Strategic Direction 2022 - 2026

STRATEGIC DIRECTION 2022 – 2026

How we will mobilise fiveessential healthcare sectors toaddress healthcare inequity
DECEMBER 2021

The world’s most vulnerable people need better access to­healthcare. In many areas of healthcare, just a few large firms
hold the key to making this possible, whether through their­market presence, dominance of manufacturing and distribution
or via innovation and intellectual property rights. The Access to
Medicine Foundation has developed a tried-and-tested model
for incentivising such companies to do more to reach people
in low- and middle-income countries. Over the next five years,
the Foundation will expand this model to cover a total of five
healthcare sectors: Big Pharma, generic medicine manufacturers, ­vaccine manufacturers, diagnostics companies and medical
gas companies. Moving the big players in each of these sectors
would transform many millions of lives. This Strategic Direction
for 2022-2026 describes a six-part approach for expanding thismodel and mobilising a diverse range of essential healthcare­companies to achieve global equity in access to healthcare.

1Strategic Direction 2022 - 2026

TH E PL AN I N B RI E F

The next five years: driving deeper andbroader access
The world’s most vulnerable people need better access to healthcare. The chronic inequalities in access are more glaring than ever in the wake of the coronavirus pandemic
with acute issues of access to medicines, vaccines and other essential health products
such as medical oxygen. Over the next five years, the Access to Medicine Foundation
intends to save more lives by expanding its tried-and-tested model of incentivising companies to help more people living in low- and middle-income countries. We will build
on our strengths as we begin to work with a wider range of firms across more sectors
to elicit systematic improvements in access to innovative medicines, vaccines, generictreatments, diagnostics and medical gases. In broadening and deepening our work,
we will focus on the largest players that dominate their respective markets, whether
through control of supply and distribution or via innovation and intellectual property
rights. This approach has been shown to work in the case of Big Pharma – as demonstrated by the success of the Access to Medicine Index – and we believe it can be equallyeffective in other parts of the healthcare supply chain. In this strategy, we set out how
we will expand our model to cover a total of five healthcare sectors.
To meet the scale of our ambition, we will engage more companies and mobilise data,
rankings, analyses and a network of powerful allies – including investors, policymakers ingovernments and global health organisations – to drive the uptake of best practices. It
is only by addressing the continuum of care that the world can truly help the two billion
people who still lack access to the medicines and healthcare products they need.
BY 2026: FOU R STR ATEG IC OUTCO M ES
We will work to enable four shifts in the industry that improve healthcare in low- andmiddle-income countries:

1

A critical mass of companies is brought to the table
A diverse range of essential healthcare companies, in addition to Big Pharma,

address access as a core priority, including suppliers of generic and branded m­ edicines,
vaccines, diagnostics, devices and medical oxygen. Access-related objectives that
include vulnerable populations are becoming embedded in commercial strategies andcompany actions are being tracked by the Foundation.

2

Access to medicine is expanding along the continuum of care
Gaps in care provision start to close rapidly as best-practice access strategies­accelerate across low- and middle-income countries, and there is a portfolio of new
products in the pipeline. Increasing numbers of people can rely on a steady, sufficient,
timely and equitable supply of essential healthcare products.

3

Driving access at scale to help achieve universal health coverage
Healthcare companies improve local availability of products and relieve pressure

on health services through supply chain, product licensing and technology transfer programmes. Companies also improve affordability by matching prices to local economies
and people’s ability to pay.

4

The public, investors and policymakers are empowered to drive change
Investors and policymakers stimulate companies to step up action on accessthrough conditional funding and regulatory measures, leveraging the Foundation’s
tracking mechanisms to push for behavioural and strategic change within boardrooms.
They are supported by an informed and engaged public.
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Strategic Direction 2022 - 2026

WHY NOW, WHY US?

The challenge for this next decade
The need for equitable access to medicine has never been more important or moreurgent. The challenge for the global community this decade must be to close what is
an unacceptable gap between the “haves” and the “have-nots” so that the most vulnerable people, including millions of women, girls and children, are not left at theback of the line. This applies just as much to life-saving products against non-communicable diseases, such as cancer and diabetes, as to interventions against infectious diseases. With the world striving to achieve the Sustainable Development Goals(SDGs) by 2030, there is no time to lose.
The COVID-19 pandemic, which has already destroyed so many lives and livelihoods, has been a stark reminder of the damage caused when billions of people living in low- and middle-income countries are relegated to the end of the queue for
vaccines and treatments, and how inequity undermines global health security. The
crisis also highlights the key role that just a few companies play in the development,
manufacture and distribution of essential health products. Actions by these companies and the enabling conditions set by governments to facilitate access make theultimate difference for patients.
Why transformation of the healthcare ecosystem is needed
Global health has seen important advances in recent decades and many leading
pharmaceutical companies have made progress in improving access to medicine
since the Foundation started benchmarking their performance in 2008. Yet the fact
remains that billions of people still cannot access the medicines that they need, andessential healthcare services are out of reach for half the world’s population. The
people on the frontline of this crisis are the 83% of humanity who live in low- and

83% of all people alive today live in the 106 coun-

middle-income countries.

tries covered by the research of the Access to

Too many medicines and other essential healthcare products – both old andMedicine Foundation

new – remain unaffordable and unavailable. The skewed incentives driving industry
investment patterns mean that innovations routinely fail to reach the people whoneed them most. A lack of lucrative markets in low- and middle-income countries
too often leads healthcare companies and their investors to ignore access in thesecountries. This has resulted in much of the industry overlooking essential areas of
medicine, such as the hunt for new life-saving antibiotics and cures for crippling
tropical diseases.
There is a pressing need to marshal resources more efficiently and to motivate
more companies to step up. Although this is a daunting task, we know what needs
to change – and we have proved we can move the dial by encouraging companies
to do more. The Foundation has demonstrated the power of data, collaboration andpersuasion to trigger action by the pharmaceutical industry over many years andensure expanded access to products.
We plan to exploit our mechanisms of action to move Big Pharma more systematically and rapidly, while expanding our work to encompass more manufacturers ofhealthcare products in four additional sectors: generic medicines, vaccines, diagnostics and medical gases. This will enable us to be a catalyst to transform the healthcare ecosystem for the better. The Foundation’s solutions-oriented approach andits unique ability to convene all stakeholders to address the pressing issues will beneeded more than ever in the wake of the COVID-19 pandemic as the global healthcommunity prepares for future challenges.

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FIVE ESSE NTIAL H E ALTHCARE SECTO RS

Motivating the pivotal players
The next five years offer a major opportunity for the Foundation to continue todrive change within Big Pharma, while expanding its proven tactics to other crucial players in the global healthcare supply chain, thereby covering more essential health products. This will involve making the case for far-reaching change not
only to companies but also to policymakers and investors. Governments, multilateral organisations and the financial backers of healthcare businesses all have a crucial role to play in shifting access policies. Healthcare is not only about medicinesand vaccines; a wider group of companies is also critical in providing patients witha continuum of care. In many cases these firms hold the key to increasing accessto scientific innovation in low- and middle-income countries and the Foundation’s
established system of incentivising better access standards can be applied equally
across these supportive products.
Two clear examples here are medical gases – including medical oxygen – anddiagnostics: sectors where there are a handful of large players with pivotal roles inbringing solutions to health systems. Indeed, it is a common feature of all the sectors where the Foundation currently operates and where it plans to step up activities that a relatively small number of companies control the market, whether
through dominance of manufacturing and distribution or via innovation and intellectual property rights. Moving these big players therefore holds the key to improving
the scale of access globally and delivering on the SDGs.
This approach of focusing on the largest companies has already worked in thecase of the large research-based pharmaceutical companies covered by the Accessto Medicine Index. We believe this strategy can also prove highly effective in motivating pivotal suppliers of other essential health products.

FIGURE 1 The five overlapping groups of essential healthcare industries
The Foundation’s model works best when the ecosystem that is being incentivised consists primarily of a small group of players that haveeffective control of the market for specific products, either via their ability to innovate, their holding of patents or through market dominance.
There are five groups here that are important in high-burden disease areas: Big Pharma, generic medicine manufacturers, vaccine manufacturers, diagnostics companies and medical gas companies. In all cases, there are a few dominant players that can have a big impact on healthcare inlow- and-middle-income countries.

