Performance in the 2022 Index
6th place. Pfizer leads in Governance of Access, excelling in its approach to incentivising responsible promotional practices. It performs well in the other two Technical Areas, engaging in high-quality capacity building initiatives across all fields, and performing well in access planning and strategies.
Governance of Access: 1st place. Pfizer leads in this area. It has an integrated access-to-medicine strategy with direct board-level responsibility for access to medicine and incentives for its senior executives, including the CEO, and in-country and regional managers. It discloses outcomes of its access-to-medicine activities, has a robust set of compliance controls to mitigate the risk of non-compliance in countries in scope of the Index and demonstrates best responsible promotional practices relative to other companies in scope of the Index.
Research & Development: 5th place. Pfizer performs well in this area. Pfizer has a structured access planning framework and has access plans for the majority of late-stage candidates in its pipeline. The company has an average-sized priority pipeline and performs well in R&D capacity building.
Product Delivery: 6th place. Pfizer performs well in this area. The company has comprehensive access strategies in place for its products, but for healthcare-practitioner administered products the strategies focus mostly on upper-middle and lower-middle income countries. It engages in high-quality capacity building initiatives across all fields (i.e., manufacturing, supply chain and health systems strengthening).
Opportunities for Pfizer
Improve access planning for R&D projects for non-communicable diseases. Pfizer has access plans in place for 64% of projects for non-communicable diseases. These plans primarily focus on registration preparation in countries in scope. Pfizer can establish access plans for all projects from Phase II onwards, including danuglipron for type 2 diabetes. Furthermore, it can enhance existing plans to incorporate more access components such as equitable pricing and sustainable supply.
Expand technology transfers to manufacturers in more LMICs. Pfizer has transferred technology for the on-patent pneumococcal vaccine (Prevnar 13®) and the COVID-19 vaccine (Comirnaty®) to manufacturers in Brazil and South Africa. Pfizer can partner with more manufacturers in LMICs to build manufacturing capacity and improve local availability of additional products such as subcutaneous depo medroxyprogesterone acetate (Sayana Press®), a long-acting reversible contraception.
Measure and share outcomes of An Accord for a Healthier World. In 2022, Pfizer launched its An Accord for a Healthier World which aims to provide all its patented medicines and vaccines at not-for-profit prices to 45 lower-income countries. To scale up this initiative and support integration into local health systems, Pfizer can track and share both short- and long-term patient outcomes as part of its impact evaluation of this programme, in addition to outcomes such as patient reach and product volumes sold.
Expand access to on- and off-patent cancer treatments to low-income countries. Pfizer has access strategies for four of its cancer treatments, including on-patent product palbociclib (Ibrance®) for breast cancer and off-patent product vincristine (Vincristine) for leukaemia, in upper-middle income countries and lower-middle income countries. Pfizer can expand access to these products in low-income countries as part of its commitment to An Accord for a Healthier World.
Changes since the 2021 Index
Launched ‘An Accord for a Healthier World' in May 2022, which commits to provide all its current and future patent protected medicines and vaccines available in the United States or European Union on a not-for-profit basis to 45 LMICs.
Received FDA Emergency Use Authorisation for the oral antiviral medicine nirmatrelvir/ritonavir (Paxlovid®) and signed a procurement agreement with UNICEF to supply up to 4 million treatment courses in LMICs.
Adopted the ESG Scorecard, which will be used as a tool to assist in determining the funding for the annual short-term incentive plan.
Received FDA regulatory approval for its COVID-19 vaccine (Comirnaty®) and filed for registration in 37 countries in scope of the Index.
Established new COVID-19 partnerships with UPS Foundation, Zipline, and Global Environment and Technology Foundation among others to address vaccine supply and delivery issues in LMICs.
Supplied its COVID-19 vaccine (Comirnaty®) through the COVAX facility and pledged to provide 2 billion doses to LMICs in 2021 and 2022.
Invested USD 100 million into the newly launched Antimicrobial Resistance (AMR) Action Fund.
Signed a non-exclusive voluntary licensing agreement with the Medicines Patent Pool (MPP) for nirmatrelvir/ritonavir (Paxlovid®), used as an oral COVID-19 treatment. This agreement covers 95 countries.
Sales and operations
Business segments: Biopharmaceutical products and consumer health.
Therapeutic areas: Hospital care, immunology, inflammation, internal medicine, oncology, rare diseases and vaccines.
M&A news: Pfizer acquired Arena Pharmaceuticals in March 2022 for USD 6.7 billion.
Pfizer's products are sold in 98 out of 108 countries in scope of the Index. Pfizer has sales offices in 27 countries, and sells via suppliers and/or pooled procurement in an additional 71 countries.
