I have been asked many times: Does the vision of the CEO have the power to change a pharmaceutical company so it can solve global health challenges? 

My answer is “yes.” The power of a top drug industry executive to change the global healthcare landscape is real. On the downside, he or she (and, let’s face it, they are still nearly all men) can cause plenty of damage by adopting the wrong policies. But if they are truly willing to make the radical changes that this industry desperately needs, they can also make a big difference for the good.

The question matters more than ever. As the world grapples with the biggest health crisis in more than a century, the pharma industry has a crucial role to play in ensuring that drugs and vaccines for COVID-19 reach those who need them most, whether rich or poor. We are relying on the industry’s infrastructure, production capacity and scientific know-how to throw the world a lifeline during this pandemic.

However, the issue is also highly relevant because a new generation of CEOs has recently taken over at the helm of some of the largest global pharma companies. Gilead, Sanofi, and Pfizer are among the drug makers whose chief executives have been in their roles for two years or less. And all of us—from government ministers to stock market investors to children in rural Africa—need them to steer their corporations in the right direction.

I lead the Access to Medicine Foundation, where for more than fifteen years we have evaluated pharma’s contribution to global health. Over that time we have seen progress, most notably in R&D and in how companies approach access to medicine. Our foundation also publishes the Access to Medicine Index, where we rank companies on how well they serve the health needs of the global population.

Historically, there have been important interventions, such as the decision in the 1980s by Roy Vagelos, then leading Merck, to distribute the river blindness drug ivermectin free of charge, setting the standard for industry engagement in eliminating several neglected tropical diseases via donations.

But corporate activity from the pharmaceutical industry still concentrates on too few countries and too few diseases, and a handful of companies are left carrying most of the load when it comes to expanding drug access to underserved parts of the world. 

We have seen the likes of GlaxoSmithKline, under former CEO Sir Andrew Witty, shift to a volume-based approach from a margin-based one in order to ramp up access in low-income markets, for example for vaccines. He led GSK to reduce drug prices in 50 of the poorest nations, released intellectual property rights into a patent pool to encourage new drug development, and invested 20% of profits from the least-developed countries in medical infrastructure for those countries. While some say it cost GSK money and perhaps even contributed to Witty losing his job, the company’s actions saved a lot of people’s lives, which should matter.

It is concrete steps like these—rather than warm words or statements from companies—that we evaluate. For example, how responsibly are operations governed? Where are firms deploying their R&D efforts? How do they manage intellectual property issues? And, crucially, how are they addressing pricing and improving capacity to ensure people all around the world get the medicines they make? These are the factors that determine whether a company moves up or down the Access to Medicine Foundation rankings. 

In January 2021, we will publish the next Index, and I expect it to be scrutinised more intently than ever. This year has been a uniquely testing time for the industry, but the message to pharma has been clear: Guaranteeing equitable access to medicine is not only the right thing to do, but it is also the strategically and economically smart thing to do. COVID-19 has underscored the pivotal importance of access for the long-term sustainability of the pharma sector, and it has pushed the issue up the agenda for investors who provide companies with their financial lifeblood.

A new guard of industry CEOs, different in their views and more public in their voice and vision, now has the opportunity to move the dial. We have already seen them speak up on several other important ESG (environmental, social, and corporate governance) issues, including gender and race equity, work-life balance and the environment. Unfortunately, they have also been far too reticent on the need for better access to medicine. 

This younger generation of pharma CEOs is active on social media, which tells us they are not afraid of making their views public. Yet they still front an industry that is widely distrusted and is better known for the high price of its drugs than for the lives it can save. Now is the moment to change this. To do so, we need CEOs who put people before profits and are ready to solve chronic industry challenges. The prize is that by stepping forward they will be able to rally like-minded investors and unleash the potential of like-minded employees, who will be incentivized by having jobs with a greater social and health impact.

Making binding commitments to expand access to specific drugs is a powerful starting point for these new CEOs to show leadership and encourage others to follow. In areas such as maternal and child health, antimicrobial resistance, non-communicable diseases and now COVID-19, we have seen that commitments made by a few players can have a snowball effect, leading to matching pledges and actions by others.

But commitments in specific areas are just a start. More fundamentally, the industry needs to address the high cost of medicines by challenging the ingrained expectations of sky-high profit margins that underpin them. CEOs need to convince shareholders that their companies should benefit people globally—not just for altruistic reasons, but because expanding access into emerging markets and low-income countries can unleash untapped revenue streams, albeit at lower margins. Until this happens, the simple fact is that many life-saving medicines invented by pharma will remain out of reach for hundreds of millions of people. 

We need one CEO to stand up and address these deep-rooted inequities embedded in the current pharma business model.

Who will step forward?

Jayasree K. Iyer is the executive director of the Access to Medicine Foundation.

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