Vaccine manufacturers• $ 33 bn market• 5 manufacturers produce 60% of global volume• 4 large manufacturers control 90% of global vaccine value

Big Pharma• $ 760 bn market• 80% is covered in
the Access to
Medicine Index
Big Pharma

Vaccinemanufacturers

Generic medicine
manufacturers

Diagnostics companies• $ 83 bn global in-vitro diagnostics market• $ 43 bn point-of-care diagnostics market• Highly fragmented market• Many small players alongside a few large
companies

Diagnostics
companies

Medicalgas
companies

Medical gas companies• $ 15 bn market• Biggest 3 companies cover 69%
of the industrial gas market, incl.
medical oxygen

Generic medicine manufacturers• $ 386 bn market• Represent 60-80% of all medicine volume in
key markets worldwide• Few major global players alongside many
regional & local manufacturers

Note: circle size provides an indication of the comparative market value per sector. Values are approximations.

4Strategic Direction 2022 - 2026

B IG PHARMA

Continuing to drive Big Pharma’s uptake of scalable solutions
As innovators and producers of medicines, pharmaceutical

Finally, pharmaceutical executives need to embrace accesscompanies have a clear societal duty to improve health. Theyin low- and middle-income countries as a core part of busi-

must ensure availability of their products to all people.

ness strategies. It is no longer acceptable to park the access

The Foundation’s analysis shows that there has been aissue in a separate silo labelled “philanthropy” or “corporate

steady improvement over time, with eight of the top 20

social responsibility” where it does not receive daily board-

research-based pharmaceutical companies now developing

level attention or investment.

systematic access planning approaches to make future med-

Addressing all of these points will involve a structuralicines and vaccines accessible in poor countries at launch.

rethink by some pharmaceutical companies. However, thisNonetheless, fewer than half of all late-stage R&D pro-

shift may not be as wrenching as some in the industry fear,

jects are currently supported by an access plan and products

since it is aligned with the thinking of many of the pharma-

already on the market are largely overlooked when it comesceutical industry’s biggest investors. As concerns over envi-

to efforts to improve access.

ronmental, social and governance (ESG) issues grow across all

Big Pharma still needs to do much more in four key areas,industry sectors, more and more investors are actively push-

all of which will be a focus of the Foundation’s work over theing for pharmaceutical companies to demonstrate a truly sus-

medium term.

tainable profile.

Firstly, companies must increase and sustain R&D invest-

In the 21st century, the key to that sustainability for Big

ment in the areas of greatest need, addressing priorities

Pharma will lie in meeting societal demands for improved

such as innovation for poverty-related diseases, the hunt

healthcare. From the investor perspective, this goal is vital forfor replacement antibiotics or child-friendly formulations of

the long-term commercial success and viability of companies,

existing medicines. Investors and other stakeholders muston the grounds of good citizenship, attracting and retaining

push management teams to invest in more sustainable busi-

talented staff and commercial self-interest as emerging mar-ness models where financial returns are driven not by chasing

kets become ever more important.

higher margins, but by delivering more effective treatments
to the largest number of patients. Governments, too, need

RO LE I N ACCESS

to rethink and reform policies in public financing of research,

Here are the three key areas where Big Pharma companies play a role inproduct regulation and international trade to encourage
investment in priority areas and ensure broad access.
Secondly, companies must expand the availability of new
and existing products to more populations, especially themost neglected and vulnerable groups in the world’s low-income countries. Just 13% of essential products that must be
administered by a healthcare practitioner – such as injectable
treatments for cancer and new medicines for mental healthconditions – are currently offered through access strategies
in low-income countries, according to the latest Foundation
findings. This rises to 26% in the case of self-administeredproducts – mainly pills – which is still an unacceptably low
figure.
Thirdly, companies should be doing much more to ­support
healthcare systems in low- and middle-income countries
and help to lay the foundations for universal health cover-ensuring access to medicine:
Increase and sustain R&D investment• Engage in R&D for set global health priorities• Ensure that, upon launch, the products they develop reach those global
populations that are most in need
Expand the availability of new and existing products to more populations• Register products widely in low- and middle-income countries• Ensure supply security and sustained local availibility of marketed
products• Support healthcare systems in developing countries and help to lay thefoundations for universal health coverage (UHC)
Embrace access in low- and middle-income countries as a core part ofbusiness strategies• Ensure continuous supply of essential health products• Address shortages and stockouts• Improve local availability and strengthen supply chainsage (UHC). This requires pharmaceutical companies to takea pragmatic and flexible view on pricing, bearing in mind therange of payers for their products – from government-run
health systems to patients paying out of pocket. Access strategies with the biggest impact on UHC will be those that
aim to make products affordable for all patients across theincome pyramid. And Big Pharma has a role in ensuring thatits actions align with local, national and international players
in infrastructure, supply chains and capacity building.

5Strategic Direction 2022 - 2026

G E N E RIC M E D ICI N E MAN U FACTU RE RS

Ensuring generic medicine manufacturers supply for the world
The world’s generic medicine manufacturers possess thestrategies for low- and middle-income country markets andadaptive R&D capability and large-scale manufacturing capac-

deliver on licensing opportunities is therefore crucial to future

ity to supply billions of much-needed medicines to poorer

global health across multiple fronts.

countries. In recent years, many of these manufacturers –Generic medicine manufacturers can reach many more

including those based in low- and middle-income countries

underserved populations with both off-patent products andsuch as India, China, Brazil and South Africa – have strength-

innovative, high-priority medicines in several ways. One route,ened their capabilities. Some have even developed propri-for example, is by ensuring earlier product launches in low-

etary technologies, thereby fortifying their global portfolio

and middle-income countries for medicines covered by licens-and footprint. Yet generic treatments, from medicines used

ing agreements – a vital first step in facilitating sustaina-

to control hypertension and diabetes to biosimilars used toble access to treatments. At the same time, generic medicine

fight cancers, are not always available or accessible to every-

manufacturers need to commit to registering their in-licensed

one who needs them, due to issues of inadequate or insecure

products as rapidly as possible in countries where the burden

supply, insufficient manufacturing in low- and middle-incomeof disease is high.

country markets, unaffordability, lack of compatibility withlocal environments and substandard quality.

Security of supply is another challenge, particularly when

Just as the world depends heavily on a small number ofdemand increases due to unforeseen circumstances, as was

Big Pharma companies for developing innovative medicines

the case with the COVID-19 pandemic. To help achieve global

in key areas, the industry’s deep supply chain is also increas-

health security and prevent shortages of existing manufac-

ingly dominated by large generic medicine manufacturers, both

tured products, while at the same time ramping up global sup-of finished medicines and vaccines and of bulk active pharma-

ply of new or urgently needed products, manufacturers needceutical ingredients (API). As a result, such companies are wellto consider several elements.

placed to participate in delivering on global health priorities.

In the manufacture of APIs, for example, trade and foreign

Due to generic medicine companies’ strong position in low-

policy feuds between sovereign states and border closuresand middle-income country markets, they can push for adap-

when supplies of particular ingredients are tight, often cre-tive R&D for products where treatments are already on theate a fragile supply situation. This vulnerability to raw material

market but where there are clear gaps in access and supply,

shortages is exacerbated by the fact that most APIs are pro-such as for child-friendly formulations and new regimens for

duced in just two countries: China and India.

infectious diseases.

