31/03/21

R&D gap stymies access to children’s medicines – report

child receives medicine
A pharmacist dispenses medicine to a sick child. A new report says that only about six per cent of pharma R&D projects target children. Copyright: Vicki Francis/Department for International Development, (CC BY 2.0). This image has been cropped.

Speed read

  • Only about six per cent of pharma R&D projects target children
  • ‘Game-changing’ treatments lack access plans to reach those in need
  • Joined up effort is needed to ‘drive market incentives, leverage funding’

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Only about six per cent of research and development (R&D) projects from 20 leading global pharmaceutical companies target children, despite major gaps in the paediatric medicines pipeline, a report shows.

Many new treatments are under development which could “dramatically improve” the health of children in low- and middle-income countries (LMICs), says the Netherlands-based Access to Medicine Foundation, which produced the report. However, many projects lack access plans to ensure the drugs reach those who need them.

The analysis released last week (25 March) is based on the 2021 Access to Medicine Index, an independent ranking of the world’s leading pharmaceutical companies on their actions to improve access to medicine worldwide, published in January.

“We need to get targeted focus and action from companies and the global health community about the challenges in paediatric markets, which are often not prioritised and result in millions of preventable deaths,” said Claudia Martinez, research programme manager for the Access to Medicine Index.

“We need to get targeted focus and action from companies and the global health community about the challenges in paediatric markets, which are often not prioritised and result in millions of preventable deaths,”

Claudia Martinez, Access to Medicine Index

Over five million deaths occur each year among children under five from preventable and treatable disease, according to UNICEF, with the majority in LMICs.

Over 5 million children under 5 die yearly from preventable and treatable diseases. Image credit: Access to Medicine Foundation

The report, which analysed data from 20 pharmaceutical companies, says only 69 of a total 1,073 R&D projects, about six per cent, target children under 12-years old.

While 18 of the companies have projects aimed at children, most are focused on just three diseases: lower respiratory infections, cancer and HIV/AIDS. The pipeline for diseases such as sickle cell disease, epilepsy and diarrhoeal disease that disproportionately affect children in LMICs s are completely empty.

Citing challenges to the paediatric pipeline including clinical trial enrolment, regulatory requirements and tough market economics that limit treatment availability, the report gives five examples of “game-changing” treatments as examples of good practice.


These are treatments currently in late-stage development that have significant potential for LMICs including a nasal powder for severe hypoglycaemia from Eli Lilly, a dispersible tablet form of dolutegravir, a medicine from GSK for treating HIV, and praziquantel, a taste-masked dispersible tablet from Merck and Astrellas for treating paediatric schistosomiasis, or bilharzia, a water-borne parasitic disease predominantly found in Africa.

“Development and investment really aren’t enough. If you don’t think about access planning and how to ensure people will access them then it’s a job half done,” she said.

Defined as concrete, targeted plans that ensure new products are accessible and affordable in all the markets where they’re needed, access plans were found with 31 of the 69 paediatric projects. Only three of the five “game-changing” treatments had such plans.

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For Manuel Martin, access policy advisor for the Doctors Without Borders (MSF) Access Campaign, it is not as simple as whether a company has access plans in place.

“The details of the access plans are what matters and following up on their progress,” he said. “Companies may be measuring themselves against each other based on the report, but this may not be the gold standard we want.”

Martin believes that access to paediatric medicines is a widespread and systemic problem that goes beyond corporate practices. “This highlights to world leaders, governments and policymakers that more needs to be done, and that’s something the Access to Medicine Foundation recognises,” he said.

The analysis calls for pharmaceutical companies, product development partners, governments and the global health community to work together to drive market incentives, integrate access planning and leverage government and donor funding.

“What’s coming through the pipeline and the sheer scale of the gap shows we need change faster,” Martinez added.