Public health

Tuberculosis (TB) is one of the world’s most deadly infectious diseases. In 2022, when this agreement was signed, more than 1.1 million people died from the disease. TB is preventable and curable but can require specialised treatment if resistant to first line antibiotics. Drug-resistant tuberculosis (DR-TB) is increasingly a global public health crisis, with cases identified on every continent.

In 2022, the World Health Organization (WHO) estimated that 410,000 people are living with DR-TB and approximately 150,000 received treatment. Of those who began treatment in 2020, only 64% were treated successfully. This is partly because previously recommended treatment options required patients to take up to 20 pills per day for up to 20 months. Some of the drugs have toxic side effects, making adherence a challenge.

In 2022, the WHO recommended a treatment regimen called BPaLM that is only six months and includes newer, more effective TB drugs. Trials found the regimen to be more than 89% effective in curing patients with multidrug-resistant TB.

Market situation

Pretomanid (the Pa in BPaLM) was developed by the TB Alliance, which has granted non-exclusive licenses for high-burden, low- and middle-income countries to multiple drug manufacturers, including Viatris.

When the WHO recommended BPaLM, the regimen was much more expensive than the standard of care, meaning procurers and governments faced difficult decisions with limited budgets.

In December 2022, MedAccess, Viatris and the TB Alliance announced that Viatris had agreed to reduce the price of pretomanid by 34% in more than 130 low- and middle-income countries. This price reduction brought the overall price of the BPaLM regimen much closer to current treatment costs, allowing countries to more easily switch to this new, more effective regimen, and is made possible by a volume guarantee agreement.

Lives changed

Downstream patient outcomes were estimated based on final results of the TB PRACTECAL study presented at TB Union 2022, and represent relative risk as compared to current standard-of-care regimens.

Money saved

Impact is estimated based on actual price reductions for pretomanid over the course of the volume guarantee, taking into account expected market dynamics.

Markets shaped

We work with partners, including donors, procurers and Ministries of Health, to track changes in health markets where our investments are supporting access to products. We monitor for changes to policy, procurement practices and supplier movement, all of which affect markets and contribute to the long-term sustainability of impact.

Public health

Cancer is becoming a major health issue in Africa. In 2024, there were 1.2 million new cancer cases and over 720,000 people died from the disease. Experts predict that by 2050, the number of new cancer cases will more than double.

One of the biggest challenges is that over 70% of cancer cases are diagnosed at advanced stages, making treatment less effective and increasing the need for radiotherapy.

However, only 33 out of 54 African countries report having access to radiotherapy technology, even though 50% of cancer patients need it as part of their treatment.

Market situation

The International Atomic Energy Agency suggests that there should be one radiotherapy machine for every 250,000 people. To meet this standard, Africa would need 6,000 radiotherapy machines, but it currently has far fewer at just 660.

The number of radiotherapy machines – and access to those that are installed – in Africa is very limited. Countries often get into a situation where they have paid significant up-front costs for the machines and then have significant additional maintenance costs to keep the machines running.

In countries where domestic resources for health are tight, they are unable to work with that level of unpredictability and therefore either stop using the machines, cannot use them during long periods of downtime, or don’t purchase them in the first place.

Lives changed

Downstream patient outcomes are estimated based on cancer incidence in Kenya and Tanzania, most recent estimates of cancer survival rates in low- and middle-income countries, and the estimated impact of radiotherapy treatment on 5-year survival rates post-treatment.

Money saved

Impact is estimated based on current financing models for medical equipment, funded by public procurers in Kenya and Tanzania.

Markets shaped

We work with partners, including donors, procurers and Ministries of Health, to track changes in health markets where our investments are supporting access to products. We monitor for changes to policy, procurement practices and supplier movement, all of which affect markets and contribute to the long-term sustainability of impact.

Public health 

Low blood oxygen, or hypoxemia, is a serious problem caused by issues with blood flow or breathing. It can occur with anaemia, heart disease, tuberculosis, asthma, COPD, and pneumonia, and is a major risk during surgery, labour and delivery. 

In low- and middle-income countries (LMICs), one in six children under five and one in five newborns admitted to hospitals suffer from hypoxemia. Also, 15% of pregnant women may face life-threatening complications needing emergency oxygen. Hypoxemia can increase the risk of death by up to seven times, causing over one million preventable deaths yearly in these countries. 

The only treatment for hypoxemia is medical oxygen. It is deemed essential but is underfunded. Up to 56% of healthcare facilities in LMICs struggle with limited or no oxygen supply. Access to oxygen in East Africa is even lower; reports indicate that in Kenya and Tanzania, fewer than 40% of public healthcare facilities have oxygen consistently available. 

Market situation

In LMICs, hospitals and clinics often buy oxygen in small amounts, which means they pay more because they can’t get bulk discounts. They usually buy oxygen in cylinders and have to transport it over long distances, which adds to the cost. This process is expensive and inefficient, making it hard for health facilities to afford enough oxygen. As a result, demand remains limited discouraging investment in better oxygen production and distribution systems.

The COVID-19 pandemic highlighted the need for better oxygen systems. While many initiatives have focused on raising funds and improving oxygen storage and distribution, there has been less emphasis on increasing a sustainable oxygen supply. This broader focus is essential to ensure that oxygen systems are strong and reliable, not just during pandemics but at all times. 

Public health

Low blood oxygen, or hypoxemia, is a serious problem caused by issues with blood flow or breathing. It can occur with anaemia, heart disease, tuberculosis, asthma, COPD, and pneumonia, and is a major risk during surgery, labour and delivery.

In low- and middle-income countries (LMICs), one in six children under five and one in five newborns admitted to hospitals suffer from hypoxemia. Also, 15% of pregnant women may face life-threatening complications needing emergency oxygen. Hypoxemia can increase the risk of death by up to seven times, causing over one million preventable deaths yearly in these countries.

The only treatment for hypoxemia is medical oxygen. It is deemed essential but is underfunded. Up to 56% of healthcare facilities in LMICs struggle with limited or no oxygen supply. Access to oxygen in East Africa is even lower; reports indicate that in Kenya and Tanzania, fewer than 40% of public healthcare facilities have oxygen consistently available.

Market situation

In LMICs, hospitals and clinics often buy oxygen in small amounts, which means they pay more because they can’t get bulk discounts. They usually buy oxygen in cylinders and have to transport it over long distances, which adds to the cost. This process is expensive and inefficient, making it hard for health facilities to afford enough oxygen. As a result, demand remains limited discouraging investment in better oxygen production and distribution systems.

The COVID-19 pandemic highlighted the need for better oxygen systems. While many initiatives have focused on raising funds and improving oxygen storage and distribution, there has been less emphasis on increasing a sustainable oxygen supply. This broader focus is essential to ensure that oxygen systems are strong and reliable, not just during pandemics but at all times.