Manica Balasegaram & Martin Fitchet
Despite delivering extraordinary gains in the fight against child mortality and diseases such as HIV, polio, and malaria, the global health system has come under strain not only from shrinking resources but also from unprecedented scrutiny and rising expectations. Critics rightly point out that today’s global health architecture is fragmented, costly, and not always responsive to evolving needs. Donor and recipient governments, as well as other funders, are increasingly demanding a more efficient system that reduces duplication, breaks down silos, empowers country leadership, and supports national health systems. We cannot meet today’s health needs—let alone tomorrow’s—with yesterday’s tools. Drug resistance is rising, pathogens are evolving, and too many populations still cannot access new medicines, vaccines, and diagnostics.
Improving coordination and delivery while neglecting innovation risks creating a system that is better organized but not more effective. The real challenge, then, is to ensure that a reformed global health system, driven by the needs of countries, can continue to produce the next generation of health tools. This will require building relationships among governments, researchers, funders, and manufacturers to meet needs that markets are ill-suited to address. One model to follow is a product development partnership (PDP), a nonprofit organization that brings together public, private, academic, philanthropic, and civil-society actors to develop drugs, vaccines, and diagnostics for today’s most pressing global health challenges.
Many of these challenges, from malaria and neglected diseases to neonatal infections and drug-resistant bacterial infections, cause immense human suffering but fall out of the scope of traditional market-driven pharmaceutical development, owing to high costs and uncertain returns. Governments, for their part, lack the capacity or will to move these technologies all the way through the development pipeline. PDPs close this gap between scientific possibility and real-world solutions. By operating on a not-for-profit basis, they can take risks that commercial actors cannot and prioritise public health over market returns.
This realignment of incentives treats innovation as a global public good. Over the course of nearly 30 years, PDPs have delivered more than 79 novel health tools to 2.4 billion people, aiding the at-risk populations— including children, newborns, pregnant women, and people living in low-resource settings—least likely to benefit from medical advances. We have witnessed firsthand the positive impact of PDPs. Acoziborole, a single-dose oral drug for sleeping sickness developed by the Drugs for Neglected Diseases initiative, has paved the way for the elimination of this deadly disease by improving treatment for patients in remote areas. Coartem Baby, developed through a partnership between the Medicines for Malaria Venture and Novartis, is the first and only antimalarial specifically for babies weighing 2–5 kilograms.
These breakthroughs show how PDPs can provide practical, life-saving tools to people who have been left behind by the traditional profit-driven pharmaceutical system. Equally important, PDPs collaborate not only with governments, but also the private sector, research organizations, and communities, allowing them to engage with national priorities, conduct trials in high-burden settings, and ensure that new products are relevant, affordable, and usable in real-world contexts. This is fundamental to how the model works. As the focus shifts to country leadership, PDPs illustrate how this can be achieved in practice, through partnership rather than prescription. A country-led global health system must still deliver essential outputs like innovation, which can be achieved by strengthening the mechanisms that already work. This is not an optional add-on: without new medicines, vaccines, and diagnostics, today’s gains will not be sustained, and tomorrow’s needs will go unmet. Partnership-based approaches must remain at the heart of a system designed to serve countries and communities first.
Manica Balasegaram is Executive Director of the Global Antibiotic Research & Development Partnership. Martin Fitchet is CEO of the Medicines for Malaria Venture.
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