The vulnerable position of low- and middle-income coun-

The interplay between R&D-based pharmaceutical compa-

tries, including those in sub-Saharan Africa, is increased sub-nies and generic medicine manufacturers is critical to solving

stantially by the fact that these countries typically have little

such problems – and constructive relations between the two

if any on-the-ground pharmaceutical manufacturing capacity.

in areas such as technology transfer and the licensing of intel-

This leaves local populations at the mercy of sometimes unreli-lectual property rights can be one of the strongest drivers toable shipments from other nations. Building up manufacturing

delivering truly equitable access and improve local availability.

capacity and improving local availability of finished products inpoorer countries must be made a priority in future if the world

Generic medicine manufacturers are responsible today

is to improve the security of supply. Creating a more broad-for supplying more than 80% of all essential medicines.

based and resilient manufacturing base will also help individual

Importantly, as licensees they produce a wide range ofcompanies to mitigate shortages and stockouts.

life-saving treatments for major killers, making them a vital

Failure to address the innate fragility of the supply chain

conduit for new products into low- and middle-income coun-risks causing more problems and will lead to more cost spikes

tries. HIV/AIDS shows what is possible. In this case a global

in future – and the hardest hit patients will be those in thecommitment to universal access to antiretroviral therapy,

world’s poorest and least profitable markets.

delivered via generic medicine suppliers, has turned the

The complementary efforts of the Foundation and vari-tide of infection over the past decade and saved millions ofous patent pools to expand the use and impact of non-ex-

lives. But HIV/AIDS is just one disease, and similar efforts are

clusive voluntary licensing is a prime example of what can beneeded in other areas such as tuberculosis and other infec-

achieved. Since 2012, such deals have led to more than 30

tious diseases – including those which could become future

million patient-years of treatment for people with serious

pandemics – as well as non-communicable diseases that are­diseases such as HIV/AIDS, hepatitis C and tuberculosis.

a growing burden on health in poorer countries. Ensuring

At present there is no comprehensive platform to track thethat generic medicine manufacturers optimise their accessprogress of the generics industry or identify key opportunities

6Strategic Direction 2022 - 2026

for companies to be more responsive to global health chal-

RO LE I N ACCESS

lenges, although the Foundation has made a start through its

There are three key areas where generic medicine manufacturers play apioneering work in addressing the role of generic medicine
manufacturers in the Antimicrobial Resistance Benchmark.
The current gap in information about the role of the generics industry in access to medicine creates a significant opportunity for the Foundation in monitoring the registration of
new products, tracking the speed of their availability in various markets, and scrutinising how manufacturers work withdifferent global organisations in priority areas.

role in ensuring access to medicine:
Invest in R&D for global health priorities (where applicable)• Invest in R&D where applicable and engage in partnerships to adapt priority products for low- and middle-income country settings and vulnerable populations
Engage in partnerships for needed products• Engage in non-exclusive voluntary licences (VL)• Deliver to and prioritise underserved populations• Register in-licensed products widely in low- and middle-income countries• Expand sustained access for vulnerable populations* and ensure continuous local availability of affordable products
Improve supply security and ensure product quality• Ensure continuous supply• Increase local manufacturing• Address shortages and stockouts• Strengthen supply chain• Ensure Good Manufacturing Practice (GMP) standards are applied* Vulnerable populations include displaced individuals, women & girls, children, people
living at the base of the income pyramid.

7

Strategic Direction 2022 - 2026

VACCI N E MAN U FACTU RE RS

Enabling greater vaccine access
Vaccination is one of the most powerful and cost-effective

occurrences seen in health systems worldwide, alongside

health interventions available. Vaccines currently prevent 2-3

antibiotic shortages.

million deaths every year from diseases including diphtheria,

Local manufacturers should be encouraged to invest in

tetanus, pertussis, influenza and measles. As such, they are

their production plants and build resilience so that they areamong our strongest tools for preventing epidemics and pan-better equipped to respond to rises in demand, including indemics. Yet despite tremendous progress, far too many peo-times of crisis. Advance market commitments from pooled

ple around the world – including nearly 20 million infants eachprocurement agencies and clear prioritisation from global

year – have insufficient access to vaccines, and preventable

immunisation campaigns can give them a financial incentive

diseases still cost millions of lives each year. Low- and mid-to take these steps.

dle-income countries represent a disproportionate burden

Finally, local manufacturers can engage in capacity buildingof vaccine-preventable disease and often have lower vaccine

initiatives in partnership with local organisations to improvecoverage than high-income countries. Despite their broad

the supply chain infrastructure. Such initiatives could include

social and economic benefits, vaccines face extensive accesstechnical support or improved cold storage management.

issues including inadequate supply, specifically to low- andSince the COVID-19 pandemic began, the importance andmiddle-income countries, as well as gaps in R&D and limited

responsibilities of local vaccine manufacturers in ensuringcorporate involvement in the vaccine space.

supply and access has received increased recognition fromThe need for vaccines has never been greater. Over thethe global health community. While it is paramount that thesepast 10 to 15 years, a succession of serious infectious disease

companies’ efforts are supported and sustained, monitoringoutbreaks has occurred, including Ebola, Zika and COVID-

and evaluation of their activities should also be a priority for

19, with the latter expecting to cause USD 28 trillion worth

global health stakeholders.

of damage by 2025. Vaccine manufacturers have a criticalrole to play in ensuring that immunisation reaches people liv-

RO LE I N ACCESS

ing in low- and middle-income countries. The world relies on

There are three key areas where vaccine manufacturers play a role in

the industry to ramp up global supply and provide vaccines atensuring access to medicine:scale when they are needed.
Many vaccines currently on the market are not necessarily
tailored to address the specific needs of low- and middle-income country markets, resulting in limited access and inadequate coverage of populations against vaccine-preventablediseases. For example, many vaccines require cold storage,
which is often unavailable in remote areas in low- and middle-income countries. Local manufacturers, when equipped
to do so, can contribute to the development of vaccines thattake such requirements into account.
A more fundamental problem is the absence of vaccines
for a number of critical diseases that are predominantly
prevalent in poorer countries, including Lassa fever, chikungunya and Nipah virus. New funding or collaboration models are needed to share the financial risks of developing vaccines against such diseases, with local manufacturers having

Invest in R&D for global health priorities• Invest in adapting priority products to suit the needs of low- and middle-income countries• Engage in R&D for identified and future gaps in infectious diseases,
including epidemics and pandemics
Deliver to and prioritise underserved populations• Engage in licensing or manufacturing partnerships with major vaccine
innovators (including Big Pharma and biotechnology companies)• Engage where available with other local vaccine manufacturers toenhance local/regional availability• Partner with international organisations to enable broad access anddelivery of vaccines to low- and middle-income countries• Ensure underserved populations are included in vaccine access
Improve supply security• Strengthen supply chains• Address shortages and stockouts

an important role to play in partnering with large R&D-based
vaccine manufacturers, research institutions and biotech
companies to co-develop and deliver products. Local vaccine
manufacturers with the required manufacturing capacity canbridge the gaps in access by collaborating to deliver to markets and populations that are commonly left behind.
Supply security is vital for vaccine access in low- and middle-income countries, in particular for children in many
African countries where local availability is limited. Shortages
and stockouts of vaccines are among the most frequent

8

Strategic Direction 2022 - 2026

D IAG NOSTICS CO M PAN I ES

Unlocking the potential of diagnostics for all
Diagnostics and monitoring devices are an essential element

markets and through the creation of sustainable supplyof the health system and a critical part of the continuum of

chains. This can be done by companies setting up partner-care. Whether performed on blood, tissue or other patient

ships with regional stakeholders that already have a footprintsamples, diagnostic tests are a vital source of information forin key markets and by entering technology transfer agree-

disease management and patient care. They help determine

ments with established manufacturers. Diagnostics compa-

the disease from which the patient suffers and which treat-nies can also support capacity building initiatives, for example,

ment should be prescribed, and can be used to monitor thefor setting up equipment, training maintenance experts, andprogress of treatment.

building up the skills needed to use diagnostics and devices in

In developed markets, they are now an integral part ofdecision-making at every step along the care pathway, andlocal markets.
Finally, the Foundation has identified a clear trend for moretheir importance is increasing all the time as healthcarecompanies and global organisations to partner together inbecomes more and more personalised. Yet in low- and mid-order to bring diagnostics and treatments together in a single

dle-income countries, diagnosis remains one of the weak-care package – but so far this is concentrated on only a few

est links in the care cascade, resulting in unnecessary suffer-diseases in a few countries, thus benefiting only a small num-ing and deaths. This has been highlighted during the COVID-

ber of patients.

