Pfizer plans to sell its entire portfolio of brand-name drugs in as many as 45 lower-income countries, one of the most comprehensive and ambitious drug-access programs ever announced by a large pharmaceutical manufacturer.

There are 23 drugs for cancer, rare illnesses, inflammatory conditions and infectious diseases in five African countries. All of the New York-based company's future therapies or vaccines will eventually be included. Pfizer said the drugs will be sold at a fraction of their price in the US and Europe. The company plans to invest in local health systems to improve diagnostic capabilities, get the drugs approved, and make sure doctors know how to administer them.

In lower-income countries, the company has sold the vaccine for about $7 a dose, which is less than the cost in the US. Peer drugmakers have run similar low-cost programs for Covid and other illnesses. Many of the newest, most advanced therapies can take years to reach low-income markets.

Albert Bourla, the CEO of Pfizer, said in an interview that there was little work happening in noninfectious diseases. There is no reason for this to happen, other than that they did not have the medicines.

Pfizer has manufactured billions of Covid vaccine doses and distributed them around the world, while also watching the shot become one of the biggest-selling pharmaceutical products of all time. The ultimate success or failure of its expanded drug access program may not be known for a long time.

Jay Iyer is the CEO of the Access to Medicine Foundation, which advocates for drug availability and ranks companies based on how equitably they make products.

Pfizer was fourth on the foundation's index last year. Many large drugmakers have historically focused their emerging-market operations on fast-growing economies, where the unmet need can be large, but so is the future sales opportunity.

Brazil, India and China are critical to the business of those companies, but they don't prioritize the lowest-income countries.

Pfizer should be judged on the volume of drugs it sells to patients in lower-income countries, according to an interview before the announcement.

Pfizer will open the program to any other low-income country, as well as nations that have transitioned from low-middle income to low-middle income in the last decade, as defined by the World Bank. The World Bank defines low-income countries as those where the per capita gross national income is less than $1,000.

Pfizer wouldn't give an exact price for the drugs in those countries, but said they would be based on the cost of manufacturing. Some therapies, particularly easier-to-manufacture pills, will sell for pennies on the dollar. More complex drugs are more expensive and may need additional financing or charity from the company or other groups.

I wouldn't be surprised if they find it difficult. It will be important for the partners to come together.

Pfizer decided to make and sell the drugs themselves, instead of seeking partners in some markets. Drugmakers have sometimes made such agreements to supply treatments in low-income and developing countries.

Pfizer would need to find a low-cost manufacturer that wanted to make the medicine and then negotiate terms. It may not work with more complex products. The advanced manufacturing required would have meant a long lead time. The price of the vaccine was lowered for those markets.

Cary Adams, CEO of the Union for International Cancer Control, said that a voluntary license is an option, but it has to be attractive to a manufacturer.

Pfizer won't limit the amount of drugs it provides under the program, and will spend money to expand manufacturing if demand exceeds capacity, according to Bourla.

Pfizer's business and reputation have been helped by the Pandemic, which brought in $81.3 billion in sales and $22 billion in profit in 2011. The company's reputation has been changed from the biggest and baddest of big pharma to the company that helped save millions of lives during the Pandemic.

According to a draft report by the World Health Organization, life expectancy in lower-income countries has grown by about 10 years because of a focus on treating infectious diseases. The average person can expect to live to over 80 in high-income countries, while less than 65 years old in poorer regions.

Other issues with local health systems have been exposed by the rise in life expectancy in lower-income areas. People in poor countries are often not diagnosed with cancer until they are far away from the disease. According to Adams, the Union for International Cancer Control, most cancers in low- and lower-middle income countries are found at stage 3 or stage 4 when the chances of survival are lower.

70% of deaths of cancer occur in low- and lower-middle income countries because they don't have the capacity to treat the disease. It is not a simple problem that can be solved.

Pfizer plans to work with the Bill Gates Foundation and other large international health groups to improve access to diagnosis and doctors in those places, particularly on more advanced diagnostic techniques to identify subtypes of cancer that can be targeted by newer therapies.

Bourla said that the Covid-19 pandemic provided important lessons. Many of the vaccine doses have gone unused because of a lack of health-care infrastructure or distrust.

It's one thing to have the breast cancer medicine, and another thing to make sure the women get a mammogram. We need partners like the WHO and the Gates Foundation. There are people on the ground.