Globally, 2 billion people still cannot access the medicine they need. Among the many stakeholders working to improve this situation, pharmaceutical companies have a crucial role to play. For almost ten years now, the Access to Medicine Foundation has built stakeholder consensus on what we can expect from pharmaceutical companies.

This consensus is distilled every two years into the methodology for the next Access to Medicine Index, with input from experts working across the access-to-medicine field. The metrics at the core of the methodology translate into ambitious, yet achievable expectations for pharmaceutical company behaviour in each area the Index measures.

How we measure

The Index measures companies across seven areas of behaviour – called Technical Areas – that are key for improving access to medicine. When it comes to calculating companies’ overall Index scores, the different areas are given different weightings, reflecting their varying importance for access.

Evolution of the framework
The comparative weights of each Technical Area and each Strategic Pillar are given in percentages (of a company’s final overall Index score). For the 2016 Index, the weighting of the Performance pillar has increased to 50%. For the previous two Indices, its weighting remained static at 40%.

2017 Methodology Review and consensus building

Each Access to Medicine Index is the product of a two-year process known as the ‘Index cycle’, which begins with a review of the Index methodology. The 2017 Methodology Review for the 2018 Access to Medicine Index is now underway.

The aim is to align the Index metrics with changes in access-to-medicine priorities and expectations as to how pharmaceutical companies can make products more available, accessible and affordable. We also use the review to reaffirm the robustness of the next Index analysis, and ensure our capacity for trend analysis is maintained.

Strategic guidance is provided by the Expert Review Committee (ERC) for the Access to Medicine Index. The ERC is an independent body of experts from, among others, the WHO, governments, patient organisations, the industry, academia and investors.

The previous Methodology Review was carried out in 2015.

Since the first Access to Medicine Index in 2008, members of the Foundation’s Expert Review Committee (ERC) have provided independent, strategic guidance to each review of the Access to Medicine Index methodology. The current ERC is made up of independent experts, including from the WHO, the industry, NGOs, academia and investors. They are all active on the access to medicine agenda and together represent a variety of stakeholder groups. The ERC provides external advice on the scope, structure, and analytical approach of the Access to Medicine Index.

For the 2018 Access to Medicine Index, we are pleased to have Professor Hans Hogerzeil chairing once again, and to welcome five new members: Fumie Griego (Assistant-Director General of the IFPMA), Frasia Karua (Interim General Manager for Amref Enterprises), Yo Takatsuki (BMO Global Asset Management), Joshua Wamboga (Chair-Elect of the International Association of Patient Organisations), and Prashant Yadav (University of Michigan).

Hans Hogerzeil
Hans Hogerzeil
Professor in Global Health at the University of Groningen, The Netherlands. Former WHO Director for Essential Medicines and Pharmaceutical Policies
Prashant Yadav
Prashant Yadav
Expert in Healthcare Supply Chains, Senior Fellow at the William David Institute, Visiting Scholar at Harvard Medical School
Frasia Karua
Frasia Karua
Interim General Manager Amref Enterprises, Amref Health Africa
Yo Takatsuki
Yo Takatsuki
Associate Director, Governance and Sustainable Investment, BMO Global Asset Management
Joshua Wamboga Magawa
Joshua Wamboga Magawa
Board Chair Elect, IAPO; Executive Director, UNASO
Fumie Griego
Fumie Griego
Assistant Director General for Strategic Planning, Policy and Research at IFPMA
Sanne Frost Helt
Sanne Frost Helt
Chief Advisor for Global Health, HIV/AIDS and SRHR, Ministry of Foreign Affairs, Denmark
Regina Kamoga
Regina Kamoga
ountry Manager, Community Health and Information Network (CHAIN), Uganda
Suzanne Hill
Suzanne Hill
Director, Essential Medicines and Health Products,WHO
Richard Laing
Richard Laing
Professor of Global Health, Boston University School of Public Health, USA
Aurelia Nguyen
Aurelia Nguyen
Director of Policy & Market Shaping, Gavi
Eduardo Pisani
Eduardo Pisani
Director General, International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)
Dennis Ross-Degnan
Dennis Ross-Degnan
Associate Professor at the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
Dilip Shah
Dilip Shah
Member, Management Committee, IGPA and Secretary General, Indian Pharmaceutical Alliance
Helena Viñes Fiestas
Helena Viñes Fiestas
Head of Sustainability Research (SRI/ESG), BNP Paribas Investment Partners (BNPP IP)