19 pandemic, with high-income countries having testing rates

Despite the fragmented nature of the diagnostics sector

for SARS-CoV-2 10 times higher than low- and middle-income

overall, there is a concentration of the biggest companies incountries.

several key therapeutic areas, which provides an opportunity

The diagnostics sector remains highly fragmented andto use the Foundation’s tried-and-tested model of incentivisa-

there is a lack of joined-up strategy for realising the potential

tion. In the medium term, we intend to engage a few big play-of diagnostic testing in lower-income countries. This results

ers to deliver the maximum impact.

in gaps in the supply of and in access to testing and monitoring devices across multiple therapeutic areas, including infec-

RO LE I N ACCESS

tious diseases, maternal and neonatal health conditions andThere are four key areas where diagnostics companies play a role in ensur-

pregnancy, and prevalent NCDs such as diabetes and cardiovascular disease. Significant challenges exist in realising thispromise, as R&D priorities remain skewed to wealthier markets, laboratory capacity is a frequent bottleneck, and delivery obstacles persist even for relatively simple diagnostic kits.
Looking at R&D, in addition to new diagnostics for priority diseases, there is also an urgent need for technologies
that are better suited to lower-income countries – whether
through more robust and easy-to-use design, or via less reliance on central laboratory systems and fixed utilities (electricity, internet, gas, etc). Partnerships can incentivise global
companies to foster this kind of adaptive R&D ecosystem.
Such partnerships can be forged with local manufacturers,
which have better visibility of the market and the needs ofpatients.
Diagnostics also need to be affordable for every payer,from a supranational donor, such as the Global Fund or
UNICEF, to public health systems, to patients paying out-ofpocket for self-test and monitoring devices. Beyond pricing

ing access to medicine:
R&D• Invest in R&D to address identified global priority gaps
• Invest in R&D to translate existing diagnostic and monitoring technologies to meet specific low- and middle-income country needs• Plan for access early in development to ensure broad access to populations in need at launch
Manufacturing and Quality• Produce high quality diagnostics and devices• Ensure local availability by securing manufacturing capacity to multiple
global sites
Deliver to and prioritise underserved populations• Ensure diagnostics are available at scale for health systems and different payers*• Prioritise access to underserved and vulnerable populations often left
behindDiagnostic capacity building• Build local capacity by ensuring healthcare professionals have training on
proper usage and administration

strategies for the actual diagnostic device or test, companies• Provide support for maintenance and upgrades

need to factor in all the elements that will be required to per-

*Different payers refer to reimbursed systems, patients paying out of pocket, etc.

form the test, such as reagent liquids or assay tips/cups, andmaintenance costs.
Additionally, there is a need to increase the availability ofdiagnostics in low- and middle-income countries by increasing the on-the-ground presence of suppliers in underserved

9Strategic Direction 2022 - 2026

M E D ICAL GAS CO M PAN I ES

Tackling the crisis in medical oxygen supply
The COVID-19 pandemic has highlighted a chronic crisis in

RO LE I N ACCESS

medical oxygen supply that should have been tackled long

There are four key areas where medical gas companies play a role in ensur-

ago and now needs to be addressed as a matter of urgency.
Many low- and middle-income countries have faced horrificshortages, resulting in unnecessary patient deaths and hugebills for families forced to purchase costly cylinders on the private market for unwell relatives.
Clearly, an integrated solution is necessary to address the
problem of medical oxygen supply, not only to help deal with
the COVID-19 pandemic but to save millions of lives in thelong term. Oxygen is vital for treating other deadly conditions,
including pneumonia, which claims the life of a child every 39
seconds. It is also a common requirement during complications in childbirth. Essential efforts to reduce gaps in this area
are needed to progress toward universal health coverage andreach the various targets of the SDGs.
In most of Europe and North America, medical oxygen isdelivered by tanker, stored in large vessels, and eventually
piped directly to bedsides. But many poor countries lack thisinfrastructure and rely instead on cylinders, which increases
the price per volume used.
There are several challenges to improving access to medical oxygen in low- and middle-income countries, including market concentration, with the biggest three companies responsible for 69% of the global industrial gas market.

ing access to medicine:
Prioritise and invest in access in low- and middle-income countries• Establish a clear access strategy and implement access KPIs
• Ensure delivery of medical oxygen to a broad array of countries andacross different regions and provinces• Delivery of required additional materials (e.g. cylinders) or strategic
sourcing of necessary additional equipment to ensure appropriate use
upon delivery• Create more capacity for liquid medical oxygen vs. for industrial use
Engage rapidly during emergencies (e.g. in pandemics)• Engage with multilateral organisations to expand access (e.g. the
ACT-A Oxygen Emergency Taskforce) to sign formal Memorandums ofUnderstanding (MOU) and agreements• Engage in bilateral agreements to expand access during emergencies• Provide transparent information on MOUs and the stipulations of bilateral agreements• Deliver on existing commitments
Engage in sustainable access approaches for health systems• Develop long-term contracts for liquid oxygen• Include ongoing service and maintenance support within such contracts• Demonstrate approaches to enable affordability for and within different
hospital and care settings within specific countries (e.g. a private hospital in Rio vs. a public hospital in a rural/remote area or resource-deprived
area)

Historically, the industry has not prioritised public health, asStrengthen sustainable supply

medical oxygen represents only a small proportion of its over-• Improve delivery mechanisms and delivery speed, including last mile

all business. Access is also hampered by a fragmented supply chain, involving complicated logistics and distribution networks, which can make supplies unaffordable.
The leading manufacturers of medical gases have a vitaldelivery• Capacity building in collaboration with local partners and governments inlow- and middle-income countries to ensure continuity and appropriate
use/maintenance/forecasting techniquesrole to play in providing sustainable supplies to health centres globally, and therefore have a duty to invest in capacity
to ensure improved access. They must prioritise and invest in
low- and middle-income countries, be proactive in finding new
ways of increasing supply and reducing the cost in poorer
countries when an emergency strikes, and engage in longterm sustainable access approaches for health systems. So
far, the disjointed approach by the industry is reminiscent of
the position pharmaceutical companies were in several years
back, underscoring the potential for change.
Fixing the problem requires leadership from the companies
that dominate the industry. The medical oxygen supply chain
involves many distributors, but six manufacturers – including
the three market leaders – dominate the market, making itripe for the application of the Foundation’s system of encouragement that it has used for more than 15 years in the pharmaceutical sector. This work has already started, in partnership with the Every Breath Counts Coalition and others, butthere is more to be done.

10Strategic Direction 2022 - 2026

HOW WE WO RK

A unique catalyst for action
The Foundation is in a unique position to act as a catalyst for this muchneeded change by ensuring that morecompanies play their part and raise their

MISSION

game on access. We do this by work-

Stimulate and guide essential healthcare companies to bring theirproducts to people in low- and middle-income countries

ing alongside other stakeholders on
Identify critical issues

systemic access challenges, signalling

Build consensus on the role of industry in accesswhere gaps exist, highlighting patternsof corporate behaviour that work, anddriving solutions. Our independence andPerform in-depth analysis of data andprovide original insights

long-running specialisation in industry

CONVENING POWER
Multistakeholder dialogue

practices also allows us to track objectively the progress made by companies.
To trigger radical transforma-

OUTPUTRESEARCH REPORTS

Illustrating opportunities for each company to
do more, accompanying best practices

tive change inside companies, theFoundation now uses a combination ofdata, research insights, rankings andreport cards, while leveraging a networkof influential stakeholders, including
investors, policymakers in governments
and the public.

direct influence

DRIVE ACTIONGLOBAL HEALTHORGANISATIONS• policy & practice• stimulate collaboration
with industry

The Foundation’s leadership has an

GOVERNMENTS• policy briefings• recommendations

INVESTORS• collaborative engagement
on access issues• information sharing & education

indirect influence

open line to many boardrooms. In addi-

THE PUBLIC• Inform the publicthrough media

indirect influencetion, we carry out direct change-mak-global media

ing activities with companies, from regular interactions with top executives
to town hall meetings for hundreds of

INDUSTRY

employees. All these activities – and the
media attention we engender as the
go-to independent expert source on
access to medicine – help to motivateand empower company access teams by

CONVENING POWER
Multistakeholder convening
Best practice sharing
Independently fostering partnerships

Improve buy-in and endorsementof access at CEO/Board level
Empower internal
access teams

showcasing concrete examples of whatworks and what does not.
Independent third-party evaluation confirms that our work has madea significant contribution to advancing
the pharmaceutical industry’s engagement with access issues. At the same

OUTCOME

time, the Access to Medicine Index has

Companies make progress on their access to
medicine policies and practices

evolved into the primary benchmark inthe space. By providing a tool for learning and discussion, the Foundation helps
companies understand the scope of

IMPACT

More people in low-and middle income countries
have access to healthcare products

their own activities and how to put bestpractices to use, while spurring healthy
competition between firms to do better.

