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 for the 2018 Access to Medicine Index

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. This process aligns the Index metrics with changes in access-to-medicine priorities and stakeholder consensus on what we expect from pharmaceutical companies to improve access to medicine. We also use the review to reaffirm the robustness of the next Index analysis, and ensure our capacity for trend analysis is maintained.

The latest review, held in 2017, led to the publication of the methodology for the 2018 Access to Medicine Index. It details the scopes of analysis, the analytical framework and final indicator set for 2018. It also describes the consensus-building process and how the latest cycle shaped the 2018 Access to Medicine Index. The refined methodology has a tighter focus on where companies have the largest potential for impacting access.

The 2018 Access to Medicine Index will measure the access-to-medicine performances of 20 pharmaceutical companies in relation to:

  • 69 indicators organised in 7 Technical Areas
  • 106 low- and middle-income countries with an identified need for greater access to medicine
  • 77 diseases and pathogens, including the highest-burden diseases.

To read more about the 2018 Access to Medicine Index Methodology Report, please click here.

2017 Methodology Review for the 2018 Access to Medicine Index

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 reviewed the Index methodology based on feedback from independent experts and stakeholders active in access to medicine. The aim was 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 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 was reviewed by the Expert Review Committee (ERC), who provided strategic guidance and recommendations. Specialist advice on key areas of the Index analysis was 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 reached 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 were 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.

All comments and feedback received via these consultations were taken into account, shaping the 2018 Access to Medicine Index Methodology Report.

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 collected data was 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.

The 2017 consensus-building process and review led to adjustments to analytical scopes and the development of new measurements were needed.

1. Analysis scopes in 2018

The 2018 Index will measure the same 20 companies as in 2016, as they remain the largest R&D-based pharmaceutical companies with the most relevant expertise and portfolios. Considering their size, resources, pipelines, portfolios and global reach, these companies have a critical role to play in improving access to medicine. The majority have consistently qualified for inclusion since 2008. Their efforts to improve access to medicine will be assessed across 106 low- and middle-income countries and in relation to 77 high-burden diseases, conditions and pathogens.

2. 69 indicators

The 2017 methodology comprises 69 indicators, including five new indicators developed in response to changes in global health priorities. One new indicator, for example, specifically recognises R&D projects targeting priority R&D gaps or needs identified by stakeholders such as WHO. The Index research team applied stricter standards than in 2015 for deciding when to retain, strengthen, merge or remove a metric: four indicators are mergers of pre-existing ones and 15 indicators have been removed. As a result, the methodology has a tighter focus on where action by pharmaceutical companies has the greatest potential for improving access to medicine.

3. Targeted analysis of priority R&D

WHO and others have called for R&D to be urgently prioritised for specific diseases in order to address urgent public health issues. The 2018 Index will analyse how companies are responding through an assessment of R&D for priority diseases. More than half of the disease scope (45 out of 77) have an identified priority R&D gap or need, including for new diagnostic products, vaccines or medicines.

4. Cancer is now in scope

Cancer incidence continues to rise in low- and middle-income countries. These countries shoulder a considerable proportion of the global cancer burden, and are increasingly prioritising cancer care in national healthcare plans. In 2018, the Index will assess companies’ actions to improve access to cancer control for the first time. Cancers that place a high burden on public health will be analysed in R&D, while cancer medicines on the latest WHO Model List of Essential Medicines (2017) qualify for analyses of pricing, patenting and donations practices.

5. Closer analysis of behaviours that facilitate access to medicine

The Access to Medicine Index measures four aspects of pharmaceutical company behaviour – transparency, commitment, performance and innovation (referred to as Strategic Pillars). Their relative importance varies depending on the action in question, whether it is negotiating voluntary licenses, marketing activities or capacity building initiatives, for example. For the first time, this variation has been captured in the Index’s analytical framework.

6. New metrics for capturing the quality and impact of access initiatives

In 2018, the Index will take a deeper look at the quality of companies’ capacity building initiatives, by comparing a selection against a framework of good practice standards developed by the Index research team. The Index will also deepen its analysis of where and how companies monitor and measure the impact of their access-to-medicine activities.

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.

For the 2016 Index, the methodology review started with a series of indicator-level tests carried out by the Index research team to pinpoint risks of redundancy, where scoring guidelines could be tightened for 2016, and where data quality could be enhanced. The outcomes were used to inform methodology proposals that were also closely informed by stakeholder views. Strategic guidance was provided by the Expert Review Committee (ERC) for the 2016 Access to Medicine Index Methodology Report, an independent body of experts from, among others, the WHO, governments, patient organisations, the industry, academia and investors.

Learn more about the Methodology for the 2018 Access to Medicine Index.

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