Geographic Reach assesses the extent and effectiveness of a company’s presence in underserved regions, particularly low- and middle-income countries (LMICs). It considers factors such as the number of countries served, population coverage, product registration in LMICs, physical presence (offices/facilities) in those areas, strategic partnerships to extend reach, and the actual health impact achieved in those regions.
These figures represent company-reported reach through specific access and global health programs, and definitions vary. For instance, GSK’s figure is high largely due to the volume of vaccine recipients in low-income countries whereas Sanofi’s Global Health Unit (launched in 2021) currently targets non-communicable diseases in limited countries. Each company’s scope of programs (vaccines, chronic disease medicines, donations, etc.) influences the scale of annual patient reach. All data are the latest available from 2022–2024 disclosures.
While Lilly's geographic reach in LMICs remains more limited compared to leaders like GSK, Novartis, and Sanofi, its 30x30 initiative is actively working to expand its presence through strategic partnerships with organizations like UNICEF and Direct Relief. These collaborations are helping Lilly extend its footprint in new regions and strengthen health systems—particularly for non-communicable diseases (NCDs), such as diabetes and cancer. However, Lilly's global reach and health systems strengthening efforts are still smaller in scale compared to Novartis, GSK, and J&J, who have significant investments in local capacity-building.
To enhance its global impact, Lilly should evaluate whether expanding its physical presence in LMICs is feasible. If not, alternative strategies could include leveraging digital health technologies, deepening local partnerships, and optimizing product accessibility and regulatory approvals in LMICs to increase patient reach.
GSK and Novartis lead; Sanofi growing rapidly: GSK and Novartis maintain the broadest geographic reach with notably strong distribution networks in LMICs including sub-Saharan Africa, Asia and Latin America. Sanofi maintains a wide geographic reach, bolstered by its vaccines business and historical footprint in Africa and Asia - notably, the company’s new Global Health Unit specifically targets 40 of the world’s poorest countries. J&J has a global presence but some of its pharmaceutical products (e.g. advanced oncology or immunology drugs) are less distributed in LMICs compared to GSK/Novartis; nonetheless, J&J’s consumer health and medical device divisions and initiatives in countries like South Africa and India give it a strong standing. Novo Nordisk, while more focused on diabetes care, supplies insulin to nearly every country (50% of the world’s insulin supply), including in most LMICs. Roche tends to focus more on developed and upper-middle income markets. Eli Lilly have a limited direct presence in LMICs, though is expanding reach through its 30x30 initiative and new partnerships.
Top companies embed themselves in local eco-systems: Geographic impact is not just about reach, but about embedding deeply within local health ecosystems. Establishing local offices, manufacturing facilities, partnerships, and employing local teams to deliver more effective local interventions. Novartis and GSK lead here with robust infrastructures in LMICs, including local offices, manufacturing facilities, and R&D centers. Sanofi and J&J have notable but varied levels of on-the-ground presence. Novo Nordisk’s diabetes initiatives often operate through partnership-driven models rather than extensive physical expansion. Lilly and Roche have limited direct footprints, relying more on donations, partnerships, and localized collaborations rather than direct in-country operations.
GSK leads in patient reach but actual patient data across organizations was hard to nail down: It’s important to note that while we unearthed this data in the table above, it was often buried in broader sweeping claims or reporting. In this regard, the clarity of Lilly’s 30x30 aim is important to note. Based on what we were able to uncover, GSK leads in total patient reach (~89 million patients), largely through vaccines and HIV treatment. Novartis sees 37.3 million patients served in 2023 through its health equity and access initiatives - notably, within this total, the flagship Global Health programs in LMICs reached 28.7 million patients in 2023. J&J’s deworming program alone covers 100 million individuals annually (notably though, this is a more realistic portrayal of their equity impact than the “1 billion lives” they speak about more generally) . Lilly, while still behind industry leaders currently, has significantly expanded its impact, reporting 18 million people reached in underserved regions as of 2023, up from 13 million in 2022. Roche has a smaller reach, with ~40,500 patients in LMICs benefiting from its access programs.
Product Registration in LMICs: GSK, Novartis, and Sanofi continue to prioritize product registrations in LMICs, ensuring broad availability of essential medicines. Novo Nordisk’s affordability programs have grown significantly, particularly in insulin access. Lilly has improved its outreach through technology transfer partnerships (e.g., EVA Pharma’s insulin production for Africa), but further efforts are needed to streamline product availability in LMIC markets. Roche’s patient reach, while increasing, remains more focused on niche, high-need disease areas.
Strategic Partnerships: GSK and Novartis continue to lead in public-private partnerships, pioneering programs like Project Last Mile and Healthy Family to extend their reach. J&J and Sanofi have made steady progress through health worker training and affordability programs. Lilly is increasingly utilizing partnerships to expand its impact, notably through UNICEF and Direct Relief, as well as its insulin supply initiatives. However, its partnerships remain more targeted and smaller in scale compared to industry leaders. Roche, while advancing its City Cancer Challenge and select country-specific access programs, remains more limited in broad global health equity efforts.
Novartis’s Healthy Family: Novartis’s Healthy Family program employs local health educators and sales representatives to reach underserved communities in rural areas, providing health education and access to affordable medicines, showcasing the effectiveness of social business models in expanding access.
Sanofi’s Global Health Unit: Sanofi’s dedicated Global Health Unit focuses on providing essential medicines at zero profit in the poorest countries, strengthening supply chains, and supporting local health care delivery, highlighting the importance of institutionalizing a focus on underserved regions.
How can Lilly leverage its global presence to create deeper, more sustainable local health ecosystems rather than just expanding geographic reach? In terms of geography, is it more inline with our strategy to follow the white space? Follow the incidence/prevalence? How are we balancing LMICs with the health equity gaps in the U.S. market?
How can we establish a presence without building a physical presence in each country? Are there creative ways to meet health equity needs without building local infrastructure? Is entering more countries the only way to serve more people?