[ESG = Environmental, Social, and corporate Governance]

December 2023:

At first glance, the ‘Environmental, Social and Governance’ (ESG) practices of the pharmaceutical industry can seem a subject far removed from the concerns of patients. This view has led many within pharma to assume that patients themselves feel uninterested in ESG. Yet, a November 2023 report, Pharma and ESG: the Patient Perspective, drawing on the results of a PatientView survey of 832 patient groups worldwide(1), concluded the majority of the survey’s respondent patient groups (and the patients they represented) were indeed keen to engage with pharma and its ESG activities. From their perspective, ESG policies of pharma companies need to be intrinsically linked to better outcomes for patients.


On the topic of ‘E’ (Environment): pharma supply chains that are more environmentally friendly

The Covid-pandemic of 2020-2021, revealed to patients the fragility of pharma’s production chains. Most of these had long been shifted to distant lands, following the trail of ever-cheaper production costs. Lengthy supply chains became easily disrupted as the pandemic led to the closure of distribution depots and drug shortages became commonplace. The patient groups responding to the PatientView Pharma and ESG survey argued that pharma’s manufacturing activities should be relocated back nearer to each company’s markets—a move that would also bring the added benefit of reducing the environmental impact of pharma’s distribution activities.


On the topic of ‘S’ (Social): greater social inclusion in clinical trials

The pharma industry has recently become aware of a strong advantage of increasing diversity of the patient populations recruited to clinical trials for new drug treatments.(2) Research has demonstrated that patients of varying genders, ages, races, and social backgrounds sometimes respond differently (both in terms of efficacy and safety) to treatments.(3) Without such information readily available from clinical trials, prescribing clinicians can be unaware of, and unable to account for, patients’ alternating background factors when deciding on treatments. Patient groups responding to the PatientView Pharma and ESG survey point out another benefit to greater social inclusion in clinical trials: by ensuring that diverse patients worldwide are involved in R&D processes, genuine priority unmet patient needs have a better chance of being addressed.


On the topic of ‘G’ (Governance): Better governance to assure patient access to medicines

Pharma has found itself under increasing scrutiny in relation to the pricing of treatments, particularly those which are life-saving(4). Patient groups told the PatientView survey that companies should focus more on affordability throughout the development and commercialization of a treatment, in other words help make treatments more affordable for healthcare systems, insurers or individual patients. It is clear that if patients value effective, safe and reasonably priced treatments, then the ESG practices of pharma do truly matter to them.


Next Steps

To-date patients (and patient groups) have had little involvement in the development of pharma’s ESG activities. 55% of respondents to PatientView’s Pharma and ESG survey admitted they were unfamiliar with the pharmaceutical industry’s ESG policies. This is not for want of trying, 52% are actively advocating for greater inclusion in pharmaceutical companies’ efforts to improve their ESG polices; a further 21% admitted that while they do not currently conduct such advocacy, they would like to do so.

There remain further difficulties in finding out just how pharma companies are performing against their own ESG agendas, only 16% of patient groups who responded to the survey reported that it was easy to find useful information on the ESG goals of most pharmaceutical companies. This was articulated candidly by a regional obesity society in the UK: “companies all tick the right boxes, issue reports (some of the bigger ones), sign up to the various declarations and quote generously from UN goals. How they perform is very difficult to track.”

With this in mind how can the voice of patients be better incorporated into matters of ESG? In part, pharmaceutical companies must do more themselves to ensure that patients are directly included in the discussions. One Brazilian national patient group suggested in the PatientView survey that “companies could put together focus groups with patients and their carers, in order to communicate ESG strategies, primarily making the connection between the importance of this strategy and the treatment”.

With the increasing patient interest and incoming legislation mandating larger pharma companies report on matters relating to ESG(5), pharma now has the opportunity to bridge the gap between their current ESG activities and improving patient outcomes. For the first time with ESG, patients (and the groups that represent them) find themselves apprehensively waiting in the wings.


1. PatientView, Pharma and ESG: the Patient Perspective, Patient View, London, 2023.
2. Michelle Kelsey, et al., ‘Inclusion and Diversity in Clinical Trials: Actionable Steps to Drive Lasting Change’, Contemp. Clin. Trials, 2023.
3. National Academies of Sciences, Engineering, and Medicine, et al., ‘Improving Representation in Clinical Trials and Research: Building Research Equity for Women and Underrepresented Groups’, Washington (DC), National Academies Press (US), 2017.
4. ‘A Decade Marked by Outrage over Drug Prices’ NPR, 2019.
5. European Union, ‘Directive (EU) 2022/2464 of the European Parliament and of the Council’, 14th December 2022, https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32022L2464