The Covid-19 pandemic provided the pharmaceutical industry with an opportunity to showcase its social value proposition to the world. Not only has society been able to view the direct link between investments in research and development and the production of life-saving drugs, but the world has also witnessed unprecedented global collaboration between the public and private sector to bring these vaccines to market in record time.
With the rise of environmental, social and governance investing and increased demand for companies to align their business practices to the United Nations’ Sustainable Development Goals, the pharmaceutical sector sits in a promising position to improve access to medicine in low- and middle-income countries.
As a result, many companies are starting to quantify and document how they are developing innovative treatments for unmet medical needs that can reach as many patients as possible. Data has become a growing asset for companies and investors alike, and the rise of value-based health care has intensified the need to capture patient outcomes and allow for more innovative pricing models based on real-world data.
The pharmaceutical industry, which in recent years suffered from a tarnished public reputation, has had the opportunity to rebrand itself. This, however, has been juxtaposed against the stark inequality of the global health care system and the access to medicine crisis. As the Covid-19 vaccine rollout programmes commenced last year, billions of people in low- and middle-income countries were at the back of the queue to receive them and the world witnessed the political gridlock around vaccine nationalism.
The pandemic has also revealed the fragility of the vaccine supply chain and the lack of preparedness to address future health crises, with only a few companies carrying out the majority of the most urgently needed R&D projects. According to the Access to Medicine Foundation, which seeks to change how pharmaceutical companies provide their medicines for the poor, there are currently no projects in the pipeline for 10 of the 16 diseases identified by the World Health Organisation as the greatest public health risks.
However, pharmaceutical companies cannot bring about change in isolation. Numerous factors determine the extent of patient access, including the effectiveness of health care systems, access to insurance, government taxation and procurement policies. One of the main barriers referenced by companies has been the lack of healthcare infrastructure. In addition, many healthcare systems lack specialist professionals. There are also logistical challenges, particularly in rural areas, as well as patient factors such as misperceptions and stigma around diseases and medicines. Addressing these issues requires buy-in from governments and the pooling of resources, skills, experience and goodwill across multiple stakeholders.
It is important for investors to understand how different pharma companies are addressing access to medicine within their business strategy, especially as the risk of “Sustainable Development Goal-washing” increases. A company’s approach to addressing access to medicine could be viewed as a proxy for innovation and good governance and may provide investors with a lens with which to view how the company may navigate other emerging challenges.
Quantifying access to medicine and comparing like-for-like, however, is a difficult task as pharma companies have different product portfolios and business strategies. One tool investors can leverage is the Access to Medicine Index, which ranks 20 of the world’s largest pharmaceutical companies based on how they manage risks and opportunities related to access to medicine in low- and middle-income countries.
Product development partnerships have also been commercially attractive opportunities for pharma companies due to the population growth and increasing economic prosperity of many emerging markets. For example, AstraZeneca entered China’s market in 1993 and the country now contributes to more than 20 per cent of the company’s revenue. This growth is highlighted by AstraZeneca’s expectation back in 2019 that innovative treatments are likely to contribute 60 per cent of its China revenue by 2024.
Not only does this highlight the importance of time and experiential knowledge that comes from longstanding local partnerships, but also the significant contributions emerging economies can make to the future competitiveness and strategies of international pharma companies.
Many pharma companies have also started to address access issues by developing more innovative pricing strategies. For example, by developing a patient affordability model, Pfizer increased access to its self-administered oncology products in countries like the Philippines, where less than 2 per cent of patients in the private sector could afford to pay the list price.
Many innovative pricing models have been made possible due to the increased collection and analysis of data. Companies are investing in digital health technologies and data analytics to collect and analyse real world evidence, track patient outcomes and better understand how patient characteristics affect health outcomes.
Data has become a valuable asset, helping companies determine where to channel R&D, how to position products and providing a feedback loop to allow for more holistic innovation across the value chain. In lower income markets, where there is less of a data barrier due to the lack of infrastructure and ingrained hospital IT networks, there is the opportunity to drive rapid data collection at scale and direct health care delivery through mobile communication.
In March 2020, Pfizer was the first biopharmaceutical company to issue a sustainability bond, with the proceeds supporting the management of the company’s environmental and social impact. It was shortly followed by Novartis, which issued its first sustainability-linked bond with interest payments tied to the achievement of patient access targets in low- and middle-income countries.
The global pandemic has provided the pharmaceutical industry with an opportunity to rebrand itself and build on existing collaborative efforts to tackle areas beyond Covid-19. It is up to the investment community to hold companies accountable to these targets, encourage innovative pricing models and partnerships, monitor how companies are collecting data and measuring their impact, and to challenge companies over whether they are doing enough to ensure their products are reaching as many people as possible.
Olivia Gull is an analyst at Janus Henderson Investors, which is a member of The Gulf Bond and Sukuk Association