11

Strategic Direction 2022 - 2026

M OD E L I N ACTI ON

How we put our model for change into practice

To trigger radical transformative

NGOs, g­ overnments and investment­findings and policy advice, enablingchange inside pharmaceutical­circles. All our reports are online andevidence-based decision-making.

companies, the Foundation com-open-­access, including the detailed

Governments play a central role inbines data, research insights, rank-­company comparisons and validated

setting the global health agenda andings and report cards, while lever-best practices, and have been down-prioritising disease areas, sustaina-

aging diverse networks of influen-

loaded more than 100,ooo times.

ble procurement decisions, and spe-tial stakeholders.

cific policy developments. By working closely on disseminating ourHere, a series of snapshots of

B U I LD CO N S E N SUS O N

findings, the Foundation supports

our current research and engage-U RG E NT PR I O R ITI ES

governments in moving the needle

ment work demonstrates how

Since 2008, the Foundation has­further and faster on key accessthe teams working at the Accesssystematically built consensus on

issues. In 2020, the UK government

to Medicine Foundation put thiswhat we can expect from pharma

used the methodology and resultsmodel for change into practice.

companies on access to medicine.

of the AMR Benchmark to inform

We consult 150+ experts and stake-the ­criteria for selecting compa-

holders to ensure a diverse range

SU PPO RTI N G TH E G LO BAL

nies and to set expectations forof viewpoints and technical exper-

H E ALTH AG E N DA

the pilot of its first-ever Antibiotic

tise. In balancing these views, we

For the global health community,

Subscription Model. In 2021, thehave defined the priority actions

we bring 15+ years’ experience ofNorwegian ­government drew onfor pharma companies, what ‘good’engaging pharma companies withthe results of the 2021 Access tolooks like and how to get there,

specific access issues and achieving

Medicine Index in identifying its fourin governance and compliance, R&D

a sustained level of industry respon-

principles for urgent pharma action

and product delivery.

siveness. Our research incentivises

to combat COVID-19.

and tracks how pharma companies
respond to global health priorities,
CHILDREN AND THE ‘BIG THREE’ EPIDEMICS

Ending the burden ofHIV, malaria and TB
in children

2021 ACCESS TO MEDICINE INDEX – OVERALL RANKING

3

JUNE 2020

4

Pfizer Inc

5

SanofiGlaxoSmithKline plc
1

4.23

3.47

6

NovartisAG
2
TakedaPharmaceutical
Co, Ltd

4.18

3.31

Children in low- and middle-income countries still remain on the frontlineof the ‘big three’ infectious diseases. Despite great advances over the years,
AIDS, malaria and TB continue to account for over half a million child deaths
each year, mostly in children under the age of five. This series of articles
assesses the current situation for each of the three epidemics. It stresses theurgent need for a diverse range of new treatments that are suitable for children, especially with the growing threat of drug resistance, with recommendations for governments, regulators, the pharmaceutical industry and others.

1

GlaxoSmithKline plc

2

Novartis AG

4.18

Johnson & Johnson

3.76

3

AstraZeneca plc

8

Merck KGaA (Merck)

4

Pfizer Inc

5

Sanofi

3.76

Roche
HoldingAG
Pharmaceutical
Co, Ltd
6 Takeda

10

AstraZeneca
7 Nordisk
Novo
A/Splc

3.09

3.31

3.07

3.30

2.96

8

Merck KGaA (Merck)9

Roche Holding AG

3.07

10

Novo Nordisk A/S

2.96

3.09

11

Eisai Co, Ltd

12

Boehringer Ingelheim GmbH

13

Bayer
Eisai Co, Ltd
11 AG

2.87

2.63

14

GmbH
12 Boehringer
Astellas
Pharma Ingelheim
Inc

2.84

2.33

14

Gilead Sciences Inc

13

Bayer AG

2.63

14

Astellas Pharma Inc

2.33

14

Gilead Sciences Inc

15

Merck & Co, Inc (MSD)

16

DaiichiSankyoCo,& Co,
IncLtd(MSD)
15 Merck

17

16 Daiichi
AbbVieInc Sankyo Co, Ltd

18

Eli Lilly & Co

19

Bristol Myers Squibb Co

17

AbbVie Inc

18

Eli Lilly & Co

19

Bristol Myers Squibb Co

1.88

2.33

1.80
1.73

1.73

1.59

1.59
2

2

3

3 4

45

1.55

yet to be set, such as non-commu-

2.33

1.80

11

action in areas where priorities are

2.87
2.84

1.88

00

1.55
5

● Governance
Governance of Access● Research& Development● Product Delivery●of Access● Research& Development● Product Delivery

2021 R AN KI NG ANALYSIS

2021 R AN KI NG ANALYSISGSK retains the No. 1 position, yet only slightly

aheadof Novartis.
The leaders
followedby
GSK retains
theNo. 1 position,
yetareonlyslightly& Johnson,
Pfizer and
The twoahead ofJohnson
Novartis.
The leaders
areSanofi.
followedbyleading companies are in close competition, bothJohnson & Johnson, Pfizer and Sanofi. The two

2021 Antimicrobial Benchmark – SMEs and the antibiotic market

providing evidence that additional patients wereleading companies
areaccessin closecompetition,
bothreached throughstrategies
such as equita-

I N CEN T I V E S

Why do we need to ‘to fix the market’ for antibiotics?

pricing andvoluntarylicensinginitiatives.
GSK’s
providingble
evidencethat
additional
patients
werein R&Dstrategies
is a significant
factorits
reached performancethrough access
such
as in
equita-Most SMEs have not yet brought products to market, and new antibiotics generally
generate low revenues. As a consequence, SMEs have little room for error when it

retention of the top spot. It has access plans cov-comes to commercialisation once research grants have expired. They are expected

ble pricing and voluntary licensing initiatives. GSK’s

to navigate financial “valleys of death” – which starts when funding for early-stage

ering the largest proportion of late-stage projects

research runs out and only ends if investors or Big Pharma start to show interest.*

performancein Novartis
R&D is closes
a significant
in its(20/25).
in on the factor
No. 1 position

At minimum, this forces SMEs to pause development while they hunt for financing.
At worst, it means that promising and urgently needed candidates for new medi-

performancein Productretentionthroughof theitstop
spot. It hasaccessDelivery,plans andcov-

cines, diagnostics and vaccines disappear when SMEs go bankrupt.

outproportion
for being the only
company to projects
apply
ering thestands
largestof late-stage

A promising drug is not enoughFor example, in 2021, the Swiss biotech company Juvabis was forced to reduce its

orities,and has &a structured
process to develop
Research
Development

access plans for all projects. Novartis and Johnson

acrossstrategies
different regions
socio-economic
equitableucts
accessin atandleast
one low-ingroups, also demonstrating increases in patientcome country for all products assessed. Pfizer

To provide a buffer against bankruptcy – and encourage more companies toreach. Near the bottom of the ranking, Astellas,is newly inthe top5, andSankyo
leadsarewhen
it comes
AbbVieand Daiichi
the onlycompa-

to reward the market entry and the sustained availability of new products, through

ble
staff
incentives.
GSK
leads
with
the largest pipeline comprised ofprojects that target well-established treatment pri-nies that
do notto
have
an access-to-medicine
stratto addressing
accessself-administered
prod-

GSK leads with the largest pipeline comprised ofpatient populations across the income pyramid& Johnson follow, scoring well in all areas.

with equitable pricing strategies and responsible IP
management. GSK is second, and both companies

leverage
theirDelivery
know-how and resources to address
Product

60

66

116

13

11

8
5

and cancer. Through strategic brief-2015

mittees and working groups, we

projects that target well-established treatment pri-

Product
Deliveryorities,and has a structured process to develop

Novartis
leads,
targetingcountries
and and Johnson
accessplans
for allmultiple
projects.
Novartis

84
54

nicable diseases incl. heart diseases
ings, collaborative activities, com-

processes across their operations or by setting via-

Research & Development& Johnson follow, scoring well in all areas.

to addressing
to self-administeredprodstands out
for beingaccessthe onlycompany to apply

