The Access to Medicine Index is an independent initiative that ranks the world’s 20 largest research-based pharmaceutical companies according to their efforts to improve access to medicine in 107 low- to middle-income countries. The Index assesses how companies are making their products more available, affordable, accessible and acceptable to patients in need. By comparing companies to one another, the Index aims to stimulate pharmaceutical companies to play a bigger part in addressing the challenges of access to medicine in developing countries and to offer them insight into the activities of their peers. Furthermore, the Access to Medicine Index seeks to create a platform for stakeholders from the pharmaceutical industry, governments, investors, civil society, patient organisations and academia to gather and form a common view of how these pharmaceutical companies can make further progress.
Contents
The Access to Medicine Index is published every two years by the Access to Medicine Foundation, an international not-for-profit organisation dedicated to improving access to medicine for people in need. The organisation is based in Haarlem, The Netherlands and receives financial support from donors such as the Bill & Melinda Gates Foundation, the UK Department for International Development (DFID) and the Dutch Ministry of Foreign Affairs.
Ranking
The Access to Medicine Index, published in November 2016, ranks the top 20 pharmaceutical companies as follows:
History
The Access to Medicine Index was developed starting in 2004 on the initiative of Dutch entrepreneur Wim Leereveld. After years of working with the pharmaceutical industry, he concluded that simply "naming and shaming" the industry did not do enough to encourage pharmaceutical companies to play their part in improving access to medicine in the developing world. Leereveld noticed that there were many different (and sometimes conflicting) opinions about what the pharmaceutical industry should be doing with regard to access to medicine, but that there was no tool to recognise good practice within the pharmaceutical industry and no framework for collective dialogue surrounding this issue. He set out to develop a ranking system that would show which pharmaceutical companies do the most to improve access to medicine and how, and also help stakeholders to collectively define companies’ role in increasing access to medicine.
The first Access to Medicine Index was published in 2008, followed by a new Index every two years.
Methodology
The 2015 Methodology for the 2016 Access to Medicine Index was published in October 2015.
The Access to Medicine Index uses a weighted analytical framework to capture and compare company data. The framework is constructed along seven areas of focus called ‘Technical Areas’, which cover the range of company business activities considered relevant to access to medicine. Within each area, the Index assesses four aspects of company action called ‘Strategic Pillars’: commitments, transparency, performance and innovation.
Scope
Company Scope
The Access to Medicine Index ranks 20 of the world's largest originator (research-based) pharmaceutical companies, based on market capitalisation and the relevance of their product portfolios to diseases in the developing world. One unlisted company, Boehringer Ingelheim, is also included since it meets the size and portfolio relevance criteria.
In 2008 and 2010, the Access to Medicine Index also measured companies engaged exclusively in the production of generic medicines. Based on feedback from the 2011 stakeholder consultations, these companies were excluded from the 2012 Index and subsequent iterations. The Access to Medicine Foundation states that it recognises that these companies play a significant role in access to medicine, particularly in low- and middle-income countries.
Geographic scope
The Access to Medicine Index focuses on low- and middle-income countries, based on World Bank and United Nations classifications measuring economic advancement, human development, and relative levels of inequality. The 2016 Index measures developments in a total of 107 countries.
The 2016 Index includes countries that are considered to be low income and lower-middle income countries by the World Bank, and Least Developed Countries (as defined by the United Nations Economic and Social Council). In addition, countries that are classified as low human development countries and medium human development countries by the UN Human Development Index are included. Finally, based on the UN Inequality-Adjusted Human Development Index, the Index includes countries which, while they may have higher measures of development, have comparatively high levels of socio-economic inequality.
Disease scope
The Access to Medicine Index covers a range of diseases based on their aggregate global disease burden and their relevance to pharmaceutical interventions, in accordance with non-age-weighted WHO Disability Adjusted Life Years (DALY) data. Those diseases for which pharmaceutical interventions were irrelevant (such as violent death, trauma and snakebites) are excluded. In the 2016 Index, the disease scope will consist of a combination of the following:
Product type scope
To reflect the range of available product types for prevention, diagnosis and treatment of diseases, the Index maintains a broad product type scope which draws closely from definitions provided by the G-Finder Report.
Index coverage and use
Since its inception, the Access to Medicine Index has progressed to be a frequently cited and ‘authoritative’ benchmark for pharmaceutical companies with regard to their access to medicine initiatives. In addition to global media outlets reporting on the Access to Medicine Index and its findings, significant coverage includes:
Criticism
The results of the Access to Medicine Index are largely based on company data provided by the pharmaceutical companies themselves. Self-reported data does carry with it an inherent risk, but the Access to Medicine Index also uses dependable external sources to verify data provided by the companies wherever possible. Additionally, it is in companies’ best interest to be as forthcoming as possible, as they are a) rated by the Index on their degree of transparency and b) rated on their performance every 2 years, so that failures to meet their commitments and/or inconsistencies over time are likely to be uncovered. Besides, as drug access is only one dimension of the Corporate Social Responsibility (CSR) within the pharmaceutical industry, it would not be reasonable to evaluate the CSR practices of pharmaceutical companies only using this index.