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Improving Access to Cancer Care a First Analysis of Pharmaceutical Company Actions in Low- and Middle-Income Countries

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Improving Access to Cancer Care a First Analysis of Pharmaceutical Company Actions in Low- and Middle-Income Countries Improving access to cancer care A first analysis of pharmaceutical company actions in low- and middle-income countries Companies are addressing access to cancer care – can efforts be channelled to where they will have most impact? Pharmaceutical companies are addressing access to cancer Treatment is only one element of cancer care, which also care in developing countries: 16 of the world’s largest pharma- comprises, for example, prevention, diagnosis and palliative ceutical companies are engaged in 129 diverse access initia- care. Although the 16 companies together address most ele- tives in low- and middle-income countries. The largest pro- ments in some form, in some countries, efforts are not evenly portion (55%) are related to building local capacity, followed spread, varying by cancer and country/region. by pricing actions on specific products. There is large variety Health systems in lower income countries need strengthen- in the scope, breadth, location and scale of the initiatives, as ing in order to support and sustain cancer care. Governments well as in the cancers being addressed. Impact per initiative is shoulder the main responsibility in this regard. rarely disclosed, and warrants structured monitoring and Pharmaceutical companies share an opportunity to address evaluation. all elements of cancer care, through tailored multi-sector partnerships that take a systems-level approach to making lasting improvements. Karin P Q Oomen Access to Medicine Foundation 22 MAY 2017 Lead Researcher Naritaweg 227A 1043 CB Amsterdam Suvi Karuranga The Netherlands Researcher [email protected] Jayasree K. Iyer +31 (0) 20 21 53 535 Executive Director www.accesstomedicinefoundation.org Landscape study | Access to cancer care ACKNOWLEDGEMENTS The Foundation is grateful to Dr. Ben Anderson of the Fred Hutchinson Center (Seattle, USA), and to Julie Torode Deputy CEO and Director of Advocacy and Networks for the Union for International Cancer Control (Geneva, Switzerland) for their thoughtful review of an earlier draft of this study. This acknowledgment is not intended to imply that the individuals mentioned endorse conclusions or recommendations made in the published paper. Decisions regarding the inclusion of feedback were made by the Access to Medicine Foundation. ACCESS TO MEDICINE FOUNDATION The Access to Medicine Foundation is a non-profit organisation. It aims to advance access to medicine in low- and middle-income countries by stimulating and guiding the pharmaceutical industry to play a greater role in improving access to medicine. For ten years, the Foundation has been building consensus on the role for the pharmaceutical industry in improving access to medicine and vaccines. It published its first bench- mark of industry activity in this area in 2008, in the first Access to Medi- cine Index. The fifth Access to Medicine Index was published in 2016. In 2017, the Foundation published the first Access to Vaccines Index. ADDRESS Naritaweg 227 A NL-1043 CB Amsterdam The Netherlands CONTACT On behalf of the Access to Medicine Foundation, please contact Jayasree K. Iyer, Executive Director E [email protected] T +31 (0)20 21 53 535 W www.accesstomedicinefoundation.org FUNDERS The Access to Medicine Foundation is funded by UK AID, the Bill & Melinda Gates Foundation and the Dutch Ministry of Foreign Affairs. Access to Medicine Foundation Improving access to cancer care A first analysis of pharmaceutical company actions in low- and middle-income countries ACCESS TO MEDICINE FOUNDATION 22 May 2017 Landscape study | Access to cancer care Table of contents 7 EXECUTIVE SUMMARY 10 Main findings 12 INTRODUCTION 14 Methods and limitations 15 LANDSCAPE ANALYSIS How are pharma companies addressing access to cancer care? 25 ONCOLOGY PORTFOLIOS AND ACCESS INITIATIVES 26 Companies’ oncology footprints 16 companies have 171 cancer medicines 27 Which companies have the largest oncology portfolios, including products on the EML? 38 Pricing initiatives Patient assistance/support programmes account for highest proportion of pricing actions 39 Pricing initiatives by company 49 Discussion: where are pricing initiatives heading? 