The Index team is reviewing the Index methodology drawing on feedback from independent experts and stakeholders active in access to medicine. The aim is to align the methodology with changes in access-to-medicine priorities and expectations as to how pharmaceutical companies can make their products available, accessible and affordable to people living in developing countries.

The Index team is gathering input for the Methodology Review in three main ways:

  1. Formal review and advice

During the review, the methodology approach, proposal and final version is reviewed by the Expert Review Committee (ERC), which provides strategic guidance and makes recommendations. Specialist advice on key areas of the Index analysis is provided by members of the Technical Sub-Committees (TSCs). The ERC and TSC members are all experts in different aspects of access to medicine and the pharmaceutical industry.

  1. Targeted expert consultations

The Index team is reaching out to a broad range of experts with different expertise and perspectives, including from governments and the global health and investor communities. Many of these consultations are based around specific questions relating to our methodology and analysis. These questions had been defined per indicator, based on data gathered in 2016, to reaffirm the robustness and usefulness of the next Index analysis.

  1. Feasibility checks with pharmaceutical companies

In early 2017, pharmaceutical companies analysed in the Index provided feedback on the process of gathering, submitting and verifying data.

 

While refining and finalising the methodology for the next Index, all comments and feedback received via these consultations will be taken into account, and weight in balance with each other.

The 2017 Methodology Review for the 2018 Access to Medicine Index followed four design principles:

  1. Reflect changes in the access-to-medicine landscape and the role for pharmaceutical companies

The research team reached out to a broad range of experts active in access to medicine, including from governments, international institutions such as the World Health Organisation, from academia, investors and the pharmaceutical industry, to gather technical advice on specific aspects of the changing access-to-medicine landscape and how these can be reflected in the next Index analysis. Critical to this was ensuring that in each area of measurement, the role of the R&D-based pharmaceutical industry was clear.

  1. Preserve the capacity for fine-grained comparison between companies’ performances

The ability of indicators to reveal differences between company performances was checked using analyses such as correlation matrices, distribution analyses and response rate analyses. The need to tailor indicators for companies with very different portfolios or disease focuses was taken into account.

  1. Maintain capacity for trend analysis between successive Indices

Adjusted indicators were checked to ensure that they collect data that is comparable to data from past Indices for key access-to-medicine topics.

  1. Ensure data can feasibly and efficiently be collected by companies

New and adjusted indicators were checked to ensure that data can be collected by the companies measured.  The team considered existing indicators and questions, removed redundancies and ensuring data was asked for and could be provided in the most efficient way possible, with no loss of quality.

Methodology for the 2016 Access to Medicine Index

In 2016, the Index measured the same 20 companies as in the 2014 iteration: these companies remained the largest R&D-based pharmaceutical companies with the most relevant expertise and portfolios. The geographic scope totaled 107 countries: a handful of countries moved out of scope, as socio-economic conditions improved, while others (Iran, Jamaica, Mexico, Panama and Peru) moved into scope. The disease scope for the 2016 Index comprised 50 conditions and diseases. In 2016, more up-to-date data on disease burdens had become available, bringing three additional non-communicable diseases into scope.

The 2016 Index uses 83 indicators: 6 were new in 2016 and 9 are mergers of pre-existing indicators. 9 indicators from the previous methodology were removed. Changes were made following statistical analyses, either to improve our measurements of company practice, to align with changes in global-health priorities, or to improve efficiencies in analysis and data capture.

 

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