We Asked, You Answered: Reflections on the First Round of MVAC Feedback

Market-Driven, Value-Based Advanced Commitment (MVAC) is a new mechanism to help re-direct private-sector R&D investments where they’re needed most. We propose to use MVAC to encourage investments in tuberculosis (TB), which affects 10 million people worldwide. In this blog post, we reflect on the first round of feedback on our consultation draft on MVAC.

In March, our team at OHE and the Center for Global Development posted a consultation draft of a policy proposal for a Market-Driven, Value-Based Advanced Commitment (MVAC). The MVAC is a new mechanism that puts middle-income country governments in the driver’s seat to accelerate R&D for diseases that affect the world’s poor—specifically, the 10 million men, women, and children who develop tuberculosis (TB) disease each year and desperately need better therapies.

The MVAC model would help redirect private-sector R&D investments where they’re needed most, while ensuring affordable access and at-scale deployment when innovative drugs come to market. In the long run, the MVAC is intended to serve as a bridge between the dysfunctional status quo and a more sustainable and effective R&D ecosystem—one which more closely emulates the positive characteristics of high-income country markets for healthcare products.

Alongside the draft, we issued a sincere and open call for feedback “from country governments, funders, industry, civil society, and academia—to stress test our ideas; identify holes in our thinking; and help craft a tighter proposal that is responsive to stakeholder needs.” We asked, and you answered—and we’ve been gratified by the crowdsourced response from the broader community. In the months since we posted the consultation draft, we’ve received several thoughtful written responses and enjoyed the opportunity to speak frankly with a wide array of community members.

In full transparency, reactions have been mixed. Some have been enthusiastic about a practical path forward; others have voiced concerns that the MVAC would further entrench a fundamentally flawed model of financing pharmaceutical research and development. Almost all have raised valid concerns about specific design elements, requiring further consideration. But as we hoped, the feedback has indeed helped us tighten our thinking, identify gaps in our analysis, and better understand differing perspectives—a testament to the value of open dialogue and respectful debate.

The MVAC consultation process remains ongoing; all input we receive will inform our revision of the consultation draft. For those of you attending the World Health Assembly, we hope you’ll join us for the next step in that process—an open learning and networking event on May 19th.

For now, we wanted to reflect on the first round of feedback, including some of the main points raised by disease advocacy and access to medicines civil society groups in particular, and how they have influenced our thinking (though of course, we’ll elaborate further in a revised consultation draft). In a more detailed blog post we:

• clarify our position on licensing arrangements and application of tiered and value-based pricing;
• identify areas where we can work together with key stakeholder and experts to find a solution, such as the issue of managing multiple entrants and risk of “over-paying”;
• discuss areas where there may be a need to agree to disagree, such as the debate around transparency of price and R&D costs as a means of improving access to innovative medicines.