0 Recommendations


By Sharonann Lynch | 30 Oct, 2018

[Excuse duplicates]

Please see below for an open appeal to GFATM and donors regarding the Global Fund PROCUREMENT CLIFF where affordability, quality, and supply of TB drugs and diagnostics are at risk with the rush to switch to national procurement as part of the Global Fund’s co-financing and transition policies. See handout attached for a short overview of the issue.

The problems we raise in this letter is not theoretical. According to the Global Drug Facility, within the past 12-18 months:
 15 countries have had TB DRUG STOCK OUTS in EECA, Asia, and Africa
8 countries have had FAILED TENDERS for TB DIAGNOSTICS in EECA, Asia, and Africa
29 countries have procured TB DRUGS of UNKNOWN QUALITY in EECA, Asia, Africa, & Latin America
6 countries have procured TB drugs and diagnostics not recommended in WHO testing & treatment guidelines in EECA, Asia, and Africa
21 countries have procured TB drugs and diagnostics at prices (well) above lowest world-wide prices in EECA, Asia, Africa, & Latin America

Amb. Deborah Birx, US Global AIDS Coordinator, U.S. Department of State, USA

Dr. Jim Yong Kim, President, World Bank

Dr. Tereza Kasaeva, Director, Global TB Program, WHO

Mr. Peter Sands, Executive Director, Global Fund Against HIV, TB, TB, and Malaria

Mr. Lelio Marmora, Executive Director, UNITAID

Ms. Stéphanie Seydoux, Ambassador for Global Health, France

Mr. Daniel Graymore, Head of Global Funds and Senior Representative in Geneva, DFID, United Kingdom

Dr. Gerd Müller, Minister for Development and Economic Cooperation, Germany

Mr. Hans-Peter Baur, Deputy Director General for Democracy, Human Rights, Social Development and Digital World, Federal Ministry for Economic Cooperation and Development (BMZ), Germany

Ms. Amy Baker, Director General, Health and Nutrition, Global Affairs, Canada

Ms. Marja Esveld, Senior Global Fund Program Coordinator, Ministry of Foreign Affairs, Netherlands

Dr. Lucica Ditiu, Executive Director, Stop TB Partnership

Kieran Daly, Deputy Director, Global Policy and Advocacy, Bill & Melinda Gates Foundation


Please see below for cc list

October 26, 2018



Dear all,


We are writing to urge you to take prompt action following the United Nations High Level Meeting on TB to address the grave risks posed to countries that are rapidly shifting from pooled procurement of TB medicines and commodities, supported by the Global Fund to Fight AIDS, TB and Malaria (Global Fund), to national procurement.


Over the last 16 years, the Global Fund has helped to build ‘healthy markets’ for HIV, TB, and malaria by coordinating pooled procurement across countries, attracting additional manufacturers, encouraging submission to and procurement of medicines approved by the WHO Pre-Qualification Project or stringent drug regulatory authorities (SDRAs). In addition, commodities procured from the Global Fund enjoy a waiver which helps to address the common problem of pharmaceutical corporations not registering their products in all countries the Global Fund supports. Taken together, these strategies help ensure that essential, quality-assured medicines are accessible for people in need.


Donors have provided billions of dollars to create the current markets that have, in turn, facilitated access to affordable, quality-assured medicines. The success in this area has been unprecedented, but these gains are now threatened with current trends in decentralized procurement, fragile procurement systems, and market fragmentation.


An increasing number of countries are moving away from the Global Fund procurement mechanisms as a part of the implementation of the Global Fund’s Sustainability Transition and Co-financing (STC) policy.


This includes eligible countries (classified as having high disease burden and low income) that are co-financing greater proportions of medical commodities, as well as countries slated for transition from future Global Fund support. Many of these countries face serious challenges with rapidly switching to national procurement systems for first- and second-line TB drugs and diagnostics.


Many of the countries affected have national procurement systems that are not designed to access international pooled procurement mechanisms, nor do they have the negotiating power to attract suppliers to bid for their tenders or secure the most affordable prices should any suppliers decide to bid. Also, many countries do not require WHO Pre-Qualification or SDRA approval to ensure continuity in quality of the products, nor are they able to efficiently issue waivers for medical commodities that have not been registered, effectively preventing participation in pooled procurement mechanisms.


