On a positive note, a groundbreaking study found about one in eight deaths had been averted among children eligible for Mosquirix (RTS,S) vaccination during four-year pilot introductions in Ghana, Kenya and Malawi. This news carried particular resonance for our reporting team: one of our first articles explored Gavi’s 2016 funding for the initial RTS,S field tests, and in the 10 years since, we’ve exhaustively tracked this vaccine, from country introductions to GSK’s tech transfer to Bharat Biotech to WHO prequalification and beyond. The three-decade journey of the product from GSK’s labs to the arms of the children whose lives it might save — a journey made possible by collaborators like PATH, WHO, Gavi, country officials, and other stakeholders — exemplified the focus of our news service. The question that has guided our coverage over the last decade: How can global health actors collaborate effectively with industry to develop and deliver vaccines, drugs, and diagnostics equitably and accessibly?
On the negative side, shortly before the real-world malaria vaccine results appeared in The Lancet, Gavi warned publicly that funding gaps could cost 600,000 lives by 2030. A $3 billion funding shortfall has led to an adjusted strategy, including a scale-back in malaria support. This news was a reminder that some of the biggest global health wins we’ve covered in the prior decade depended on factors — such as significant public R&D investments, aggregated demand, robust donor funding, and willing industry partners — that we can’t take for granted.
As we enter our 10th year of publication, we’re taking this opportunity to spotlight successes like RTS,S. As you’ll see below, market forces and global health priorities have aligned in some surprising and significant ways. We’ll also highlight persistent challenges in areas like antimicrobial resistance and pandemic preparedness, for which market solutions can be stubbornly elusive.
While the next 10 years will look very different, our hope is that the wins of the past can inspire new solutions for a changing world.
In October 2016, UNICEF said it had halved the average price per dose of penta vaccine in its next tender period. The news was remarkable: prior to 2006, the penta market had just a single WHO prequalified manufacturer and a supply of about 16 million doses per year. A decade later, there were eight prequalified producers and an estimated supply of 600 million - 650 million doses annually. The weighted average price in Gavi countries at the end of this period was less than a third of what it had been at the start.
UNICEF attributed the progress to “market shaping across Gavi Alliance partners,” including the Gates Foundation, WHO and UNICEF itself.
This wasn’t the result of market forces left unchecked; the Gavi penta market had been carefully stewarded by coordinated actors sharing global health goals. According to a 2019 article in Vaccine: X, interventions included WHO technical support to regulators and manufacturers; PATH- and Gates Foundation-brokered technical assistance to manufacturers; and a Gates-backed risk sharing agreement that encompassed technical support and a volume guarantee (the latter generated savings of about $150 million over four years).
Countless similar efforts in the years since have had favorable outcomes, with notable examples including a 2017 collaboration to lower the price of a Pfizer injectable contraceptive by 15% and a pair of 2025 deals making generic versions of Gilead’s lenacapavir HIV PrEP drug available for $40 per person per year in 120 LMICs.
Offering a detailed overview, the searchable table below includes hundreds of multipartner efforts and investments from the Linksbridge Pharma News archives. You’ll find deals to expand access to existing products, de-risk the development of important new global health medicines, and support regional manufacturing of drugs and vaccines.
Not all product challenges in global health hinge on the (comparatively) simple problem of ensuring drugmakers make suitable drugs in adequate quantities at low prices. Using a traditional market-focused lens to address antimicrobial resistance (AMR), the need for regional manufacturing of drugs and vaccines, and pandemic preparedness can prove vexingly tough. How can a system incentivize manufacturers to produce next-gen antibiotics if effective stewardship would require limitations to those products’ sales? How can newly established vaccine makers in sub-Saharan Africa compete with established producers on price? How can vaccine makers profitably develop vaccines for diseases that aren’t yet a threat?
