Build trust with society
Novartis aspires to be the most valued and trusted medicines company in the world. We work to build trust with customers, patients, partners, associates and society more broadly. We do this by making our medicines accessible to as many people as possible and addressing priority global health issues, while embedding ethics into our business and becoming a more sustainable and responsible company.
At Novartis, we recognize that our long-term success depends on building trust with society. In 2020, we launched a new Code of Ethics, developed by our associates, to help strengthen principle-based decision-making across the company. We announced ambitious new targets for access to our medicines and issued a sustainability-linked bond to reinforce our commitment to achieving them. We also advanced our global health efforts, strengthened our environmental targets, and mobilized to support patients and communities affected by the COVID-19 pandemic. Reflecting our progress, we continued to improve our third-party environmental, social and governance (ESG) ratings performance.
The following is a summary of initiatives and progress in 2020. For more details on how we build trust with society, please see the Novartis in Society ESG Report 2020.
Supporting the global COVID-19 response
We continue to support the wider public health response to the pandemic through concerted efforts to address access to essential medicines. Early in 2020, we expanded production capacity and stabilized prices for essential medicines like antibiotics. Together with the Bill & Melinda Gates Foundation and 15 other pharmaceutical companies, we committed to expand global access for COVID-19 diagnostics, therapeutics and vaccines. In addition, Novartis medicines are being studied in dozens of investigator-initiated trials around the world. For more information, please see the section “Deliver transformative innovation.”
We launched the Novartis COVID-19 portfolio, including 15 drugs that treat key symptoms of COVID-19, such as fever, coughing, respiratory problems and pneumonia. The medicines – including dexamethasone, which has been shown to reduce deaths in severe COVID-19 pneumonia – are made available to governments, nongovernmental organizations and other institutional customers in up to 79 eligible low-income and lower-middle-income countries at zero profit. Novartis is working with the African Union (AU), through the Africa Medical Supplies Platform, to facilitate the supply of these medicines to AU member countries.
We have committed up to USD 40 million to projects around the world to support local communities impacted by the crisis. As part of this commitment, we provided aid to dozens of countries in sub-Saharan Africa, including a USD 1 million contribution to the International Rescue Committee to support its COVID-19 response efforts for refugee populations in East Africa.
We have committed up to USD 40 million to projects around the world to support local communities impacted by the crisis
Holding ourselves to high ethical standards
We continued to make progress in embedding principle-based decision-making in our business interactions and helping ensure our leaders and employees act appropriately to meet society’s expectations when faced with ethical dilemmas. In September, we rolled out our new Code of Ethics across the organization. More than 3 000 Novartis associates helped develop the new set of principles to guide ethical behavior. The code helps associates navigate ethical dilemmas by raising awareness of potential biases and the potential impact of decisions. We are rolling out a global e-training for all associates to be completed in 2021.
Novartis also resolved several legacy litigation matters in 2020, marking an important milestone on our journey to build trust with society. We reached settlements with the US Department of Justice and the US Securities and Exchange Commission, resolving all Foreign Corrupt Practices Act investigations into historical conduct by the company and its subsidiaries. We also resolved a civil suit pending in the US District Court for the Southern District of New York challenging speaker programs and other promotional events conducted from 2002 through 2011 by Novartis Pharmaceuticals Corporation in the US. As part of this settlement, Novartis will continue to evolve its approach to peer-to-peer medical education in the US by transitioning predominantly to digital formats.
Being part of the solution on pricing and access
As a global medicines company, we believe expanding access to our medicines is an important measure of our success, and we aim to hold ourselves accountable. In September, we issued a EUR 1.85 billion sustainability-linked bond, the first of its kind in the healthcare industry, which links targets for expanding access to innovative medicines and addressing key global health challenges – two areas where we can drive the greatest value for society – to the interest rate of the bond.
By 2025, we aim to increase patient reach in low- and middle-income countries with our strategic innovative therapies by at least 200% and with our global health flagship programs in leprosy, malaria, sickle cell disease and Chagas disease by at least 50%. We estimate that achieving these targets will result in a potential reach of over 24 million patients across therapy areas.
By 2025, we aim to increase patient reach in low- and middle-income countries with our strategic innovative therapies by at least 200%
Expanding access to innovative medicines
We are making steady progress with expanding access to our innovative therapies. For example, we have established outcome-based agreements for Luxturna, our breakthrough gene therapy for an inherited retinal dystrophy, whereby payment is linked to a successful outcome for each patient at an agreed milestone. In addition, we are exploring other innovative payment models such as installments and deferred payments. Early access schemes are available in markets where the therapy is not yet approved.
