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 equity
Our overarching objective is to drive health equity. We are committed to advancing global health and to using our scientific and technological innovations 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 innovations and products to patients in low- and middle-income countries.
- Drive the elimination of schistosomiasis as a public health problem.
- Catalyze innovative solutions for global health challenges, primarily targeting schistosomiasis and malaria. In particular, we strive to reach those who are most vulnerable, namely women and children.
Three core operating principles drive the execution of our Global Health strategy:
- Pioneering solutions: We develop new medicines and support the development of diagnostics for schistosomiasis as well as new treatment options and vector control solutions for malaria through our integrated science and technology approach.
- Engaging with cross-sector partners: We participate in multi-stakeholder global health platforms to amplify the impact and shape the progress of the United Nations (UN) Sustainable Development Goals. We join access alliances and create partnerships to implement our programs.
- Creating sustainable business models and opportunities: We strive to increase our company’s competitiveness and value while delivering long-term benefits to society by reaching underserved populations with our products and technologies.
We also engage in building capacity and expertise across the value chain to strengthen health systems in low- and middle-income countries.
Our Access to Medicine approach
We strive to make health solutions available, affordable and accessible to all. As part of our sustainability strategy, we are implementing our access strategy for low- and middle-income countries. This will help us fulfill our ambition of serving a total of 170 million patients annually across these countries by 2030. In 2023, we reached around 140 million patients.
Our strategy comprises two important aspects. First, we aim to accelerate and expand access to more than 80 million patients by 2030 with our healthcare innovations and portfolio of products for non-communicable diseases, such as cancer indications and endocrine disorders (more details about our SHAPE program can be found under Prices of Medicines). This strategy integrates a systematic approach to drive health equity and enables us to:
- Enhance our impact through equitable pricing to improve affordability while strengthening health systems.
- Ensure more patients can access our existing innovative therapies in a broader range of countries.
- Improve access to our healthcare innovations through our systematic approach to R&D access planning. Our objective is to ensure that future registrations in low- and middle-income countries are implemented within 12 months of the first global launch, such as in the European Union and the United States.
Second, we are continuing our efforts to eliminate the neglected tropical disease schistosomiasis as a public health problem. We aim to reach more than 90 million patients per year by 2030 through donations and new sustainable access models for established treatment and innovations. In the reporting year, we reached 84 million patients. We also invest in the fight against malaria.
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 goal 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 21 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 new treatment option for children aged six and under, and for new and more sensitive diagnostics. We also build research expertise and capacity through our collaborations with institutions in endemic countries.
- Behavioral change: 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 have also supported WASH (water, sanitation and hygiene) projects with the aim of preventing transmission of the disease by providing functioning sanitary infrastructures and access to clean water.
- Advocacy and partnerships: We accelerate 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 estimates, almost half of the world’s population is at risk of contracting malaria. The latest annual figures report over 240 million cases of malaria and more than 600,000 related deaths, with around 80% occurring in children under the age of five. Currently, 95% of cases and deaths occur in Africa.
There is a growing need for new medicines to overcome increasing drug resistance, as well as additional preventive measures to achieve the ultimate goal of elimination. Through our As One Against Malaria program, we develop and help deliver integrated health solutions to fight this deadly disease.
Roles and responsibilities
Our Global Health organization is responsible for Group-wide initiatives, programs and sponsorships. Our experts work closely with the business sectors to internally leverage our common strengths and competencies. Our Global Health team also works with a broad range of international and local partners.
Our Health Equity (formerly Access to Health) unit extends the reach of our Healthcare portfolio in low- and middle-income countries. It leverages a strategic approach and shared value initiatives implemented in collaboration with our global and country teams.
Working closely with external partners (such as WHO), our Schistosomiasis Elimination Program executes initiatives to contribute to the elimination of schistosomiasis as a public health problem by 2030.
Our Global Health Institute catalyzes innovations for global health challenges by translating science, technology and digital approaches into transformative, integrated health solutions (e.g. treatments, diagnostics, technologies, and preventive measures) to fight schistosomiasis and malaria.
Our commitment: Providing a solid basis for access to health
Our commitment to expanding health access is summarized in our Charter on Access to Health in Developing Countries.
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. We use the results of this benchmarking to inform our strategy.
The latest Index was published in November 2022. We ranked fifth, moving up from eighth place in the previous 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 for global health, including donations (e.g. praziquantel), and work with partners to explore new procurement models for equitable and sustainable access to established treatment and innovations for NTDs.
To prevent and control high-burden non-communicable diseases (NCDs), we 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 the shared value program, which supports our teams in low- and middle-income countries to implement initiatives that address health system barriers to patient access through capacity building and training for healthcare professionals. For example, a team in Argentina carried out a series of activities to raise awareness and train healthcare professionals on the importance of early detection and treatment of growth hormone deficiency in children, reaching 300 pediatricians in rural areas of the country. By the end of 2023 our shared value initiatives had reached around 54 million people via screening and awareness and trained around 20,000 healthcare professionals.
Our collaborations in Africa to establish robust supply chains are also crucial for ensuring safe, effective and continuous healthcare delivery. Our Access Mentorship program, through which 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 2023, a Startup competition resulted in the launch of collaborations in Indonesia and the Philippines. The objective is to support local health systems in strengthening and accessing pilot initiatives around non-communicable diseases (e.g. thyroid disorders).
