STICHTING ACCESS TO MEDICINE FOUNDATION

AnnualReport2023

Access to Medicine Foundation – Annual Report 2023

ACCESS TO M E D I CI N E FOU N DATI O N
The Access to Medicine Foundation is an independent

Table of contents

non-profit organisation that seeks to transform the healthcare ecosystem by motivating and mobilising companies
to expand access to their essential healthcare products
in low- and middle-income countries.
3

Executive Board Report

The Access to Medicine Foundation is independently
funded by:
The UK Foreign, Commonwealth, and Development Office5

Access to Medicine Index

9

Generic & Biosimilar Medicines Programme

The Dutch Ministry of Foreign Affairs

13

Antimicrobial Resistance Programme

The Dutch Ministry of Health, Welfare and Sport

16	Diabetes Care Programme

The Leona M. and Harry B. Helmsley Charitable Trust

17	Medical Oxygen ProgrammeBill & Melinda Gates Foundation

19	Wider stakeholder engagement

Wellcome Trust

20

Operations

AXA Investment Managers

22

Outlook for 2024

23

Financial statements

Stewart Investors

24	Balance sheet as at 31 December 2023
(after appropriation of result)25	Statement of income and expenses for the year
ended 31 December 2023
26	Notes to the financial statements36	Independent auditor’s report39	The Access to Medicine Foundation
as of 31 December 2023

Naritaweg 227-A
1043 CB, Amsterdam
The Netherlands
For more information about this publication, please contact
info@accesstomedicinefoundation.org+31 (0) 20 215 35 35
www.accesstomedicinefoundation.org

2

Access to Medicine Foundation – Annual Report 2023

Executive Board Report3

Access to Medicine Foundation – Annual Report 2023

Executive Board Report
In 2023, the Access to Foundation expanded its changemaking activities acrossdiverse healthcare sectors, highlighting opportunities to expand access to medicine
for people and communities living in low- and middle-income countries (LMICs).
In line with the Foundation’s Strategic Direction, this involved stimulating a wide
range of major players, including medical gas companies, generic medicine manufacturers, and R&D-based pharmaceutical companies, to recognise their roles andresponsibilities in the global health landscape – and to take action.
The Foundation embarked on pioneering research in areas such as generic
medicines. Recognising this industry’s critical role in expanding access to essential
medicines worldwide, the Foundation’s Generics & Biosimilar Medicine Programme
produced a first-of-its-kind analytical framework for analysing the access efforts
of companies in this sector. This framework sets out what ‘best practice’ looks like
and was used to assess five generics companies in a report that was published in
September 2023. The Foundation’s Medical Oxygen Programme also launched its
inaugural report in 2023. The findings build on the Foundation’s active engagementwith organisations during the COVID-19 pandemic, aiming to mobilise key players
in the medical oxygen ecosystem to address chronic shortages of this lifesaving
intervention. A report from the Antimicrobial Resistance (AMR) Programme, focusing on strategies for more responsible antibiotic manufacturing, was also released.
Alongside this, there was a commitment to broadening engagement, so thata wide range of stakeholders – from policymakers to investors – can use theFoundation’s findings to drive action from companies to enhance availability andaffordability in LMICs. By organising roundtable discussions with a diverse rangeof stakeholders, as well as investor briefings, the Foundation facilitated solutionoriented conversations on topics including diabetes care and AMR. Consultations
on the Methodology for the 2024 Access to Medicine Index also led to the launchof a new Methodology with enhancements to better capture patient reach, which
will further boost the Foundation’s ability to evaluate whether companies are
ensuring their products reach the people who need them.

Major milestones in 2023

Speaking
at theWorld HealthSummitCo-hosting an event with
the World Economic Forum on
the role of the generics industry
in access to medicine

Projectmanagement
training

JA N

FEB

MAR

A PR

M AY

JUN

JUL

AU G

SEP

OCT

N OV

D EC

Amsterdam Session on accessto diabetes products4

Access to Medicine Foundation – Annual Report 2023

Access to Medicine Index
In 2023, the Foundation sought to activate the research findings of the latest
Access to Medicine Index by engaging with senior figures at companies, aswell as leading investors and policymakers, to drive change. At the same time,
the research team began work on the next Index, reviewing and updating
the methodology to ensure an insightful and impactful assessment in 2024.
Making change with the 2022 Index
In early 2023, following on from the Index publication in November 2022, representatives from all 20 of the companies assessed in the Index took part in Learning& Evaluation (L&E) sessions – an increase on the 19 companies who participatedin L&E sessions for the previous Index. These bilateral sessions delved into thespecific Opportunities highlighted for each company, as well as the broader findings
and analysis. Overall, the sessions were constructive, and companies were eager
to learn more about partnerships and collaboration opportunities.
Across the year, many companies in scope of the Index took significant steps toexpand access to medicine. For example, Pfizer expanded its ‘Accord for a HealthierWorld’ product offering to include its full portfolio in 45 lower-income countries,
while Eli Lilly announced a partnership with generics maker EVA to boost insulin
access in Africa and Bangladesh, progressing on the Opportunity to expand registration of medicines that was highlighted in its 2022 Index Report Card – specifically analogue insulins. In May, Sanofi stated in its 2023 ESG Conference Call that
the Foundation has driven its change in access planning, and that the Opportunities
highlighted in the Index drove its Ghana agreement on insulin.
Active engagement by investors also ensured that the changemaking momentum generated by the Index continued across the year. Over 112 investors attended
one or more of the 19 investor briefings delivered by the Foundation, each ofwhich offered a deep dive into the performance of the 19 publicly listed companies included in the Index. Overall, the SDG3 Collaborative – a long-term investor-led initiative that uses the Index to drive progress toward the UN’s Sustainable
Development Goal 3 – has been proactive in its engagements with companies.

The 2022 Index included a Special Reporton SRHR (sexual and reproductive healthand rights). To disseminate these findings
and engage with relevant global healthstakeholders, the Foundation’s AnneCharlotte Douard spoke at the
Reproductive Health Supplies Coalition
Meeting in Ghana.

5

Access to Medicine Foundation – Annual Report 2023

The Collaborative’s ‘lead investors’, who sign up to lead engagements with a specificpharmaceutical company on behalf of the Collaborative, reported back during theinvestor briefings about how they had raised the Index findings and emphasised
the importance of addressing the Opportunities in the company’s Report Card.
Members of the Collaborative are signatories to the Foundation’s Index Investor
Statement, which comprises 142 signatories, with total assets under management (AUM) exceeding USD 22 trillion. One new signatory in 2023 was VGZ, oneof the Netherlands’ largest healthcare insurers. Existing members also emphasised the value of the Index and the investor collaborative; EdenTree Investment
Management published an expert briefing that provides an overview of the Index
and how EdenTree uses it in its investment process, while Edmond de Rothschild
Asset Management highlighted its status as a signatory investor at a conference
on thematic investing.
Part of the Foundation’s efforts with investors this year have included increased

ADVI S I N G TH E G7 O N PAN D E M I C
PR E PAR E D N ESSIn February 2023, the Foundation provided
policy input and recommendations to theG7 about their Pandemic Preparedness andResponse “G7 100 Days (Plus)” communiqué.
The Foundation’s recommendations were:
Promote synergies between PPR and UHC;
Ensure UHC responsive to ever-changing
health threats; Enhance coordination andcreating an enabling environment for 100
Days Mission (100DM); Ensure access to
medical countermeasures (100DM PLUS).
At the end of April 2023, the G7 publishedits communiqué, which drew heavily on theFoundation’s input.

outreach to investors outside of Europe, including Japan- and US-based investors, to stimulate and support them in engaging with companies on access to
medicine – especially the pharmaceutical companies based in their respective
countries. In September, the Foundation was in Japan to build relationships andco-host a side event with the Medicines Patent Pool at PRI Tokyo, titled “The S
of ESG in Healthcare: Enabling Strategic Access to Medicine globally”. This was theFoundation’s most well-attended ‘PRI in Person’ side event to date, signaling how
a growing number of investors are showing interest in viewing healthcare companies through an ESG lens. The discussion explored the benefits of integrating
access in the investment process from a business perspective and underscoredits impact on health equity and positive impact on investment yield, and several
participants shared how they had previously used the Foundation’s insights
to inform their engagements.
A new Methodology for the 2024 Index
The Methodology for the 2024 Index was published in October. Before work on
the next Index can begin, the Methodology is always comprehensively reviewed,
and this was an especially critical moment to consider how the access-to-medicine
landscape is changing as new policies and practices emerge – especially in thewake of COVID-19. Accordingly, consultations were carried out with over 100 global
health experts and stakeholders with a diverse range of viewpoints and technicalexpertise. This included consultees from governments, investors, NGOs, funders,
researchers, and all 20 companies in scope of the Index. Of the stakeholders who
took part in the methodology review, 37% were from LMICs, an increase from theprevious Methodology’s consultation process and in line with the Foundation’s

The Foundation co-hosting an investor
event with the Medicines Patent Poolat PRI Tokyo.