Revenue by segment (2020) – in USD
Biopharmaceutical products 41.91 bn
Total 41.91 bn
Sample of pipeline and portfolio assessed by the Index
PIPELINE for diseases in scope
Pfizer has a total of 57 R&D projects in scope with 21 of these projects targeting priority diseases. The other 36 R&D projects target other diseases in scope. Of the projects targeting priority diseases the focus is on coronaviral diseases (six projects) and lower respiratory tract infections (5). Of the projects targeting other diseases in scope, the focus is on oncology (22). Twenty-six R&D projects are in late-stage development that target either a priority disease (13) or address a public health need in LMICs (13).* Evidence of access planning is in place for 85% of these projects: 13 targeting a priority disease and nine addressing a public health need in LMICs.
PORTFOLIO as selected for analysis by the Index
Pfizer has 84 medicines in scope, 18 of which are on patent, and five vaccines. 56% of the medicines (47) are on the WHO EML. In addition, the company markets four contraceptive methods and devices. The off-patent medicines target communicable diseases (CDs) (15) such as HIV/AIDS (4) malaria (3) and tuberculosis (5); non-communicable diseases (NCDs) (46) such as cancer (26), cardiovascular diseases (10) and mental health conditions (3). One off-patent medicine is indicated for the treatment of the neglected tropical disease soil-transmitted helminthiasis. The on-patent medicines target CDs such as respiratory infections (3), HIV/AIDS (1) and NCDs such as cancer (12), stroke (1) and unipolar depressive disorders (1). Pfizer's preventative vaccines (5) target CDs such as meningitis (3), lower respiratory infections and COVID-19.
Performance breakdown
Governance of Access
Has an access-to-medicine strategy with measurable objectives, integrated within its overall corporate strategy. Pfizer performs strongly. Its access strategy is integrated within its Purpose Blueprint, which outlines Pfizer's strategic direction, and covers all therapeutic areas in which the company is involved, including rare diseases. The highest responsibility for access lies directly with Pfizer's executive management team with board oversight, namely with the Corporate Governance & Sustainability Committee.
Provides evidence of financial and non-financial access-related incentives at the executive level. Pfizer performs strongly. It incentivises its senior executives and in-country managers to perform on access to medicine with financial and non-financial rewards. The CEO also has access-related incentives linked to the Purpose Blueprint goals, including improving access through partnerships.
Publicly discloses outcomes of its access-to-medicine activities. Pfizer performs strongly in transparency of access activities. It publicly discloses its commitment to global public health, including new commitments in response to the COVID-19 pandemic, measurable goals, objectives and targets for improving access to medicine in countries in scope of the Index. It facilitates accountability and transparency by consistently sharing the outcomes of its access-to-medicine activities, including its progress on SDG3-related targets, in a centralised manner within its ESG Report.
Performs well in responsible promotional practices. Pfizer’s sales agents are not solely incentivised on sales volume targets. The company does not set incentives at the individual level. It has a global policy on interactions with healthcare professionals, but does not publicly disclose information related to transfers of values to healthcare professionals in countries in scope of the Index (e.g. payments for attending events or promotional activities), unless required by law or by local regulations.
Has a robust set of compliance controls to ensure that governance efforts are not undermined by non-compliant or corrupt activities. Pfizer performs strongly, demonstrating evidence of all components looked for by the Index: fraud-specific risk assessment, country risk-based assessment, audits (both internal and external, covering third parties and in all countries where it operates), formal processes to ensure third-party compliance with company standards and a continuous system to monitor activities. No breaches in countries in scope of the Index were publicly found in the period of analysis.
Publicly supports the Doha Declaration on TRIPS and Public Health. Pfizer publicly shares support of the Doha Declaration on TRIPS and Public Health, but expresses reservations on its provisions, namely on the use of compulsory licensing. There is evidence of industry association lobbying on intellectual property (IP) and the usage of TRIPS flexibilities, namely of compulsory licensing, by national governments in some countries in scope of the Index. As a member of the industry association, Pfizer, like all other member companies in scope of the Index, is by default connected to this activity.
Research and Development
Access planning processes encompass all projects in the pipeline. Pfizer has a structured process in place to develop access plans during R&D. The process is intended to be applied to all R&D projects (both in-house and collaborative) for diseases in scope of the Index.
An average-sized priority R&D pipeline compared to its peers, with access plans in place for 100% (13/13) of the late-stage candidates. Pfizer has 21 projects including 13 late-stage candidates in its pipeline that target a priority product gap. These projects focus mostly on lower respiratory tract infections and coronaviral diseases. All of Pfizer’s 13 late-stage candidates targeting a priority product gap have access plans in place. Notably, Pfizer signed a non-exclusive voluntary licensing agreement with the Medicines Patent Pool (MPP) for its COVID-19 antiviral nirmatrelvir (PF-07321332) when the compound was still in development. The agreement allows sub-licensees to produce generic versions of the drug for supply in countries in scope of the Index.
