Several pharmaceutical companies are prioritising low-income and least developed countries within their inclusive business models, with this trend rising.
The pharmaceutical companies analysed by the Access to Medicine Index have systematically been expanding access to their essential products in several low- and middle-income countries (LMICs)*, but many populations – especially those living in low-income countries – remain largely overlooked by companies’ access strategies.
This was highlighted in the 2022 Index, with the 2024 Index still finding that far fewer products, for example, are covered by access strategies in low-income countries (39%) than in lower-middle-income countries (76%) and upper-middle income countries (85%).
Historically, most medicines and vaccines have reached people in low-income countries via companies’ donations programmes or through donor-driven supranational procurement.
While these strategies can (and are) addressing some of the gaps in these countries, more comprehensive, tailored and inclusive approaches are required to successfully address chronic access issues for vulnerable patients in the long term.
Over the last five years the Index has identified steps by some companies to cover more countries and products as part of their efforts to expand access.
Five companies in particular have developed and launched inclusive business models with comprehensive approaches to facilitate access to their products for neglected populations, including those in low-income countries and least developed countries.
Overall, these five companies’ models distinguish themselves in that they aim to reach underserved or unserved populations in LMICs that traditional business models have failed to cover.
They focus on partnerships to tackle access barriers, with long term plans for scalability to include additional countries and products and include long-term aims to generate a sustainable source of revenue.
These five companies are taking various approaches to operating their inclusive business models, including the types of strategies they use to reach neglected populations.
However, they all involve companies’ selling and supplying either a set of products or their entire portfolio – for which they implement specific affordability strategies that can be tailored to specific settings across and within LMICs.
This includes tailored pricing commitments, inter-country, as well as intra-country pricing, which Bristol Myers Squibb, Novartis and Sanofi facilitate through second brands.
In addition, these models have also been developed to suit local health systems and address comprehensive access barriers, such as health system capacity and supply chain constraints.
Five models that aim to expand access to low-income countries**
As set out in the accompanying map on the next page, the commitments tied to the models from Bristol Myers Squibb, Novartis, Novo Nordisk, Pfizer and Sanofi cover 102 countries, collectively.
This includes all 48 low-income countries and/or least developed countries analysed in the Index, 32 of which are in Africa.
These countries make up about 13% of the global population, and a 2021 estimate finds that 35% of the total population in these countries were living below the international extreme poverty line of USD 1.90 per day.1
The range of products covered by these inclusive business models varies among companies, but all include products traditionally excluded from strategies targeting low-income and least developed countries.
Bristol Myers Squibb, Novartis, Novo Nordisk, and Sanofi include select items from their global portfolios, while Pfizer offers all the on- and off-patent products that the company currently has global rights to, as well as future products.
Portfolios offered under these models mostly consist of products indicated for non-communicable diseases (NCDs), accounting for 73% of all products (see the figure below).
This includes both older treatments and newer on-patent medicines typically not covered by companies’ access strategies in low-income countries. These portfolios encompass both small molecules and biologics, such as monoclonal antibodies for some companies. While not an exhaustive list, these are some of the NCDs covered:
Given that low-income countries have, historically, been overlooked when it comes to being supplied with NCD products, this coverage within the companies’ business models is encouraging.
Especially since NCDs disproportionately affect people in LMICs, where 80% of those affected live (5.7 billion) and more than three-quarters (31.4 million) of global deaths related to NCDs occur.2,3 Globally, cardiovascular diseases account for the majority of NCD deaths, followed by cancers, chronic respiratory diseases and diabetes, conditions that several of the products in these models’ portfolios target.
Notably, Pfizer’s Accord also includes contraceptives from the company’s portfolio. This is the first time such products have been made available via a model like this and can be particularly impactful for sexual and reproductive health and rights in LMICs; 164 million women globally wish to delay or prevent pregnancy but are not using any form of contraception.
Sub-Saharan Africa exemplifies this gap, with the usage of modern contraceptives being the lowest in the world at 56%.4
The remaining 27% of products in these models’ portfolios are indicated for communicable diseases that still pose a high burden of disease in LMICs. Products included are mainly for malaria, neglected tropical diseases and tuberculosis, as well as antibacterials indicated for multiple infections.
The wide-reaching product and country coverage across these five models is encouraging, but the 2024 Index finds that the outcomes of these models are somewhat mixed, with overall delivery lagging.
While the more recently launched models are still in earlier stages, for the older, more established models, implementation is currently limited. Moreover, Sanofi is the only company, so far, to clearly report on how many patients are specifically being reached with the products delivered via its model.
Examples of implementation, and patient reach reporting, of the five companies’ inclusive business models are ordered based on chronological order of establishment:
Aside from the overall lack in clear and consistent reporting from companies on the patient reach outcomes of their respective models, patient reach figures that have been reported still fall short of meeting a realistic percentage of the healthcare needs of neglected populations across LMICs.
Given the rising burden of NCDs in these countries, for example, many patients are still being left behind in receiving the vital healthcare products that these models have been designed to provide access to.
In addition, the 2024 Index finds that reporting on the specific needs for further advancement of partnerships is lacking across the board.
Overall details regarding which products have been registered and made available, as well as any memoranda of understanding established with national governments for product delivery, remain insufficiently documented.
Moving forward, it is vital that companies consistently and transparently report this information and the level of progress, especially the number of patients reached.
Although current progress on the implementation of these five models is limited, the small steps that have already been taken can be meaningful if companies and their partners can accelerate access and deliver on the wide-reaching commitments to reach more patients across LMICs.
As more companies engage in inclusive business models with wide-ranging product and country coverage, it is important that they drive progress to deliver and expand on their commitments.
Central to this will be continuing to evolve models in a way that is informed by local needs and countries’ priorities to ensure these models effectively address the access challenges they have been designed to overcome.
By seeking greater synergies for collaboration across industries and with governments, particularly in low-income countries, for example, companies can amplify their impact and more successfully leverage shared expertise and resources.
It is also critical that progress (or lack thereof) is transparently reported, particularly data on patients reached, to ensure no one is left behind.
Not only does this promote accountability in delivering on commitments, it also supports partnerships with other key stakeholders (e.g., local governments) who are working on existing initiatives to promote access to care.
This will also help map out tangible, sustainable and replicable solutions to bridging chronic access issues in low-income countries, which can be explored by other companies.
Also Read
In today’s dynamic market, identifying the right stocks to invest in can make all the…
In the fast-paced world of technology stocks, few companies have seen such consistent growth and…
In a recent incident that has captured the attention of travelers and aviation enthusiasts alike,…
When it comes to picking a stock with strong potential for 2025, NVIDIA (NVDA) stands…
The global logistics industry is undergoing a seismic shift, driven by the integration of blockchain…
Cryptocurrency has become a buzzword over the past decade, capturing the imagination of tech enthusiasts,…