Half of the world’s population lacks access to essential health services. Therefore, we are striving to innovate, make health solutions affordable and accessible, raise awareness about diseases, and help people learn how to manage them. We work with partners to tackle these complex challenges.
Our approach to improving health for all
Our overarching aim is to create a healthier future for all. We are committed to advancing global health and to using our scientific and technological innovation to improve the health of underserved populations in low- and middle-income countries.
Our Global Health strategy aims to develop and provide access to health solutions in low-and middle-income countries by creating equitable and sustainable access mechanisms for patients and society. Besides enabling access to our healthcare portfolio, our strategy focuses on diseases that disproportionally impact underserved populations. These include the neglected tropical disease (NTD) schistosomiasis, which is largely unknown in industrialized nations and attracts little attention or funding, and malaria. Specifically, the goals of this strategy are:
- To expand access to our healthcare portfolio of products and technologies to patients in low- and middle-income countries.
- To eliminate schistosomiasis as a public health problem.
- To catalyze innovative solutions for global health challenges, primarily targeting schistosomiasis and malaria. We strive to particularly reach those who are most vulnerable: women and children.
Three core operating principles drive the execution of our Global Health strategy:
- Creating sustainable business models and opportunities: We strive to increase our company’s value and competitiveness by solving unmet health needs of underserved populations with our products and technologies.
- Engaging with cross-sector partners: We participate in multi-stakeholder global health platforms to help achieve our goals and support the United Nations (UN) Sustainable Development Goals. We use access alliances and create partnerships to implement treatment programs on the ground and for research and development projects.
- Developing innovative solutions: We develop new medicines, diagnostics and vector control solutions for schistosomiasis and malaria through our integrated science and technology approach.
We also engage in building capacity and expertise across the value chain to strengthen health systems and make them more resilient to health crises.
Our Access to Medicine approach
Our access strategy for low- and middle-income countries is a core part of our broader sustainability strategy. In these countries, we aim to accelerate and expand access to our portfolio of products, for example for cancer indications and neurological as well as immunological disorders.
Our strategy is also designed to help reduce launch delays by taking low- and middle-income countries into special consideration in our integrated development plans. With this approach, we also aim
- to ensure wider availability by registering our products across a greater number of countries, particularly those with a high disease burden;
- to improve affordability (further details can be found under Prices of Medicines);
- to extend faster accessibility of our medicines through global health partnerships and shared value initiatives that address health system barriers to access.
Eliminating schistosomiasis as a public health problem
Schistosomiasis, also known as bilharzia, is a tropical disease caused by parasitic worms. The disease affects almost 240 million people worldwide and kills an estimated 200,000 people every year. More than 90% of cases are in sub-Saharan Africa, significantly burdening public health systems and local economies.
The ultimate aim of our schistosomiasis-related work is to eliminate the disease as a public health problem in line with the World Health Organization (WHO) NTD Roadmap 2021-2030. We are committed to the objectives of the Kigali Declaration on NTDs, in which participating companies, governments and private organizations commit to helping control and ultimately eliminating the 20 most prevalent NTDs, including schistosomiasis.
To achieve the elimination of schistosomiasis, we have adopted an integrated strategy, which we are implementing in close collaboration with multiple partners worldwide. The approach focuses on four pillars:
- Treatment: We donate up to 250 million tablets of praziquantel to endemic countries every year in partnership with WHO. Nearly 50 years after its development, praziquantel remains the standard of care for the effective treatment of schistosomiasis around the world.
- Research and Development (R&D): We advance R&D to support the global fight against schistosomiasis. In particular, we drive collaborative programs for a next generation of drugs, for the development of arpraziquantel, a potential new treatment option for children aged six and under, and for new and more sensitive diagnostics. We are also building research expertise and capacity through our collaborations with institutions in endemic countries.
- Health education & WASH (water, sanitation and hygiene): We believe prevention is the most effective health intervention. Therefore, we invest in behavior change initiatives to raise awareness of the causes and dangers of schistosomiasis and teach people how to prevent it. Since the disease is transmitted through contaminated water, we also support WASH projects that aim to prevent transmission of the disease by providing sanitary infrastructures and access to clean water.
