Swiss drugmakers among few still investing in medicines for poorer countries

Around two billion people lack access to essential medicines, with most living in low- and middle-income countries, according to the World Health Organization. For many, paying for treatment means paying directly: up to 90% of people in these countries buy medicines out of pocket.

The Access to Medicine Foundation’s latest index finds that the issue has moved closer to the centre of pharmaceutical business planning. Its tenth edition, published on November 12, assesses the world’s 20 largest drugmakers. The report says 68% of late-stage drug candidates now have an access plan, more than triple the share in 2018.

Swiss companies stand out in the ranking. Novartis took first place for the second consecutive edition, while Roche climbed to sixth. The wider industry picture is less settled. The report says progress has plateaued as companies struggle to turn plans into measurable improvements for patients. Geopolitical tensions and shrinking international aid budgets add pressure to efforts to develop and deliver treatments in poorer markets.

Novartis ranks first, backed by access plans for nearly all its drug candidates in late-stage clinical trials. The Basel-based company has also set measurable targets for the number of patients its products should reach, according to the Access to Medicine Index.

Roche, also based in Basel, rose from 11th place in 2024 to sixth in the latest ranking, sharing the position with Boehringer Ingelheim. The report credits Roche’s work to expand access to cancer medicines and its clinical trials in sub-Saharan Africa.

The results place the two Swiss companies among a small group of large pharmaceutical firms still making access to poorer markets part of their business activity. Across the industry, access planning has become more common in research and development and supply planning. The index records access plans for 68% of late-stage candidates, more than three times the proportion in 2018. For the foundation, that shift marks a change from treating access as a side effort to incorporating it into corporate decisions. The next measure is whether those plans reach patients in practice.

The industry’s progress has plateaued, the index says, as companies move slowly from access plans on paper to implementation and measurable gains in patient access. Jayasree Iyer, chief executive of the Access to Medicine Foundation, says geopolitical pressures are making that transition harder.

Nationalist policies encourage companies to focus on their home markets, while steep cuts to international aid threaten funding for research into neglected diseases and for the infrastructure needed to distribute life-saving treatments. Those pressures affect more than research: medicines also depend on health systems able to deliver and administer them.

Iyer told Swissinfo that the number of drug candidates has fallen significantly in recent years, despite expectations that large pharmaceutical pipelines would support investment in priority diseases. “This should be the industry’s wake-up call to ask if we are actually designing the right drugs that the world actually needs,” she said. The index’s findings put the challenge to companies plainly: access strategies need to translate into products and delivery that reach patients beyond wealthy markets.

Projects for neglected tropical diseases have dropped to one-third of their 2018 peak, with dengue among the diseases cited by the index. The decline comes as aid cuts threaten research funding and the systems that move treatments to patients. Iyer said the overall number of drug candidates has also fallen significantly in recent years.

For Switzerland, the index’s rankings highlight the role of Novartis and Roche in an industry where investment in access remains uneven. Novartis has set patient-reach targets and access plans across nearly all late-stage candidates. Roche’s improved standing reflects efforts around cancer medicines and clinical trials in sub-Saharan Africa.

The foundation’s broader assessment is that access has gained a place in boardrooms and business plans, but implementation remains the test. That matters in countries where patients often pay directly for medicines and where health systems may lack the capacity to administer new treatments. The report’s findings connect drug development, affordability and delivery: progress depends on companies continuing to design for priority diseases and plan for access beyond wealthy markets.