Engine consortium (ENABLE) and the National Institutes of Health (NIH) for
pre-clinical development and completion of Phase I clinical trials.
join the field – the economic and policy environment for antibiotic R&D must be
reformed. This means developing the right mix of incentives to support R&D, andLE AD E RS PE R TECH N I C AL AR E AGovernance of Access
GSK and Takeda lead, followed closely by Novartis.
Governance of Access
All three demonstrate strong responsible business
GSK and
Takedalead,stringent
followedclosely by Novartis.
practices
eitherby enforcing
compliance
processes
acrosstheir operations
or by responsible
setting viaAll threedemonstratestrongbusiness
blepractices
staff incentives.
either by enforcing stringent complianceequitable access strategies in at least one low-in-

through its
performance
Product
Delivery,is newlyin the top 5, inandleads whenit comesand

cal trials and promising preclinical activity against drug-resistant pathogens, in particular Acinetobacter baumannii, a critical priority pathogen for antibacterial R&D
according to the WHO, and Mycobacterium abscessus. To get to this stage, Juvabis
had received extensive support from the European Gram-Negative Anti-Bacterial

LE AD E RS PE R TECH N I C AL AR E A

come country for all products assessed. Pfizer(20/25). Novartis closes in on the No. 1 position

workforce to four employees due to financing constraints.17 This is despite its candidate antibiotic EBL-1003 demonstrating safety and tolerability in Phase I clini-

102

whether companies are taking

3.30

3.65
3.47

9

Access to Medicine Foundation

3.65

Johnson & Johnson

718

of Essential Medicines. We assess

4.23

2021 ACCESS TO MEDICINE INDEX – OVERALL RANKING

TOC_Action fig Investors

such as in the WHO’s Model List

Access to Medicine Foundation

6
2016

2017

No. of signatories

2018

2019

2020

Signatories’ AUM (USD tn)

help maximise the impact of global

M O B I LI S E TH E POWE R O F

health organisations, e.g., in 2021, to

I NVESTO RS

establish a guide for good ­practice150+ institutional investors, within stewardship and access planning

USD 25 trillion in AUM, use our

AG E N DA-S E T TI N G(SAP), to help curb antimicrobial

research to trigger change in the

R ES E ARCH R E PO RTS

resistance.

pharma industry. Investors are

new financing, reimbursement and regulatory tools. Currently, the majority of R&D

egy different
with a businessrationale.
Myers Squibb
ucts acrossregions
andBristol
socio-economic

incentives are ‘push’ incentives: financial and technical grants available to support
drug development. These typically support the riskier early phases of development,takes the bottom rank with limited evidence of

which account for roughly 20% of the total costs required to bring a project to thegroups, also demonstrating increases in patient

How are companies plugging the funding gap?

reach. Near the bottom of the ranking, Astellas,access initiatives across the areas measured.

This chart totals the support that SMEs have raised via various push and pull incentives by
24 SMEs active in late-stage antibacterial and antifungal R&D.**

PF

R& D VA LLE Y O F D E AT H

PU S H I N CEN T I V E S

PU LL I N CEN T I V E S

Financial and technical grants avail-

Here is where much of the

Cash payments or contracts that reward com-able to support drug development.

funding received at the earlier

panies for bringing a product to the market.

Example: CARB-X

stages of development runs out.

Example: NHS UK Subscription Reimbursement
Model

2,000,000,000
mn
USD 2,000

local
access barriers
theirmultiple
capacity buildNovartis
leads,throughtargetingcountries anding initiatives.

patient populations across the income pyramidwith equitable pricing strategies and responsible IP

AbbVie and Daiichi Sankyo are the only compa-

management. GSK is second, and both companies

nies that do not have an access-to-medicine strat-

leverage their know-how and resources to address

egy with a business rationale. Bristol Myers Squibb

local access barriers through their capacity build-takes the bottom rank with limited evidence ofing initiatives.

7

access initiatives across the areas measured.

1,500
1,500,000,000
1,000
1,000,000,000
CO M PA N Y PA R T N E RS H I P S

500
500,000,000
0Discovery

I N V E S TO RS

PreclinicalThe discovery phase of researchis considered the most risky, withmany investigative leads leading to
failure. At this stage, SMEs are often
dependent on funding, or pushincentives, from governments andphilanthropic organisations.

Phase I

Phase IIAs a project begins to move throughthe pipeline, venture capitalists
and angel investors then selectSMEs to fund. Funders mostlybank on projects with a promising
return-on-investment.

*E.g., Pfizer recently acquired Amplyx Pharmaceuticals Inc., securing ownership of
Amplyx’s lead novel compound, Fosmanogepix (APX-001), under development for thetreatment of invasive fungal infections as well as their early-stage pipeline of potential
antiviral and antifungal therapies.

Phase III

MarketApproval

To help drive a project beyond thegap and into market, SMEs mainly
rely on partnerships with moreresourced and experienced pharmaceutical companies.

7

G OV E R N M E N T S A N D
FO U N DAT I O N S

Post-market
Approval

CO M M E RCI A L VA LLE Y O F D E AT H

Funding for SMEs tend to dry
out for a second time once theapproved antibiotic hits the market.
SMEs then rely on sales revenues
and on any royalties and milestones
from deals with other companies.

** These companies are developing 28 late-stage projects, and were identified by the
WHO and Antimicrobial Resistance Benchmark. Only companies with access and/or
stewardship plans in place were included, see Appendix I.

8

Our research uncovers where pro-strongest when they pool theirgress is being made, where gaps

influence and speak with one

remain, and which companies per-voice to a company. Through 200+

form best. Our insights are drawn

engagements per research cycle,

from a unique combination ofe.g., workshops and researchsources, from companies, public

launches, we inform investor teams

sources, and expert organisa-

on specific opportunities for eachtions. With our thematic reports,

company to improve access. The

we bring emerging or hidden

Index Investor Statement is theissues into the forefront, such as

4th largest ESG investor initiative

the f­ ragility of antibiotic supply

I N FO R M G OVE R N M E NT

chains. These reports are proven

D ECI S I O N - MAKI N G

agenda-­setters and have practical

We equip global health leaders

recommendations for companies,

with the most relevant researchand the only one focused on health.

12Strategic Direction 2022 - 2026

building a platform for experts withcustom workshops for sharing

mechanisms as well as long-term

diverse perspectives to unpack

good practices validated by theand coordinated financial support

pharma’s actions on critical access

Foundation. Through these, wefrom multiple donors and national

topics, as well as to validate cur-unpack tough topics with peers

governments.

rent best practices and to assessand ­independent experts from,progress. Today, we use this plat-10
3orcompanies
do note.g., governments
investors.

form to convene working sessions

Participants use theinsights
for atlest someto

on urgent and unaddressed topics,

steer access initiatives.
Our
mostandtifungal
medicines

inviting hand-picked experts fromacross industry and global health,where they often meet each otherfor the first time before they
start collaborating. Starting in
September 2020, the Foundation

deploy sales agents
antibacterial and5(Johnson & Johson,
recent session identified
7 lesOtsuka, Teva)sons from COVID-19 for pharma
7 companies fully or
partially decouplingbonuses fromvolumescompanies.
2018

2020

co-convened a series of Access

Eight companies are moving to makeaccess planning mainstream

to Medical Oxygen roundtables,

20 companies

the first to bring medical gas com-

19

12

I N D E PE N D E NT

panies to the table. In June 2021,

Not yet planningsystematicallythese roundtables led to landmark
I N D E PE N D E NT SO U RCE FO R
M E D IAagreements from two companies
low- and middle-income countries.

Global media seek out the

Are developing
systematic accessplanning approaches

1
2018

2020

Foundation for insight into how
to global health issues. Journalists

15

use our research as a trusted, independent source on complex topics,

8

such as medical oxygen short-

17

access to medicine in low- and­evaluation concluded that “thework of the Foundation has likely
already c­ ontributed to improve17

9ages, superbug dangers and pricing dilemmas. Each research reportof its progress in ­advancing­middle-income countries. This

20 companies

pharma companies are responding

In 2020, the Foundation commissioned an independent ­evaluation8

to address oxygen shortages in

CO N FI R MATI O N O F I M PAC T

17 companies
now set goals
and targets
related toaccess to
medicine

access to medicine for millions ofpeople and also produced millions
in cost savings for low- and middle-income countries.”