In the case of AMR, there are overlapping problems limiting costly investments in new drugs: as short-duration interventions, antibiotics don’t invite the ongoing sales of most pharma blockbusters; nor is the addressable population large (unlike the market for many vaccines); and stewardship considerations may mean using the best products the most sparingly. CARB-X Executive Director Kevin Outterson put it simply at the 2020 World Economic Forum: “If you invent a mediocre antibiotic, your sales will be low; if you develop a great antibiotic, your sales will be lower.”
Global health actors have responded by devising new incentives. These have taken the form of “push” incentives, aiming to move candidates through the pipeline by de-risking R&D investments, and “pull” incentives seeking to guarantee a return on products that align with global health AMR priorities.
On the push side, the public-private partnerships CARB-X and GARDP launched in 2016, followed by Novo Nordisk’s REPAIR Impact Fund in 2018 and the industry-backed AMR Action Fund in 2020. In varying ways, these organizations all seek to stimulate investment in R&D for AMR-combatting products.
On the pull side, the E.U. and U.K. have launched antibiotic subscription models that would pay drugmakers based on the public health value of their antimicrobial products, rather than on actual usage; the E.U. has also implemented a voucher system by which priority antimicrobials can earn an additional year of market exclusivity for a different product; and Japan has piloted a “revenue assurance” program offering compensatory payments if antibiotic sales fall short of thresholds.
Recent antibiotic approvals — including GARDP-backed Nuzolvence (zoliflodacin) from California-based Innoviva and BARDA-supported Blujepa (gepotidacin) from GSK — show that economically viable antibiotic development is possible when push funding is available to help bring antibiotics through the pipeline.
Conversely, Shionogi’s self-funded cefiderocol antibiotic (Fetroja) benefited from a suite of access efforts after its approval. The Osaka-based drugmaker licensed the antibiotic to GARDP, which then partnered with the Stop TB Partnership’s Global Drug Facility on pooled procurement for the drug. Cefiderocol was also the center of several pull-incentive efforts, including in Britain and Japan. This year, cefiderocol earned Shionogi a $119 million supply deal with BARDA.
San Francisco–based Achaogen spent 15 years (and by some $1 billion) developing its complicated urinary tract infection antibiotic Zemdri. After the U.S. FDA approved the drug and WHO added it to its list of essential medicines, the company filed for bankruptcy with less than $1 million in Zemdri sales in 2018.
Other antibiotic developers faced a similar demise, including Melinta Therapeutics, Iterum Therapeutics, and Tetraphase Pharmaceuticals. Similarly, even though Venatorx attracted R&D support for its cefepime-taniborbactam antibiotic from GARDP, BARDA, and AMR Action Fund, the FDA rejected it, leading Venatorx to offload it to Basilea, and ultimately to wind down its operations.
But perhaps the starkest illustration of the market’s perverse incentives is the story of Cidara Therapeutics. Despite succeeding in developing the first new treatment option for candidemia and invasive candidiasis in 10 years, the company struggled financially and found success — via a $9.2 billion Merck acquisition — only after it pivoted away from antifungals. The market rewarded the exit, not the drug development.
Global health actors like Africa CDC have identified reliance on imported vaccines and drugs as a significant cause of inequitable health outcomes. In response, numerous multipartner initiatives are focused on expanding regional manufacturing, including Gavi’s African Vaccine Manufacturing Accelerator (AVMA) — an up to $1 billion capital-providing mechanism that is likely to make its first cash disbursement to an African vaccine manufacturer in the second half of this year. AVMA and related initiatives, such as Africa CDC’s continental pooled procurement mechanism (an effort backed by A.U. governments and partners) aim to create predictable demand and a viable vaccine manufacturing ecosystem.
Despite these efforts, the reality is that “new entrants will have higher costs and higher prices,” Yalda Momeni — Gavi’s Senior Specialist, Vaccine Future Supplier Base Strategy — told Linksbridge. Price incentives have already pushed procurers toward cheaper products made elsewhere over locally made vaccines, and getting new manufacturers to market requires bridging that gap. Other challenges include the potential for a production glut if too many facilities come online without secured demand, and shifting market dynamics that have led pharma giants (including Moderna and BioNTech) to change tack on their respective African vaccine production plans.
