Access to Medicine Index

One of the more interesting examples in recent years is the Access to Medicine Index (ATMI). While in The Netherlands, I took the train to Haarlem to meet the founder, Wim Leereveld, in a renovated office with a fine table from old wood and large windows by the canal. The Access to Medicine Index points the world’s largest pharmaceutical companies to help solve this global crisis.  Hundreds of millions are afflicted with neglected diseases for which no affordable remedies have been developed or for which treatments fail to reach patients. One classic CSR argument is that, in the private sector, larger market share infers substantial market impact. Therefore companies with large market footprints have a responsibility to the broader socio-economic context. An index ranking companies that compete in a marketplace is a powerful tool to leverage the underlying competitive nature of companies and to simplify a complex subject. Firms operate by competing for a share of the consumer expenditure. The competitive dynamic in the private sector – eat your competitor’s breakfast or competitor eats yours - entails building, and then maintaining, a larger market share. A global ranking also offers the gap to play up the old trans-Atlantic rivalry: European companies ranked better in 2008.

An investigation of ATMI reflects some interesting lessons. An obvious challenge is defining a sector; should research pharma companies be in the same category as generic pharma companies which are really just large factories? ATMI is still trying to find the balance. In defining what the rules of the game are, for example what criteria to rank the companies on, one must connect the need for simplicity with being comprehensive to offer a “smart” answer. Who judges? While a third party may be outsourced to for the actual research operations, deciding the criteria may need some (heated) discussions behind closed doors, or using stakeholder groups of private sector, public sector, NGOs, civic associations, pharma investors, consumer groups and others. Input from institutional investors was important, including UKSIF director My-Linh Ngo of Henderson in London (see Henderson SRI blog). If the companies dislike the rules for judging, and/or the companies feel they are more influential than the index, ignoring or undermining the index is a negotiating strategy, like Pfizer. Of course this is counter-weighted by companies enthusiastic about the index because they rate highly on the criteria, like GSK. It is a balancing job. The ATMI website explains the 8 critera approach. By creating a benchmark against which company behaviours and activities are measured an argument we make is that an index may help drive positive action by the private sector in existing and new areas of products and services.

The good-looking ATMI website offers a fair amount of information, including the upcoming workshop in Nairobi, a good strategy to interpret locally the index criteria, and perhaps the impact. And being public, the ATMI has a fair degree of support (Bill Gates in Time July 2008) as well as detractors (to-and-fro debate with Health Action International in the pages of The Lancet). Indexes thrive on publicity and awareness, and The Lancet articles on the ATMI have helped. Awareness is one of the core success factors, although I am unsure if the old PR adage applies: whether good or ugly, all publicity is good publicity. Wim comes from the pharma sector, and is at least 6ft. 2in., proof of the Dutch height sterotype.  I am still researching what makes the Dutch so tall: is it the cheese?! Which had me thinking about metrics, and the harder part of idnexes. Measuring outcomes against the mission. Through the index model as change agent logic model, how many people in Ecuador, Sri Lanka or The Gambia now have access to TB, malaria and HV drugs because of the ATMI?