Access to Medicine Index 2022 ▶ Company report cards

RA N KSCO R E33.93

7 (2021)

AstraZeneca plc
Stock exchange: LSE • Ticker: AZN • HQ: Cambridge, United Kingdom • Employees: 83,100

PERFORMANCE IN THE 2022 INDEX
3rd place. AstraZeneca ranks among the top three companies
in the Index. The company performs well in all three Technical
Areas, particularly in its approach to patent transparency andsharing of intellectual property assets. It has strengthened

How score was achieved
4.43

Governance of Access
3.03

Research & Development

4.29

Product Delivery

its performance in R&D access planning, as well as

01

manufacturing and supply chain capacity building.

2

3

Average

Leader4

5

Governance of Access: 2nd place. AstraZeneca has a strong
performance in this area. It has an access-to-medicine strat-

the companies. Furthermore, it performs well in R&D capac-

egy integrated into its overall corporate strategy and a robust

ity building.

set of compliance controls to mitigate the risk of non-compliance in countries in scope of the Index. It also incentivises its

Product Delivery: 1st place. AstraZeneca leads in this area. In

senior executives, the CEO and in-country and regional man-all product categories, it applies tailored access strategies

agers to perform on access-to-medicine goals.

across different country income classifications. It also excels
in its approach to access strategies for supranationally pro-Research & Development: 6th place. AstraZeneca performs

cured products. The company has shared the highest number

well in this area. It has a structured access planning processof intellectual property assets to third-party research-in place and applies this to nearly all late-stage candidates.

ers. Furthermore, the company has piloted both new andAlthough its priority pipeline is small compared to its peers,scaled-up existing inclusive business models and it engages in

it has the largest pipeline for non-communicable diseases ofmany high-quality capacity building initiatives across all fields.

OPPORTUNITIES FOR ASTRAZENECACHANGES SINCE THE 2021 INDEX

Improve the quality and geographic coverage of access plans. AstraZeneca has project-• Created a dedicated vaccines and immune therapies

specific access plans in place for almost all late-stage R&D candidates. These plans focus
mostly on registration in the emerging markets of Brazil, India and China. In its plans, thecompany can include more access components such as equitable pricing and licensing.

unit for COVID-19 vaccine and antibody treatments andthe existing portfolio for respiratory viral disease.
• Initiated two global training programmes —Furthermore, it can expand the geographic coverage of these plans to focus more on low-

Parexcel and UNIFY — to expand the pool of under-

income countries. For example, the access plan for nirsevimab, indicated for the prevention

represented principal investigators and clinical researchof respiratory syncytial virus, can be expanded to include more than five countries in scopeof the Index.

coordinators.
• Supplied more than two billion doses of COVID-19
vaccine (Vaxzevria) to LMICs at not-for-profit throughBring equitable pricing initiatives to scale. Through the Healthy Heart Africa (HHA)
initiative, the company identifies different levels of ability to pay and affordability in markets
to inform its pricing model. AstraZeneca can consider expanding the pricing model of HHA

private licensing agreements.
• Supplied its COVID-19 vaccine (Vaxzevria) through the
COVAX facility.

to other countries in sub-Saharan Africa that are not part of the programme yet, such

• Initiated new partnerships with the UK Royal Academy

as those with the highest burden of hypertensive disease, including the Central Africanof Engineering to strengthen healthcare innovation

Republic. The company can apply the HHA model to cover more therapeutic areas such as
diabetes and oncology.

across Africa.
• Expanded the Healthy Heart Africa (HHA) programme
to Senegal, Côte d’Ivoire, Rwanda and Nigeria. This

Expand access to its diabetes medicine, dapagliflozin (Farxiga/Forxiga®), through non-initiative aims to improve access to end-to-end

exclusive voluntary licensing and/or equitable pricing. The company has an access strategy

hypertension management and was recently expanded

for dapagliflozin across upper-middle income countries, lower-middle income countries andlow-income countries, including one of the countries with the highest burden of disease

to more therapeutic areas such as diabetes.
• Joined the Access to Oncology Medicines (ATOM)

for diabetes. AstraZeneca can provide evidence of implementing access strategies in

Coalition, a new global initiative that aims to improveother countries with high burdens of disease such as Sri Lanka, Kiribati and Micronesia foraccess to essential cancer medicines in LMICs.

example via equitable pricing and/or non-exclusive voluntary licensing agreements.
Expand access to cancer products such as osimertinib (Tagrisso®), through equitablepricing and/or non-exclusive voluntary licensing. The company has equitable accessstrategies in place in UMICs and LMICs. The company can provide evidence of expanding
access to the product in LICs and countries where the burden of the disease is highest, suchas China, Armenia and Thailand.