2010 2012 2014 2016 2018

is covered widely at launch in
20+ articles in quality global and

PHAR MA CO M PAN I ES

national media, including jour-

CO - D E VE LO P CO M PAN I ES’

AR E MAKI N G G R AD UAL

nals and op-eds. In this way, theE XPE RTI S E

PRO G R ESS O N G LO BAL

media translate our research into

We engage directly with health-

H E ALTH

standards of behaviour that thecare companies at many levels,

During the past decade, pharma

public can demand from pharma­targeting their biggest oppor-

companies have graduallycompanies.

tunities to deliver change. Withchanged how they do business,­executive leadership, we discusswith 100+ best practices identi-

strategic improvements to develop,

fied since 2012. Several compa-

scale up and supply essential healthnies now aim to reach people on

products to reach more people.

very low incomes. R&D pipelines

We work with companies’ accesshave grown, particularly for dis-

teams to match the daily reality

eases such as malaria, HIV/AIDSof their business ­operations

and TB. Equitable pricing, vol-with best practices. Eachuntary licensing and product­publication starts a new cycle

donations are being used moreof briefings and workshops,­frequently to improve access. The­totalling 300+ engagements

Foundation sees the biggest pro-

Since our beginnings as a research­annually, reaching 58 health-gress where there are clear globalorganisation, we have ­steadilycare companies in 2020. Each

health ­priorities in place, supported

deepened our engagement streams,

year, company experts join our

by publicly funded market-shaping

CR E ATE CO N D ITI O N S FO R
N E W CO LL ABO R ATI O N S

13Strategic Direction 2022 - 2026

WHAT LE AD E RS SAY

The expert view on the value of our work

“I’ve been impressed by the Accessto Medicine Index. It presents well-­balanced stakeholder views on
good practices for the pharmaceutical industry and it provides clear
standards against which the performance of individual companies canbe judged.”
Mary Robinson, Chair of theElders, First woman Presidentof Ireland, former UN HighCommissioner for Human Rights“When I talk to executives frompharmaceutical companies, they tellme that they want to do more forneglected diseases, but they at leastneed to get credit for it. The Accessto Medicine Index does exactly that.”
Bill Gates, Co-chair, Bill & Melinda
Gates Foundation“There is more that we can do andare doing. This year, the index istougher than ever. It challenges us
to think harder about how we drive
innovation and enable access to our
products. This is a challenge that weare ready and willing to take on. We
will continue to push ourselves to go
further and faster to make sure our
medicines and vaccines reach more
people.”Sir Andrew Witty, former CEO of
GSK“I welcome this comprehensive article on ending the burden of HIV,malaria and TB in children, andespecially appreciate the strongemphasis on the crying need forchildren living with HIV to access themost up-to-date paediatric ARVs.”
Sister Mary Owens, Executive
Director, COGRI - Nyumbani programs for children living with HIV“As an early supporter of the Accessto Medicine Foundation, I have been
impressed by its growth and impact.
Its credibility is based on consistent
rigour and integrity, and these underpin the Foundation’s authoritative
voice for urgent action to improveaccess to healthcare. Bringing transparency to the pharmaceuticalindustry, it incentivises companies todirect resources to improving healthcare in under-served markets. Since
its effects are systemic, it represents
good value for public money.”
Michael Anderson, CEO MedAccessand former Director-General,
UK Department for International
Development“The Sustainable Development
Goals and human rights demandaccountability, which consists ofmonitoring, review and remedialaction. By deepening monitoring,
the Access to Medicine Foundation
makes an indispensable contribution
towards the accountability of pharmaceutical companies for the SDGs.”
Paul Hunt, Former UN Special Rapporteur on the Right to the Highest
Attainable Standard of Health“This independent Antimicrobial
Resistance Benchmark is a huge
step forward and shines a light on
the pharmaceutical industry’s progress in tackling drug-resistant infections. It can help pave the way for atransparent learning culture wherebest practice is shared, progress celebrated, and gaps where further
work is needed are identified.”
Dame Sally Davies, UK Special
Envoy for AMR“The Access to Medicine Foundation
has made an important contribution

in stimulating pharmaceutical companies to do more in the global fightagainst AIDS, TB and malaria. The
AMR Benchmark is an important
addition to the Foundation’s toolkit.”Peter Sands, Executive Director,
Global Fund to Fight AIDS, Tuberculosis and Malaria

their impact during the pandemic,
and long after the pandemic is over,by strengthening health systems to
do a better job of treating tens of
millions of hypoxemic patients eachyear.”
Leith Greenslade, Coordinator
Every Breath Counts Coalition“The Access to Medicine Foundation’s research sheds light on issues
that would otherwise remain underreported when it comes to thepharma industry and access to medicine and vaccines. This research
informs priority setting and policy
interventions based on the identified gaps.”
John-Arne Røttingen, Global HealthAmbassador, Norwegian Ministry ofForeign Affairs“The Access to Medicine Foundation
has recruited hundreds of investors and trillions of dollars to champion the cause of vulnerable populations in low and middle-income
countries. This will significantly
influence the way in which healthcare companies do business aroundthe world and contribute substantially to the achievement of the Sustainable Development Goals. AXA
IM has actively been collaboratingwith and supporting the activities of
the Access to Medicine Foundation
for many years. We believe this isessential to positively influence thebehaviors of companies we invest
in and to ensure a robust and sustainable financial performance forthose companies, to the ultimate
benefit of our clients.”
Marco Morelli, Executive Chairman,
Axa Investment Managers“The Access to Medicine Index is a
powerful tool for guiding and incentivising companies to do more forpeople living in low-and-middle-income countries, and especially inthe field of NCDs. The Access to
Medicine Foundation also uses its
research findings to help advancethe work of other partnering organisations, such as the NCD Alliance.
With its unique and important role,
the Foundation’s model for change
encourages companies to address
noted access issues.”
Katie Dain, CEO NCD Alliance“The pandemic has exposed theurgent need to expand the Accessthe Medicine Foundation’s provenmodel of engaging pharmaceuticalcompanies to the oxygen industry.
The big oxygen companies all needrobust, long-term access to oxygen
strategies, with performance indicators that can highlight best practices and areas where more attention is needed. The Foundation canhelp oxygen companies increase“Africa has been overlooked when it
comes to research and developmentof life-saving medical commodities,
including COVID-19 vaccines. Free
market demand and supply principles will not work on their own without an equitable access dimension.
The Access to Medicine Foundation is important for accountability - tracking how and where healthcare companies live up to their commitments; as well as encouraging
them to do better – in bridging gaps
in equitable access to health products and achieving universal healthcoverage.”
Dr Githinji Gitahi, Group CEO,
Amref Health Africa

14Strategic Direction 2022 - 2026

ROAD MAP TO 2026

How the Foundation will leverage its
approach to achieve change
Since 2003, the Access to Medicine Foundation has evolved from a research­organisation providing a definitive ranking of pharmaceutical companies into a
powerhouse producing unique and independent insights about the industry. It has
demonstrated an ability to move the needle on access issues that are critical inlow- and middle-income countries. Two independent impact assessments haveconfirmed its capacity for stimulating change, concluding respectively that theFoundation “has made commendable contributions towards advancing the engagement of the pharmaceutical industry with the issue of access to medicine” and that“the work of the Foundation has likely already contributed to improve access to
medicine for millions of people and also produced millions in cost savings for lowand middle-income countries”. The independent assessments also highlight a “clear
appetite” from stakeholders for additional research and analysis by the Foundation,
including from the pharmaceutical industry, governments, global health organisations and investors.
There is now a strategic opportunity for the Foundation, with its special positionin the global health ecosystem, to expand its sphere of influence into the areasof greatest untapped potential. The Foundation’s strategic direction for 2022–
2026 builds on the success of the organisation since its establishment more thana ­decade ago, and on its ability to guide and incentivise positive action from the­private sector by:• preserving existing research areas and continuing to deliver research and analysis
with demonstrated impact on industry behaviour;• expanding and tailoring its successful model to new healthcare sectors to help
more people across multiple disease areas; and• amplifying our change-making capacity to incentivise companies further toaddress access at scale.
To achieve this, we will develop the Foundation’s organisation and strengthen andsolidify its presence within the global health ecosystem.
We will take a six-part approach to ensure that the current cohort of companies inscope continues to bridge the vast gaps in access and, in parallel, bring in a diverse
range of other healthcare companies to also play their part.
Approach in six parts

1

Bring
on board a
critical massof companies

2

Build
networks to
influence
new sectors
and increase
activities
with existing
companies

3

Clarifyroles andsociety’s
expectations
from industry

4

Developappropriate
tools totackle eachsector and
theme

5

Track
progress andvalidate bestpractices6

Enablepolicy shifts,
effective
collaborationand more
investment
from different
actors15

Strategic Direction 2022 - 2026

1

Bring on board a wider critical mass of companies

and agreed upon by stakeholders. Currently, many of the roles

Engaging a number of companies that are new to thethat companies carry out are poorly articulated. This is par-Foundation will be one pillar of the strategy, while at theticularly the case in the new sectors we will be focusing on,

same time we will sustain and strengthen interactions withand there is little agreement on what firms should be doing

existing priority businesses. Several companies within theand how to do it responsibly and effectively. The Foundation

Foundation’s strategic expansion framework are already thewill leverage its expertise in building multistakeholder con-target of some engagement, and have been for several years:

sensus between different players across multiple sectors, invia the Antimicrobial Benchmark (generics), via the Accessorder to set priorities, and work out what best practice looks

to Medicine Index (diagnostics) and via our recent work onlike in differing situations.