Strategic Direction.
Overall, the consensus was that there should be continuity with the previous
Index Methodology, which will facilitate an analysis of longer-term change.
However, the Methodology review led to several indicators being updated andrefined, as well as the introduction of an additional indicator.

Stakeholders consulted
consulted during
during thethe 2024
2024 Index
Index Methodology
Methodology review
review
Stakeholders
Public private
partnerships
Investors
Funders
Research
and academic
institutions
Governments
Private sector

7
9
10

7 2

Stakeholders(%)
10

Pharmaceuticalindustry

21

15

18

Internationalorganisations
Non-governmentalorganisations

6

Access to Medicine Foundation – Annual Report 2023

One key enhancement to the Index Methodology is an increased focus on measuring patient reach. While patient reach has been addressed and analysed as partof several indicators in previous Index methodologies, refinements were introduced
for the 2024 Index which will allow a greater understanding of whether and how
companies’ efforts are ensuring their products reach the patients who need themin LMICs.
The Methodology was ratified by the 2024 Expert Review Committee (ERC) in
July. The ERC is an independent body that comprises a diverse range of international experts on access to medicine – including participants from the World HealthOrganization (WHO), governments, the pharmaceutical industry, NGOs, academia,
and investors. The ERC reviewed proposals for the scope, structure, and analytical
approach of the 2024 Index; made recommendations where the consensus view
was unclear, or where uncertainty existed in areas of measurement; and endorsed
the final Methodology.
Following publication of the Methodology in October, the Foundation commenced the process of data collection and verification. The initial step of the 2024
Index, involving pipeline and portfolio verification for all 20 companies, was completed by the end of the year. To help companies navigate this process, in 2023
the Index team introduced a new approach – providing companies with a prerecorded video of the 2024 Index Methodology training for internal use, so that

If the vision of the globe’s top
industry executives is truly forevery patient to have access toa drug, no matter their location
or socioeconomic status, thenthis methodology will be
extremely important.
Jayasree K. Iyer in PharmaBoardroom
CEO, Access to Medicine Foundation

the interactive, virtual methodology Q&A sessions held in October could focus
on specific questions.

7

Access to Medicine Foundation – Annual Report 2023

01

02

03

01 Access to Medicine Foundation
CEO, Jayasree K. Iyer, speaking ona panel at the World Health Summit
in Berlin. Credit: World HealthSummit02 Jayasree speaking on‘Leapfrogging local production in
LMICs with need-based Innovationand talent cultivation’ at theWorld Local Production Forumin The Hague.
03 The Foundation’s Suzi van Es
speaking at Responsible Investor
Europe 2023 as part of a panel
discussion on ‘Antibiotic resistance:
What role do investors have in
addressing this systemic societal
risk?’ Credit: Responsible Investor
04 The Foundation’s Marijn Verhoef
speaking at the FT Global Pharma
and Biotech Summit in November.

04

8

Access to Medicine Foundation – Annual Report 2023

Generic & Biosimilar Medicines Programme
A key milestone in 2023 was the publication of a first-of-its kind research
report from the Foundation’s newly established Generic & Biosimilar Medicines
Programme. An assessment of five major players in the generics industry was
carried out using the analytical framework published in February.
Creating and launching the Analytical Framework
In February, the Foundation published the first-ever analytical framework for manu­
facturers. The framework outlines the core areas of responsibility for generic andbiosimilar manufacturers in access to medicine and sets out the validated parameters companies can be evaluated against.
To build the framework, the Foundation engaged with over 70 stakeholders fromacross the global health ecosystem, including representatives from companies inscope, whose input was carefully considered. The framework proposals underwent
thorough review by an Expert Committee (EC), tasked with deliberating on andendorsing the research areas, themes, and assessment parameters outlined within
the analytical framework. The EC consists of members with diverse backgrounds
and an array of expertise, including representation from industry associations,investors, research and academic institutions, and international and non-governmental organisations (NGOs).
The Analytical Framework caught the attention of the media, the industry, andother stakeholders who recognised it as a significant step in the generics space.
For example, the Foundation authored an op-ed for the Financial Times on the needfor greater access and availability to generic medicines, and hosted a ‘fireside chat’with expert guests who spoke on the importance of this new framework and thevalue of measuring companies’ actions in access.
The framework tapped into ongoing interest in the availability of generic medicine in specific countries, and which companies make which products. In 2023, it
became clear that the Foundation’s list of priority generic products can also be used
as a tool by others in the global health space. For example, the Foundation shared
the list with The Access to Oncology Medicines (ATOM) Coalition and provided
guidance on why and how the products had been identified as priorities, helping
them to reach consensus on their own focus product list.

9

Access to Medicine Foundation – Annual Report 2023

Access to Medicine Foundation CEO Jayasree K. Iyer at the joint eventwith the World Economic Forum on the evolving role of generics.

Joint event with World Economic Forum on the evolving role of generics
In May, the Foundation and the World Economic Forum (WEF) organised a dialogue to discuss the role of the generics and biosimilars industry in ensuring
equitable access to medicines globally, along the sidelines of the 76th World
Health Assembly in Geneva. Almost 60 high-level participants joined this interactive discussion, including CEOs, experts involved in developing and/or producing
medicines, policymakers from government, representatives from non-profit
implementing organisations, and regulators. Several leading manufacturers andregulators based in LMICs were also in attendance, including participants from
Kenya, Ghana and Nigeria.
First assessment: 5 Company Profiles

GMM-ExecSum1
Experts take part in a fireside chat to mark thelaunch of the framework.
The 5 companies assessed in this report
This report includes Company Profiles of five major genericand biosimilar medicine manufacturers. On the map, thecountries
where they
have their
headquarters
are shown.
The
5 companies
assessedin thisreportOn 26 September, the Foundation published the first-of-its-kind report featuring

Hikma
UK

tailored Company Profiles of five manufacturers of generic and biosimilar
medicines: Cipla, Hikma, Sun Pharma, Teva and Viatris. The report delves into

Sun PharmaIndia

the strategies and initiatives of these five market-leading companies andassesses their efforts to enhance access to essential health products within
their portfolios. It comprises tailored Company Profiles that outline specificand actionable opportunities for each company, and assess each company’s
respective performance against its own potential in terms of capabilities,
portfolios, and scopes, and showcases its initiatives and strategies aimed atenhancing access to its products for people living in LMICs. Additionally, thereport presents key findings that shed light on industry-wide practices andrecommendations across four critical areas: Registration, Access Strategies,
Improving Local Availability, and Adaptive Research and Development.

Viatris
US

Cipla
India
Teva
IsraelFive major generic and biosimilar medicine
manufacturers were analysed and profiled.
This map shows the countries where they
are headquartered.

10

Access to Medicine Foundation – Annual Report 2023

The report was featured in several media outlets, including Bloomberg, theHindu Business Line, Financial Express, STAT, BestStocks, and the Pharma
Letter. The Foundation also wrote a viewpoint for PharmaBoardroom,“How Can the Generics Industry Up its Game on Essential Medicine Access?”
This report does not use a formal ranking or scoring system for evaluatingcompany performance. However, standout examples have been identified
across the different research areas assessed by the Framework – including
examples of partnerships, solutions, and other ways companies are working on
expanding access and availability in LMICs. These examples demonstrate whereother companies may be able to learn from their peers and adopt similar positive actions, where relevant, to further improve access.
Launching the report far and wide
The Foundation launched the report in Mumbai, London, and online, with
events tailored to different stakeholders and designed to maximise the impactof the findings.
In Mumbai, where many generic and biosimilar medicine manufacturers are
based, the Foundation brought together a variety of stakeholders – including
companies in scope of the report. This event, co-hosted with Stewart Investors,
aimed to disseminate the report’s findings and stimulate discussions on solutions to enhance access to generic and biosimilar medicines in LMICs. An
expert panel engaged in a discussion on the evolving business model within thegenerics industry. The event was attended by investors, policymakers, global
health partners and pharmaceutical companies. The discussion highlighted theimportance of transparency in understanding where access gaps lie and forsharing learnings and successful approaches across the industry. One of the
key takeaways from the discussion was that setting up local manufacturing
facilities or operating through regional hub-based models can be effective ways
to ensure local product availability and bring products closer to the people whoneed them.

Generic Biosimilar Medicines Programme Company Profiles launch event in Mumbai.

