Global report exposes gaps in access to essential medicines in developing countries

The 2026 Access to Medicine Index, published by the Access to Medicine Foundation, finds that although pharmaceutical companies are increasingly incorporating access considerations into product development, significant barriers related to affordability, availability and healthcare delivery continue to prevent patients from accessing essential treatments.

The report notes that access plans now cover 69 per cent of late-stage pharmaceutical pipeline candidates, more than three times the proportion recorded in 2018, indicating growing recognition of the need to address access challenges before medicines reach the market.

However, progress remains uneven, particularly in the treatment of non-communicable diseases, with 43 per cent of access plans for such products focusing solely on regulatory registration rather than addressing wider barriers that determine whether patients can obtain treatment.

Cancer medicines account for approximately half of all clinical candidates in pharmaceutical research and development, reflecting the growing focus on oncology.

While access strategies now cover 65 per cent of oncology pipeline candidates, the report identifies significant geographical disparities, with strategies targeting 74 per cent of assessed cancer products in lower-middle-income countries compared with only 19 per cent in low-income countries.

It also highlights the need to address barriers beyond the availability of medicines, including screening, early diagnosis, treatment affordability and inadequate healthcare infrastructure.

On diabetes, the report identifies 25 research and development projects across six pharmaceutical companies, with innovation largely concentrated on glucagon-like peptide-1 (GLP-1) medicines.

However, access to newer diabetes treatments remains limited in low- and middle-income countries, while insulin, despite being a long-established treatment, remains inaccessible to many patients.

Pharmaceutical companies Lilly, Novo Nordisk and Sanofi have taken steps to expand insulin access, but the report says significant gaps persist, particularly in lower-income countries.

The assessment also found that six pharmaceutical companies now operate multi-country inclusive business models designed to reach underserved populations, up from five in the 2024 Index.

Collectively, the models cover all 113 low- and middle-income countries assessed, although limited reporting on individual products and countries makes it difficult to establish their actual impact on patient access.

The foundation called on pharmaceutical companies to strengthen partnerships with local healthcare providers and organisations, develop sustainable business models and improve reporting on the number of patients benefiting from their access programmes.

Access to Medicine Foundation Chief Executive Officer Jayasree K. Iyer said the industry had made considerable progress over the past two decades but needed to extend its efforts to more patients.

“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.

The report identifies funding constraints, geopolitical instability and increasing healthcare needs as some of the pressures affecting the global health system, warning that persistent inequalities could leave vulnerable populations further behind.

Access to Medicine Foundation Director of Research Claudia Martínez said progress was still concentrated among a limited number of pharmaceutical companies, products and disease areas.

“The 2026 Index shows some important shifts in how companies are approaching access. We’re seeing more sustainable models for reaching patients, important product approvals, promising innovations in the pipeline and new licensing agreements. But these efforts are still concentrated among too few companies, products and diseases. The challenge now is to take what works further and faster, and see these approaches adopted much more widely across the industry,” Martínez said.

In its assessment of 20 years of changes in the pharmaceutical industry, the Index found that access to medicine has increasingly moved from the margins of corporate operations to become a more integral part of business strategies.

Novartis retained the top position in the 2026 Index for the second time, leading across all three technical areas: Governance of Access, Research and Development, and Product Delivery.

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

The foundation said the 2026 assessment places greater emphasis on implementation and measurable outcomes, with fewer indicators designed to better distinguish between companies' commitments and their actual progress.

It urged pharmaceutical companies and other global health stakeholders to build on existing progress by ensuring that medical innovation translates into affordable and sustainable access to treatment, particularly in countries with limited healthcare resources.