9

All companies were assessed based on
information that was valid in the latest
period of analysis (ending at 31 May2022). This data was either submitted bycompanies, found in the public domain or
was accessible through other sources.

The term LMICs is used to denote all
low- and middle-income countries inscope of the Index, except when analysing
companies’ access strategies where
the use of LMIC refers to lower-middle
income countries as per the World Bank

income groups classification. Likewise, theterms LIC and UMIC refer to low income
countries and upper-middle income
countries.

Access to Medicine Index 2022 ▶ Company report cards

SALES AND OPERATIONSBusiness segments: Pharmaceutical

AstraZeneca's products are sold in 62 out

Therapeutic areas: Biopharmaceuticalsof 108 countries in scope of the Index.

Revenue by segment (2021) – in USD(including cardiovascular, immunology,

AstraZeneca has sales offices in 19 countries,

Pharmaceuticalmetabolism, renal and respiratory), oncology andand sells via suppliers and/or pooled		rare diseases.

procurement in an additional 43 countries.

Total

37.42 bn
37.42 bn

Product categories: Innovative medicines andvaccines.
M&A news: AstraZeneca acquired Alexion
Pharmaceuticals in July 2021 for USD 13.3 billion.

Sales by geographic region
40

Revenue (Bn USD)

Sales in countries in scope

30
20
10
0

In scope, has sales offices
In scope, any sales

2017

2018

2019

Established Rest of WorldIn scope, no sales

EuropeNot in scope

2020

2021

Emerging Markets

USA

SAMPLE OF PIPELINE AND PORTFOLIO ASSESSED BY THE INDEXPIPELINE for diseases in scope

PORTFOLIO as selected for analysis by the Index

AstraZeneca has a total of 105 R&D projects in scope with four of these

AstraZeneca has 30 medicines in scope, 25 of which are on patent, andprojects targeting priority diseases. The other 101 R&D projects target

two vaccines. 22% of these medicines and vaccines (7) are on the WHO

other diseases in scope. Of the projects targeting priority diseases, theEML. The off-patent medicines target mainly non-communicable diseases

focus is on COVID-19 (three projects). Of the projects targeting other dis-

(NCDs) such as hypertensive heart disease (2), asthma (2) and cancer (1).

eases, the focus is on oncology (62).

The on-patent medicines also mainly target NCDs, such as diabetes mel-

Twenty-five R&D projects are in late-stage development that target

litus (8), cancer (8), and different respiratory diseases (7). In addition, theeither a priority disease (3) or address a public health need in LMICs (22).*

portfolio includes a COVID-19 vaccine and an influenza vaccine.

Evidence of access planning was in place for 96% of these projects: threetargeting a priority disease and 21 addressing a public health need in LMICs.

105 projects in the pipeline

32 products as selected for analysis by the Index†

4

Maternal and neonatal 1

Maternal and neonatal 0100

Non-communicable1

Multiple categories
040 60 80 100 120
projects in the pipeline

10

20
30
40
50
products on the market

Phase I

Phase II

Phase III

Registration/approval

Other***

Total

0

0

0

2

0

2

0

4

Contraceptives

Targets established R&D priorities

off patent

Addresses needs of LMICs*

5

5

4

0 27

Diagnostics

Other projects in scope

24 34 13

3

0 74

Other

*50 diseases and 243 product gaps inscope have been established as a priority by global health stakeholders. For
other diseases, the Index used a set of criteria to determine which projects in thepipeline offer a clear public health benefit to patients in LMICs. Only projects in13

the clinical phase of development were
included for this analysis.
**Neglected tropical diseases, while also
communicable, are highlighted separately
throughout the Index.
***Other includes projects that have atechnical lifecycle and projects that fol-

‡

Total

Pre-clinical

Vaccines

Medicines on patent

Other

Discovery

WHO EML

Breakdown of products
WHO EDL

20

Breakdown of projects

1029

Non-communicableMultiple categories 002Communicable**

Neglected tropical 0

Non-EML

Communicable**

Neglected tropical 0

25

3 22
3

2

5

1

1

2

0

0

0
0

0
0

low a different development cycle (e.g.
diagnostics).
†Products included in the analysis wereselected using a set of criteria determinedby stakeholder consensus.
‡Other includes vector control products.