But the most significant challenges are systemic. Reliable electricity, clean water, and a talent base require massive upfront investments that donor funding hasn’t prioritized. The next decade will start to reveal which regional manufacturing models are genuinely viable. Sustainability could lie in non-vaccine health commodities in the initial years, where some of the vaccines-related ecosystem pressures are less acute.
The stories of Cape Town-based Biovac and Aspen Pharmacare illustrate what regional manufacturing can achieve and two stubborn structural problems: price and demand.
Biovac has spent a decade assembling a robust portfolio, including a Group B Streptococcus vaccine, hexa, IPV, meningitis vaccine, PCV, and OCV. The company has also scored big investments in its capacity and recently secured a funding package to build Africa’s first end-to-end multivaccine manufacturing facility. But the decade also surfaced a key problem for regional vaccine manufacturing: South Africa’s decision to buy Serum Institute of India’s cheaper PCV over Biovac’s domestically produced product highlighted how limited budgets incentivize procurers to focus on price over buying locally.
Aspen entered the vaccine space through its 2020 fill-finish deal for J&J’s Covid vaccine, which in 2021 evolved into a tie-up with J&J to package and sell its own version of the jab. But when not a single order materialized, the company was left with near-idle production lines and a cautionary lesson about building capacity ahead of securing demand. Despite efforts to diversify and fill idle capacity — including through a 10-year SII vaccines deal, distribution agreements with Eli Lilly and Novo Nordisk, and a $552 million World Bank loan — the company struggled financially. Only recently did Aspen begin talks with Africa CDC on a demand alignment framework — one that could have changed Aspen’s story had it arrived years earlier.
When seeking to address pandemic preparedness, global health actors face unique challenges. Demand for pandemic vaccines is generally hypothetical until a crisis strikes. Moreover, donor funding is cyclical — surging during emergencies and fading during interpandemic periods (when the groundwork needs to be laid). In 2017, there were early attempts to institutionalize preparedness financing, with the launch of both CEPI and the World Bank’s Pandemic Emergency Financing Facility, but the world remained significantly ill-prepared.
Covid briefly created opportunities for interventions from the market shaping playbook. COVAX aggregated demand with Gavi as the centralized buyer, and donor funding flooded in. These conditions alone couldn’t guarantee equitable access without a legally binding commitment — something the pandemic treaty negotiations have spent years attempting to codify, and something the treaty that arrived in 2025 still hadn’t resolved.
What the past decade has built is a maturing pipeline of candidates for pathogens with pandemic potential. Initiatives like CEPI’s 100 Days Mission and its 3.0 strategy aim to shift pandemic preparedness from a reactive scramble into a proactive, globally coordinated response, and investment across a range of diseases shows real progress. Whether CEPI investments can continue to produce approved products depends in part on whether outbreak attention holds long enough to sustain funding through to approval.
The 2015-2016 Zika outbreak shows what happens when attention moves on: companies jumped into vaccine R&D as the outbreak peaked; as it slowed, Sanofi stopped its vaccine R&D and Moderna eventually walked away from its Zika shot. A decade later, no approved vaccine exists.
The biggest global health wins of the last decade were built on conditions that took years to construct and are now under strain. Funding cuts and the increasing politicization of global health goals threaten to undermine historic gains, and the ecosystem of partnerships and organizations that delivered those gains faces stark headwinds. Still, we have countless examples of new products successfully developed, lifesaving medicines made more accessible, and deaths averted through expanded vaccine availability. Novel approaches to managing antimicrobial resistance are being explored, and in the challenging areas of regional manufacturing and pandemic preparedness, stakeholders continue their important work. The news — good and bad — will go on, and we’ll be here to bring it to you.
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