Our portfolio of emerging market brands (EMBs) for developing countries, which takes local affordability into account, continued to expand. We now have 118 EMBs (previously known as local brands) approved for some of our most innovative medicines across more than 50 developing markets. We reached approximately 369 000 patients with EMBs in 2020, an increase of 18% from the previous year. In addition, we continued to reduce the time lag in introducing innovative therapies in developing countries. For example, Piqray for advanced breast cancer was launched in India one month ahead of the first EU country.
Our sub-Saharan Africa (SSA) organization was established to reach more patients in a region that is home to the largest underserved population in the world. We aim to double patient reach across income segments by 2022 through integrated access strategies, value-based healthcare and pricing, as well as health system strengthening initiatives. For example, in June, we joined a collaboration with the American Cancer Society and the Clinton Health Access Initiative to expand access to 20 lifesaving cancer therapies in 26 countries across SSA and Asia. Novartis is contributing with a portfolio of chemo- and hormonal therapies for breast, cervical and prostate cancers, with plans to add more therapies in the future.
Building sustainable healthcare ecosystems
The challenge of improving access to medicine and healthcare is multifaceted and cannot be solved by any one organization alone. We collaborate with public and private partners to deliver sustainable solutions together.
In SSA, we are working with partners to build a holistic approach to improving outcomes for people with sickle cell disease. Through public-private partnerships between Novartis, ministries of health, patient groups and nongovernmental organizations, we focus on making diagnosis and treatment available, accessible and affordable for patients and their families; promoting scientific research, training and education; and pursuing robust monitoring and evaluation of the program (please also see “Tackling global health challenges”).
Also in SSA, we have reached over 95 000 healthcare professionals across the region with an education program to strengthen the diagnosis, treatment and management of heart failure. In East Africa, together with the University of Nairobi and a local cardiovascular (CV) health clinic, we are piloting the use of handheld Butterfly iQ™ ultrasound devices to make it easier to diagnose heart failure, especially in remote areas.
For the past five years, the Novartis Foundation has been working to improve CV health in low-income urban populations, co-creating a program called Better Hearts Better Cities with local authorities and other partners. The initiative shows exciting potential to transform population-wide CV health around the world. For example, preliminary results found blood pressure control tripled in São Paulo, Brazil, and increased eightfold in Dakar, Senegal – an important outcome, since controlling blood pressure reduces the risk of CV events such as heart attacks and strokes.
As a next step, the Novartis Foundation is working with Microsoft to launch AI4BetterHearts, the first global data collaborative on CV health, which aims to use advanced analytics to better understand and manage CV health.
In September, the Novartis US Foundation announced an additional commitment of USD 15 million to develop partnerships and fund community organizations and programs that address health inequities, building on the more than USD 10 million committed to date. A key area of focus will be addressing the under-representation of minorities, including Black Americans, in clinical trials. Diversity in clinical trials is critical to understanding how medicines will work in all patient populations impacted by a disease.
Tackling global health challenges
We continued to make progress across our four flagship programs – sickle cell disease, malaria, leprosy and Chagas disease – maintaining our focus on diseases with a significant impact on global health.
Sickle cell disease is recognized by the World Health Organization (WHO) as a public health priority and a neglected health problem in sub-Saharan Africa, which carries approximately 80% of the global disease burden. The Africa sickle cell disease program, launched in Ghana in November 2019, made steady progress with more than 3 400 patients being treated with hydroxyurea in 11 treatment centers across the country. We also expanded the program to East Africa with the signature of three new memoranda of understanding with the ministries of health of Uganda, Tanzania and Kenya. The program aims to reach 10 countries by 2022.
In addition to our work to help improve the standard of care for people with sickle cell disease, we are committed to expanding the reach of cutting-edge innovations to patients everywhere that need them, including in SSA. We are starting a collaboration with the Bill & Melinda Gates Foundation to explore the discovery of in vivo gene therapies for sickle cell disease, where cells are modified inside the body, which has potential to facilitate access to these advanced therapies in lower-resource settings.
For malaria, we continued to develop our industry-leading pipeline of drug candidates, including KAF156 (ganaplacide) and KAE609 (cipargamin), to address the emerging threat of resistance and support elimination. Several ongoing trials of these compounds are focused on evaluating their safety and efficacy in treating malaria in children as young as 6 months old. Meanwhile, INE963 – a fast-acting, long-lasting antimalarial that could potentially be delivered as a single-dose cure – is expected to enter clinical trials in 2021.