- Advocacy and partnerships: We are accelerating the progress towards schistosomiasis elimination through partnerships as well as through the dialogue with the wider stakeholder community, for example via the Global Schistosomiasis Alliance (GSA).
Preventing and fighting malaria to support elimination
According to WHO’s estimates, nearly half of the world’s population is at risk of contracting malaria. In 2020, more than 200 million cases of malaria and over 600,000 related deaths were recorded, with about 80% occurring in children under the age of five. 95% of cases and 96% of deaths occur in Africa. The numbers continue to increase as the focus in many endemic countries has shifted to controlling the Covid-19 pandemic.
There is a need for new products to overcome the problem of increasing drug resistance and to achieve the goal of elimination. Through our As One Against Malaria program, we help to deliver integrated and sustainable health solutions involving treatments, diagnostics and preventive measures to fight malaria.
Roles and responsibilities
Our Global Health organization is responsible for Group-wide initiatives, programs and sponsorships. It embeds initiatives to strengthen capacity in low- and middle-income countries. Our experts collaborate closely with the Life Science, Healthcare and Electronics business sectors to leverage our common strengths and competencies. Our Global Health organization also facilitates access to health in underserved populations and leads the implementation of our strategy to eliminate schistosomiasis as well as the development of innovative solutions for infectious diseases including malaria.
Our Access to Health unit enables access to our company’s healthcare portfolio in low- and middle-income countries through a strategic access approach and shared value initiatives that we implement in collaboration with our global and country teams.
Our Schistosomiasis Elimination Program implements our efforts to eliminate schistosomiasis in close collaboration with external partners, such as WHO.
Our Global Health Institute catalyzes innovations for global health challenges by translating science, technology and digital approaches into transformative, integrated health solutions (treatments, diagnostics, technologies, preventive measures) to support control and elimination programs related to infectious diseases – mainly schistosomiasis and malaria.
Our commitment: Providing a solid basis for access to health
Our commitment to expanding health access is summarized in our Access to Health Charter. It sets out the following guidelines on:
- Our approach
- Pharmaceutical product donations and philanthropic activities
- Falsified medicines
- R&D for infectious diseases
- Equitable pricing in low- and middle-income countries
- Intellectual property rights
- Sustainable supply chains
Every two years, the Access to Medicine Foundation publishes the Access to Medicine Index. The Index benchmarks 20 of the world’s largest research-based pharmaceutical companies on activities and initiatives that experts consider most relevant for access to medicine in low- and middle-income countries. These initiatives range from research & development and intellectual property sharing to capacity building and donations. We use the results of this benchmarking to inform and guide our access to health strategy.
The latest Index was published in November 2022. We ranked fifth, moving up from the eighth position in the 2020/2021 ranking. Our ranking is mainly attributable to our strong performance in the areas of research and development, intellectual property and capacity building.
Sustainable access to medicines in low- and middle-income countries
We apply access models in global health, which include donations (e.g. praziquantel), and work with partners to explore new models such as at cost procurement mechanisms for upcoming innovations for NTDs (e.g. arpraziquantel, rapid diagnostic tests).
To prevent and control high-burden, non-communicable diseases (NCDs), we significantly invest in access initiatives that address health system gaps in low- and middle-income countries. We adopt a partnership approach to maximize our impact in this complex and challenging environment.
This includes our shared value program, which supports our teams in low- and middle-income countries in implementing initiatives to address health systems barriers to patient access through capacity building and training for healthcare professionals. For example, in the context of the shared value program, the team in Argentina carried out a series of activities to raise awareness about the importance of early detection of head and neck cancer, reaching 4.6 million people across the country. To date, our shared value initiatives have reached 28 million patients via screening and awareness and trained around 15,000 healthcare professionals.
Our collaborations in Africa to establish robust and sustainable supply chains are also crucial for ensuring safe, effective and continuous healthcare delivery. Our Access Mentorship program, where expert volunteers from our Global Supply Network Organization share knowledge with local African distributors, demonstrates our commitment to improving supply chain operations and increasing access to healthcare.
