2026 Access to Medicine Index: Africa's Three Biggest Markets Left Off Access Plans

Nigeria, Ethiopia and the Democratic Republic of Congo — Africa's three most populous countries — appear in fewer than 10 of the 245 pharmaceutical access plans analysed for the 2026 Access to Medicine Index, published Tuesday by the Access to Medicine Foundation. The gap sits inside a dataset covering 20 of the world's largest research-based drugmakers.

More than half of the 245 plans include no country in sub-Saharan Africa at all. That is the headline finding, and it lands despite measurable industry-wide progress: access plans now cover 69 percent of late-stage pipeline candidates, more than triple the share recorded in 2018. Coverage is growing. Distribution is not.

Where does the coverage actually sit?

South Africa, and to a lesser extent Kenya, dominate companies' access strategies, reflecting established healthcare infrastructure and research capability. Nigeria's exclusion carries concrete downstream risk. With heavy burdens of cancer, diabetes and cardiovascular disease, the country could miss treatments now moving through pipelines — because access planning, not just registration, determines how products get supplied, priced and distributed.

The Index found that 43 percent of access plans for non-communicable disease products stop at regulatory registration. They do nothing on affordability or distribution. Even where companies intend to enter developing markets, patients can still face prohibitive prices and weak supply networks.

How bad is the cancer gap?

Cancer accounts for roughly half of all clinical candidates assessed. Access plans cover 65 percent of oncology pipeline candidates. But only 19 percent of assessed cancer products have strategies covering low-income countries. Of 25 newer cancer products assessed, 16 — 64 percent — have no registration in sub-Saharan Africa. More than half have no registration anywhere in Africa.

African patients risk exclusion at two stages: during access planning in development, and again at regulatory approval.

What is happening on R&D and manufacturing?

Only 14 of the 20 companies engaged in R&D for priority diseases in 2026, the lowest count since 2018. Investment concentrates in commercially attractive areas — cancer, GLP-1 diabetes treatments — while diseases with heavy burdens in developing countries draw limited research.

Manufacturing capacity compounds the problem. Africa imports at least 70 percent of its pharmaceutical products. Yet only four of the 20 assessed companies hold technology-transfer agreements in sub-Saharan Africa, and three of the five identified agreements sit in South Africa. Much of the continent stays dependent on external supply chains.

Claudia Martínez, the Foundation's director of research, said progress through approvals, licensing agreements and new delivery models remains concentrated among too few companies, products and diseases. "The challenge now is to take what works further and faster, and see these approaches adopted much more widely across the industry," Martínez said.

Who is moving?

Nine of the 20 companies have specific opportunities to improve African access over the next two years — oncology expansion, local manufacturing, broader registration and sickle cell disease access.

Bristol Myers Squibb, through its Innovative Medicines Access Programme, has established pathways for nivolumab in Uganda, Zambia and Nigeria. In Uganda, work with the Uganda Cancer Institute supported publicly funded procurement; in Nigeria, supply has gone to Lakeshore Cancer Center, with expansion to a public hospital network underway. Roche has partnered with DRC health authorities on cancer screening, diagnostics and treatment, including an agreement to screen one million women for cervical and breast cancer over five years.

Novartis, ranked first for the second consecutive Index, expanded its sickle cell programme across Ghana, Kenya, Tanzania and Uganda — training more than 8,000 healthcare professionals, screening over 200,000 newborns and infants, and supporting more than 150 treatment centres. It led all three assessed areas: governance of access, R&D, and product delivery. GSK ranked second, followed by AstraZeneca, Sanofi, Bayer, Boehringer Ingelheim, Roche and Pfizer.

The ranking marks 20 years of Foundation tracking. CEO Jayasree K. Iyer said companies now have more tools and consider access earlier, but flagged funding constraints and geopolitical instability as growing pressures. "The opportunity now is to build on that foundation and reach many more people," Iyer said.

The Foundation is pressing companies to plan access earlier in development, set measurable targets for patient reach, affordability and supply, and report patient numbers transparently rather than relying on partnership announcements. For Nigeria, the practical fix runs both ways: regulatory efficiency, stronger procurement and stable foreign exchange would make the market commercially viable. Without broader access planning, the Foundation warns, pharmaceutical innovation could deepen inequality rather than close it.