11

Access to Medicine Foundation – Annual Report 2023

The Foundation also hosted an investor event in London, in collaboration with
Nomura Asset Management. While the event took place in person in London,
several investors were able to join virtually from the Netherlands. This event
featured a presentation of the report’s findings, followed by an investor-led panel
discussion (a Foundation first). Investors had the opportunity to delve into thefindings of the Company Profiles publication and discuss how companies andother sector partners can collaborate effectively to expand access to essential
generic and biosimilar medicines in LMICs.
In November, the Foundation hosted and moderated a fireside chat to discuss
solutions and innovative approaches for companies to overcome supply chain
challenges in making essential medicines, including many generics and biosimilars, more available to people living in LMICs. Additionally, key areas of action

For the very first time,
we’re shining a spotlighton the actions, efforts, andcommitments of leading
generic and biosimilar medicine
manufacturers to broaden
access to lifesaving medicines
in LMICs.
Claudia Martinez
Head of Research, Accessto Medicine Foundation

for different stakeholders, including procurers, manufacturers and local organisations, aiming to ensure continuous and resilient supply of essential medicines
were identified. Participants in the discussion included senior leaders from NGOs
working on access and pricing in Africa.
The Foundation was invited to speak about the findings of the report at the2023 8th Annual Antiretrovirals Buyer Seller Summit, Mozambique. This event isorganised by the Global Fund to Fight AIDS, Tuberculosis and Malaria, together
with the United States President’s Emergency Plan for AIDS Relief (PEPFAR),
and the Department of Heath of the Republic of South Africa.

The Foundation’s Bram Wagner speaking at theinvestor-focused launch event in London.

Fireside chat on the topic: “Innovative pathways: Ensuring
the availability of essential medicines for all”.

12

Access to Medicine Foundation – Annual Report 2023

Antimicrobial Resistance Programme
In 2023, the Foundation’s AMR Programme delivered two major publications:the first a report on companies’ efforts to manufacture antibiotics responsibly,
and the second a progress update on whether – and how – companies haveseized the Opportunities highlighted in their 2021 AMR Benchmark Report
Cards. In addition, the Foundation engaged extensively on AMR and global
access issues, providing insights and contributing to critical initiatives.
Report on AMR and responsible manufacturing
In August, the report “What steps are companies taking to help curb AMR by
manufacturing responsibly?” was published. By assessing examples from selectedcompanies of varying sizes that manufacture and market antibiotics, the report
identifies opportunities for progress that their peers can follow. The reportspecifically mentions Abbott; Aurobindo; Centrient; Fresenius Kabi; GSK; Pfizer;
Novartis and its generics division, Sandoz*; Shionogi; Teva; and Viatris.
While steps taken by these companies – both at their own manufacturing sites
and those of their suppliers – demonstrate progress is possible, more companies
need to act now for industry-wide change to take effect. Stakeholders – including
procurers, investors and regulators – are already increasingly expecting pharmaceutical companies to demonstrate their commitment to limiting their impact on
AMR and the environment. This report offers practical examples that both large
and small companies can follow to ensure they meet these expectations. With
responsible manufacturing, companies can help curb rising drug resistance while
positioning themselves favourably in the antibiotics market.
Driving change with the findings on manufacturing
The publication of the report provided the Foundation with renewed opportunities to advance ongoing conversations with a variety of stakeholders on theimportance of curbing AMR and the role that responsible manufacturing practices can play. This included engaging experts via fireside chats and webinars,
as well as via the media. The findings of the report have been featured in media
outlets including Express Pharma, ESG Investor and Business Line.
In addition, the Foundation moderated a webinar (co-hosted with the WHO)on “The critical role of responsible manufacturing in addressing AMR: A pathforward”, during which panellists shared their views on the growing demand
for responsible practices within the manufacturing landscape to curb AMR. The
discussion highlighted the potential of reward-based procurement mechanisms
to benefit proactive companies while ensuring continued access to essential
medicine. Importantly, regulations were recognised as a way of creating an equal

The Access to Medicine Foundation’s
new report on Antimicrobial
Resistance and Responsible
Manufacturing is a welcomed andmuch-needed analysis. This is amajor changemaking tool for all
sectors – and shows that leadership,collaboration and innovation can
improve antibiotic supply chainsand curb the drivers of AMR and its
impact on our shared environment.
Professor Dame Sally Davis
UK Special Envoy on AMR

playing field to enable and empower pharmaceutical companies to manufacture
more responsibly.

*Novartis has completed a 100% spinoff of its generics and biosimilars business, Sandoz. On 4 October
2023, Sandoz became an independently listed company.

13

Access to Medicine Foundation – Annual Report 2023

The Foundation’s Martijn van Gerven and Margo Warren represent
the Access to Medicine Foundation at the World AMR Congress.

In August, the Foundation participated in an expert group meeting for the development of WHO guidance on waste and wastewater from pharmaceutical manufacturing with a focus on antimicrobials. The publication of the Foundation’s report on
responsible manufacturing fed into the G20 discussions on responsible manufacturing taking place in India, and an embargoed copy of the report was shared withexpert envoys on AMR form the UK, the Netherlands and Canada to help informtheir policymaking activities at the G20.
In September, the Foundation spoke at the World AMR Congress in Philadelphia,
on the topic of how to ensure responsible manufacturing of – and appropriate
access to – essential antibiotics. During the Congress, in-depth discussions took
place with both the AMR Industry Alliance and BSI regarding the manufacturingcertification programme’s status and audit processes. Based on the findings of theFoundation’s report, it was further discussed how companies could increase theirefforts to minimise the risk of AMR from antibiotic manufacturing.
Tracking progress on 2021 AMR Benchmark Opportunities
In 2023, the Foundation followed through on its commitment to tracking and highlighting company progress, specifically zeroing in on the question of whether – andhow – companies had taken action on the Opportunities identified for them in theirrespective Report Cards in the 2021 AMR Benchmark. Companies were asked toprovide updates to the Foundation, which was supplemented with information fromthe public domain. Companies were also invited to include details of any plans andcommitments, as well as updates on barriers, challenges, or issues they had comeacross. The updates provided were used to create a short summary of progress
per Opportunity per company, as well as a cross-cutting analysis of the progressof the industry.
In November, during World AMR Awareness Week, the Foundation published its
report. Over the last two years, the Foundation found that companies had mademost progress on their Opportunities related to access, especially in expanding
product registration and engaging in long-term initiatives to boost availability andaffordability in LMICs. The report also found some positive examples of acquisitions
to expand R&D pipelines for anti-infectants. Unfortunately, R&D projects targeting
priority pathogens and urgent AMR threats were still lacking. Least progress wasmade in the decoupling of sales bonuses, which can reduce the risk of mis-sellingor over-selling these products. None of the companies with an Opportunity to fully
decouple sales bonuses from antibiotic sales volumes had yet made this change.

14

Access to Medicine Foundation – Annual Report 2023

While the November report focused on Opportunities from the 2021 Benchmark,the Foundation also identified key developments among the companies moregenerally in 2023. For example, following conversations with Shionogi that began
in 2017, the pharmaceutical company reached a non-exclusive voluntary licensing agreement with Indian company Orchid Pharma in September. Johnson &Johnson reduced the price of its multi-drug-resistant tuberculosis bedaquiline
and announced that it would not file secondary patents, steps the Foundation
had highlighted as an Opportunity in previous AMR Benchmarks and in the
Access to Medicine Index.
Sharing AMR expertise
The Foundation has become a go-to source of expertise on AMR, engaging
widely with a variety of stakeholders and offering inputs and insights that canhelp the world tackle this grave threat. The Foundation participated in the annual
Global AMR R&D Hub stakeholders meeting in Berlin in October, and was invited
to join the inaugural AMR Multistakeholder Partnership Platform meeting inRome in November, which was launched by the Quadripartite organisationsin 2023. The Foundation also provided input and data to the UK’s Department
for Health and Social Care for its new AMR National Plan 2024-2029. In June,
the Foundation was invited by the Wellcome Trust to a workshop on Microbial
Reservoirs and Transmission Dynamics of Escalating Infectious Diseases in Ethiopia.
The Foundation also spoke at the Emerging Antimicrobials and Diagnostics
in AMR Symposium.
Engaging with investors
Signatories to the Investor Action on AMR (IAAMR) initiative remain engaged withthe topic, as do many non-signatories who also recognise the material threat of
AMR to global health and the economy. With a growing understanding of AMR asa systemic risk, more investors are now incorporating AMR into their climate or
biodiversity workstreams, and the Foundation has been promoting this directionof travel – including by sharing research findings at investor events. In March, theFoundation participated in the CitiBank GPS Webinar, sharing how investors canleverage the 2021 AMR Benchmark to enhance their engagements with companies
in the pharmaceutical sector. In June, the Foundation participated in a panel
discussion hosted by Responsible Investor, focused on the critical issue of antibiotic
resistance and the pivotal role that investors can play in addressing this systemicsocietal risk.
In November, the Foundation welcomed investor members and guests to its
annual IAAMR meeting co-hosted by the FAIRR initiative and UK Department of
Health and Social Care as the other founding members. Discussions focused on theInitiative and its upcoming plans. Speakers brought to life several developments in
AMR such as global efforts on pull incentives, the success of England’s subscription
model and where efforts need to be focused for the upcoming high-level meetingon AMR at the United Nations, including how investors can get involved. Others
addressed the role investors play in micro stewardship and what other opportunities investors should focus on such as impact investing and the challenges in pharmaceutical business models positing innovative solutions for finance and AMR.

