This week the 2018 Access to Medicine Index was published revealing that there is a handful of pharmaceutical companies developing the bulk of urgently needed new medicines for the poor.

The fact that a handful of companies are carrying the bulk of the priority R&D load shows how fragile the situation is. A retreat by even one of these players would have a significant impact — Jayasree K. Iyer, Executive Director of the Access to Medicine Foundation

An independent ranking of 20 of the leading pharmaceutical companies on their efforts to improve access to medicine in low and middle-income countries, the Index is endorsed by more than 80 investors, collectively managing assets worth more than USD 10 trillion.

GSK holds its position at the top while Novartis moves into second, ahead of Johnson & Johnson and Merck KGaA.

The biggest jump in charitable action was made by Takeda, who moved up ten places to number five.

Notably, American companies dominated the bottom rungs of the list.

The four leaders, together with Sanofi, account for 63% of the priority research and development (R&D) being undertaken. GSK,  Novartis, Johnson & Johnson, and Merck KGaA – frame access as a business proposition and most consistently invest in projects and initiatives that the global health community has identified as top priorities.

“The fact that a handful of companies are carrying the bulk of the priority R&D load shows how fragile the situation is. A retreat by even one of these players would have a significant impact,” said Jayasree K. Iyer, Executive Director of the Access to Medicine Foundation. “If more companies joined this group, that would bring much-needed resilience.”

Getting more companies involved in priority R&D would not only increase the numbers of products being developed but would also reduce the negative impact of individual companies deciding to halt their engagement in such R&D.

The Index observed that the industry’s engagement in R&D is focused on five diseases that are a high priority for global health initiatives: HIV/AIDS, tuberculosis, Chagas disease and leishmaniasis. 45 diseases have been identified as a priority for R&D by the World Health Organisation (WHO).

Research found that the majority of the priority R&D projects are being carried out with public sector research organisations. There are some companies however that are developing priority products without public sector intervention. Merck KGaA, for example, is developing tests and treatments for schistosomiasis, a water-borne parasitic disease that affects around 252 million people.

Since the last index was released in 2016, at least 66 products have moved through the pipeline to reach the market.

An area that is lagging is cancer…

Cancer is taking an increasing toll in low and middle-income countries, where approximately 65% of cancer deaths now occur. The Index examined company efforts to increase access to cancer products for the first time this year, focusing on those that are included on the WHO list of medicines it considers essential for all healthcare systems, identifying 72 products. Novartis markets the largest proportion of these, including half of the cancer products that have an access initiative attached to them.

Plans are in place for 5% of candidate cancer products by the time they reach the later stages of development, compared with 54% for communicable disease pipeline products.

Information from The Access to Medicines Foundation.