How Do We Make Sure Everybody in the World Has Access to Medicines?

Of all people living on the planet today, there are an estimated 2 billion who do not have access to essential medicines and vaccines. Most of them live in developing countries. While scientific breakthroughs are leading to the development of new medicines to treat or cure many diseases, these fail to reach everyone who needs them. Even medicines that have been known for a long time are hard to get a hold of in certain parts of the world! This is called the access-to-medicine issue. In this article, we will explore four distinct approaches where pharmaceutical companies can improve their efforts on this issue, namely: availability, accessibility, affordability and acceptability.

The As of access to medicine.
called the access-to-medicine issue, which stems from the " As": Availability, Accessibility, A ordability, and Acceptability. The lack of access to medicine is unfair and causes extensive amounts of pain and su ering. It can also push people into poverty. The companies that discover and manufacture medicines, called pharmaceutical companies, play an influential role in the access-to-medicine issue. Indeed, as they invent, produce, and supply most of the medicines in the world, these companies also have an important responsibility to help all people get access to medicines, through the As ( Figure ) .

AVAILABILITY
New medicines and other life-saving products must be made rapidly available to the people who need them, wherever they live. Most medicines are made by pharmaceutical companies in China, India, and the United States. However, regardless of where they are made, pharmaceutical companies should make sure that patients living in other countries have access to medicines. In order to do this, pharmaceutical companies need to register their products and ship them to countries where there is a need. If a medicine is not registered in a country, the product cannot be sold there. While this sounds like an easy procedure, less than one-quarter of recently launched medical products have been filed for registration in most countries that are in need of them [ ].
The reason that many medicines are not registered is because customizing the registration to meet the strict requirements of every country can be a hard task for a company, especially since the criteria may vary from one country to another. Furthermore, the registration process can take a long time in some countries with poor healthcare systems. While registration in some countries can take a few months, in others it can take many years! Adriana lived a normal and happy life with both of her parents in Brazil. Sadly, day, her mom was diagnosed with cancer of the kidneys. Her physical condition deteriorated quickly, with symptoms including weight loss, fever, and constant bone pain. The doctors, worried by her condition, could only administer Adriana's mother a mediocre treatment. The best treatment, though available in the United States, was and is still not registered in Brazil. Because of this, all individuals in Brazil su ering from kidney cancer have no access to the best treatment, even though it is available in other parts of the world.
For you and your family to get access to the best treatment available for a disease, that product must first be registered in your country. If the pharmaceutical company behind the cancer kidney medicine had successfully registered the product in Brazil, Adriana's mother would have received the best treatment available, increasing her chance of survival.

ACCESSIBILITY
Even if a product has been successfully registered, can the patients access it? In developed countries, patients can rely on a strong system of hospitals, clinics, and pharmacies, which o er a wide range of medicines. To obtain the medicines, people can go by car or public transportation. Even better, in certain parts of the world, people can get their medicines delivered at home! However, not all countries have such strong healthcare systems in place.
For Akwasi, who su ers from diabetes and lives in a small, remote DIABETES A disease in which blood sugar levels are too high. Without treatment, the disease can cause eye problems, vision loss, heart problems, and strokes. village north of Ghana, accessing the medicine he needs, insulin, can be a di cult task. The closest clinic is more than kilometers away. Without public transportation or access to a car, reaching the closest clinic can be expensive and take a long time. Even worse, the clinic might not be equipped to provide the quality of care that Akwasi needs. Akwasi's situation is not unique: around % of Ghana's population lives in rural areas, where hospitals and clinics are not as numerous as in the cities . https://data.worldbank. org/indicator/SP.RUR. TOTL.ZS?locations=GH.
To ensure that patients receive the appropriate treatments even when they live in remote areas, such as islands or villages surrounded by jungles, pharmaceutical companies can develop strategies, such as partnering with drone companies to deliver its medicines (Figure ). Furthermore, pharmaceutical companies can work to improve community-based care by improving the skills and confidence of healthcare workers. For example, companies can provide training to teach healthcare workers about the best way to use a new medicine to a patient in need.