15

Access to Medicine Foundation – Annual Report 2023

Diabetes Care Programme
In 2023, the focus of the Diabetes Care Programme was on bringing the rightpeople together to identify possible solutions and ways to expand access –not only to insulin, but also to the commodities and monitoring devices neededby people living with diabetes in LMICs.
Amsterdam Session: From insulin to glucose self-monitoring devices

What is an Amsterdam Session?

In June, the Foundation hosted a workshop in Amsterdam, or “Amsterdam Session”,

Amsterdam Sessions provide a space for

exploring ways to scale up efforts to increase access to diabetes medicines andcommodities in LMICs. This followed on from the Diabetes Care Programme’s
July 2022 workshop, as well as the Foundation’s report on insulin access thatwas published in October 2022. The workshop was attended by representatives
from the ‘big three’ insulin manufacturers: Novo Nordisk, Sanofi, and Eli Lilly. In
addition to these insulin manufacturers, other pharmaceutical companies attended
the event, as well as manufacturers of glucose monitoring devices; global healthorganisations; patient advocacy groups; and experts from LMICs.
The session explored a range of potential strategies, highlighted priority areas
for action, and provided participants with the opportunity to share information

people working with and within healthcarecompanies to come together and identify
solutions to improve access to essential
healthcare products. Through moderated
working groups and panel discussions,the sessions facilitate the sharing of bestpractices and approaches. Participants use
the insights to redefine access strategies andinternal metrics. In turn, the sessions informthe Foundation’s own approach to incentivising and stimulating companies to do more to
improve and save lives in poorer countries.

about existing access-focused approaches and cross-industry partnerships to drive
access across the continuum of care. For instance, participants talked about efforts
to expand access to products for specific populations, or to streamline the supply
chain. A post-workshop report was published, summarising the key takeaways
and proposed solutions.
Activating the Foundation’s findings
Across the year, the Diabetes Care Programme was focused on sharing the findingsof the October 2022 research report and insights from Amsterdam Sessions andworkshops more widely, and ensuring they reached stakeholders with the power
to make impact – from policymakers, to companies, to the public. For example, theFoundation recorded and shared several ‘fireside chats’, in which experts shared
their insights and took part in a discussion. Events were another key forum; theFoundation participated in a multistakeholder meeting organised by Health Action
International in December, as well as the annual conference of the International
Society for Pediatric and Adolescent Diabetes in November. In January, productive
conversations took place at an event organised by Santé Diabète, WDF (World
Diabetes Foundation), and AFD (Agence Française de Développement), on thesubject of integrating the prevention and management of diabetes/tuberculosis
and diabetes/HIV to strengthen health systems.
In July, the Africa Diabetes Alliance utilised the Foundation’s research to inform
its organisational strategy, illustrating the practical application of the Foundation’s

Discussions taking place at the Amsterdam
Session in June.

research in addressing critical health issues.
Engaging with investors
The three major global insulin producers – Eli Lilly, Sanofi and Novo Nordisk – were
all assessed in the 2022 Index, and the SDG3 Collaborative’s investor signatories
were therefore invited to the Foundation’s investor briefings that provided deep
dives into each company’s performance. The investor briefings also provided a forum
to talk not only about the insulin-related opportunities included in companies’ Index
Report Cards, but also about the findings of the 2022 research report on accessto insulin. The Foundation has appointed eight investor leads across these threecompanies and is supporting them – alongside the wider SDG3 Collaborative – on
engagements on priority products and gaps in access that have been identified.

16

Access to Medicine Foundation – Annual Report 2023

Medical Oxygen Programme
The first research report from the Medical Oxygen Programme was publishedin April. The Foundation maintained a significant presence within the medical
oxygen landscape as an independent member of the Global Oxygen Alliance(GO2AL); the Foundation’s CEO is also an advisor to the Lancet Commission
on Medical Oxygen.
Report on increasing access to medical oxygen
The research team published a report in April that investigates what medical gas
companies are doing to improve access to medical oxygen in LMICs. The report,
titled “What are gas companies doing to scale up access to liquid medical oxygen?”,covers Air Liquide, Air Products, Linde, Messer, Nippon Sanso Holdings Corporationand SOL Group.
The devastating impact of the COVID-19 pandemic exposed the major underlying
inequities in access to medical oxygen in LMICs, highlighting longstanding problems
that remain largely unaddressed. In this report, the Foundation outlined six priority
areas for action, focused on how major gas companies can increase supply of
medical liquid oxygen and expand access over the long term. Starting with a highlevel overview of companies’ responses in LMICs to the COVID-19 pandemic,
the report analysed whether companies were taking long term and sustainableaction in these areas. Standout examples of company action, especially during
the COVID-19 pandemic, were identified in the report – as were opportunities
to harness this momentum.
Translating findings into action
The Foundation engaged with four of the six companies in scope of the Medical
Oxygen Programme during bilateral meetings in November. Discussions focusedon the findings and recommendations from the April medical oxygen report, as
well as the actions companies in scope will take in response to the findings andrecommendations. Other topics relevant to the companies’ work, as well as opportunities for engagement with groups such as GO2AL and the Lancet Global HealthCommission on Medical Oxygen Security, were also discussed. The sessions wereopen and fruitful, with many topics covered, including both opportunities andchallenges identified by the companies.
Visualising the critical need for oxygen in LMICs
Visualising the critical need for oxygen in LMICs
Visualising the critical need for oxygen in LMICs

73 million
73 million

people with hypoxemia
attended healthcare
peoplehypoxemia
facilitieswith
in LMICs
inattended
healthcare
2021*
facilities in LMICs in
2021*

22 million
were people with22
million
COVID-19
were people with
COVID-19

51 million
were people who needed
51
millionoxygentherapy for conditions
were people
who needed
otherthan COVID-19
oxygen therapy for conditions
other than COVID-19

Source adapted from Asian Development Bank. Strengthening Oxygen Systems in Asia and the Pacific. 2022.
Source adapted from Asian Development Bank. Strengthening Oxygen Systems in Asia and the Pacific. 2022.

17

Access to Medicine Foundation – Annual Report 2023

The findings of the report were covered by a variety of news outlets, including ina powerful op-ed in a key industry publication, gasworld. There have also been
more than 15 articles in news outlets based in LMICs, including IOL in South
Africa, Monitor in Uganda, The Hindu BusinessLine in India and The Star in Kenya.
The Foundation followed this up by contributing an op-ed to gasworld that was
published online and in the magazine, highlighting companies’ actions so far andhow they can go further to address chronic, longstanding shortages still faced in
LMICs. The Foundation also took the opportunity to publish an op-ed in DevEx
for World Lung Day (25 September), highlighting how the World Health Assembly(WHA) resolution on increasing access to medical oxygen provides companies witha detailed guide to Member States’ and the WHO Director-General’s priorities andplans, and consequently acts as an opportunity to catalyse their actions to makemedical oxygen available and affordable to all patients.
External events were important for ensuring companies engaged with theMedical Oxygen Programme in 2023, and the Foundation used high-profile platforms to share findings and highlight opportunities for companies to improveaccess. The Foundation participated in the 2nd Global Forum on Childhood
Pneumonia in Madrid, highlighting the findings of the just-published oxygen report.
At the World Health Assembly in Geneva in May, the Foundation took part in a panel
discussion on “How COVID-19 breathed new life into medical oxygen”. At the 2023
gasworld Asia-Pacific Industrial Gases Conference, the Foundation spoke on apanel alongside representatives from companies including SOL Group, which was
an opportunity to highlight key actions identified by the Foundation’s research thatindustry can take, including implementing corporate access-to-medical-oxygen
strategies, developing measurable KPIs and creating dedicated internal accessteams that report directly to senior management.
Lancet Global Health Commission and GO2AL

The findings of the Foundation’s
research report were covered by avariety of news outlets, with two
op-eds written by Foundation staff
published by gasworld and DevEx,
respectively.

