Unpacking the Multilateral Architecture for Global Health R&D

Partnership that brings together public, private, and philanthropic organizations to finance and coordinate the development and manufacturing of vaccines and platform technologies against emerging infectious diseases. CEPI operates as both a funder and a facilitator, pooling contributions from governmental and nongovernmental donors to finance R&D conducted by grantee partners as part of a coordinated global approach. CEPI’s target diseases are informed by WHO’s list of priority pathogens with epidemic potential and the R&D Blueprint.

CEPI also co-leads, alongside Gavi and WHO, the vaccines pillar of ACT-A, which is focused on developing and ensuring equitable global access to COVID-19 vaccines.

Global nonprofit partnership dedicated to accelerating antibacterial innovation by investing in early-stage development of new antibiotics, vaccines, rapid diagnostics, and other tools. CARB-X operates as a pooled financing mechanism and pipeline coordinator, leveraging resources from its funding governments and philanthropic partners to manage and support a portfolio of R&D projects conducted by industry, academic, and nonprofit partners.

Forum that brings together the world’s seven leading economies to discuss and establish shared priorities for economic development and health. Outcomes and commitments, established through the Health Ministerial Meeting, Finance Ministerial Meeting, and Leaders’ Summit, can influence each nation’s individual investments in health R&D. Members include Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States.

Forum that brings together the world’s twenty leading economies to discuss and establish shared priorities for economic development and health. Outcomes and commitments, established through the Health Ministerial Meetings, Joint Health and Finance Ministers Meeting, and Leaders’ Summit, can influence each nation’s individual investments in health R&D. Members include Argentina, Australia, Brazil, Canada, China, the European Union, France, Germany, India, Indonesia, Italy, Japan, Mexico, Russia, Saudi Arabia, South Africa, South Korea, Turkey, the United Kingdom, and the United States.

Public-private partnership that brings together donor and developing country governments and other development entities to expand access to vaccines in low-income countries. With donor funding, it provides financial support to eligible countries to procure vaccines and equipment for their immunization programs. By creating a high-volume, predictable demand for vaccines, it is able to work with manufacturers to negotiate lower prices for these vaccines and ensure a sustainable market. 

Additionally, for select diseases like pneumonia, Ebola, and COVID-19, it has also initiated advance market commitments to incentivize vaccine R&D. While Gavi does not directly fund product development, its efforts help shape the vaccine market to incentivize R&D.

UNICEF, WHO, and the World Bank hold permanent seats on the Gavi governance board. Gavi also co-leads, alongside WHO and CEPI, the vaccines pillar of ACT-A, which is focused on developing and ensuring equitable global access to COVID-19 vaccines.

Nonprofit partnership that brings together governments, industry, academia, and civil society to finance and support the development of new and improved treatments for drug-resistant infections and promote best practices and policy solutions to facilitate their regulatory approval, procurement, affordability, and appropriate use.

GARDP was created by WHO and the Drugs for Neglected Diseases initiative, following a proposal endorsed by WHO member states, to help deliver on the WHO Global Action Plan on Antimicrobial Resistance.

Innovative financing mechanism that pools together funding from governments and philanthropic donors to provide catalytic capital and technical assistance to low- and lower-income country governments to help them develop, finance, and implement health programming to improve care for women, children, and adolescents. This support can be used by countries to introduce and scale up access to essential health technologies for these populations.

GFF is housed at the World Bank, and it works closely with WHO, other UN agencies, Gavi, and the Global Fund to align financing from these entities with each country’s GFF investment cases.

Partnership and innovative financing mechanism that raises funding from government, private, and philanthropic donors to finance programs, implemented by in-country partners and driven by country-defined needs, that reduce the impact of HIV/AIDS, tuberculosis (TB), and malaria in LMICs. With investments of more than US$4 billion a year, it is the world’s largest financier of AIDS, TB, and malaria prevention and treatment programs. Funding supports the distribution and scale-up of treatments and preventative therapies and tools, as well as technology pilot programs and service delivery innovations.

The Global Fund’s board features nonvoting representatives from WHO, the World Bank, UNAIDS, and the STOP TB Partnership to facilitate cross-coordination. The Global Fund also co-leads, alongside FIND, the diagnostics pillar of ACT-A, which is focused on development and scale-up of COVID-19 diagnostics, as well as the health systems pillar, alongside the World Bank, which is focused on crosscutting work to promote product access.

Partnership of more than 60 countries, as well as international organizations, nongovernmental organizations, and private-sector companies, to strengthen the capacity of countries to detect, prevent, and respond to infectious disease threats and drive progress toward full compliance with WHO’s International Health Regulations and other relevant global health security frameworks. Members jointly establish Action Packages, to facilitate collaboration toward agreed-upon objectives and targets, which then inform national strategies and activities to strengthen health preparedness. GHSA primarily serves as a body to set agendas, drive collaboration, and ensure accountability; it is not a substantial direct funder of health system strengthening activities.