Within the last six months, we have witnessed acute problems resulting from countries having to switch to national procurement systems without the necessary regulatory frameworks in place: first-line TB drug stock ruptures have occurred in Eastern Europe due to lack of registered drugs; pediatric ARV formulations stockouts in South Asia have occurred because a national competitive bidding process awarded the tender to a company that couldn’t deliver the product; and stockouts of ARVs occurred in an impoverished country in West Africa that was asked to co-finance procurement beyond its capacity.


In addition to these national level problems, we are also concerned that countries leaving global pooled procurement mechanisms risks segmenting and destabilizing the fragile TB and drug-resistant TB (DR-TB) medicines market, resulting in fewer suppliers, higher prices, and a less stable supply.


Therefore, we are urging global health actors and donors to act with a sense of collective responsibility to address the risks of reduced access to affordable quality TB medicines at the national and global levels. We recommend:


1. The Global Fund carry out more rigorous risk and readiness assessments that take local procurement mechanisms into consideration, for countries facing gradual procurement co-financing, as well as countries in transition, and to make these assessments transparent and publicly available.


2. All relevant actors, including WHO, donors, affected countries, and the Global Fund act upon these assessments by developing and/or strengthening mitigation strategies to proactively monitor and address risks to the availability of commodities and scale up of treatment programs. These should cover high prices, quality concerns, barriers preventing countries from accessing pooled procurement, and weak national procurement and regulatory systems and procedures.


3. All relevant actors support national governments to adopt pro-access procurement policies, including utilizing pooled procurement mechanisms, requiring WHO Pre-Qualification or stringent drug regulatory approval in drug tendering processes, enrolling in the WHO Collaborative Registration Procedure, and ensuring transparency throughout the procurement process.


4. The Global Fund increase flexibility in its procurement co-financing agreements with countries and strive to defer such agreements, where needed, until countries are able to enact necessary changes in national laws to put some of these procurement policies in place.


As members of civil society, treatment providers, and non-governmental organizations committed to the fight against tuberculosis (TB), we will continue to press for access to affordable, quality medicines and commodities.


While we have engaged constructively with the Global Fund on these issues, we believe these concerns deserve increased attention and urgent action from additional actors.


We strongly encourage the engagement of the above actors to coordinate the assessment of risks, and support of mitigating strategies in light of these concerns.


We request you to kindly direct your responses to Erica Lessem, Deputy Executive Director for Programs TAG, at , and

Sharonann Lynch, HIV & TB Policy Advisor MSF Access Campaign, at .




AIDS and Rights Alliance for Southern Africa (ARASA)

Global Coalition of TB Activists

Global Network of People Living with HIV (GNP+)

Health GAP


International Indigenous Working Group on HIV & AIDS


LHL International

Médecins Sans Frontières (MSF)



TB Europe Coalition

TB Proof

Treatment Action Group (TAG)

Wote Youth Development Projects (WOYDEP)

CC list:


Ms. Cheri Vincent, Chief, Infectious Diseases Division, USAID

Dr. Ren Mingui, Assistant Director General for Communicable Diseases

Dr. Gottfried Hirnschall, Director of the HIV/AIDS Department and the Global Hepatitis Programme (GHP), WHO

Dr. Suzanne Hill, Director of Essential Medicines and Health Products Department, WHO

Amb. Eric Goosby, UN Special Envoy on Tuberculosis

Mr. Matthew MacGregor, Senior Project Lead Sustainability, Transition and Co-financing, Global Fund

Ms. Mariatou Tala Jallow, Senior Manager, Global Sourcing of pharmaceuticals and health products at the Global Fund,

Dr. Brenda Waning, Chief, Global Drug Facility (GDF)

Ms. Sarah Boulton Global Health Funds Team Leader, Global Funds Department, DFID, United Kingdom

Mr. Jean-François Pactet, Assistant Director, Human Development, Ministry for Foreign Affairs, France

Ms. Maurine Murenga, Communities Delegation Representative to the Global Fund Board

Mr. Mike Podmore, Developed Country NGO Delegation Representative to the Global Fund Board

Mr. Allan Maleche, Developing Country NGO Delegation Representative to the Global Fund Board

Mr. Harley Feldbaum, Head of Strategy and Policy, Global Fund

Mr. Eliud Wandwalo, Senior TB advisor, Global Fund

Communication focal points of the Global Fund board constituencies


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