52 Intellectual Property Policies Twelve companies disclose current IP policies; 2 companies discussing licensing of oncology products 52 Intellectual Property Policies per company 54 Discussion: IP management of cancer products 55 Capacity building initiatives Companies engage in wide variety of capacity building initiatives 57 Product-linked capacity building initiatives by company 60 General capacity building initiatives by company 74 mHealth/eHealth initiatives 76 Funding for initiatives 80 Discussion: Capacity building initiatives are diverse; most relate to health system strengthening 85 APPENDICES 86 Scopes of analysis 89 References 90 List of figures 4 Access to Medicine Foundation About this study Cancer is one of the greatest health challenges of our time, FINDINGS: 16 COMPANIES, 129 ACCESS INITIATIVES and a leading cause of death in every corner of the world. Currently, around 65% of all cancer deaths occur in develop- The findings of this study are presented in five main sections: ing countries. Governments bear the greatest responsibility for improving access to cancer care. Pharmaceutical compa- Landscape analysis nies have a unique role to play. Analysis of where companies are focusing their access efforts for cancer care, looking at location, cancer type, access focus The first landscape of company activities on cancer care (IP, pricing or capacity building) and activity (e.g., aware- This study is the first assessment of whether and how large ness-raising, diagnosis, treatment). pharmaceutical companies are improving access to cancer care in low- and middle-income countries (LMCs). It reports Companies’ oncology footprints on the actions of 16 of the world’s largest research-based Overview of each company’s therapeutic focus, sales and pharmaceutical companies. It analyses data collected by the oncology products, including products that are on the WHO Access to Medicine Foundation, directly from the companies Model Essential Medicines List 2015. measured and extensively supplemented through publically available information. Oncology pricing – 36 access initiatives Discussion of 36 separate initiatives that each address the The Access to Medicine Foundation has found that 16 compa- price of one or more cancer medicines in at least one coun- nies are taking some action to improve access to cancer med- try in scope. icine, implementing 129 initiatives. There is large variety in the reported initiatives, as well as in the cancers being addressed. Intellectual Property Policies – 12 companies publish IP policies Discussion of the IP policies of the companies in scope toward patent rights in poor countries. Capacity building – 71 initiatives Discussion of how each company approaches capacity build- ing, plus 21 other initiatives for health system strengthening: • Initiatives linked to specific products • General capacity building • e-Health or m-Health initiatives • Funding for initiatives 5 Landscape study | Access to cancer care 6 Access to Medicine Foundation Executive Summary Cancer is one of the greatest health challenges of our time, This landscape study is the first assessment of whether and and a leading cause of death in every corner of the world. how large pharmaceutical companies are improving access to World Health Organisation (WHO) estimates that the number cancer care in low- and middle-income countries (referred to of people dying from cancer globally will increase by 45%, to here as LMCs). It reports on the actions of 16 of the world’s 11.5 million, by 2030. Currently, around 65% of cancer deaths largest research-based pharmaceutical companies. occur in developing countries, where cancer rates are also rising. Typically, the infrastructure and resources needed to 16 companies; 129 access initiatives ensure access to cancer care in poorer countries are limited, The Access to Medicine Foundation has found that 16 of the despite the majority having national cancer control plans. world’s largest pharmaceutical companies are taking some action to improve access to cancer care, implementing a Treatment is only one element of cancer care. It also includes diverse range of 129 initiatives. These involve pricing, capac- prevention, diagnosis and palliative care. National govern- ity building and other activities, such as stakeholder engage- ments shoulder the main responsibility for improving cancer ment. There is large variety in the scope, scale and geographic care. Pharmaceutical companies also have a unique role to focus of the reported initiatives, as well as in the cancers play. They have the ability and opportunity to improve the being addressed. accessibility and affordability of products, to meet the specific needs of people with cancer in developing countries. Such Where cancer type is specified, female cancers, haemato- companies also have valuable expertise for supporting the logical cancers and colorectal cancer gain most attention, development of resilient health systems for cancer care. with more initiatives aimed at breast cancer (42 initiatives) and cervical cancer (27) than other cancer types. The high- est numbers of initiatives are found in Kenya, China, India, Indonesia and the Philippines. This perhaps in part reflects Figure 1. By the numbers: pharma company activity to the presence of more developed healthcare systems and net- address access to
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