Market-driven, value-based, advance commitment (MVAC): accelerating the development of a pathbreaking universal drug regimen to end TB

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Chalkidou, Kalipso
Towse, Adrian
Silverman, Rachel
Garau, Martina
Ramakrishnan, Ganesh
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  • Tuberculosis (TB) is the world’s deadliest infectious disease; without a significant technological breakthrough, current trajectories suggest that the world will not achieve the Convergence 2035 targets for TB until 2074, almost 40 years later than originally projected.

  • Research and development investments for TB are dominated by public sources and total only one-third of estimated need, with private investment small and declining.

  • To crowd in private investment, we suggest a new model—the market-driven,value-based advance commitment (MVAC)—wherein high-burden middle-income countries (MICs) would offer advanced purchase commitments for a prespecified breakthrough treatment regimen.

  • Through use of early health technology assessment, an emerging practice and capability in many large MICs, the MVAC would ensure that country purchase commitments reflect local needs, value and ability to pay for innovation.

  • A multilateral development bank would underwrite the MVAC commitments, increasing their credibility to private industry without requiring countries to put aside funds in advance.

  • Discussion with developing country policymakers, industry, development banks and development partners suggest fertile ground for the MVAC approach, but high-level political commitment is still needed.

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BMJ Glob Health
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© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:
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Chalkidou, K; Towse, A; Silverman, R; Garau, M; Ramakrishnan, G, Market-driven, value-based, advance commitment (MVAC): accelerating the development of a pathbreaking universal drug regimen to end TB., BMJ Glob Health, 2020, 5 (4), pp. e002061:1-e002061:6