Since December 2022, the Foundation’s CEO, Jayasree K. Iyer, has been a memberof the advisory group for the Lancet Global Health Commission on medical oxygen security. The Commission is working towards its goals of 1) addressing major
gaps in oxygen research, 2) mobilising a broad coalition to promote best practices
in addressing the gaps in medical oxygen delivery systems and facilitating andconducting the relevant research to inform implementation, and 3) accelerating
the impact towards strong oxygen systems and reduced mortality and morbidity
globally.
The Foundation is part of several working groups which are contributing to thedevelopment of the Commission’s report, which is expected to be published in
2024. In November, Jayasree moderated an invitation-only industry consultation
for the Lancet Global Health Commission. The purpose of this consultation was
to ensure that the views of the medical oxygen industry are accounted for in thedevelopment of the Commission’s report.
The Foundation continues to actively participate in the Global Oxygen Alliance(G02AL), which was launched in May as a successor to the ‘Access to COVID-19
Tools Accelerator (ACT-A) Oxygen Emergency Taskforce.

18

Access to Medicine Foundation – Annual Report 2023

Wider stakeholder engagement
Investors
The Foundation engaged extensively with investors in 2023, empowering themto use findings from the various research programmes in engagements with pharmaceutical companies and other essential healthcare companies – as detailed inpreceding sections of this Annual Report. Overall, the Foundation’s total numberof signatory investors at the end of 2023 was 208, including signatories to theIndex Investor Statement; the COVID-19 investor statement; and the Investor
Action on AMR Collaborative.

The Foundation is making a huge
impact... through its publicationof the Access to Medicine Index itchallenges manufacturers to raise
their game.
Dr Ebere Okereke
CEO at Africa Public Health Foundation

Engaging communities and LMIC stakeholders
The Foundation has long been committed to capturing the insights and prioritiesof stakeholders from LMICs, using these to inform its work. For example, there wasa targeted effort to ensure LMIC participation in consultations for the 2024 Index
Methodology (see page 6). Paired with this, in 2023 the Foundation focused on
equipping stakeholders in LMICs with the tools needed to engage industry and promote access to medicine. Such stakeholders have included ministries of health, procurement agencies, regulatory bodies, NGOs, civil society organisations and patientadvocacy groups.
Attending and speaking at events was instrumental in forging connections withkey stakeholders and disseminating the Foundation’s findings. This included events
already outlined in the per-programme updates in this report (for example, the ARV
Summit in Mozambique, where findings from the Generic & Biosimilar Medicines
Programme could be shared), and also a variety of other events such as the IQVIA
Africa Health Summit (in Kenya) and the 2nd International Conference on Public
Health in Africa (in Rwanda).
Voices of our changemaking community
The Foundation launched the campaign “Voices of our changemaking community”

The Foundation’s Mary Moehlmann speaking ina panel at the Africa Health Business Symposium2023 in South Africa, on “The role of the private
health sector in disease surveillance andpandemic response”.

in April. The impact page on the Foundation’s website* now showcases interviews
with many global health stakeholders, including from pharmaceutical companies,
global health organisations and NGOs. Through these interviews, the Foundation
was able to demonstrate the tangible ways that the Foundation’s insights are being
used to drive change, and how collaboration with others can help close the healthcare equity gap.
An authoritative voice in the global media
The Foundation’s findings and the launches of new publications have been extensively covered in global media outlets, from the Financial Times to the Hindu – asdetailed earlier in this report. In addition to this, the Foundation has authored articles in a variety of publications that draw attention to wider, urgent access-to-medicine issues. This includes articles by the Foundation’s CEO published in STAT (Sickle
cell cures are coming. African children can’t be left behind), NRC (Farmaceuten
moeten niet zo gefixeerd zijn op winsten) and Fortune (Climate change is unleashing a tsunami of infectious diseases–and we have fewer and fewer drugs that cantreat them).

*accesstomedicinefoundation.org/achievements-so-far/the-foundations-impact

19

Access to Medicine Foundation – Annual Report 2023

Operations
Organisational development
As of 31 December 2023, the Foundation had 41 members of staff, representing
15 nationalities.
In 2023 the Foundation focused on equipping staff with the project management, leadership and presentation skills needed to carry out complex projects
effectively, efficiently and collaboratively. In March, an external trainer delivereda tailor-made project management workshop to operational managers and project
managers. The Foundation also improved processes and systems to improve governance and optimise execution of Foundation projects, including the implementation of Project Charters that allow for clearer understanding of the scope andobjectives of the Foundation’s publications and events. A new project management
system – Wrike – was also selected and implemented, providing a space in whichto collaborate on project planning and gain better oversight of projects’ progress.
In addition to the work on project planning in 2023, there were two other areasof emphasis in organisational development: leadership skills and presentation skills.

A group from the Access to Medicine Foundation took part in a training
workshop to build their project management skills. Credit: Shriram Kumar.

Across the year, operational managers and senior members of the Foundation
participated in a variety of leadership training activities, including group activities
to promote understanding of how to work together productively; bilateral meetings
with the CEO to identify areas for development and track progress; and training
from a leadership coach that was focused on priority setting, collaboration, feedback, effective communication and gap analysis. The Foundation further continued
with presentation training for selected members of staff, an initiative begun in
2022, which has equipped members of the Foundation with better tools to represent the Foundation externally.

20

Access to Medicine Foundation – Annual Report 2023

The Foundation aims to become a carbon-neutral organisation by 2025. While theFoundation’s carbon footprint is generally low, due to factors such as the hybrid
model and the use of virtual events, travel was still identified as an area that could
be addressed based on the Foundation’s independent carbon footprint assessment
in 2022. Therefore, in 2023, the Foundation implemented an updated travel policy
to reduce carbon emissions year-on-year and consistently tracked carbon emissions from business travel.
Supervisory Board
Following the end of some members’ terms on the Supervisory Board of the Accessto Medicine Foundation, the Board welcomed two new members in 2023: LindaGail Bekker (who also is Chair of the Board) and Mariângela Simão. Linda-Gail andMariângela bring a wealth of hands-on experience in delivering healthcare services,making their perspectives invaluable to the Board. Linda-Gail has established herself as a distinguished professor of medicine and a physician-scientist. Her organisation is renowned for groundbreaking studies in the field of HIV and TB. Mariângela
has dedicated nearly three decades to working with the Brazilian public healthsystem and held the position of Assistant Director-General for Access to Medicines

New Supervisory Board members Linda-Gail
Bekker (left) and Mariângela Simão (right).

and Health Products in the World Health Organization from 2017 to 2022.
In June, the Foundation was deeply saddened to hear of the passing of John
Schaetzl, Chair of the Supervisory Board. John supported the work of theFoundation over many years. John brought his extensive experience to bear on
the issue of how to sustainably expand access to medicine in LMICs. He will be
remembered fondly by all who worked with him at the Foundation, and by his fellow
members of the Supervisory Board.
Funders
In 2023, the Foundation signed two grant agreements. A grant was formalised withJohn Schaetzl

a new funder, the philanthropic arm of Stewart Investors; this will support core
activities across the Foundation, with a specific focus on the new programmes
set out in the Foundation’s Strategic Direction for 2022-2026. The Foundation
also signed an agreement with the Wellcome Trust, in support of the AMR
Programme. Additional funders of the Foundation in 2023 included the UK Foreign,
Commonwealth and Development Office; the Dutch Ministry of Foreign Affairs; theDutch Ministry of Health, Welfare and Sport; the Bill and Melinda Gates Foundation;
the Leona M. and Harry B. Helmsley Charitable Trust; and AXA Investment
Managers.
Financials
The equity position of the Foundation at the end of the year is EUR 697.293(positive equity). Both Foundation’s income and expenses in 2023 were
EUR 3.8 million. All grants and subsidies in 2023 came from returning funders.
Expenses are allocated based on the activities for which the costs are incurred.
In 2023, the total expenses were 7% lower than in the budget for 2023
(EUR 3.773.427 vs. EUR 4.056.650). The Foundation used a prudent approachin 2023, awaiting new grants. Funding for 2024 is expected to be sufficientfor the planned activities.

