Gavi & The Global Fund Responses to Activists’ Letter on Transparency in Medical Procurement
On February 6, 2024, activists wrote to the heads of UNICEF, Gavi, the Global Fund, PAHO, and PEPFAR expressing concern about a rising trend of confidentiality and non-disclosure clauses in contracts between drug procurers and drugmakers and urging them to say “no” to secrecy clauses in medical procurement agreements.
Responses from the directors of Gavi and the Global Fund are below.
See also the response from the CEO of the Coalition for Epidemic Preparedness Innovations (CEPI) to a concurrent push from access to medicines advocates urging greater transparency and disclosure of equity provisions in CEPI’s vaccine development agreements.
Gavi
Thank you for writing to Gavi, the Vaccine Alliance to raise the important issue of transparency which is a fundamental principle for Gavi as an organisation. We are committed to listening to and addressing your concerns as we share a common goal of achieving equitable access to medical products, in our case, vaccines, and appreciate that you hold us to account through constructive dialogue aimed to promoting greater openness and transparency.
We are a public private partnership, and operate as an Alliance, with civil society organisation representation on our Board and as implementing partners. As one of the largest purchasers of vaccines in the world, Gavi leads efforts to ensure equitable access to life-saving vaccines for countries most in need. Over more than two decades, Gavi’s market-shaping work has significantly reduced costs and increased access and availability of essential vaccines for lower-income countries, supporting the entry of new manufacturers and the development of new products.
Moreover, we are keenly aware of the importance of setting best practice with regard to openness and transparency for the implementing countries we collaborate with. As such, we strive to lead by example, building transparency into all aspects of our operations – consistently ranking at the highest level in independent analyses of aid transparency amongst international development organisations. Gavi and UNICEF’s procurement process adheres to rigorous standards which are subject to regular independent audits.
As standard practice, Gavi as an Alliance, publish the prices, product profiles, manufacturers for all vaccines in our portfolio, regular analyses of vaccine markets and Board papers. UNICEF, which leads procurement on behalf of the Vaccine Alliance, publishes templates of its long-term agreements with manufacturers, reflecting the commitment to transparency as a core element of healthy markets.
Our work on COVAX with Covid-19 posed new challenges, and Gavi and COVAX partners have been vocal in their strong recommendation for supply transparency in future emergencies as a key factor for equitable access. Initially manufacturers refused price disclosure due to the instability of the COVID-19 vaccine market. In the early stage of the pandemic, Gavi and the COVAX Facility were willing to commit to confidentiality obligations in its Advance Purchase Agreements (APA) in order to secure early access to constrained global supply – and to obtain other favourable conditions that Gavi requires such as ‘best possible price’ or ‘most favoured nation’ commitments in its APAs. However, in late 2021, as the COVID-19 market matured and the world transitioned away from an emergency pandemic response, Gavi and the COVAX Facility partners took steps to enhance access to pricing information. This resulted in five manufacturers disclosing their pricing information for 2021-2023; information which is publicly available on UNICEF’s Supply Division webpage (noting two manufacturers did not consent): https://www.unicef.org/supply/media/20521/file/Covid-vaccine-prices-17012024.pdf Additionally, COVAX also published other resources as part of transparency efforts, including template agreements signed with all COVAX Facility participants, supply forecasts, allocation and shipment information as well as regular data briefs.
Gavi remains committed to transparency and accountability as fundamental principles and we continually seek to improve our practices. We are grateful for your engagement in this crucial endeavor and are open to further dialogue.
Best regards,
David Marlow
Chief Executive Officer (interim)
Geneva, 19 February 2024
Thank you for writing to the Global Fund and for raising these important questions. As you know, the Global Fund has played – and continues to play – a critical role in achieving affordable access to life-saving medical commodities for the poorest and most vulnerable communities in the world. The recent price reductions for anti-retroviral (ARV) medicines – taking the annual cost of treatment down to $45 – and the 20% reduction in the price of GeneXpert TB cartridges – to $7.98 – are examples of our ongoing efforts.
Transparency is critical to achieving our objective of affordable access, and is essential for any organization investing public money for the public good. Transparency is thus one of the Global Fund’s founding principles, and is vital to our effectiveness. So thank you for holding us accountable to that.
Our commitment to transparency, as established by the Global Fund’s Board decision GF/B03/DP15 on 10 October 2002, states “disclosure of information on prices paid for purchases by Fund Recipients is a matter of principle and will facilitate a process leading to lower prices. The Fund will ensure that information on prices paid on products of assured quality with the same conditions (e.g., including other goods or services included in the contract) is made publicly available”.
A Price and Quality Reporting mechanism (PQR) was created to make publicly available procurement transaction data. This includes supplier or manufacturer name, dosage, unit cost, packaging information, shipping or other related costs, and the total cost of transaction. See here for more details.
To achieve this, the Global Fund has included, in its framework agreements with manufacturers, the right to disclose information through the PQR. The Global Fund also publishes reference prices for key products critical for the fight against the three diseases. These reference prices are not only widely used by our grant recipients, but also by national and international buyers of health products, in particular for ARVs and antimalarial products.
However, in some circumstances, the ability for the Global Fund to disclose certain information publicly may be constrained due to legal considerations or contractual provisions. We strive to minimize such limitations, while ensuring we achieve our goal of providing affordable access to lifesaving health products to the people we serve.
Sincerely,
Peter Sands
Executive Director