GlaxoSmithKline has once again come top of an analysis which rates 20 drugmakers and their ability to get their products to the world’s developing countries, while the industry as a whole is doing more than it was two years ago.

The Access to Medicines Foundation, based in the Netherlands, says that 17 out of the 20 companies are performing better than they did in 2010. The foundation has published its Access to Medicine Index, which shows that Johnson & Johnson was one of the most dramatic risers, up from ninth two years to second, "closely behind" GSK which stayed at the top.

The report says this rise is due largely to J&J's consolidation of its access activities under one business unit, "which has resulted in a more strategic and integrated approach", and to its acquisition of vaccine maker Crucell. Sanofi was third.

The AtM Index reveals that the companies which rose in rank the most were Merck KGaA, followed by J&J and then Bayer. AstraZeneca fell down the rankings most significantly, followed by Boehringer Ingelheim, then Novartis and Roche. "The bottom of the league" is dominated by Takeda, Daiichi Sankyo and Astellas.

The analysis notes that "there is more target setting and some now devote as much as 20% of their pipeline to developing products that address the needs of the poor. It cites Sanofi for adapting its leishmaniasis drug, which currently requires health workers to administer repeated injections, to develop a product patients can apply to their skin at home. Also, J&J is collaborating to develop a portable rapid screening test for tuberculosis "that doesn’t need to be operated by a health professional, requires patients to simply cough into a breathalyser and yields results within minutes".

Room for improvement

However, "there are still several areas where all companies could improve their approaches significantly", the Index claims. These include being more transparent about lobbying, expanding tiered-pricing schemes, making drug donations more needs-based and allowing clinical trial data to be used to accelerate the approval of generics in developing countries.

The report specifically highlights a lack of transparency around the outsourcing of trials to contract research organisations. It states that "company accountability involves ensuring the wellbeing of trial participants through adequate due diligence in selecting these contractors, monitoring how they conduct the trials and willingness to enforce codes of conduct with disciplinary action". However, only four (Merck & Co, Sanofi, GSK and Eisai) provided evidence that they use disciplinary measures to enforce codes of conduct with their CROs.

Wim Leereveld, founder of the AtM Index, said  this year shows that companies are becoming more organised internally in their approach to access "and that those who do this best tend to perform well across the other aspects we measure. The leaders are really raising the bar".

The Index, which is funded by the Bill & Melinda Gates Foundation, the Dutch Ministry of Foreign Affairs, the UK Department for International Development and other charitable organisations, sees companies graded on more than 100 factors, including whether they are developing new drugs for neglected diseases.