The almost yearly Access to Medicine Index measures the 20 behemoths of the pharmaceutical industry, encapsulating 70% of global pharmaceutical revenues. However, the report doesn't look at the bottom line: It looks at medicine accessibility in low- and middle-income companies (LMICs), and—as with everything in the past year—COVID-19 made its mark, demanding supply chain innovation and collaboration in new ways.
In a foreword to the report, Access to Medicine Foundation Executive Director Jayasree K. Iyer writes, "The Access to Medicine Index provides a guide to the practical, proven steps that can be taken by multinational pharmaceutical companies to improve access to life-saving medicines. Importantly, these measures will not only help the world’s poor but also improve companies' long-term business sustainability."
The Access to Medicine Foundation, which centers its research and collaboration on medicine accessibility and antimicrobial stewardship, acknowledges that many companies did help pandemic response via drug licensing, donations, and more, but the report notes that these accessibility efforts should continue long after the pandemic ends.
"Big [pharmaceutical] companies are essential in ensuring rapid development and access to vaccines, therapeutics and diagnostics, including providing the capacity for scaled-up manufacturing and global distribution without disrupting supply chains leading to shortages and stock-outs," they write.
"However and to a large extent, this industry only mobilised against COVID-19 once it became clear that the outbreak affected rich as well as poor countries, thereby opening up the possibility of substantial recurring pharmaceutical revenues."
Besides the projects developed within the Access to COVID-19 Tools Accelerator that the international initiative COVAX resides under, only 7 of 24 COVID-related projects in phase 2 or 3 clinical trials had an access plan by June 2020. Access plans could include tactics such as licensing agreements, partnerships with supranational organizations, or affordable pricing commitments.
Overall, GlaxoSmithKline is still the index's highest-ranked company, rising from a score of 4.01 out of 5 in 2018 to 4.23 for its governance of access, research and development, and product delivery. Novartis is once again the runner-up, but it shot from 3.21 in 2018 to 4.18 to almost close the gap. The lowest score on the 2021 index is for Bristol Myers Squibb, at 1.55.
COVID adaptations to supply chains, stock supply
According to the authors, companies have been able to at least partially maintain accessibility during the COVID-19 pandemic by sharing expertise, manufacturing property, and intellectual property (eg, Gilead's voluntary licensing of remdesivir), as well as by donating products and increasing inventory and affordability.
At least eight companies had to adapt their supply chains owing to COVID-related disruptions such as factory shutdowns, border closures, and export disruptions and delays. The report especially highlights AstraZeneca for its efforts in distributing all its finished pack inventory, ramping up production on safety stocks and bulk production, assessing emergency air freight capacity for multiple countries, and using 140 new freight routes as well as new seaports.
Other mitigations companies used before or during the pandemic included additional staffing and collaboration to provide local and global supply chain support, demand forecasting, and additional stock of active pharmaceutical ingredients.
While some health systems were supported with resource allocation, a lack of suppliers still led to shortages and substandard or falsified products, especially in sub-Saharan Africa, write the authors. To further research around medicine access in this region, the Pandemic Supply Chain Network was founded in January 2020 and subsequently created the African Cold Chain System Coalition to bolster research and analysis. Johnson & Johnson is the only drug company currently serving as a member of the network, alongside organizations including the World Health Organization and the World Economic Forum.
More supply chain initiatives
Compared with 2018, the index found 6.7% less manufacturing capacity initiatives (42) and 53.3% more supply chain capacity initiatives (46). Most manufacturing initiatives are based on what the foundation classifies as "emerging markets"—India (16), Brazil (12), and China (10)—while most supply chain initiatives are in sub-Saharan Africa (36).
Fifteen companies had applicable manufacturing initiatives, the same number as in 2018, but the amount meeting Good Practice Standards (GPS), which include solving local needs and having measurable objectives, went from 25 to 20. The most common manufacturing initiatives were technology transfer to LMICs (25) and good manufacturing practices (19).
Thirteen companies engaged in supply chain initiatives, compared with 12 in 2018, and 28 initiatives met GPS, compared with 15 in 2018. The most common initiatives were distributor support (16), which includes local distributor support and cold-chain supply, data sharing (14), and non-distributor support (14).
Despite increased efforts in these areas, the authors point to a lack of "last-mile" supply effort. "There is also a lack of larger-scale supply chain building initiatives in partnership with national governments which would allow continuous and time-efficient supply of medicines with a greater patient outreach," they write.
"There are signs of progress in a range of areas, from the setting of access-related performance incentives, to processes to ensure access to future products, to efforts to evaluate the impact of access initiatives," they conclude. "Yet actions to address access to specific products remain focused on a few products and a few countries, with the same handful of emerging markets benefiting most often."