Many projects address a public health need in LMICs,* with 69% (9/13) of the late-stage projects covered by access plans. In this analysis, Pfizer has 13 late-stage R&D projects that target a disease and/or product gap not yet established as a priority by global health stakeholders. These projects are all deemed by the Index to offer a clear public health benefit for people living in LMICs.* Primarily, these projects have clinical trials in countries in scope of the Index or are first-in-class molecules. Most target cancer. Pfizer provides evidence of access plans for nine of these projects. These plans focus mainly on registration preparation in countries in scope of the Index.
Does not publicly disclose R&D investment data disaggregated by disease category, product type or phase of development. Pfizer does not disclose disaggregated R&D investment data to global health organisations.
Three of the five R&D capacity building initiatives included meet all Good Practice Standards. Pfizer's performance is above average in this area. The number of initiatives meeting all inclusion criteria is higher than average and more initiatives meet all Good Practice Standards than what is average for this indicator. For example, in collaboration with the Wellcome Trust, the SPIDAAR program (Surveillance Partnership to Improve Data for Action on Antimicrobial Resistance) builds antimicrobial resistance (AMR) surveillance capacity in Africa by tracking resistance patterns to better understand the burden of AMR on patients living in LMICs.
Product Delivery
Public commitment not to enforce patents in countries in scope. Pfizer publicly pledges not to enforce patents in Least Developed Countries.
Publicly discloses information on patent status. Like most of its peers, Pfizer publicly discloses the patent statuses for small molecules in scope via the Pat-INFORMED database. It discloses the patent status of its entire small molecule portfolio. The information includes filing date, grant number, grant date and jurisdiction.
Performs above average in terms of sharing intellectual property (IP) assets with third-party researchers. Pfizer engaged in two new IP-sharing agreements with third-party research institutions or drug discovery initiatives established during the current analysis period that meet all inclusion criteria for evaluation. The company does have existing agreements of this nature in place that were established before the current Index cycle and meet all inclusion criteria for evaluation.
Uses licensing to enable generic supply. Pfizer has one non-exclusive voluntary licensing agreement in place for one compound (for diseases in scope). Its licence for nirmatrelvir/ritonavir (Paxlovid®), agreed with 38 sublicensees, encompasses 95 countries, with 93 countries relevant to the Index, including 66 middle income countries.
Filed to register new products in 14 countries in scope on average. Pfizer did not disclose evidence of filing for registration any of its new products in more than half of the top ten high burden countries (for products that could be assessed with available global burden of disease data, which excludes COVID-19). Among new products, its most widely registered is the COVID-19 vaccine (Comirnaty®), rapidly authorized in 37 countries in scope of the Index. Bevacizumab-bvzr (Zirabev), indicated for colorectal cancer among other cancer types, has been filed in four of the top ten high burden disease countries such as Democratic People's Republic of Korea, Thailand and Ukraine.
Has access strategies for all supranationally procured products in scope for this analysis. Pfizer performs above average in securing access for its products procured supranationally. For the five products assessed in this category, the company demonstrates strategies both in countries eligible for supply from such procurers and in at least one non-eligible country. For example, the company supplied COVID-19 vaccine (Comirnaty®) in Rwanda via multiple supply pathways, including via the COVAX Facility. This supply supported the local government in achieving their target vaccination rate aligned with local policy recommendations. The price offered is a not-for-profit price and consistent across all supply pathways. In 2021, around 7.4 million doses were supplied in support of the government's vaccination program.
Has access strategies for the majority of healthcare practitioner-administered products in scope of this analysis. Pfizer has average performance in this area. The company provides examples of access strategies which consider affordability in both UMICs and LMICs for the five products assessed, yet falls short at providing examples for LICs. It makes efforts to reach additional patients using pricing strategies considering relevant payers' ability to pay. For example, while Pfizer is negotiating with the national authority in Ghana for the inclusion of the ceftaroline fosamil (Zinforo®) in the National Insurance Scheme, the company has initiated a patient affordability programme in 2021, which offers the product at 50% of the total cost and patients are allowed to complete payment over 60 days. Pfizer provides evidence of how patient reach has been increased through this approach.