0

Access to Medicine Index 2022 ▶ Company report cards

AstraZeneca plc

GOVERNANCE OF ACCESSRANK 2SCORE 4.43

Has an access-to-medicine strategy with meas-

goals, objectives and 2025 targets for improv-

the Index: fraud-specific risk assessment, coun-urable objectives, integrated within the overall

ing access to healthcare in countries in scope.

try risk-based assessment, a continuous system

corporate strategy. AstraZeneca performs

It facilitates accountability and transparency by

to monitor activities, audits (both internal andstrongly. It has an access to healthcare strat-

consistently sharing the outcomes of its accessexternal, covering third parties and in all coun-egy integrated within its core business, beyond

to healthcare programmes, including its Healthy

tries where it operates) and has formal processes

philanthropy. The strategy covers all therapeu-

Heart Africa and Healthy Lung initiatives, in a cen-

to ensure compliance with company standards

tic areas the company is involved in. The highest

tralised manner within its ESG Report.

by third parties, including contract language andresponsibility for access lies directly with thetraining on the AstraZeneca Code of Ethics. No

board, with a dedicated board of directors mem-

Performs above average in responsible pro-breaches in countries in scope of the Index were

ber responsible for sustainability, including accessmotional practices. AstraZeneca’s sales agents

publicly found in the period of analysis.

to healthcare.

are not solely incentivised on sales volume
targets. The company, however, does not dis-Publicly supports the Doha Declaration on

Provides evidence of financial and non-financial

close the level at which sales incentives are set.

TRIPS and Public Health. AstraZeneca pub-access-related incentives at the executive level.

AstraZeneca does not publicly disclose informa-

licly shares support of the Doha Declaration on

AstraZeneca performs strongly. It incentivises

tion related to transfers of values to healthcare

TRIPS and Public Health, but expresses reser-

select senior executives and in-country managers

professionals in countries in scope of the Index

vations on its provisions, namely on the use of

to perform on access to medicine with finan-(e.g. payments for attending events or pro-compulsory licensing. There is evidence of indus-

cial and non-financial rewards and the CEO has

motional activities) unless required by local

try association lobbying on IP and the usage ofaccess-related incentives linked to its ESG perfor-

regulations, but has policies on third party

TRIPS flexibilities, namely of compulsory licens-mance. For example, AstraZeneca's "Contribution

engagement, which can limit compensation anding, by national governments in some countries into society KPI" measures progress on annual andgovern contributions and other items to health-scope of the Index. As a member of the industry

long-term targets and includes "Access to health-care professionals under certain circumstances.

association, AstraZeneca, like all other mem-care" as one of three pillars of sustainability.

ber companies in scope of the Index, is by default
Has a robust set of compliance controls to

Publicly discloses outcomes of its

ensure that governance efforts are not under-access-to-medicine activities. AstraZeneca per-mined by non-compliant or corrupt activities.

forms strongly in transparency of access activities.

AstraZeneca performs strongly, demonstrat-

It publicly discloses commitments, measurable

ing evidence of all components looked for by

RESEARCH & DEVELOPMENTRANK 6connected to this activity.

SCORE 3.03

Access planning processes encompass all

CEPI and Gavi and a licensing agreement with

AstraZeneca does not not disclose disaggre-

projects in the pipeline. AstraZeneca has a

Serum Institute of India (SII) to supply one billion

gated R&D investment data to global healthstructured process in place to develop accessdoses for LMICs.

organisations.

applied to all R&D projects (both in-house andMany projects address a public health need inThree of the five R&D capacity building ini-

collaborative) for diseases in scope of the Index.

