Redefining sustainability in health care: putting patients before profits

Sustainability appears to be a priority for most companies today, with teams of staff at major corporations dedicated to it and to providing strong messaging on its importance. But in terms of the real, practical implications for consumers, these efforts frequently fall short. In the pharmaceutical industry, sustainability is often a poorly defined buzzword, and the goal seems to be maintaining profit-making over the short term rather than sustaining health for populations in the long term.

Although investors now judge more and more businesses on their environmental, social and governance (ESG) performance, a 2021 analysis showed that only 0.2% of companies around the world were strongly aligned with the United Nations Sustainable Development Goals.

This is a worrying disconnect, especially in the health sector, given that health itself is a sustaining and sustainable investment.

Access to pharmaceutical products and health care services should be sustainable for everyone, regardless of where they live, and sustainability efforts should focus on long-term investment in creating health equity.

While pharmaceutical companies currently talk a lot about their commitment to a “patient-centric approach,” and while big gains have been made in the past decade in understanding the benefits of infusing patient centricity into R&D, the approach of pharmaceutical companies to patient centricity is rarely seen in how they view sustainability in health care.

To give just one example of the challenges people in low-income countries can face in accessing drug treatment in the longer-term, look at the experience of Jimmy (we are not using his real name to protect his privacy), a 60-year-old father, husband, and electrician in Kenya. He received life-saving and life-changing treatment for his chronic myeloid leukemia via the Max Access Solutions program, which one of us (P.G-G.) leads. It provides access to drugs donated by pharmaceutical companies. Yet, as he recalled to the Max Foundation, “One time I did not have transport funds to attend the clinic. I hitchhiked a lift from a long-distance trailer, but it got mechanical problems mid-way to Nairobi. I sold my phone and jacket to complete the journey.”

In a world in which an individual might need to sell their possessions to even get to the hospital and access their treatment, achieving “sustainability” will require efforts from multiple angles.

We see three practical steps pharmaceutical companies can take to become truly sustainable:

First, they need to think about sustainability not as short-term profitability but rather as an investment that will eventually transform low-resource countries into functioning markets. A recent Brookings Institution study found that every $1 invested in health in low-income countries yielded an economic return of between $2 and $4. Such investments can lead to an acceleration in economic development, maximizing access to care for all and achieving the Sustainable Development Goals.

Second, they need to ring-fence a consistent annual budget for investment in advancing access to medicines in the same way as they do with R&D budgets. Consistent, long-term investment is necessary to achieve sustainability.

Third, they should proactively include patients when developing access strategies, and should measure success through patient outcomes. When designing access programs, companies need to ask if their therapies are affordable and sustainable for people over the long term.

While the 2022 index compiled by Access to Medicine, an organization led by one of us (J.K.I.), registered progress by some of the world’s largest pharmaceutical companies in expanding access to more of their products, most of these efforts still leave people in the poorest countries behind. Individuals living in low-income nations often do not get access to the treatments they need, including medicines and other health care products. The problem is especially acute for women and girls. The latest index found major R&D gaps in products to diagnose and treat maternal hemorrhage — the leading cause of maternal death worldwide — and maternal sepsis, another life-threatening condition.

Companies need to develop new treatments, but must also ensure that both basic essential products and cutting-edge treatments are consistently available to more people in more countries.

Corporate responsibility does not stop there. Pharmaceutical companies also have a role to play in ensuring that health care systems are supported horizontally, rather than in just a limited set of disease areas, so patients’ needs are met across the continuum of care. In addition to access to innovative medicines, people around the world also require timely access to quality essential medicines, diagnostics, preventive vaccines, and other essential products like medical oxygen.

One basic requirement for increasing access is ensuring secure supply chains, an area where the pharmaceutical industry plays a central role. It can reduce the risk of shortages and stockouts through diversification of suppliers, capacity building, and technology transfers to support local manufacturing in resource-poor settings. With true commitment to patient centricity, the private and public sectors can work together to build a more resilient and stable health care system for the poorest and most vulnerable in society.

Ultimately, this is all about pharmaceutical companies staying the course and making long-term commitments on access and support for health systems, rather than focusing on delivering selected consumable medical interventions from their product portfolios.

Many of the nearly 650 million people in the world living below the poverty line rely on foreign aid and donated products for their basic medical care. While new economic models are needed to ensure that access is not solely dependent on aid and donations, and while true transformation can come only from sustained access to affordable health care, donation-based programs are still a lifeline for people who have no other way to gain access to the medicines they need. In pursuit of sustainability, pharmaceutical companies can build on efforts such as the Max Foundation’s program for chronic myeloid leukemia or the Mectizan Donation Program to combat river blindness, with the goal of helping low-resource countries achieve economic sustainability in health care over time.

Every pharmaceutical company that is serious about sustainability should challenge itself to reframe its interpretation of what “sustainability” means. Businesses need to stimulate innovation in product design, development, and access by putting the right resources in place to ensure that patients are served equally. Profits will be a by-product of sustainable access — but patients must come first.

Jayasree K. Iyer is CEO of the Access to Medicine Foundation. Pat Garcia-Gonzalez is CEO of the Max Foundation.