Access to Medicine Index: Can a global scorecard framework promote a system of public accountability across the pharmaceutical sector to support increased access to essential medicines in developing countries? Prepared For: Roxana Bonnell, Open Society Foundations (The following report has been presented to, but does not reflect the views of, the Open Society Foundations. This report was provided for review, however the author assumes full responsibility for any errors noted. Follow up queries related to this report can be directed to [email protected]) Prepared By: Jamie Attard Master of Public Policy Candidate The Sanford School of Public Policy Duke University Faculty Advisor: Dr Anthony So Spring 2013 1 CONTENTS A. EXECUTIVE SUMMARY ............................................................................................................. 5 B. POLICY / RESEARCH QUESTION ............................................................................................ 9 C. BACKGROUND .............................................................................................................................. 9 I. ACCESS TO ESSENTIAL MEDICINES ................................................................................................... 9 II. THE GLOBAL BURDEN OF DISEASE ................................................................................................. 10 III. THE HUMAN RIGHT TO HEALTH ................................................................................................... 11 IV. PHARMACEUTICAL SECTOR RESPONSE TO ACCESS TO ESSENTIAL MEDICINES ........................ 12 V. THE ACCESS TO MEDICINE RESPONSIBILITY OF THE PHARMACEUTICAL SECTOR ..................... 12 VI. CATALYZING INDUSTRY CHANGE THROUGH GOVERNANCE BY TRANSPARENCY ..................... 14 VII. THE ACCESS TO MEDICINE INDEX .............................................................................................. 15 D. RESEARCH METHODOLOGY ................................................................................................. 16 I. ATMI SCOPE AND METHODOLOGY ................................................................................................. 16 II. ATMI FINDINGS .............................................................................................................................. 17 III. ATMI IMPACT ................................................................................................................................ 17 E. ANALYSIS AND FINDINGS ....................................................................................................... 17 I. ATMI IS SHAPING PHARMACEUTICAL PRACTICES, BUT CONTINUED IMPACT IS UNCERTAIN .... 17 II. ATMI IS NOT OPTIMALLY MEETING ITS OBJECTIVE OF PROMOTING MULTI-STAKEHOLDER DIALOGUE ............................................................................................................................................ 19 F. RECOMMENDATIONS ............................................................................................................... 23 I. SIMPLIFYING THE MEASUREMENT FRAMEWORK WOULD ENHANCE STAKEHOLDER UNDERSTANDING ................................................................................................................................. 23 II. STRENGTHENING THE MEASUREMENT FRAMEWORK IN TERMS OF MEASURES, WEIGHTING AND FOCUS WOULD ENHANCE ACCURACY AND COMPLETENESS OF FINDINGS ....................................... 28 III. GREATER TRANSPARENCY WOULD STRENGTHEN THE CREDIBILITY OF RESULTS ................... 31 IV. GREATER DISCLOSURE AND ANALYTICAL TOOLS WOULD MORE EFFECTIVELY INFORM STAKEHOLDERS ................................................................................................................................... 34 V. ADDITIONAL DISTINCT MEASURES WOULD ENHANCE INSIGHT ON ACCESS TO ESSENTIAL MEDICINES BOTTLENECKS.................................................................................................................. 37 2 G. STUDY LIMITATIONS ............................................................................................................... 41 H. AREAS FOR FURTHER STUDY ............................................................................................... 41 I. CONCLUSION ............................................................................................................................... 45 J. APPENDIX ..................................................................................................................................... 46 I. FACTORS LIMITING ACCESS TO ESSENTIAL MEDICINES ................................................................ 46 II. DEFINITION OF TYPE I, II AND III DISEASES ................................................................................. 