In 2022, we also initiated the Access to Health pitch competition to engage with start-ups in Indonesia, Vietnam and the Philippines. This initiative aims to identify innovative solutions that address health system gaps and make our products more accessible to underserved populations.
We have also developed an evaluation tool to track the impact of our access programs on patients, healthcare providers and health systems. This tool will enable us to monitor our progress over time and to continue integrating recommendations from the Access to Medicine Index into our strategy.
Eliminating schistosomiasis: Four pillars
To support the elimination of schistosomiasis, we have adopted an integrated approach based on four pillars: treatment, research & development, health education & WASH, and advocacy & partnerships.
Treatment
As part of our long-standing partnership with WHO, we are committed to producing and donating up to 250 million praziquantel tablets every year. This initiative is a major part of our integrated and coordinated approach to treating and eliminating schistosomiasis as a public health problem. Since 2007, we have donated 1.7 billion tablets to WHO to combat this disease. They have been distributed in 47 endemic African countries, primarily to treat school-aged children. In 2022, we donated more than 200 milliontablets for distribution in 27 countries, 24 of which are in sub-Saharan Africa. Due to Covid-19, demand and implementation at country level was severely impacted.
Countries that have received donations of praziquantel tablets
To improve transparency of the supply chain for NTD medicine donations, including praziquantel, we use NTDeliver, a digital tool. We work with multiple partners to optimize efficiencies and timelines from the manufacturing site to the national warehouse, and from there to the delivery of treatments. In Kenya, a tailored tracking system has been implemented to capture real-time data up to the distribution level, reporting the number of tablets used and any remaining stock. In 2022, this digital last-mile tracking system was rolled out in six Kenyan counties.
Research and development
In partnership with the Pediatric Praziquantel Consortium, we have developed a potential new treatment option, arpraziquantel, for preschool children aged six and below who are infected with schistosomiasis. The clinical development program was completed with positive results from the pivotal Phase III trial performed in Côte d’Ivoire and Kenya. In November 2022, we submitted the regulatory application to the European Medicines Agency (EMA), which started its review process. A scientific opinion from EMA is expected in late 2023. This will facilitate WHO pre-qualification and local registrations in African countries. We plan to start the launch phase in 2024 and to provide the drug through a new procurement mechanism currently under development to ensure equitable and affordable access to this new treatment option. Furthermore, the ongoing ADOPT implementation research program is collecting data and best practices that will pave the way for future large-scale delivery in endemic countries.
In 2022, we also progressed with the development of new drugs to prevent and cure schistosomiasis. A promising candidate is currently in pre-clinical development.
To support drug discovery, we have introduced innovative artificial intelligence and epidemiology modeling for targeted treatments and started to develop new medical device technologies to diagnose schistosomiasis, including female genital schistosomiasis.
In this context, there is still a critical need for more sensitive diagnostics to detect cases in low-endemicity settings for the effective management and surveillance of schistosomiasis and as tools to eliminate the disease. Therefore, we continued our collaboration with the Foundation for Innovative New Diagnostics (FIND) and a consortium of partners to develop a sensitive rapid diagnostic test to improve schistosomiasis mapping and case detection.
All our research & development programs integrate and invest in scientific, educational and training initiatives to enhance expertise and capacity in low- and middle-income countries. More information can be found under Building health capacity and awareness.
Health education and WASH
Our health education project with the NALA (Neglected Tropical Disease Advocacy, Learning, Action) Foundation focuses on southwestern Ethiopia. It includes WASH activities and aims to promote long-term sustainable behavioral change via a community-based approach to eliminate schistosomiasis and other neglected tropical diseases. In 2022, we launched two research projects to serve as proof of concept: community-based schistosomiasis snail mapping, and operational research. This research compares two districts to evaluate the effectiveness of behavioral change in combination with mass drug administration versus mass drug administration alone. Results are expected in 2023.
Despite the challenges, including the Covid-19 pandemic, security issues and political instability, the NALA Foundation was able to continue the implementation of school-, community- and WASH-based interventions. An impact evaluation in two of the target districts showed a meaningful decrease in the prevalence of schistosomiasis since the start of the program in 2017.