In March, we also announced a new collaboration with Medicines for Malaria Venture and the PAMAfrica consortium, funded by the European & Developing Countries Clinical Trials Partnership, to evaluate a new formulation of Coartem for infants weighing less than 5 kilograms. This is one of the most vulnerable groups affected by malaria, for whom there is currently no approved treatment. The trial is expected to start in 2021.
Novartis is spearheading leprosy elimination efforts. In January 2020, the Novartis Foundation was selected as one of the initial four partners for Microsoft’s AI for Health initiative, a five-year program to accelerate and scale up global health initiatives through the power of technology.
We continued our work to find treatments for people with Chagas disease, a potentially life-threatening tropical disease estimated to affect approximately 6 million people, primarily in Latin America. We advanced our clinical study to evaluate the safety and efficacy of heart failure drug Entresto in 900 patients with Chagas-related heart failure in Argentina, Brazil, Colombia and Mexico, with approximately 6% of patients already enrolled. Meanwhile, the Novartis Institute for Tropical Diseases launched a Chagas disease drug discovery program and is pursuing multiple potential therapies.
We also continued to work with health authorities and stakeholders across Latin America to support health system strengthening to tackle Chagas disease. For example, in Bolivia, we are collaborating with the Barcelona Institute for Global Health (IS Global) to enhance awareness of Chagas disease and improve the well-being of Chagas disease patients.
Novartis is focused on developing treatments for other neglected diseases such as dengue fever, a mosquito-borne disease that is listed by the WHO as among the top 10 threats to global health. Novartis is developing a compound with the potential to be the first direct antiviral treatment for adults and children with dengue fever, and the first antiviral for prevention of dengue infection. Our dengue drug discovery program is partly funded by the Wellcome Trust.
We are also working with partners on potential new treatments for visceral leishmaniasis, a leading parasitic killer, and cryptosporidium infection, a major cause of diarrhea-associated deaths among young children in developing countries.
Being a responsible citizen
We aim to conduct business responsibly, wherever we operate. This includes minimizing our impact on the environment and helping ensure patient health and safety.
Tackling climate change is part of our commitment to improving global health. Extreme heat and poor air quality caused by climate change threaten to exacerbate heart and respiratory diseases, among other illnesses, while rising global temperatures may increase the prevalence and geographic spread of insect-borne diseases like malaria. In 2020, we strengthened our environmental targets to aim for full carbon neutrality across our entire supply chain (Scope 1, 2 and 3) by 2030, from a previous target aiming for a 50% reduction in emissions.
Our focus on efficiency and renewables has resulted in a 19% reduction in greenhouse gas emissions against our 2016 baseline. In November, we announced five virtual power purchase agreements in Europe with three different developers covering six wind and solar energy solutions. We expect this agreement to help address our carbon footprint across our European operations over a period of 10 years from the start of operations. This agreement follows our first major wind power deal in Santa Rita East, Texas, which currently addresses all the electricity bought for our operations in the US and Canada.
We also continued to make significant progress on water and waste reduction in 2020. We achieved a 35% reduction in water consumption and a 36% reduction in waste disposal compared with our 2016 baseline year.
We signed the CEO Water Mandate, an initiative of the UN Global Compact aimed at mobilizing business leaders to address global water challenges through water stewardship. We also joined PREMIER, a new six-year project with the Innovative Medicines Initiative focused on evaluating and mitigating the risk of medicines in the environment. The project aims to deliver an innovative framework for characterizing the environmental risks of active pharmaceutical ingredients, which can ultimately be used to explore and promote greener drug design and manufacturing.
Being a responsible citizen also means prioritizing the health and safety of patients. We take a holistic approach to preventing harm caused by falsified medicines using data analytics and technologies in spectrometry, packaging and printing machinery, and mobile apps. In 2020, our monitoring efforts led to 68 online investigations and the removal of more than 13 900 illegal product listings.
While pandemic lockdowns strained enforcement capabilities, we maintained close collaboration with international agencies, including Europol, Interpol, the World Customs Organization and the Pharmaceutical Security Institute. We investigated 247 incidents of suspected falsified medicines, which led to 60 successful enforcement actions and the seizure of 1.7 million medicines (unit dosage forms) by law enforcement and health authorities.