49 III. ANALYSIS OF GLOBAL BURDEN OF DISEASE STATISTICS ............................................................ 50 IV. INTERNATIONAL HUMAN RIGHTS LEGAL FRAMEWORK ............................................................. 53 V. DALYS (‘000S) BY CAUSE AND INCOME GROUP (3% DISCOUNTING, AGE WEIGHTS) ................ 55 VI. ANALYSIS OF PHARMACEUTICAL INDUSTRY AND SEGMENTS ..................................................... 56 VII. CHANGES IN PHARMACEUTICAL PRACTICES IN PROVIDING ACCESS TO MEDICINE ................ 59 VIII. PHARMACEUTICAL SECTOR ACTIVITIES CONSIDERED IMPORTANT IN ENHANCING ACCESS TO ESSENTIAL MEDICINES ................................................................................................................. 65 IX. ANALYSIS OF ALTERNATIVE INDUSTRY CHANGE APPROACHES ................................................. 71 X. INDUSTRY CHANGE EXAMPLES ..................................................................................................... 74 XI. AGI LEADING PRACTICES ............................................................................................................. 78 XII. ATMI BACKGROUND AND 2010 AND 2012 RESULTS ................................................................... 83 XIII. STUDY DETAILS ........................................................................................................................... 87 XIV. ATMI 2012 MEASUREMENT FRAMEWORK INDICATOR SUMMARY .......................................... 92 XV. TOP DALYS (‘000S) IN LMIC AND LIC (3% DISCOUNTING, AGE WEIGHTS) .......................... 95 XVI. PROJECTED 2030 TOP DALYS (‘000S) IN LMIC AND LIC (3% DISCOUNTING, AGE WEIGHTS) .............................................................................................................................................................. 96 XVII. EVALUATION OF 2012 ATMI INDICATORS FOR COMPLETENESS AND ACCURACY ............... 97 XVIII. EVALUATION OF 2012 ATMI INDICATORS ........................................................................... 101 XIX. COUNT OF MEDIA REPORTS CONTAINING “ACCESS TO MEDICINE INDEX” EXCLUDING SOCIAL MEDIA .................................................................................................................................. 103 XX. COUNT OF MEDIA REPORTS CONTAINING “ACCESS TO MEDICINE INDEX” INCLUDING SOCIAL MEDIA .................................................................................................................................. 104 XXI. INDEXED SHARE PRICE MOVEMENTS OF 2008 ATMI 5 WORST PERFORMERS (6/16/08 RELEASE) ........................................................................................................................................... 105 XXII. INDEXED SHARE PRICE MOVEMENTS OF 2008 ATMI 5 BEST PERFORMERS (6/16/08 RELEASE) ............................................................................................................................................................ 105 3 XXIII. INDEXED SHARE PRICE MOVEMENTS OF 2010 ATMI 3 WORST PERFORMERS AND 2 WORST DECREASES (6/21/10 RELEASE) ......................................................................................................... 106 XXIV. INDEXED SHARE PRICE MOVEMENTS OF 2010 ATMI 3 BEST PERFORMERS AND 2 BEST IMPROVERS (6/21/10 RELEASE) ........................................................................................................ 106 XXV. INDEXED SHARE PRICE MOVEMENTS OF 2012 ATMI 3 WORST PERFORMERS AND 2 WORST DECREASES (11/28/12 RELEASE) ....................................................................................................... 107 XXVI. INDEXED SHARE PRICE MOVEMENTS OF 2012 ATMI 3 BEST PERFORMERS AND 2 BEST IMPROVERS (11/28/12 RELEASE) ...................................................................................................... 107 XXVII. ANALYSIS OF CIVIL SECTOR PUBLIC RECOGNITION OF ATMI RESULTS (AS OF 2/10/13) . 108 XXVIII. ANALYSIS OF PRIVATE SECTOR RECOGNITION OF ATMI RESULTS AND RANKING (AS OF 2/10/13) .............................................................................................................................................. 109 XXIX. INDEXED SHARE PRICE MOVEMENTS OF TOP 4 AND WORST 4 ATMI PERFORMERS SINCE 2008 .................................................................................................................................................... 111 XXX. ANALYSIS OF CHANGES IN COMPANY PERFORMANCE FROM 2010 TO 2012 ....................... 112 XXXI. ANALYSIS OF DIFFERENT BENCHMARKING APPROACHES OF THE PHARMACEUTICAL SECTOR .............................................................................................................................................. 121 XXXII. PHARMACEUTICAL INDUSTRY LOBBYING PROFILE, 2012 .................................................