Opinion: How can we address the daily emergency of access to health care?

Lower prices for health products in low- and middle-income countries have been a global priority for the past quarter of a century. The movement was kickstarted by outcry at the high cost of early HIV medications, which saw millions of people priced out of lifesaving treatment.

Despite progress, billions of people every day go without the medical products they need. Too often, either pharmacy shelves are empty or the medicines on them are simply too expensive. We have the power to change this — by strengthening health care product markets.

Medical products should always be affordable, but the lowest price is not necessarily the best price. Sometimes, driving prices too low can do more harm than good. In the worst-case scenario, manufacturers avoid or leave markets they see as unsustainable, too often leaving a single manufacturer as the sole supplier.  

A healthy market sees competition between multiple manufacturers driving innovation — both in new products and improvements to existing ones — while ensuring that affordable, sustainably priced supply meets demand. Sadly, very few health markets in LMICs could be described as healthy.

Multiple market shaping challenges

We are at a critical moment for global health. Thanks to collaborations between global organizations and national governments, record numbers of people are accessing the health products they need to live healthy, productive lives. But these successes are under threat.

Donor support for health is under pressure as other pressing priorities, such as climate change, compete for funds. Countries’ health budgets are under intense pressure as global economic uncertainty continues to bite. At the same time, many countries are expected to transition away from Gavi, the Vaccine Alliance’s support for vaccines and The Global Fund to Fight AIDS, Tuberculosis and Malaria funding to tackle HIV, tuberculosis, and malaria.

In middle-income countries, which often have limited public health systems, many patients turn to private pharmacies to secure the health products they need. Take Lebanon — a lower-middle-income country where in 2022 40% of households earned less than $100 per month — where people living with Type 1 diabetes face costs of more than $120 for a month’s supply of long-acting insulin on the private market. According to Health Action International, in 2023 the same product cost about $33 in the Netherlands, $28 in France, and just $17 in Australia.

Next week, 150 global health market shapers will meet in Barcelona for the Global Health Market Shaping Conference. The meeting will be an opportunity to face these challenges head-on and agree on how we can strengthen health markets so that people can access the products they need.

4 key objectives

Today, we are setting out four key objectives to strengthen market shaping for global health and increase access to medical products for millions more people.

1. Identify priority products. With limited market shaping capacity available, which products should we prioritize? Efforts to date have tended to focus on HIV, tuberculosis, and malaria. While tackling these three diseases remains important, rigorous analysis across disease trends and product classes will unearth new opportunities for impact. For example, diagnostics are vital for patients to get the right treatment but markets in many countries are uncompetitive and weak. Once we agree on the priority products, we can map out how to increase access to them.

2. Align on visions for product markets. When priority products have been identified, we are more likely to succeed if we define a clear vision for what a healthy market looks like for each product. The key partners — governments, manufacturers, procurers, global and regional health bodies, and innovative finance organizations — would do better to align early and often to ensure this shared vision maximizes access and health outcomes. Gavi’s market-shaping road maps — covering vaccines, cold chain equipment, and diagnostics — are an excellent example of how this can be done.

3. Increase transparency. As market shapers, we should share as much information as possible about our agreements and what they have achieved. This includes being honest about what has not worked or where our actions have led to unintended consequences. We routinely share on the MedAccess website the rationale behind our agreements and their projected impact. This should be the minimum standard for all market shapers.

4. Be accountable. Historically, suppliers have been held accountable by advocates for a range of access issues. We want civil society and advocacy groups to hold everyone accountable — not just manufacturers and governments but also market shapers such as MedAccess. As we develop shared visions for healthy markets, we should all be ready to stand up and account for our efforts.

Make no mistake, market shaping is difficult, often unglamorous work. But by uniting urgency and ambition we have an opportunity to permanently bridge the gaps that stop medical innovations reaching the people who need them.

Learn about MedAccess market-shaping work and subscribe to hear more.