AFFORDABILITY
If you are lucky, you live in a country where the cost of your medicine is covered by your government. If so, that is great, because you will not have to spend your own money

Collin-Lefebvre and Iyer
Making Healthcare Accessible to Everybody

Figure Figure
Some companies are developing innovative techniques to reach isolated patients, such as using drones to deliver important medicines and vaccines! on important medication to treat your diseases. However, the government does not cover the cost of medicines in every country. For instance, in most low-and middle-income countries, home to most of the world's poorest people, individuals are required to spend their own money to buy the medications they need. More precisely, in low-income countries, up to % of the money spent on medicines comes directly from the people who will use them [ ]. A ordability thus becomes a key barrier to access.
Adils' family, who lives in Morocco, must spend their own money for most of the medicines they need. Adil's household makes about e per month and this amount covers their basic needs, such as housing, food, and education. If Adil suddenly gets an infection like hepatitis C, the drug to treat this disease

HEPATITIS C
A liver disease caused by a virus. The symptoms can range from fever to liver cancer.
can easily cost more than the e his parents make each month [ ]. If such a situation happens, Adil's family will have to make critical choices about how they spend their money, compromising on some expenses, such as food or education, to a ord medicine.
A ordability is not just an issue in low-income countries. A recent drug therapy for a rare childhood disorder, spinal muscular atrophy,

SPINAL MUSCULAR ATROPHY
A genetic disorder characterized by weakness and breakdown of the muscles used for movement. recently appeared on the market with a price tag of $ . million in the United States . Would you or your family be able to a ord https://www.statnews. com/ / / /is---million-too-muchfor-a-drug-fora ected-parentsthere-is-no-debate/! this medicine?
To ensure a ordability, companies need to assess people's ability to pay. The price of a medicine should not be the same across the globe, because di erent populations have di erent incomes and expenses. One way to set a ordable prices for medicines is to pay close attention to the factors in each country that a ect people's ability to pay, such as household income, education level, occupation, and more. That way, a medicine priced according to the population's ability to pay in the United Kingdom will be priced di erently in Morocco, so that people there can more easily a ord it. for consumption. This halal label can also be required for vaccines and other medicines, and this label can a ect the community's acceptance. If a medical product is not halal, certain religious or community leaders might not support the product, and local communities might be reluctant to use it [ ].
Pharmaceutical companies are expected to respond to community or population-specific concerns. They have the responsibility to understand the fears or worries of the patients and design their products with these in mind. While this can apply to the creation of halal medicines for the Muslim community, it also applies to many other situations and contexts, for example, making sure cough syrup tastes sweet enough that people will take it!

CONCLUSION
While the access-to-medicine issue is a topic that a ects us all, individuals who are the most a ected live in low-and middle-income countries. This is an inequality that should not be accepted as people all over the world should have equal access to good health. When developing new drugs, pharmaceutical companies should always be thinking about the As . These companies have the power and money to make their medicines more available, accessible, a ordable, and acceptable to people in need. If they take action to improve access to their medicines, no one will be left behind. /frym. .

CONFLICT OF INTEREST:
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Collin-Lefebvre and Iyer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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THOMAS COLLIN-LEFEBVRE
Thomas Collin-Lefebvre is the Researcher to the Executive Director at the Access to Medicine Foundation. He supports the Foundation's strategy, its stakeholder dialogues and research programmes. He previously held the position of Strategy Research Assistant in the Foundation's investors team. Thomas previously worked as an analyst for a large Canadian pharmaceutical company, kids.frontiersin.org March | Volume | Article | supporting business opportunities across the globe. He also held short-term positions in governmental a airs in Taiwan, as well as in a non-profit organization in Bangladesh. Thomas holds a Masters of Sustainability and Social Innovation from HEC Paris, and a Bachelor's degree in International Business from McGill University. *thom-cl@hotmail.com JAYASREE K. IYER Jayasree K. Iyer leads the Access to Medicine Foundation as Executive Director. As a spokesperson, she is actively involved in stimulating change within the pharmaceutical industry. She has worked at the interface of the global health community and the pharmaceutical industry for years. Before joining the Foundation in , Jayasree was responsible for creating, negotiating, and managing public private partnerships in R&D between the public sector and the industry, for infectious diseases and oncology. She has worked at NGOs, academic institutions and think tanks, and holds Masters and Ph.D. degrees from Singapore and the Johns Hopkins School of Hygiene and Public Health.