21

Access to Medicine Foundation – Annual Report 2023

Outlook for 2024
Through its work, The Foundation has built a strong reputation rooted in thecredibility and sustainability of its research, which has helped to effect policychange across the global health landscape. In 2024, the Foundation is committed
to widening its impact throughout its research programmes by building on findings
and moving companies to adopt identified strategies.
In assessing the scale and scope of pharmaceutical companies’ efforts to expand
access to their products, 2024 marks a significant year for the Access to Medicine
Index. The focus on patient reach in the upcoming ninth iteration of the Index will
be vital in providing a more comprehensive evaluation of companies’ efficacy indelivering products to people living in LMICs. The Index will also outline opportunities for companies to expand their initiatives, including measures that can improveaccess to products for diseases and conditions with widespread impact, such as
diabetes and infectious diseases.
Through its Diabetes Care Programme, the Foundation will further promotecollaboration among industry stakeholders to ensure people living with diabetes
in LMICs receive access to essential treatment and health commodities. By leveraging opportunities with companies, investors and policymakers, the Foundation
will further advance the changemaking activities initiated in the Generics &Biosimilar Medicines and Medical Oxygen Programmes in 2023, respectively.
This year will be pivotal for the Foundation’s work in antimicrobial resistance(AMR). In the lead up to the UN General Assembly High-level Meeting on AMR,
the Foundation will use practical examples from its extensive research to provide
governments and industry with recommendations on how to address this global
health threat. Alongside this, the Foundation has commenced the developmentof the Methodology for the new AMR Benchmark and will publish the third reportin a series focusing on key areas pharmaceutical companies need to focus on
to expand access to antibiotics and curb AMR.
This ongoing work across the essential healthcare sectors set out in theFoundation’s Strategic Direction encompasses not only strengthening mobilisation efforts but also solidifying impact through innovative initiatives and strategic
partnerships. The Foundation will continue to focus on driving sustainable change,
scaling interventions, and working with companies and global health stakeholders
to act on identified opportunities that will result in long-term impact.

22

Access to Medicine Foundation – Annual Report 2023

Financial statements

23

Access to Medicine Foundation – Annual Report 2023

Balance Sheet as at December 31, 2023
(after appropriation of result)

31 December 2023

ASSETS

Non-current assets

eur

eur

31 December 2022

eur

eur

Property, plant and equipment

24.53233.937

Financial fixed assets

22.43622.436

Current assets
Receivables, prepayments andaccrued income
Cash and cash equivalents

EQUITY & LIABILITIES

460.496897.574

1.302.287

1.982.068

1.809.751

2.936.015

EquityGeneral reserve553.293553.293

Designated fund144.000

96.000697.293649.293

Current liabilities
Accounts payables

26.619131.889

Taxes and social
security contributions

74.54276.780

Deferred income

858.697

1.871.173

Other debts and accruals

152.600

206.880
1.112.458

2.286.722

1.809.751

2.936.015

24

Access to Medicine Foundation – Annual Report 2023

Statement of Income and Expenses
for the year ended December 31, 2023

Results 2023

Budget 2023

Results 2022

eur

eur

eur

Grants and subsidies

3.766.927

4.136.650

3.714.937

Exchange difference

-

-

3.120

6.500

-

124

Total income

3.773.427

4.136.650

3.718.181

Salaries and wages

INCOME

Financial income

EXPENSES
2.373.171

2.651.192

2.219.383

Social security and pension contributions

537.281536.870468.402

Other personnel expenses

226.474

180.574

162.120

Depreciation of plant, property and equipment

17.683

21.63015.250---Travel expenses

130.042169.436168.065

Housing expenses

119.438

125.203120.063

Consultants and similar expenses

253.963278.305377.260

Supplies and similar expenses

84.515

Book loss disposals

111.00389.316

Exchange difference

2.276

-

-

Financial expenses

2.096

4.124

7.228

3.773.427

4.056.650

3.622.286

80.00095.89580.00095.895

Total expenses

Net result
Distribution of net result
Addition to general reserve25

Access to Medicine Foundation – Annual Report 2023

Notes to the Financial Statements
1.

GENERAL INFORMATION

1.1

Activities
Stichting Access to Medicine Foundation (the ‘Foundation’), witha statutory seat in Haarlem, the Netherlands, is a foundation (‘stichting’)
incorporated according to Dutch law. The Foundation’s registered office
is Naritaweg 227-A, 1043 CB Amsterdam. The Foundation is registeredwith the Chamber of Commerce under number 34185938.
The Access to Medicine Foundation is primarily involved in the promotion of access to health care (in the widest sense) and, in particular, toencourage the pharmaceutical industry to accept a larger role regarding
access to medicine in low- and middle-income countries. To achieve this,the Foundation develops and publishes the Access to Medicine Index and
the Antimicrobial Resistance Benchmark and other publications.
The Foundation was established on February 5, 2003 and its ﬁrst accounting period ended on December 31, 2003. Thereafter, the Foundation hasreported its ﬁgures on a calendar-year basis (12 months). The current
reporting period covers the period from January 1 to December 31, 2023.

1.2

Going concern
The equity of the Foundation amounts to EUR 697.293
as at December 31, 2023.
The budget for the next year is covered by grant agreements with the UK
Foreign, Commonwealth & Development Office, the Bill & Melinda Gates
Foundation and the Dutch Ministry of Health, Welfare and Sport, AXA
Investment Managers, The Leona M. & Harry B. Helmsley Charitable Trust,
Stewart Investors and the Wellcome Trust.
The continuity of the Foundation depends to a significant extent on thewillingness of funding organisations to continue or renew these financing
facilities. The accounting principles applied to the valuation of assets andliabilities and the determination of results in these financial statements are
based on the assumption of continuity of the Foundation.

1.3

Estimates
In applying the principles and policies for drawing up the financial statements, the management of the Foundation sometimes needs to makeestimates and judgments that may be essential to the amounts disclosed
in the financial statements. To provide the transparency required underBook 2, article 362, paragraph 1 of the Dutch Civil Code, the nature of theseestimates and judgments, including related assumptions, is disclosed where
necessary in the notes to the relevant financial statement item.

26

Access to Medicine Foundation – Annual Report 2023

2

ACCOUNTING POLICIES FOR THE BALANCE SHEET

2.1

General information
The financial statements have been prepared in accordance with the
Guideline for Annual Reporting 640 ‘Non-profit Institutions’ of the Dutch
Accounting Standards Board.
Assets and liabilities are generally valued at historical cost or at fair value
at the time of acquisition. If no specific valuation principle has been stated,valuation is at historical cost. In the balance sheet, statement of income
and expenses, references are made to the notes.

2.2

Prior-year comparison
The Foundation has made a reclassification between Current liabilities andEquity. The Designated fund is intended for the preparation of an Impact
Analysis Report. The analysis and publication of the report will take place in
2024. Furthermore, the accounting policies have been consistently applied
to all the years presented.

2.3

Foreign currencies

2.3.1

Functional currency
The financial statements are presented in Euros (€), which is the functional
and presentation currency of the Foundation.

2.3.2

Transactions, assets and liabilities
Foreign currency transactions in the reporting period are translated into
the functional currency using the exchange rates prevailing on the datesof the transactions.
Monetary assets and liabilities denominated in foreign currencies are translated into the functional currency at the rate of exchange prevailing on thebalance sheet date (31 December 2023: 0.8668 GBP = 1 EUR; 31 December
2022: 0.88519 GBP = 1 EUR). Foreign exchange gains and losses resulting
from the settlement of such transactions and from the translation at yearend exchange rates are recognised in the income statement.
Translation differences on non-monetary assets held at cost are recognised
using the exchange rates prevailing on the dates of the transactions.

2.4

Property, plant and equipment
Property, plant and equipment are stated at historical cost plus expenditurethat is directly attributable to the acquisition of the items, less straight-line
depreciation over their estimated future useful lives. Allowance is made forany impairment losses expected on the balance sheet date.

2.5

Financial fixed assets
Financial fixed assets like deposits are valued at historical cost. Impairment
losses are deducted from amortised cost and expensed in the income
statement.

27

Access to Medicine Foundation – Annual Report 2023

2.6

Receivables, prepayments and accrued income
Trade receivables are recognised initially at fair value and subsequently
measured at amortised cost. If payment of the receivable is postponed
under an extended payment deadline, fair value is measured on the basisof the discounted value of the expected revenues. Interest gains are recognised using the effective interest method. When a trade receivable is uncollectible, it is written off against the allowance account for trade receivables.
Outstanding payments in arrear from funders, are also shown here.

2.7

Cash and cash equivalents
Cash and cash equivalents include cash in hand, bank balances anddeposits held at call with maturities of less than 12 months. Bank overdrafts
are shown within borrowings in current liabilities on the balance sheet.
Cash and cash equivalents are valued at nominal value.

2.8

Current liabilities and deferred income
Liabilities are initially recognised at fair value, net of transaction costs
incurred. Liabilities are subsequently stated at amortised cost, being theamount received taking into account any premium or discount, less transaction costs.
Any difference between the proceeds (net of transaction costs) and theredemption value is recognised as interest in the income statement over theperiod of the borrowings using the effective interest method.
All donor payments received by the Access to Medicine Foundation for
activities that have not been performed yet are presented as ‘deferredincome’ under current liabilities.

3

ACCOUNTING POLICIES FOR THE INCOME STATEMENT

3.1

General information
The result is determined as the difference between total income and total
expenses. Income and expenses are recognised in the income statementin the period that they are realised.