COVID-19 (medical oxygen). However, to ensure that accessis prioritised, the Foundation needs to develop closer ties
with the senior leadership and access teams in these companies and ensure that they are willing to share practices and4

Develop appropriate tools to tackle each sector andtheme

In order to to address the changes needed to improve access,are keen to improve their performance. In many cases, thisevery sector and every company will require a tailored

will involve educating and training company staff via work-

approach. The Foundation will build on its existing toolkits forshops and townhall meetings on key access issues and poten-

indexing and benchmarking, best practice sharing, and pol-tial solutions. The Foundation benefits from its independ-

icy shaping interventions, as well as on its convening power,

ent status, its unique position and presence in many commu-

while adapting the approaches and mechanisms of influencenities, and its international network. This creates an opportu-

set out above. For example, the emergency created by thenity to develop an understanding around the issues that each

COVID-19 pandemic requires an immediate response by med-

individual company faces, supported by validated solutions

ical gas companies – which means tracking the response also

identified through our research, and to educate the corporateneeds to be immediate. Yet at the same time the industry’s

decision-makers who can make a difference on the ground in

solutions must be sustainable and address chronic shortages

bridging gaps in access.

in medical oxygen. We will therefore need a mix of tools to2

incentivise long-term strategic shifts for this sector.
Build networks to influence new sectors andincrease activities with existing companies

The Foundation has a large network of stakeholders whoroutinely use its work, including international health organ-

5

Track progress and validate best practices
Measuring performance is central to the Foundation’s

approach and its credibility. Clear metrics have establishedisations, institutional investors, governments, NGOs andthe Foundation as the only independent organisation thatthe general public, as well as the companies themselves.

has consistently evaluated industry progress on global health

For each sector and access issue, the Foundation builds

issues over time. They have also made it a trusted partner for

and activates new networks of influence, to ensure that tai-multiple stakeholders. By reporting its access data in the pub-lored approaches are used. For example, the Antimicrobial

lic domain, the Foundation fosters transparency and account-

Resistance Benchmark is of particular interest to the poli-ability, thereby creating a platform for sharing validated best

cy-shaping sector, prompting the Foundation to work closelypractices. This is crucial for amplifying the access solutions toin the interface between donors, companies and govern-

more companies.

ments. In other cases, where the Foundation’s work is especially relevant to publicly listed companies, investors havebeen instrumental in shifting the mindsets and decisions ofcompany boards. This experience can be further leveraged

6

Enable policy shifts, effective collaboration and moreinvestment from different actors

To foster change in a sector, the enabling conditions, incen-

when targeting new healthcare companies. As we bring more

tives and policy environment around the companies need to

private companies on board, new channels, such as with pro-move in tandem. The Foundation’s strong voice and position

curers, governments and local NGOs, will be established toin different forums enables it to facilitate this process by help-

widen the sphere of influence and guide more change.

ing shape the policy decisions that are taken by governments,

3

investors, donors and others involved in global health. While
Clarify roles and society’s expectations fromthe Foundation’s primary focus is measuring and monitoring

industry

the performance of companies, it also has a key role to play in

Healthcare companies play many roles, from conducting R&D

contributing insights and information to enable better coun-and developing new products to building capacity and advanc-try-level policies and practices to expand access to medicine

ing access to the products they manufacture. These roles –and reach many more people.

and the responsibilities they carry – need to be well defined

16Strategic Direction 2022 - 2026

WO RKPL AN AN D BU DG ET

Stepwise expansion across the sectors
In the five years to 2026, the Foundation will grow its output in tandem with its
capacities in a structured, step-wise manner. It will invest in its research and outreach capacities concurrently as it expands its activities to five sectors. In the years
2022-2023, we will focus on the few key players in each sector that have an opportunity to deliver critical and urgently needed change, building in scope for continuous learning. These learnings will be applied during the years 2024-2026, as we
broaden our activities into a fully-fledged research programme for each sector, witha focus on both current and future health challenges. Throughout, the Foundation
will maintain its established work to mobilise Big Pharma on the chronic need tosustain investment in R&D and scale up access programmes for low- and middle-income countries.
In order to maintain its influence and credibility, the Foundation is committed

Funding allocation 2022-2026

to remaining fully independent from healthcare companies. The Foundation now

Management
and operations
Fundraising­comprises a 30-member team structured in well-established units for research,engagement, communications and supporting functions that together implement3%

its current programmes. To deliver our full roadmap up to 2026, we aim to securelong-term funding from diverse sources for a total of EUR 22 million for the five-

Outreach andengagement

year period. With new investments across the organisation and into the research
programmes, both new and current, we will also realise significant economies of9%

EUR 22 million 50%

Research
and analysis

38%

2022 - 2023

YE AR 1-2

Deliverables• 2022 Access to Medicine Index• Antimicrobial Resistance (AMR) Research Programme that
unpacks critical resistance issues and the role for companies• Sector-specific reports from Programmes on generic medicine manufacturers, vaccine manufacturers, diagnostics companies and medical gas companies• Articles and analyses on critical access topics, such as:affordability; equitable distribution of health products; access

RESEARCH DRIVEN OUTPUTS

to products associated with sexual and reproductive health;access to products for non-communicable diseases, including diabetes; pandemic preparedness and advances in universal healthcare

2024 - 2026
Deliverables• Full-fledged Research Programmes in each sector, including
company-specific report cards• Up to three thematic studies per year from the Research
Programmes, including on AMR and cross-sector opportunities• 2024 Access to Medicine Index• Independent impact assessment report 2025/6• Continuous publication of articles and analysis on criticalaccess topics

YE AR 3-4-5

CO N T I N U O U S LY B U I L D I N G A M E C H A N I S M O F I N F LU E N C E

scale as we expand and achieve the goals of this strategy.

Building a mechanism of influence• Engaging companies from the different
sectors• Convening meetings for companies toshare practices and experiences in a­neutral, solutions-oriented forum• Establishing and strengthening collaborations with organisations that influence
access to medicine across the five sectors• Coordinating action-oriented investor­collaborative engagements• Convening multi-stakeholder events onaccess issues, held in low- and middle-­
income countries• Making specific and applicable recommendations tailored to individual companies• Frequently distilling detailed information
for investors and policymakers to inform
decision-making• Providing specific recommendations andinsight for policymakers and donors on theinitiatives they support, e.g., in R&D, product development partnerships, and international procurement

17

Access to Medicine Foundation

Strategic Direction 2022 - 2026

ABO UT TH E ACCESS TO M E D I CI N E FO U N DATI O N

The Access to Medicine Foundation is an independent
non-profit organisation based in the Netherlands. It aims
to advance access to medicine in low- and middle-income
countries by stimulating and guiding essential healthcarecompanies to play a greater role.
FU N D E RS

Our impact on healthcare companies is made possible thanks
to support from the following:
UK Foreign, Commonwealth and Development Office
The Dutch Ministry of Foreign Affairs
The Dutch Ministry of Health, Welfare and Sport
Bill & Melinda Gates Foundation
Leona M. and Harry B. Helmsley Charitable Trust
Wellcome Trust
AXA Investment Managers

For more information about this publication, please contact
Jayasree Iyer, Chief Executive Officer
E jiyer@accesstomedicinefoundation.org
T +31 (0)20 215 3535
www.accesstomedicinefoundation.org
Amsterdam, The Netherlands

18Strategic Direction 2022 - 2026
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