Has access strategies for most of its self-administered products in the scope of this analysis. Pfizer performs above average in this area. For four of the five products assessed, the company provides examples of access strategies in countries of all assessed income levels (UMIC, LMIC, LIC), including efforts to reach additional patients using pricing strategies considering relevant payers' ability to pay for the treatments. For example, Pfizer Mexico implemented a pricing strategy for lorlantinib (Lorbrena®) as second line of NSCLC treatment that considers public sector affordability. While in the private market, Pfizer Mexico offers tiered discounts for lorlantinib based on the remaining insurance policy coverage from insurance providers and the ability of patients to pay, receiving first line and subsequent lines of NSCLC treatment. The company provided evidence of patient reach increase for three products in UMIC and LMIC country examples.
All five manufacturing capacity building initiatives included for analysis meet all Good Practice Standards. Pfizer is a leader. The number of initiatives meeting all inclusion criteria is higher than average and more initiatives meet all Good Practice Standards (GPS) than what is average for this indicator. For example, the company is working with both The Biovac Institute in South Africa as well as Eurofarma in Brazil to transfer technology to manufacture the COVID-19 vaccine for distribution in the African Union and Latin America respectively.
Two of the five supply chain capacity building initiatives included meet all Good Practice Standards. Pfizer's performance is above average in this area. The number of initiatives meeting all inclusion criteria is higher than average but an average number of initiatives meet all GPS for this indicator. Pfizer has partnered with Zipline, to test and develop an end-to-end distribution solution for COVID-19 vaccines in Ghana in order to safely distribute these to the last mile and reduce waste to expiry. This initiative meets all GPS.
All five health systems strengthening initiatives included for analysis meet all Good Practice Standards. Pfizer is one of the leaders in this area. The number of initiatives meeting all inclusion criteria is higher than average and more initiatives meet all GPS than what is average for this indicator. For example, the Ghana Sickle Cell Disease Newborn Screening and Comprehensive Care Program seeks to advance the study and treatment of sickle cell disease (SCD) across Ghana and, ultimately, other countries in sub-Saharan Africa, by piloting and testing a newborn screening program for SCD including introducing treatment protocols and understanding the willingness and ability of families to enroll in follow-up care.
Has engaged in scaling up four inclusive business models but has not shown evidence of its involvement in piloting any new inclusive business models that meet all inclusion criteria. Pfizer performs average in the use of inclusive business models aimed at meeting the access needs of populations at the base of the income pyramid (including other underserved populations) in LMICs. The Pfizer Foundation supported the development and implementation of a dengue reduction programme through Reach52. Reach52 aims to bring high-quality healthcare to remote and rural areas through data-driven programs that leverage a network of community health workers empowered by Reach52’s digital health platform.
Performs above average in terms of ensuring continuous supply of medicines in LMICs. Pfizer is involved in technology transfers with third-party manufacturers in LMICs, and has a system in place to work with relevant stakeholders to communicate issues that may affect the supply chain, produces the majority of its active pharmaceutical ingredients in-house, manages a buffer stock of relevant products and is involved in supply chain capacity building initiatives.
Has a policy for reporting substandard and falsified (SF) medicines in countries in scope of the Index. Pfizer has a policy for reporting SF medicines to the relevant national health authorities but does not specify time frames. Instead, Pfizer reports that it follows locally mandated time frames. It does not provide evidence of shortened reporting time frames for cases which only require visual inspection to be confirmed.
Donates in response to expressed need and monitors delivery. Pfizer has public policies and supply processes in place to ensure ad hoc donations are carried out rapidly in response to expressed need, and it monitors the delivery of donations.
Publicly commits to the achievement of elimination, eradication or control goals in one structured donation programme for neglected tropical diseases or malaria. Pfizer publicly commits to contributing to the elimination of trachoma by donating azithromycin (Zithromax®) from 1998 to 2030 in 29 countries in scope of the Index.
All companies were assessed based on information that was valid in the latest period of analysis (ending at 31 May 2022). This data was either submitted by companies, found in the public domain or was accessible through other sources.
The term LMICs is used to denote all low- and middle-income countries in scope of the Index, except when analysing companies’ access strategies where the use of LMIC refers to lower-middle income countries as per the World Bank income groups classification. Likewise, the terms LIC and UMIC refer to low income countries and upper-middle income countries.
*50 diseases and 243 product gaps in scope have been established as a priority by global health stakeholders. For other diseases, the Index used a set of criteria to determine which projects in the pipeline offer a clear public health benefit to patients in LMICs. Only projects in the clinical phase of development were included for this analysis.
**Neglected tropical diseases, while also communicable, are highlighted separately throughout the Index.
***Other includes projects that have a technical lifecycle and projects that follow a different development cycle (e.g. diagnostics).
†Products included in the analysis were selected using a set of criteria determined by stakeholder consensus.
‡Other includes vector control products.
