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What’s the latest on global access to medicines?

by Ramon Brown, Impact Analyst, MedAccess

A new Lancet paper reports on a continued lack of access to essential medicines in low- and middle-income countries. The paper also highlights the challenges in reducing the cost of medicines and the need for better data to track progress.

In January 2025, a new paper assessing pricing, availability, and affordability of essential medicines in low- and middle-income countries was published in the Lancet Global Health.

The paper compiled quantitative data from the public and private sectors of 54 countries at various income levels, using a survey developed by the World Health Organization (WHO) and Health Action International (HAI). This survey serves as a standardised tool to assess essential medicine access and provide insights into regional disparities and trends over time. The study specifically examined a “basket” of 15 generic medicines alongside two antibiotics, an asthma inhaler, and an antidiabetic medication, considering both lowest-priced generics (LPGs) and originator brands.

Medicine accessibility was assessed based on cost, availability, and affordability in both the public and private sectors. The findings were compared to a 2009 paper which used the same survey, allowing the authors to comment on changes in global essential medicine accessibility over the past 15 years.

Key results

All regions reported medicine availability below the WHO target of 80% in both the public and private sectors. Since the 2009 paper, the European and the Eastern Mediterranean regions showed the greatest increases in essential medicine availability, with public sector increases of 27.8% and 12.1%, and private sector increases of 3.7% and 8.5%, respectively. Conversely, the Western Pacific Region experienced the largest declines, with a 5.2% decrease in the public sector and a 7.8% decrease in the private sector.

Essential medicines were also prohibitively expensive in most surveyed countries, often far exceeding the lowest international reference pricing set by Management Sciences for Health (MSH). The South-East Asian region reported the lowest prices for both public sector LPGs and private sector originator brands, at 2.6x and 16.5x the reference price, respectively, while the Americas reported the highest prices, at 4.6x and 52.9x the reference price, respectively.

We identified three key takeaways regarding the current state of global essential medicine access.

1: Essential medicine access remains low around the world

Despite advancements in healthcare and a global shift towards more cost-effective LPGs, over one third of people globally still face barriers to accessing essential medicines. Low availability, especially in public healthcare systems, remains a critical issue.

The study highlights that globally, essential medicines are often unavailable or unaffordable, particularly in low- and middle-income countries (LMICs). In some regions, patients must pay multiple days’ wages for a single course of treatment, further exacerbating the economic burden of illness.

While some WHO regions, notably the European and Eastern Mediterranean regions, have made significant improvements in the availability of lowest-priced generic medicines, others, particularly the Western Pacific, African and the Americas, have either stagnated or experienced declines. This suggests that health systems and medicine availability are heavily influenced by regional economic and infrastructure challenges. These disparities underscore the need for region-specific policies and interventions to improve medicine access, distribution, and affordability.

2: Monitoring of global health data needs to be improved

The article demonstrated the critical need for ongoing data monitoring to track global access to and affordability of essential medicines. While valuable insights into the availability and pricing of medicines across 54 countries are provided, also highlighted are several gaps and limitations in existing data that could affect its relevance and accuracy.

Much of the data used is based on outdated pricing information, as the resource that provided pricing data for several countries was discontinued in 2015. This affects the precision of affordability metrics and fails to account for inflation, technological advancements, and market shifts.

Additionally, the reliance on data from a single point in time overlooks the dynamic nature of medicine availability and prices, which can fluctuate due to economic, political, and logistical factors. Continuous and up-to-date monitoring is essential to capture these complexities and facilitate the development of more accurate, region-specific strategies to improve access and affordability.

3: Complexity in driving down healthcare costs

Reducing drug prices is a complex matter, especially for essential medicines. While the shift towards LPGs has been key to improving affordability, the study shows that achieving significant price reductions is challenging. The availability of lowest-priced LPGs varies widely, with some regions seeing improvements and others stagnating or declining. Even where LPGs are more available, the private sector often has prohibitively high prices. For instance, private sector prices for originator brands can be several times higher than international reference prices, burdening patients financially.

Despite the growing role of LPGs, affordability remains a challenge, with patients often paying multiple days’ wages for treatment, exacerbated by inadequate public sector availability. Poor infrastructure, supply chain issues, and regulatory barriers further complicate price reduction efforts. These challenges underscore the need for a multifaceted approach, including better supply chain management, robust regulations, and increased public sector investment to ensure sustainable and equitable drug price reductions.

To improve the availability of essential medicines and enhance global health outcomes, it is essential to implement interventions that are region-specific and focus on addressing both costs and market failures, ensuring that health systems can adapt to changing needs and emerging challenges.

Continuous and up-to-date monitoring of global health data is critical to capture the complexities of medicine availability and affordability, to support the implementation of these interventions, enabling stakeholders to respond more effectively.

Read the Lancet Global Health article

A nurse takes the blood pressure of a pregnant woman. The words 'Access Matters' overlay the image.

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