Chapter 5 Analysis and conclusions
5.4 Recommendations
Based on the results of this case study on investments by insurance companies in pharmaceutical companies and their activities around Access to Medicine, the Dutch Fair Insurance Guide makes the following recommendations to the insurance groups that were examined:
1. The issue of Access to Medicine should be included in the environmental, social and governance (ESG) screening policy of the insurance groups. This will enable the investor to make a positive impact on public health by providing the pharmaceutical company invested in with sufficient assets to improve Access to Medicine. We assume that a better insight in a pharmaceutical companies' Access to Medicine programs will provide a better view on the value of long-term investments. Insurance groups should therefore gain a better understanding of the issue of Access to Medicine by:
Understanding Access to Medicine is not limited to drugs donations, research on neglected diseases and differential pricing. Corruption, bribery, product recalls and unethical marketing are also of influence to availability and affordability of medicines. Insurance groups should gain a more thorough understanding of why corruption in health systems is harmful. Unethical marketing is harmful because it immediately affects the availability and affordability of medicines, decreasing the Access to Medicine and harming public health. Unethical marketing in health care should not only be considered as 'bad for your reputation' or 'will likely result in fines', but also as a violation of human rights. Furthermore, the issue of corruption in health care
requires a broad interpretation of the definition. For example, on the one hand, practices of generic pharmaceutical companies infringing on patents in developing countries can be seen as corruption, while it improves Access to Medicine. On the other hand, political practices of originator pharmaceutical companies can sometimes be considered as corruption, while also decreasing access to medicine. This
precludes an one-size-fits-all approach to corruption.
Ensuring employees’ knowledge on the issue. Employees should be comfortable talking about human rights and health in a broad sense, being able to “[m]ake the necessary linkages to ensure they have an accurate overview of the impacts and related risks”.188
2. The issue of Access to Medicine should be addressed systematically in engagement with pharmaceutical companies. Some of the investors have taken the lead in engaging with pharmaceutical companies, but too often the engagement process is not set up systematically. Investors should cooperate more and take a common approach to engagement and voting activities.
3. The Access to Medicine Investor Statement is an excellent starting point for investors willing to take the lead. The same goes for the UN PRI platform. Some of the selected insurance groups have already taken this approach by signing the Investor Statement. Their lead should be followed.
4. Insurers should not neglect the Access to Medicine issue when exercising their voting rights. They could take a pro-active strategy and (jointly) file resolutions about Access to Medicine issues and add Access to Medicine components to filed resolutions about other topics at shareholder meetings.
5. Impact investment to improve Access to Medicine should be considered. Investment funds that bring together pharmaceutical companies and investors could lead to a positive impact on public health, while it also provides a sound investment. See for example the recently founded Global Health Investment Fund. Private equity
investments can be done within such impact investment funds. Impact investment is also a suitable method to improve Access to Medicine strategies in smaller and/or non- publicly listed companies.
6. Dutch insurance groups could and should be a lot more transparent with regard to their investments and engagement processes. Without disrespecting the duty of care they have towards clients, they could and should be more transparent in the information they provide to society. They could take the following steps in this regard:
Publish an annual overview of the number of companies with whom the insurance group has exchanged information regarding social and environmental issues (GRI indicator FS10).
Publish records of the engagement processes with individual companies or publish a detailed, and externally monitored overview of the goals and success rates of the engagement processes.
Ensure that the annual sustainability report is audited by an independent auditor. This auditor should check whether GRI standards are taken into account and whether there is information in the report regarding each of the GRI criteria. These audits should be more than just a conclusion that there is no reason to believe that the given information would be contrary to the GRI standards. They should also assess whether sufficient information has been provided with regard to decisive criteria (like sector disclosure indicators FS6 and FS10)
7. The Dutch Fair Insurance Guide calls on the insurance groups who did not cooperate to the fullest extent possible with this research project, especially Aegon, APG and
Generali, to take their clients and other stakeholders, such as many Dutch civilians, seriously. Clients and other stakeholders deserve to know what their money is used for and whether insurance companies pay sufficient attention to Access to Medicine issues with regard to their investments.
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