International financial institution, financed by its member countries, that provides direct investment and advisory services to private-sector, for-profit projects that promote development and poverty reduction in LMICs. As part of its portfolio of investments, IFC has supported projects in LMICs to increase local manufacturing capacity for health technologies, strengthen supply chains for critical raw materials, and support health care service providers to expand delivery of and access to health products and services.

While IFC operates as a financially autonomous entity, it is part of the World Bank Group, which also includes the World Bank.

UN entity that works to catalyze and advocate for an accelerated, comprehensive, and coordinated global response to the HIV/AIDS pandemic. As part of its broader portolio of work, UNAIDS provides data, strategic guidance, and technical assistance to help LMICs implement and expand access to antiretroviral therapies, pre-exposure prophylaxis, and other HIV treatment and prevention technologies.

UNAIDS helps bring together the HIV-related work of other UN system organizations including UNICEF, UNDP, UNFPA, WHO, and the World Bank.

UN-backed international organization that works to lower the price of and expand access to essential medicines in LMICs through voluntary licensing and patent pooling. MPP negotiates with patent holders for licenses to allow generic manufacturers to produce generic versions of patented medicines for use in LMICs or to produce new derivative treatments, such as pediatric forumulations and fixed-dose combinations. By facilitating generic manufacturing and increased competition, MPP drives down the price of treatments to make them more affordable and accessible in LMICs. Its mandate covers medicines for HIV/AIDS, malaria, tuberculosis, hepatitis C, COVID-19, and other treatments on WHO’s list of essential medicines. MPP was founded and is funded by Unitaid.

Mechanism that supports LMICs in introducing and expanding access to affordable, quality-assured tuberculosis (TB) treatments and diagnostics via a bundle of packaged services tailored to country need. These services include access to a pooled procurement system for ordering products, technical assistance to facilitate introduction and uptake, and programmatic grants tied to performance. GDF also works with suppliers and stakeholders to monitor the adequate supply and sustainable pricing of products and standardizes packaging to simplify drug management for health programs. GDF is housed and administered by the Stop TB Partnership Secretariat, which sits within the UN Office for Special Projects.

International organization that advances innovations for HIV/AIDS, tuberculosis, malaria, and HIV coinfections. Unitaid invests in late-stage R&D for new drugs, diagnostics, and prevention tools; helps produce data supporting guidance on product use; and supports projects to generate market demand and facilitate the introduction and scale-up of these interventions. Funded primarily through airline taxes and supplemented with additional donor government and philanthropic contributions, it serves primarily as a grant-making organization that funds implementing partner organizations.

Unitaid is a hosted partnership of WHO, which holds a seat on its Executive Board, and it founded and funds MPP. It also co-leads the therapeutics pillar of ACT-A, alongside Wellcome Trust, which is focused on developing and ensuring equitable global access to COVID-19 treatments.

UN agency responsible for providing humanitarian and development aid to children worldwide. Among its broader portfolio of activities, UNICEF supports health R&D by developing target product profiles to communicate product needs for maternal, newborn, and child health (MNCH) and directly finances projects to develop MNCH technologies, with a primary focus on devices and tools. UNICEF also funds efforts to scale up essential MNCH technologies in LMICs and strengthen cold chains, and it is the world’s largest single buyer of vaccines, procuring more than 2 billion doses annually for programs in more than 100 countries. UNICEF is funded by contributions from governments and private and philanthropic donors and carries out work through regional and country offices worldwide.

As part of the COVID-19 response, UNICEF will lead efforts to procure and supply vaccines and immunization and cold chain technologies for LMICs as part of ACT-A’s vaccines pillar, which is co-chaired by WHO, Gavi, and CEPI.

UN agency responsible for UN’s global development activities. It seeks to connect countries to knowledge, expertise, and technical and financial resources to address global development challenges and drive progress toward the SDGs. As part of its broader portfolio of health work, which is funded by voluntary contributions from UN member states, UNDP supports programming, including the Access and Delivery Partnership, to help LMICs strengthen policies, human resources, systems, and regulations to expand access to essential medicines, vaccines, diagnostics, and other tools. 

UNDP is a founding partner, alongside WHO, the UN Technology Bank, and the UN Conference on Trade and Development, of the Tech Access Partnership, which works to increase access to COVID-19 technologies by providing a partnership platform and technical guidance to help LMICs strengthen manufacturing and production capabilities. The UNDP administrator is also the vice-chair of the UN Sustainable Development Group, which unites the work of UN agencies that play a role in development including UNAIDS, UNFPA, UNICEF, and WHO.

