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Gaining access

Philanthropic initiatives ensure firms a seat at the table shaping developing market healthcare delivery

Queue Access to medicines initiatives should be considered more than just exercises in corporate philanthropy. Far-sighted organisations realise that by engaging in these inititiatives not only can they play a greater role in shaping healthcare delivery, but they can increase their access to customers as well.

In June 2008, Holland-based Access to Medicine Foundation published the first Access to Medicine Index (AMI) which ranked 20 pharmaceutical firms – including generic manufacturers – on eight criteria related to broadening access to their medicines, particularly in the world's poorest countries. The index was initially met with scepticism by pharma, even from firms that ranked highly on the index, such as GlaxoSmithKline (GSK). This was largely because of questions over methodology and because the benefit to industry was poorly articulated.

However, in the last six months since publication of the index, Wim Leereveld, chairman of the Access to Medicine Foundation, says he has seen a shift in attitude by industry. "The world is changing and industry realises there is no way back: GSK, Novo Nordisk and Merck have put the ranking in their latest annual report," he says.

There is no doubt that the interest in access to medicine initiatives is gaining momentum. In February 2009, GSK chief executive officer, Andrew Witty, outlined corporate commitments to improving global public health in a speech at Harvard Medical School, Boston, US. He focused on four measures that GSK will undertake regarding intellectual property, pricing, R&D, and infrastructure investment in the least developed countries (LDCs).

Despite encouraging steps, however, reservations about the index in the pharmaceutical industry remain. For this reason the Access to Medicine Foundation arranged for stakeholders to meet in June, in both Washington and London, to discuss improvements. Representatives from government, investors and non-governmental organisations (NGOs) were in attendance to – as Mr Leereveld explained – "develop a partnership around the index". No individual pharmaceutical companies were present, but industry was represented by IFPMA and PhRMA.

Working in partnership
Partnership in solving health problems is the operative word for Dr Jonathan Knowles, president of group research at Roche. "Roche has made two significant donations of about five milllion treatments of Tamiflu each to the World Health Organisation (WHO). Half of the donation has already been deployed to developing countries. The drug can be delivered within 24 hours to any international airport in the world. Just before Christmas, we had a rehearsal to see if we could deliver it all to an airport and get it on the plane and it worked flawlessly."

WHO regulations govern donations to mitigate the corruption within healthcare systems in LDCs, of which Dr Knowles has first-hand experience. "We have had some rather unfortunate experiences of supplying drugs to sub-Saharan Africa. You send drugs to a reputable government, however they find their way into the hands of repackagers and are then resold to Europe at high prices. The issue of political ethics and corruption cannot only be addressed by a company like Roche."

In the same vein, Dr Knowles is clear that industry ought not to bear sole responsibility for broadening access to medicines: "We can be part of the solution – but there is sometimes an expectation that we be the solution."

A common misconception of industry critics is that cheap drugs are the Holy Grail, without considering the broader aspects of healthcare systems in which medicines need to be procured, stored, distributed, prescribed, administered and monitored.

"Society doesn't look at food companies to provide food to feed all of Africa, nor to building companies to provide all the continent's infrastructure. In the same vein there is no reason to look at a pharmaceutical company and say 'you fix the HIV issue in Africa'," said Dr Knowles.

Developing infrastructure
More and more pharmaceutical firms are delivering healthcare infrastructure where none existed. An interesting take on this can be seen in Roche's sponsorship of the Phelophepa train – a mobile clinic that uses the rail infrastructure in South Africa to take healthcare services to areas where they are desperately needed. "It makes a very important contribution to the basic healthcare of the population because it doesn't just bring medicines, it brings clinical expertise too," concludes Dr Knowles.

GSK also aspires to lead in the area of developing healthcare infrastructure, as Mr Witty outlined in his Harvard speech, "We need to stop saying 'it's not our fault there is no infrastructure to deliver healthcare' and start saying 'who can we work with to ensure that the infrastructure does exist?' We are setting out a new commitment in which 20 per cent of the profit we make selling medicines in LDCs will be reinvested in infrastructure projects in LDCs, benefiting the poorest people in the poorest countries directly," Witty says.

Despite numerous initiatives in the developing world, still only one in six people globally has access to branded pharma medicine, according to Keiron Sparrowhawk, a partner at PriceSpective. "Access is still minimal in sub-Saharan Africa, for example, where of the 30-40 million people with HIV, only one in ten actually gets treated," Sparrowhawk says. Considering GSK's policies he admits they are "very good and a step in the right direction," adding that a pharma company will quicken the building of infrastructure where it sees opportunity to make profit.

Often, the emphasis of access to medicine initiatives is in the developing world, but even in a rapidly-growing, middle-income country such as Russia, leading surgeons and physicians will hear about the latest innovative medicines at international conferences, but will not have access to them – mainly because of government price restrictions and chronic underinvestment in healthcare. Mr Sparrowhawk elaborates, "We looked at BRIC countries (Brazil, Russia, India, China) to see if they value innovation and the only country that comes close is China, which undertakes assessments of new medicines. Brazil will look to other countries for this – in essence, they export the valuation."

In a high-income country, such as the UK, access to highly innovative medicines is restricted in part by the government's unwillingness to pay for treatments that are not deemed cost-effective, such as the refusal to reimburse innovative drugs for kidney cancer (See Drug Evaluation Crisis, October 2008 issue).

Conclusion
Industry-funded access to medicine initiatives have a clear philanthropic goal, which can be used to enhance public perception. Moreover, these initiatives are giving industry a seat at the table next to governments and serious NGOs such as the World Bank, WHO and the Gates' Foundation, allowing companies the opportunity to help shape pharmaceutical policy in low- and middle-income countries.

Although access to medicine initiatives are generally decoupled from explicit commercial goals, the growth potential of BRIC pharmaceutical markets is phenomenal. Firms that realise they are in the business of providing health benefits – perhaps through infrastructure investment – and not selling product, will have the competitive advantage as these developing markets mature.

The age of transparency is here and it can only be of benefit for industry to embrace the AMI, showing critics that many pharma-sponsored access to medicine initiatives obtain tremendous results. Take, for instance, Merck's river blindness programme through which Mectizan has been distributed to over 100 million people for free since 1987. By any measure, this is a phenomenal achievement, all the more remarkable in that this programme is not financed by a charity, but by a legal entity whose aim it is to provide a return to shareholders through creating and selling medicines that help the medical profession prevent and treat illness.

Pharmaceutical firms do a great disservice to themselves by not being open about their commercial raison d'etre to the broader public. It is precisely because they are profitable businesses and not charities that they can finance philanthropic initiatives in a sustainable manner.

The AMI is an independent tool to benchmark these efforts, but it needs to be explained more effectively to industry and other stakeholders.

I foresee the index being of great service to the industry in enhancing what the Association of the British Pharmaceutical Industry calls 'ROI' – the reputation of industry.

The Author
Gerhard Symons is a doctoral researcher at the Centre for Health Management, Imperial College Business School, London.
To comment on this article, email pm@pmlive.com

3rd August 2009

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