Millions Still Struggle to Access Essential Medicines Despite Pharmaceutical Industry Progress

Millions of people in low- and middle-income countries continue to struggle to obtain essential medicines, despite growing efforts by pharmaceutical companies to improve access to healthcare products, a new report has revealed.

The 2026 Access to Medicine Index, published by the Access to Medicine Foundation, shows that although drug manufacturers are increasingly considering medicine accessibility during research and product development, major gaps remain in affordability, availability and distribution.

The report assesses 20 pharmaceutical companies and finds that access plans now cover 69 per cent of medicines in late-stage development, representing more than three times the proportion recorded in 2018.

However, the Foundation warns that these commitments have yet to translate into widespread access, particularly for patients suffering from non-communicable diseases such as cancer and diabetes.

Novartis maintained its leading position in the latest rankings for the second consecutive time, followed by GSK in second place. Both companies ranked first and second respectively across the three areas assessed: Governance of Access, Research and Development, and Product Delivery.

AstraZeneca came third, followed by Sanofi in fourth position and Bayer in fifth. Boehringer Ingelheim and Roche shared sixth place, while Pfizer ranked eighth.

Cancer and diabetes medicines remain difficult to access

Cancer treatment remains one of the major areas of concern highlighted in the report, with cancer medicines accounting for nearly half of the clinical candidates assessed in pharmaceutical research and development.

Although access plans cover 65 per cent of cancer drug candidates in development, significant inequalities exist between countries.

The report found that access strategies had been developed for 74 per cent of assessed cancer products in lower-middle-income countries, compared with only 19 per cent in low-income countries.

AstraZeneca, Bristol Myers Squibb and Roche were among the companies recognised for initiatives aimed at addressing challenges beyond the availability of medicines, including cancer screening, diagnosis and treatment.

The Foundation says pharmaceutical companies need to strengthen partnerships with existing cancer programmes and treatment centres in resource-limited countries to ensure more patients benefit from medical advances.

Diabetes treatment is another area where access gaps remain significant.

The Index identified 25 diabetes research and development projects across six pharmaceutical companies, with much of the research focusing on GLP-1 medicines, a class of drugs increasingly used in diabetes treatment.

However, access to newer treatments remains limited in many low-income markets. Even insulin, which has been used for decades to manage diabetes, remains expensive or difficult to obtain for many patients.

Eli Lilly, Novo Nordisk and Sanofi have introduced initiatives to expand access to insulin, but the report says more effort is needed to ensure patients can obtain affordable and reliable supplies.

It also cautions that the growing development of newer diabetes medicines and technologies could widen existing healthcare inequalities if access is not prioritised.

Companies urged to strengthen medicine distribution

Beyond research and development, the report highlights efforts by pharmaceutical companies to reach underserved communities through inclusive business models.

Six companies now operate programmes across multiple countries aimed at improving access to medicines in low- and middle-income countries, compared with five recorded in the 2024 Index.

Together, the initiatives cover all 113 countries assessed by the Foundation.

Although most companies report reaching more patients through these programmes, the report notes that limited information at product and country levels makes it difficult to measure their actual impact.

It recommends stronger partnerships with local organisations, improved transparency in reporting and financially sustainable business models that can support long-term access to medicines.

The Foundation further argues that pharmaceutical companies should look beyond securing regulatory approval and address other barriers, including high medicine prices, weak distribution networks and inadequate healthcare infrastructure.

Foundation calls for wider industry commitment

The 2026 Index marks 20 years since the Foundation began monitoring pharmaceutical companies’ efforts to improve access to medicines in countries with limited healthcare resources.

Over the two decades, access considerations have increasingly become part of pharmaceutical companies’ business strategies and product development processes. However, the Foundation says progress remains too slow to meet the needs of millions of underserved people.

The latest assessment also introduces changes to its methodology, placing greater emphasis on implementation and measurable results to distinguish between corporate commitments and actual progress.

Jayasree K. Iyer, Chief Executive Officer of the Access to Medicine Foundation, said the pharmaceutical industry had made important strides in identifying barriers to treatment but needed to extend its efforts to more underserved populations.

“Twenty years of progress have put us in a stronger position than ever to tackle persistent gaps in access. The Index has shown what works, companies have more tools at their disposal and access is increasingly being considered earlier. The opportunity now is to build on that foundation and reach many more people,” Iyer said.

Claudia Martínez, the Foundation’s Director of Research, observed that positive developments in medicine approvals, research and licensing agreements remained concentrated among a relatively small number of pharmaceutical companies and disease areas.

She called on more manufacturers to adopt successful approaches to improving access to treatment.

The findings come at a time when healthcare systems globally are facing increasing pressure from funding shortages, geopolitical instability and growing demand for medical services.

The Foundation concludes that advances in pharmaceutical research must be accompanied by practical measures to make medicines affordable and readily available, particularly in countries where healthcare systems and household incomes remain constrained.