leadership, one of the things he and his team started working on is something called a Purpose Blueprint. It's a repositioning of how the company views access to medicines and health issues around the world. Initially, for a lot of these blueprints and strategy shifts, the first couple of years is mostly statements and commitments at best. So I think this is the year when we're starting to see the first results of it, and you can quantify some of the results.
Across the board, they’ve done well in governance, in access, in research and development, and also interestingly in product delivery, so they've done well in all the areas that we have evaluated.
I think that transformation is starting to be real. And we hope it's not only because of the new CEO, but that this is a pivot point for Pfizer. And we hope it continues in that trajectory to respond to global health issues around the world.
As COVID-19 raises awareness of the importance of access to medicines, can we expect to see more companies developing access plans, perhaps among the 60% of companies in the index without systematic access plans?
I think it’s definitely going to be a pivot point. We hope that, with the results that we bring forward landing on the right desk of people who engage with the industry and push that change, that a few more companies will look at access planning differently and really start bringing forward the commitments.
And obviously they should also be careful about whether they can truly perform on these commitments. My fear, and the fear is actually becoming more real than I realized, is there's still a lot of companies, mostly at the bottom of the index, who still heavily rely on a business model which is so centered on the U.S. market and the European market paying premiums for their products. They don't necessarily have a portfolio that they're shaping that can really offer access in low-income markets.
For a lot of companies, the answer is still, “We rely on the premiums being paid in the United States. Otherwise, we will not even look at the rest of the rest of the world.” And that mantra is what causes a huge problem. I leave so many of these calls heavily disappointed and thinking, “If this is a new CEO, they can change. They have the ability to stand up and do something.”
And I think that's the most disappointing part, when a company sees that COVID-19 has presented so much more awareness, also in the investment community, and not use it as a pivot point to change the company. It’s a shame.