Poor countries desperately need better access to generic medicines

The writer is chief executive of the Access to Medicine Foundation

The Covid-19 pandemic underscored the urgent need for equitable access to medicine. But when it comes to expanding access, the pivotal role of the world’s generic medicine manufacturers often slips under the radar. This is despite the fact that the global market was worth $311.8bn in 2022, and is projected to hit $442.3bn by 2027.

It is often assumed that generic drugs are affordable and widely available to those who need them. But this is not entirely true. For example, even after patent expiries open the door to generic rivals, low levels of competition between companies in smaller markets means that generics can actually be more expensive in poor countries than in wealthy ones.

Many essential generic medicines are also often absent from pharmacy shelves in poorer countries, particularly in rural and remote areas — frequently with devastating results.

Today, generics are a cornerstone of health systems. Ninety per cent of the medicines included on the World Health Organization’s Model List of Essential Medicines are off-patent, meaning companies can make their own versions of these key products.

The huge footprint of the sector gives it a correspondingly huge importance in addressing the issues that leave millions of people worldwide without access to the treatments they need. Generics companies must now make a conscious effort to address global health challenges and realise their potential as key players in access to medicine.

We know this is possible, because generics companies are already experts at delivering lower-cost treatments at scale, and have stepped up previously to address urgent issues. Early in the Covid pandemic, for example, manufacturers leveraged their production capacity to respond rapidly, ensuring that many existing medicines remained available despite global supply chain disruptions.

Such efforts undoubtedly saved many lives — but they remain exceptional. To remedy this, the Access to Medicine Foundation has developed a new analytical framework to guide generic medicine manufacturers in converting exceptions into the rule. Initially, the framework will be used to assess the efforts of five companies: Cipla, Hikma, Sun Pharma, Teva and Viatris.

We are at an important moment in the generics industry’s development, as there are many opportunities for companies to seize, from working with local manufacturers to improve supply in low- and middle-income countries, to investing in adaptive research and development.

There are also more opportunities to engage in licensing agreements, through which the big pharmaceutical groups allow generics companies to launch versions of their on-patent medicines. With Big Pharma increasingly issuing these licences, including the first covering a cancer drug, generics companies have both a business opportunity and a chance to expand patients’ access to innovative medicines.

There are further opportunities in the market for biosimilars — copies of biological drugs — with their global market value projected to rise to $60.8bn in 2027. Biosimilar medicines first arrived on the scene over a decade ago, but the market has recently gained momentum with the expiry of patents on blockbuster biological drugs and with the WHO’s expansion of its prequalification assessment scheme to include a number of biosimilars. Although these drugs have yet to make significant inroads in low and middle-income countries compared with high-income ones, they offer great potential if access barriers can be broken down.

Generic medicine manufacturers have a central role to play in expanding access to medicine. Now is the time for them to explore the opportunities that will ensure people around the world gain access to the medicines they need.