3.2

Grants and subsidies
Grants and subsidies are recognised as income on a systematic basis
in the same periods in which the expenses are recognised.

3.3

Exchange differences
Exchange differences arising upon the settlement or conversionof monetary items are recognised in the income statement in the periodthat they arise.

3.4

Financial income
Interest income is recognised on a time-weighted basis, taking into accountthe effective interest rate of the assets concerned.

28

Access to Medicine Foundation – Annual Report 2023

3.5

Expenses
Development costs for the Access to Medicine Index and the Antimicrobial
Resistance Benchmark are recognised as expenses, since no future benefits
are expected.
The Foundation is the owner of the intellectual property rights of theAccess to Medicine Index and the Antimicrobial Resistance Benchmark.
These rights are internally developed and on that basis not capitalised(in accordance with Dutch law).

3.6

Employee benefits
Salaries, wages and social security contributions are reported on theincome statement based on the terms of employment, where they are
due to employees.

3.7

Depreciation
Property, plant and equipment are depreciated over their estimated useful
lives from the inception of their use. Future depreciation is adjusted if there
is a change in estimated future useful life.

3.8

Financial expenses
Interest paid is recognised on a time-weighted basis, taking into account theeffective interest rate of the liabilities concerned. When recognising interest
paid, allowance is made for transaction costs on loans received as part ofthe calculation of effective interest.

3.9

Taxes
The Foundation is exempt from income tax. For services purchased
outside of the EU yet consumed in the Netherlands, the reverse charge
mechanism applies. The Foundation must then self-assess and pay VAT
on these services.

4

PROPERTY, PLANT AND EQUIPMENT
Movements in property, plant and equipment can be broken down
as follows:
Furniture
Balance as at
December 31, 2022

Equipment

Total

eur

eur

eur

46.70688.088134.794

Accumulated
depreciation(45.679)(55.178)(100.857)

Book value

1.027

32.91033.937

Cost

29

Access to Medicine Foundation – Annual Report 2023

Furniture
Movements
in book value
Additions
Depreciation

Equipment

Total

eur

eur

eur

1.418

6.861

8.279

(1.079)(16.604)(17.683)

Disposals

000Depreciation disposals

0

0

0

339

(9.743)(9.404)

Balance
Balance as at
December 31, 2023
Cost

48.12494.949143.073

Accumulated
depreciation(46.758)(71.783)(118.541)

Book value

1.366

23.16624.53220%20% - 33%

Depreciation rate

5

FINANCIAL FIXED ASSETS

Security deposit for rental payments

631-12-2023

31-12-2022

eur

eur

22.43622.436

RECEIVABLES, PREPAYMENTS AND ACCRUED INCOME
31-12-2023

31-12-2022

eur

eur

Prepayments

77.453171.673

Interest income

6.267

0

Other receivables

16.255

371

Receivable income paid in arrear

360.521725.530

460.496897.574

The fair value of the receivables equals the book value, given the short-term
character of these receivables.
7

CASH AND CASH EQUIVALENTS
31-12-2023

31-12-2022

eur

eur

1.302.287

1.982.068

Cash and cash equivalents are at the Foundation’s free disposal.

30

Access to Medicine Foundation – Annual Report 2023

8

EQUITY

8.1

General reserve
Movements in the Foundation’s reserves can be broken down as follows:
2023

2022
eur

Balance as at January 1

553.293457.3980

95.895553.293553.293

Movements
Result for the year
Balance as at December 31

8.2

Designated fund			

The Designated fund is intended for the preparation of the Impact Analysis
Report. The analysis and publication of the report will take place in 2024.
31-12-2023

931-12-2022

eur

eur

144.000

96.000

CURRENT LIABILITIESAll current liabilities are due in less than one year. The fair value of the current
liabilities approximates the book value due to their short-term character.

10

TAXES AND SOCIAL SECURITY CONTRIBUTIONS
31-12-2023

31-12-2022

74.54276.78074.54276.780eur
Wage tax

11

DEFERRED INCOME
Deferred income amounts to EUR 858.697 (2022: EUR 1.871.173).

31-12-2023

31-12-2022

eur

eur

Institutional investors

684.374

1.584.739

Governments

173.373286.434950

0858.697

1.871.173

Individual donations

Several activities for which the Foundation received grant instalments
in 2023 will take place after December 31, 2023. These activities are includedin the 2024 budget approved by the Supervisory Board on October 31, 2023.

31

Access to Medicine Foundation – Annual Report 2023

12

OTHER DEBTS AND ACCRUALS
31-12-2023

31-12-2022

eur

eur

Accrued vacation allowance

89.62096.641

Accrued vacation days

39.25047.963

Accrued auditor's fees

19.965

6.685

Other liabilities

3.765

55.592152.600

206.88113

CONTINGENCIES AND COMMITMENTS

13.1

Financial obligations
The Foundation has an office rent obligation (including parking spaces andservice charges) of EUR 30,790 per quarter with ROC Vastgoed 1 CV, which
will terminate on March 31, 2026.
Furthermore, the Foundation has a lease obligation (for a multifunctional
printer) of EUR 1,191 per quarter with BNP Paribas Leasing Solutions N.V.,
which will terminate on December 21, 2025.

14

INCOME FROM GRANTS AND SUBSIDIESResults 2023

Results 2022

eur

eur

Institutional investors

2.145.402

1.180.508

Governments

1.621.525

2.534.429

003.766.927

3.714.937

Individual donations

Grants and subsidies are recognised as income in the same periods in which
their related expenses took place.
15

EXCHANGE RATE DIFFERENCES
Results 2023

16

Results 2022

eur

eur

(2.276)

3.120

Results 2023

Results 2022

FINANCIAL INCOME

Interest

eur

eur

6.500

124

32

Access to Medicine Foundation – Annual Report 2023

17

SALARIES AND WAGES
Results 2023
eur

eur

2.217.037

2.035.069

Vacation allowance

163.108

153.602

Vacation days

(6.973)30.7122.373.172

2.219.383

Gross salaries and wages

18

SOCIAL SECURITY AND PENSION CONTRIBUTIONSResults 2023

19

20

Results 2022

Results 2022

eur

eur

Social security charges and pension costs

402.903348.592

Compensation health care insurance

134.378

119.810537.281468.402

Results 2023

Results 2022

OTHER PERSONNEL EXPENSES

eur

eur

Disability and illness insurance

133.01586.717

Commuting expenses employees

21.361

18.482Training expenses

25.582

8.727

Salary administration

12.85012.133

IND leges

2.100

1.380

Untaxed expense allowance

10.1603.580

Other personnel expenses

21.40631.101226.474

162.120

Results 2023

Results 2022

eur

eur

Office rent

76.02173.890Service charge and energy

32.17334.626

Maintenance

1.184

2.056

Cleaning

5.349

5.171

Other housing expenses

4.711

4.320

119.438

120.063

HOUSING EXPENSES

33

Access to Medicine Foundation – Annual Report 2023

21

CONSULTANTS AND SIMILAR EXPENSES
Results 2023

22

eur

eur

PR and communications expenses

109.670220.897

Impact analyses

48.00048.000

Auditor's expenses

25.380

7.671

Other consultancy expenses

70.913100.692253.963377.260

Results 2023

Results 2022

SUPPLIES AND SIMILAR EXPENSES

eur

eur

ICT expenses

79.24652.131

Telecommunications expenses

8.347

8.680

Canteen expenses

7.299

4.327

Insurance premium

7.073

6.550

Print expenses

4.803

4.466

Subscriptions

2.535

2.280

Office supplies expenses

1.288

1.605

Postage expenses

86

282

Data management (IT platform)

0

0

326

4.194

111.00384.515

Other office expenses

23

Results 2022

AUDIT FEES
The following audit fees were expenses in the income statementin the reporting period:
Results 2023

Statutory audit of annual accounts

24

Results 2022

eur

eur

25.3807.671

25.380

7.671

AVERAGE NUMBER OF EMPLOYEES						
During the financial year, the average number of employees, basedon full-time equivalents, was 40,7 (2022: 39,0).			

