Closing the Divide: Transforming Access to Medicines for 2 billion People

The statistics are staggering. Over the last 30 years, the global population has surged by approximately 2.5 billion people, growing from 5.5 billion in 1994 to over 8 billion in 2024. Remarkably, more than 98 percent of this growth has occurred in low- and middle-income countries (LMICs), regions historically beset by the toughest economic and social barriers to accessing quality medicines. Yet, despite some progress, the gap in access to affordable lifesaving medicines has widened in many respects. Today, more than two billion people worldwide still lack affordable access to quality medicines, while only 20 of the 195 UN-recognized countries account for nearly 95 percent of global pharmaceutical revenue as of 2022. With the global population projected to reach 8.5 billion by 2030 and 9.7 billion by 2050, the threat posed by poor access to essential medicines can neither be overstated nor underestimated.

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Yet, the urgency and scale of this challenge often get lost in well-meaning discussions and the cyclical nature of global healthcare events. This dilution of focus prevents the reorientation necessary to effectively tackle the problem and make access to lifesaving medicines a reality for all. Achieving this goal requires unprecedented levels of commitment from the global healthcare community on two fronts. First, there must be aggressive innovation in delivery models and mechanisms that can transform the value chain, both commercially and logistically, to create a win-win outcome for LMIC markets. Second, we must identify and leverage technologies that address existing barriers to entry and enhance the capacity of healthcare providers to deliver at the necessary volume and scale, driving down costs and making it attractive for high-quality manufacturers to serve these markets.

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Currently, three main challenges hamper affordable access to medicines. First, high levels of demand-base, financial, and regulatory fragmentation weaken healthcare providers’ ability to offer economies of scale, reducing the commercial attractiveness for manufacturers. This fragmentation leads to market failures and significant markups across the product value chain—anywhere between 200 to 400 percent from factory to pharmacy. In some cases, medicines are more expensive in LMICs than in wealthier countries, presenting our second challenge. The third challenge is the absence of a robust reimbursement system. On average, over 40 percent of patients in Africa pay for healthcare out of pocket. In Nigeria, the most populous country on the continent, over 90 percent of patients pay out of pocket for medicines. The lack of a strong social framework to reimburse medicines, combined with high markups, creates a race to the bottom on price and fuels a booming market for falsified and substandard medicines. Ultimately, patients always pay the price, often with devastating consequences, from poor treatment outcomes to death.

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The good news is that we live in a technological age, with powerful tools at our disposal that can help reduce market fragmentation and minimize market failures. Aggregating buyer demand is not a novel concept, and pooling procurement across buyers has existed for decades. However, this approach is often driven by a donation-based model, responding to crises or emergencies, and typically fades as soon as the crisis subsides. During the COVID-19 pandemic, technology enabled the aggregation of vaccine demand across African and CARICOM countries, ensuring their needs were met (albeit later than necessary). Similar efforts were seen during the Ebola, Malaria, and HIV crises.

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Creating a consolidated marketplace focused on LMICs, with technological flexibility, functionality, and scalability, could be a game-changer. Such a platform would enable demand aggregation across countries, enhance visibility of regulatory requirements, and harmonize logistics to the last mile. This would strengthen buyer positioning and provide a stable, attractive long-term growth opportunity for suppliers, facilitating the introduction of both essential and innovative medicines. Most importantly, it could significantly improve access to lifesaving medicines for the two billion people who currently struggle to obtain them.

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Nearly a quarter of a century ago, global leaders from 189 countries convened at the UN Headquarters and signed the Millennium Declaration, launching the Millennium Development Goals (MDGs). These eight ambitious targets aimed to address some of humanity’s greatest challenges by 2015, with six of them focused on promoting access to medicines and healthy living, particularly in LMICs. In 2015, the MDGs were succeeded by the 17 Sustainable Development Goals (SDGs), with SDG 3 dedicated to ensuring Good Health and Wellbeing for all. As we approach the 2030 SDG target date, the road ahead remains long and challenging.

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The question we must ask ourselves now is simple yet daunting: What will we have to show for our efforts on the access question?