UN agency responsible for advancing sexual and reproductive health. Among its broader activities, UNFPA directly procures contraceptives and reproductive health supplies to provide quality assurance and volume pricing for governments and nonprofits, and it provides technical assistance and supports implementation research to help countries introduce and scale up sexual and reproductive health interventions. UNFPA is funded through contributions from governments and private donations and works through partnerships with governments, other UN agencies, nonprofits, and the private sector to support programming in more than 150 countries.

UN program to strengthen science, technology, and innovation capacity in the world’s least developed countries. It undertakes a number of activities that broadly support health R&D capacity-building and technology adoption in least developed countries, including strengthening National Academies of Science, providing free or low-cost access to published academic research and professional content, and assessing gaps to provide recommendations to countries to improve technological capacity. It is also working to expand its activities to provide training and technical assistance on intellectual property rights, support technology transfer, and create regional innovation hubs.

The UN Technology Bank also leads the Tech Access Partnership, launched with support from UNDP, WHO, and the UN Conference on Trade and Development, which works to increase access to COVID-19 technologies by providing a partnership platform and technical guidance to help LMICs strengthen manufacturing and production capabilities.

International financial institution, funded by its member countries, that provides loans and grants to the governments of LMICs to finance infrastructure and social service improvements. As part of its broader portfolio of disbursements, the World Bank has provided financing and technical assistance to help countries procure health technologies and supplies for immunization and other health delivery programs, as well as build and equip public health laboratories to improve diagnostic, surveillance, and research capacity. 

As part of the COVID-19 response, the World Bank co-chairs, alongside the Global Fund, ACT-A’s health systems pillar, which conducts crosscutting work to facilitate access to COVID-19 technologies, and it is providing direct financing to help countries purchase and distribute COVID-19 tools to their citizens.

The World Bank comprises two institutions, the International Bank for Reconstruction and Development and the International Development Association, and houses GFF, and is part of the World Bank Group, which includes IFC. Furthermore, it participates in a number of global partnerships including Gavi and UNAIDS.

UN agency responsible for international public health. WHO’s work is governed by the World Health Assembly, a decision-making body comprised of its member states, and is financed by assessed and voluntary contributions from member states, as well as contributions from philanthropic donors. 

WHO contributes to the research, development, and delivery of health technologies in numerous ways:

• Agenda setting: Through resolutions and frameworks, WHO establishes international priorities for health R&D. WHO then translates these priorities into action plans and other efforts to guide health R&D. For example, through the Science Division’s Special Programme for Research and Training in Tropical Diseases (TDR), WHO produces a Health Product Profile Directory defining product needs for neglected diseases. For epidemic-risk diseases, WHO organizes the R&D Blueprint to identify priority diseases and guide product development activities.
• Financing: Through TDR and other programs, WHO provides grants to researchers to strengthen R&D capacity and advance research and product development to combat neglected diseases.
• Capacity-building: WHO supports member countries, particularly LMICs, in strengthening R&D capacity. For example, through programs like the Global Observatory on Health Research and Development, WHO tracks indicators of R&D investment and capacity to identify and elevate gaps; through TDR, it provides training and grants to researchers in LMICs and helps strengthen research networks; through the Regulation and Prequalification program, it undertakes regulatory system strengthening activities; and through the Science Division, including TDR, WHO creates norms and standards for good research practices. It is also a founding member, alongside the UN Technology Bank, UNDP, and the UN Conference on Trade and Development, of the Tech Access Partnership, which works to increase access to COVID-19 technologies by providing a partnership platform and technical guidance to help LMICs strengthen manufacturing and production capabilities.
• Research and product development: WHO plays a role in directly coordinating and conducting research and clinical development of health technologies. For example, WHO organized the Solidarity Trial, a multinational clinical trial to compare COVID-19 therapeutics, and likewise contributed to trials on Ebola vaccines and therapeutics, and it is co-chair, alongside CEPI and Gavi, of the ACT-A vaccines pillar, which is focused on developing and ensuring equitable global access to COVID-19 vaccines. Through TDR, WHO also supports research on neglected diseases. 
• Regulatory approval: WHO plays a role in facilitating regulation of health products. Through its Prequalification program, WHO reviews products for safety, efficacy, and quality and prequalifies them for purchase by global procurers. This process helps facilitate regulatory approval in LMICs. WHO also operates an Emergency Use Assessment and Listing Procedure to guide the use of unapproved products during a health emergency.
• Access: WHO undertakes a number of activities to support product uptake and access, including providing technical guidance on appropriate use of technologies and publishing its Essential Medicines and Diagnostic Lists, supporting implementation research through TDR and other programs, providing coordinating networks for information sharing on post-market surveillance, and directly procuring and distributing technologies as part of various health programs. Specific to the ongoing pandemic, WHO has also developed an allocation framework for fair and equitable access to COVID-19 health products.