LMICs,* with 95% (21/22) of late-stage pro-tiatives included meet all Good PracticeIn general, AstraZeneca begins developing accessjects covered by access plans. In this analysis,

Standards. AstraZeneca's performance is aboveplans for R&D projects in Phase II/III of clinicalAstraZeneca has 22 late-stage R&D projects in its

average in this area. The number of initiatives

development.

pipeline that target a disease and/or product gap

meeting all inclusion criteria is higher than aver-

not yet established as a priority by global healthage and more initiatives meet all Good Practice

A small-sized priority R&D pipeline comparedstakeholders. These projects are all deemed byStandards (GPS) than what is average for thisto its peers, with access plans in place for 100%

the Index to offer a clear public health benefit forindicator. For example, AstraZeneca's collabora-(3/3) of the late-stage candidates analysed.

people living in LMICs.* Primarily, these projects

tion with the Cancer Research and Clinical Trials

AstraZeneca has four projects, including three

concern clinical trials in countries in scope of theCentre (CRCTC) builds R&D oncology capacity inlate-stage candidates in its pipeline, that target

Index and/or are first-in-class molecules. These

Vietnam through treatment development, med-a priority product gap. These focus mostly on

projects target several diseases including cancer

ical research and continuous medical education.

coronaviral diseases. Of AstraZeneca's three late-

and kidney diseases. AstraZeneca provides evi-

This initiative meets all GPS.

stage candidates targeting a priority product gap,

dence of access plans for 21 of these projects.

all have evidence of access plans. These include

These plans focus mainly on registration prepara-commitments to register in countries in scope oftion in countries in scope of the Index.

plans during R&D. The process is intended to be

the Index. Furthermore, the plan for the COVID-

11

19 vaccine (Vaxzevria) includes manufacturing,

Publicly discloses disaggregated R&D invest-

procurement and distribution agreements withment data by phase of development. However,*50 diseases and 243 product gaps inscope have been established as a priority
by global health stakeholders. For otherdiseases, the Index used a set of criteria
to determine which projects in the pipeline offer a clear public health benefit topatients in LMICs. Projects in the clinicalphase of development were included forthis analysis.

Access to Medicine Index 2022 ▶ Company report cards

PRODUCT DELIVERYRANK 1SCORE 4.29

Public commitment not to enforce patents in

Has access strategies for the majority ofstructure, awareness programmes and training ofcountries in scope. AstraZeneca publicly pledges

healthcare practitioner-administered products

stakeholders along the patient journey.

to neither file for nor enforce patents in a sub-in scope of this analysis. AstraZeneca performs

set of Index countries. This commitment applies

above average in this area compared to otherHas engaged in scaling up two and piloting

to 80 countries in scope of the Index, of which

companies. For all five products assessed, thetwo inclusive business models. AstraZeneca

all Least Developed Countries and LICs in scope,company provides examples of access strategies

performs above average in the use of inclusive

and a subset of LMICs and UMICs. In sub-Saharanwhich consider affordability in UMICs and LMICs.

business models aimed at meeting the access

Africa, all countries are part of the commitment

It makes efforts to reach additional patients usingneeds of populations at the base of the income

beside Ghana, Kenya, Nigeria and South Africa.

pricing strategies that consider relevant payers'

pyramid (including other underserved popula-

The policy covers all products in the scope of theability to pay and additional financing mecha-tions) in LMICs. As part of the One Young World

Index and publicly discloses the list of countries.

nisms. For example, AstraZeneca set a direct

Lead2030 programme, AstraZeneca has awarded

distribution system for healthcare centres infunding to BIVE, a model that facilitates access to

Publicly discloses detailed information on pat-

Uganda to ensure supply stability and price reduc-timely, high quality and affordable private health-ent status. AstraZeneca publicly discloses on its

tion of goserelin acetate (Zoladex®). Evidence ofcare services for more than 19,000 Colombian

website information relating to the status of its

an increase in patient reach in Uganda is provided.

people, the majority being low-income coffee

patents for all products in its Index portfolio. This

farmers.

includes brand name, nature of the patent, patent

Has access strategies for the majority of its

number, expiry date and jurisdiction.

self-administered products for countries in

Performs above average in terms of ensur-

scope of this analysis. AstraZeneca has an above

ing continuous supply of medicines in LMICs.