In Ghana, we implemented our collaborative access to water program to improve WASH in communities, including schools and healthcare facilities, to combat waterborne infectious diseases such as schistosomiasis. We also trained health workers in schistosomiasis case management. Performed in partnership with World Vision, the program includes an implementation research study that analyzes WASH in healthcare facilities and water quality in selected districts. The results show that only 17% of the healthcare facilities have access to improved water supply within the premises; to address this challenge, we are partnering to provide WASH to 15 institutions by July 2023, with an estimated outreach of about 24,000 people.
More information can be found under Building health capacity and awareness.
Advocacy and partnerships
We work with international and local partners to advance schistosomiasis control and elimination. We continue to support the Global Schistosomiasis Alliance (GSA), a coordinated, multi-sectoral effort to combat the complex disease. The role of the GSA as central platform in all matters concerning schistosomiasis has been considerably strengthened over the past few years. In 2022, the GSA developed a new four-year strategy, which lays out the agenda for the global schistosomiasis community on the road to elimination.
Malaria: Treatment and prevention
Developing new therapeutic solutions
As part of our “As One Against Malaria” program, we are developing a new drug (M5717) with the potential to be a promising treatment and preventive option for malaria due to its activity in several different stages of the parasite’s life cycle. The drug has successfully completed two clinical Phase I studies as a single agent for cure and prevention, and we published the results in peer-reviewed scientific journals (e.g. The Lancet Infectious Diseases). In 2022, we joined the PAMAfrica Consortium and are preparing for the start of the clinical Phase II study as a combination therapy for cure in 2023. In addition, a clinical Phase II trial for prevention is being prepared through a new partnership. Preclinical research and new technologies, including a new 3D culture-based hepatic platform used to investigate the activity of our drug candidate, have supported the clinical development program.
Preventing and controlling malaria transmission
Preventive methods such as insect repellents are part of the strategic toolkit to combat malaria. We are testing our insect repellent IR3535® for potential use in malaria. IR3535@ is already used for protection against insect and tick bites that can transmit diseases such as Lyme disease, Zika, dengue fever, and chikungunya.
The laboratory tests conducted in Ghana evaluated the efficacy of a new formulation of IR3535® for longer-lasting protection. Based on the positive results, an additional test is being carried out in communities to determine how IR3535® performs in real-life settings. The study aims to confirm that this insect repellent is a safe and efficacious solution to prevent malaria in all populations, including pregnant women and babies.
In partnership with local institutions in Africa, we have established PAVON (Pan-African Vivax and Ovale Network), a network of centers of excellence for the epidemiological surveillance and scientific research on malaria. Across more than ten African countries, PAVON supports policy making and offers training to African scientists.
Engaging stakeholders
Partnerships and dialogue are critical to addressing global health challenges and improving access to healthcare. Our partners include multinational organizations, government agencies and NGOs, as well as academic institutions, health industry associations, private companies, and independent global health experts.
In 2022, we continued to engage with our partners and key stakeholders, including WHO, to advance global health discussions and address shared challenges, including neglected tropical diseases. We collaborate with partners such as the END Fund, WIPO and DNDi, as well as with academia in African countries. We engage in consortia of partners, such as the Pediatric Praziquantel Consortium, alliances, like the Swiss Malaria Group, and advocacy groups, including the Uniting to Combat NTDs and GSA. In addition, we work closely with foundations that support scientific research and health access, including the Bill & Melinda Gates Foundation and the Access to Medicine Foundation. We have also joined forces with funders, including the Global Health Innovative Technology Fund (GHIT) and the European and Developing Countries Clinical Trials Partnership (EDCTP).
We also strengthen our collaborations with the scientific community through publications, patent sharing and by taking active roles at international events. For example, in 2022, we organized a panel discussion with experts on schistosomiasis at the Geneva Health Forum (GHF). In 2022, our CEO Healthcare represented our company at the Gates CEO Roundtable that discussed the strategy to expand access to medicines in low- and middle-income countries. On several occasions, we presented the progress of the Pediatric Praziquantel Consortium program that we lead, including at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), the Global Health EDCTP3 Launch Event, and the International Symposium on schistosomiasis. We also attended the Annual NTD NGO Network and the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) to address the spread of misinformation about NTDs.