We also upgraded an evaluation tool to track the impact of our access programs on patients, healthcare providers and health systems. This tool serves to monitor our progress over time and continue integrating recommendations from the Access to Medicine Index into our strategy.
Eliminating schistosomiasis: Four pillars
To support the elimination of schistosomiasis as a public health problem, we have adopted an integrated approach based on four pillars: treatment, research & development, behavioral change, 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 around 2 billion tablets to WHO to combat this disease. They have been distributed in 47 endemic African countries, primarily to treat school-aged children. In 2023, we donated over 210 million tablets for distribution in 37 countries, 29 of which are in sub-Saharan Africa.
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 supply chain management 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 last-mile tracking system is now being used to capture real-time data up to the distribution level, reporting the number of tablets used and any remaining stock. In 2023, this digital system was rolled out in 13 Kenyan counties.
Research and development
In partnership with the Pediatric Praziquantel Consortium, we have developed arpraziquantel as a new treatment option for children aged three months to six years infected with schistosomiasis. In December 2023, arpraziquantel received a positive scientific opinion from the Committee for Medicinal Products for Human Use (CHMP), part of the European Medicines Agency (EMA). EMA assessed arpraziquantel under the “EU-M4all” procedure for high-priority medicines intended for markets outside of the European Union. This positive result facilitates arpraziquantel’s inclusion in the WHO List of Prequalified Medicinal Products. Prequalification will also help to support regulatory pathways in African countries. In Brazil, regulatory submission is planned by the consortium partner Farmanguinhos, the public pharmaceutical laboratory of the Fiocruz Foundation. Within the consortium, the implementation research program (ADOPT) is underway to prepare for the introduction of arpraziquantel in schistosomiasis-endemic communities. New procurement and funding mechanisms for equitable and sustainable access to the medicine – to be made available on an at-cost basis – are being collaboratively explored.
On the research side, pre-clinical tests were conducted on a promising candidate to prevent and cure schistosomiasis as part of our efforts to develop a new generation of the drug.
To support drug discovery and development, we have introduced innovative artificial intelligence and epidemiology modeling. We have also started developing new technologies to diagnose schistosomiasis, including female genital schistosomiasis.
There is still a critical need for more sensitive diagnostics to detect cases in low-endemicity settings. They can help to effectively manage and surveil schistosomiasis while forming tools to eliminate the disease. Therefore, we are continuing 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.
Our R&D 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.
Behavioral Change
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 behavioral change via a community-based approach to eliminate schistosomiasis and other neglected tropical diseases. In 2023, the main emphasis of the project was its handover to the local government. The aim was to ensure the government could integrate the program’s disease-prevention initiatives into its processes and activities, sustaining and expanding the project’s outcomes. Operational research comparing two districts was conducted to evaluate the effectiveness of behavioral change combined with mass drug administration versus mass drug administration alone. The results showed a greater reduction in the prevalence of schistosomiasis in the intervention district, strongly suggesting a positive correlation between integrated interventions and changed behavior in these communities.
In 2023, we implemented our collaborative access to water program in partnership with World Vision in Ghana to improve WASH in communities, to combat infectious diseases such as schistosomiasis. This initiative has increased access to clean water for targeted households, health facilities and schools, reaching over 22,000 people. In 2023, the involved communities in Ghana showed a significant reduction (65-78%) in the number of cases of waterborne diseases, including schistosomiasis.
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 GSA’s role as a central platform for all schistosomiasis matters has grown considerably over the past few years. In 2023, the GSA organized various meetings about schistosomiasis, including a full-day stakeholder event entitled “Celebrating recent achievements supporting elimination goals”.
Malaria: Treatment and prevention
Developing therapeutic solutions
As part of our As One Against Malaria program, we are developing a new drug called cabamiquine. It has 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. In 2023, the program progressed to clinical Phase II with the implementation of two cabamiquine combination studies for cure and prevention. 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.
In the course of 2023, our drug discovery platform generated an additional promising antimalarial candidate in early preclinical development.
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 field test was carried out to determine how IR3535® performs in real-world settings. The study indicated long-term efficacy and protection against anopheles bites in malaria-endemic areas.
In partnership with local institutions in Africa, we have established PAVON, the Pan-African Vivax and Ovale Network. It is a network of centers of excellence that support malaria elimination through the epidemiology of the parasites P. Vivax and P. Ovale and capacity building in Africa. In over ten African countries, PAVON supports policymaking, accelerates the development and uptake of new therapeutics and provides 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, governmental agencies and NGOs, as well as academic institutions, health industry associations, private companies, and independent global health experts.
In 2023, we continued engaging with our partners and key stakeholders, including WHO, to advance global health discussions and address shared challenges. We are collaborating with partners such as the END Fund and DNDi, as well as with academia in African countries. We have engaged in consortia with partners, such as the Pediatric Praziquantel Consortium; alliances, such as the Swiss Alliance for Neglected Tropical Diseases; and advocacy groups, including the Uniting to Combat NTDs and GSA. In addition, we are working closely with foundations, such as the Bill & Melinda Gates Foundation and the Access to Medicine Foundation, that promote scientific research and health access. We have also joined forces with funders, such as 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 and global health community through publications, patent sharing and taking active roles at international events. On several occasions, we presented the progress of the Pediatric Praziquantel Consortium program we lead, including at the Global NTDs Meeting (prior to G7), the EDCTP Forum and the SACRA conference. We also attended the Annual NTD NGO Network and the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) in 2023 to address the spread of misinformation about NTDs.