Performs above average in terms of sharing

average performance in this area. For three of

AstraZeneca is involved in technology transfers

intellectual property (IP) assets with third-

the five products assessed, the company pro-with third-party manufacturers in LMICs, and has

party researchers. AstraZeneca engaged invides examples of access strategies whicha system in place to work with relevant stake-14 new IP-sharing agreements with third-party

consider affordability in countries of all assessedholders to communicate issues that may affectresearch institutions or drug discovery initiatives

income levels (UMIC, LMIC, LIC). It makes efforts

the supply chain, works with several active phar-established during the current period of analysis

to reach additional patients using pricing strate-

maceutical ingredient (API) suppliers/produces

that meet all inclusion criteria for evaluation. The

gies that consider relevant payers' ability to pay

in-house APIs, manages a buffer stock of relevant

company does have existing agreements of thisand patient assistance programmes. For example,

products and is involved in supply chain capacity

nature in place that were established before theAstraZeneca has secured public reimbursementbuilding initiatives.

current period of analysis and meet all inclusionof osimertinib (Tagrisso®) in Egypt, where patient

criteria for evaluation.

reach has increased.

Uses licensing agreements to enable generic

All five manufacturing capacity building ini-

the Index in less than ten days. AstraZeneca has

supply. AstraZeneca has private, voluntary licens-tiatives included for analysis meet all Gooda policy for reporting SF medicines to national

ing agreements in place for one product, its

Practice Standards. AstraZeneca is a leader

health authorities within five days. It provides evi-

COVID-19 vaccine (Vaxzevria). Details of thesein this area. The number of initiatives meeting

dence of shortened time frames for reporting

agreements are not publicly available.

all inclusion criteria is higher than average andcases which only require visual inspection to be

more initiatives meet all Good Practice Standards

confirmed and aims to report within three work-

Filed to register new products in ten countries(GPS) than what is average for this indicator.

ing days when packaging is sufficient to assess

in scope on average. AstraZeneca filed two out

For example, AstraZeneca has conducted a fullthe case.

of nine newer products in a subset of high bur-technology transfer to Siam Biosciences for its

den disease countries. Among new products, its

COVID-19 vaccine (Vaxzevria).

Has a policy for reporting substandard and falsified (SF) medicines in countries in scope ofindicated for leukaemia, filed in 23 countries

All five supply chain capacity building initi-

icies and supply processes in place to ensure adin scope of the Index, including Ecuador andatives included for analysis meet all Goodhoc donations are carried out rapidly in response

Ukraine among the top ten high burden disease.

Practice Standards. AstraZeneca is one of theto expressed need, and it monitors the delivery of

Durvalumab (Imfinzi®) has been registered in 22

leaders in this area. The number of initiatives

donations until they reach the patient.

countries within the scope of the Index, five of

meeting all inclusion criteria is higher than aver-which are high-burden countries (China, Republic

age and more initiatives meet all GPS than what

Has no long-term donation programmes forof Moldova, Thailand, Ukraine and Vietnam).

is average for this indicator. For example, in theneglected tropical diseases or malaria that

None of its products assessed are filed for regis-

United for Health Partnership with the Egyptian

are eligible for analysis under this indicator.

tration in any LIC.

Government, AstraZeneca provides support andHowever, AstraZeneca is engaged in anothereducation to governmental pharmacists throughstructured donation programme: the Cambodia

Has access strategies for its supranation-a structured programme that involves supply

Breast Cancer Initiative whereby it has been

ally procured product in scope of this analysis.

chain management training and scholarships.

donating anastrozole (Arimidex®) and fulvestrant

AstraZeneca leads in securing access for its prod-

12

Donates in response to expressed need andmonitors delivery. AstraZeneca has public pol-most widely filed is acalabrutinib (Calquence®),(Faslodex®) to Cambodia since 2008.

uct procured supranationally. For the product

Four of the five health systems strengthen-assessed in this category, the COVID-19 vaccine

ing initiatives included meet all Good Practice(Vaxzevria), it demonstrates access strategies

Standards. AstraZeneca's performance is above

both in countries eligible for supply from suchaverage in this area. The number of initiatives

procurers and in countries that procured themeeting all inclusion criteria is higher than aver-

vaccine outside the supranational agreement.

age and more initiatives meet all GPS thanThe company provides evidence of an addi-

what is average for this indicator. For example,

tional access strategy to increase patient reach.

AstraZeneca's new initiative PUMUA aims to build

Evidence of patient reach is available.

capacity for asthma care in Africa through infra-