34

Access to Medicine Foundation – Annual Report 2023

25

MANAGEMENT REMUNERATION
During the reporting period, the Foundation paid EUR 168,020 as remuneration for the Chief Executive Officer (2022: EUR 162,934). Members of theSupervisory Board of the Foundation are not remunerated.
Results 2023

Results 2022

eur

eur

145.729143.071

12.16510.914Gross wage salary (including
vacation allowance)
Social charges
Pension charges

10.1268.949

168.020

162.934

Amsterdam, 4 April 2024
Stichting Access to Medicine Foundation

THE EXECUTIVE BOARD

THE SUPERVISORY BOARD

Jayasree K. Iyer

Linda Gail Bekker

Chief Executive Officer

Chair
Patrick Flochel
Member of the Supervisory Board
Tochi Okwor
Member of the Supervisory Board
Joelle Tanguy
Member of the Supervisory Board
Jane Masiga
Member of the Supervisory Board
Mariângela Batista Galvão Simão
Member of the Supervisory Board

35

Access to Medicine Foundation – Annual Report 2023

Independent
Auditor’s Report36

Access to Medicine Foundation – Annual Report 2023

INDEPENDENT AUDITOR’S REPORT
To: the Board of Stichting Access to Medicine Foundation
Report on the audit of the financial statements 2023 included in the annual report 2023
Our opinion
We have audited the financial statements 2023 of Stichting Access to Medicine Foundation, based in
Amsterdam.
In our opinion, the accompanying financial statements give a true and fair view of the financial position ofStichting Access to Medicine Foundation as at 31 December 2023 and of its result for 2023 in accordance with
the Guideline for annual reporting 640 ‘Not-for-profit organisations’ of the Dutch Accounting Standards Board.
The financial statements comprise:1.

the Balance Sheet as at December 31, 2023;

2.

the Statement of Income and Expenses for the year ended December 31, 2023; and3.

the Notes to the Financial Statements comprising a summary of the accounting policies and otherexplanatory information.

Basis for our opinion
We conducted our audit in accordance with Dutch law, including the Dutch Standards on Auditing. Our
responsibilities under those standards are further described in the ‘Our responsibilities for the audit of thefinancial statements’ section of our report.
We are independent of Stichting Access to Medicine Foundation in accordance with the “Verordening inzake deonafhankelijkheid van accountants bij assurance-opdrachten” (ViO, Code of Ethics for Professional Accountants,
a regulation with respect to independence) and other relevant independence regulations in the Netherlands.
Furthermore we have complied with the “Verordening gedrags- en beroepsregels accountants” (VGBA, Dutch
Code of Ethics).
We believe the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.
Report on the other information included in the annual report 2023
The annual report contains other information, in addition to the financial statements and our auditor's report
thereon.
Based on the following procedures performed, we conclude that the other information is consistent with thefinancial statements and does not contain material misstatements.
We have read the other information. Based on our knowledge and understanding obtained through our audit of
the financial statements or otherwise, we have considered whether the other information contains material
misstatements.
By performing these procedures, we comply with the requirements of the Dutch Standard 720. The scope of theprocedures performed is substantially less than the scope of those performed in our audit of the financial
statements.
Management is responsible for the preparation of the Executive Board Report in accordance with the Guideline
for annual reporting 640 ‘Not-for-profit organisations’ of the Dutch Accounting Standards Board.
Description of responsibilities regarding the financial statements
Responsibilities of management for the financial statements
The board is responsible for the preparation and fair presentation of the financial statements in accordance with
the Guideline for annual reporting 640 ‘Not-for-profit organisations’ of the Dutch Accounting Standards Board.
Furthermore, the board is responsible for such internal control as the board determines is necessary to enable
the preparation of the financial statements that are free from material misstatement, whether due to fraud or
error.
As part of the preparation of the financial statements, the board is responsible for assessing the foundation’s
ability to continue as a going concern. Based on the financial reporting framework mentioned, the board should
prepare the financial statements using the going concern basis of accounting unless management either intends
to liquidate the company or to cease operations, or has no realistic alternative but to do so.

37

Access to Medicine Foundation – Annual Report 2023

The board should disclose events and circumstances that may cast significant doubt on the company’s ability tocontinue as a going concern in the financial statements.
Our responsibilities for the audit of the financial statements
Our objective is to plan and perform the audit assignment in a manner that allows us to obtain sufficient andappropriate audit evidence for our opinion.
Our audit has been performed with a high, but not absolute, level of assurance, which means we may notdetect all material errors and fraud during our audit.
Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate,
they could reasonably be expected to influence the economic decisions of users taken on the basis of thesefinancial statements. The materiality affects the nature, timing and extent of our audit procedures and theevaluation of the effect of identified misstatements on our opinion.
We have exercised professional judgement and have maintained professional skepticism throughout the audit,in accordance with Dutch Standards on Auditing, ethical requirements and independence requirements. Our
audit included among others:

identifying and assessing the risks of material misstatement of the financial statements, whether due tofraud or error, designing and performing audit procedures responsive to those risks, and obtaining audit
evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting amaterial misstatement resulting from fraud is higher than for one resulting from error, as fraud may
involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control;obtaining an understanding of internal control relevant to the audit in order to design audit procedures thatare appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectivenessof the entity’s internal control;evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimatesand related disclosures made by management;concluding on the appropriateness of management’s use of the going concern basis of accounting, andbased on the audit evidence obtained, whether a material uncertainty exists related to events or conditions
that may cast significant doubt on the company’s ability to continue as a going concern. If we conclude
that a material uncertainty exists, we are required to draw attention in our auditor’s report to the related
disclosures in the financial statements or, if such disclosures are inadequate, to modify our opinion. Our
conclusions are based on the audit evidence obtained up to the date of our auditor’s report. However,
future events or conditions may cause a company to cease to continue as a going concern;evaluating the overall presentation, structure and content of the financial statements, including thedisclosures; andevaluating whether the financial statements represent the underlying transactions and events in a mannerthat achieves fair presentation.

We communicate with those charged with governance regarding, among other matters, the planned scope andtiming of the audit and significant audit findings, including any significant findings in internal control that we
identify during our audit.
Den Haag, April 4, 2024
JPA Van Noort Gassler & Co B.V.
Original signed by
H. Pot RA

38

Access to Medicine Foundation – Annual Report 2023

The Access to Medicine Foundation
as of 31 December 2023

SU PE RV I SO RY
BOAR D

Linda-Gail Bekker
Chair of theSupervisory Board

Joelle Tanguy
Member of theSupervisory Board

Patrick Flochel
Member of theSupervisory Board

Jane Masiga
Member of theSupervisory Board

Tochi Okwor
Member of theSupervisory Board

Mariângela Simão
Member of theSupervisory Board

CH I E FE XECUTIV E
O FFI CE R

Jayasree K.Iyer
Chief Executive Officer

M ANAG E M E NTTE AMMargo Warren
Director of Government
Engagement and Policy

FO U N DATI O NMarijn Verhoef
Director of Operations
and Research

There are 41 people working at the Access to Medicine Foundation, dedicatedto stimulating and guiding pharmaceutical companies to do more for people
living in low- and middle-income countries without access to medicine.
They work across diverse research, engagement, strategy, communications
and support teams.

39

Report Design

Copyright and sharing parts of this report

Studio Teekens, Amsterdam

You are free to:Share — copy and redistribute the material in

Photo Disclaimer

any medium or format.

The Access to Medicine Foundation gratefully

The licensor cannot revoke these freedoms as

respects the permission granted to reproduce

long as you follow the license terms.

the copyright material in this report. Every reasonable effort has been made to trace copy-

Under the following terms:

right holders and to obtain their permission for

Attribution — You must give appropriate credit,

the use of copyright material. Should you believe

provide a link to the license, and indicate ifthat any content in this report does infringe anychanges were made. You may do so in any rea-rights you may possess, please contact us at

sonable manner, but not in any way that sug-

info@accesstomedicinefoundation.org or

gests the licensor endorses you or your use.

+ 31 (0) 20 21 53 535.

NonCommercial — You may not use the material
for commercial purposes.

Disclaimer

NoDerivatives — If you remix, transform, or build

As a multi-stakeholder and collaborative pro-upon the material, you may not distribute theject, the findings, interpretations and conclu-

modified material.

sions expressed herein may not necessarily

No additional restrictions — You may not applyreflect the views of all members of the stake-legal terms or technological measures that

holder groups or the organisations they repre-

legally restrict others from doing anything thesent. The report is intended to be for informa-license permits.

tion purposes only and is not intended as promotional material in any respect. The mate-Notices:rial is not intended as an offer or solicitation for

No warranties are given. The license may not

the purchase or sale of any financial instrument.

give you all of the permissions necessary for yourThe report is not intended to provide account-intended use. For example, other rights such asing, legal or tax advice or investment recommen-

publicity, privacy, or moral rights may limit how

dations. Whilst based on information believed toyou use the material. For more information on

be reliable, no guarantee can be given that it is

how you can use this report, please contact us

accurate or complete.

at info@accesstomedicinefoundation.org or+ 31 (0) 20 21 53 535.

Access to Medicine Foundation
Naritaweg 227A
1043 CB Amsterdam
The Netherlands
www.accesstomedicinefoundation.org
info@accesstomedicinefoundation.org+31 (0)20 21 53 535