OnCo
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Pooled international procurement of essential adult cancer medicines

Countries buying cancer drugs alone pay more and face shortages. Buying together, as they already do for childhood cancer drugs and vaccines, cuts prices and secures supply.

The WHO and St Jude Global Platform for Access to Childhood Cancer Medicines (2021) pools demand across countries for paediatric essential medicines; PAHO's Strategic Fund and Gavi do the same for other products. Adult essential oncology medicines on the WHO Model List (cisplatin, carboplatin, paclitaxel, docetaxel, tamoxifen, letrozole, imatinib, trastuzumab biosimilars and others) are procured nationally at widely varying prices. The proposal is a pooled procurement mechanism for these products covering low- and lower-middle-income countries, with multi-year volume guarantees, quality prequalification and a buffer stock against shortages.

Hypothesis
Pooled procurement reduces the median price paid for essential adult oncology medicines by participating countries by at least 40% and reduces reported stock-outs by half within three years.
Rationale
Fragmented small tenders are the main reason LMICs pay more than high-income countries for the same generic; pooled volume and predictable demand are what generic manufacturers need to offer low prices and reliable supply.
What would test it
Launch the pool for ten adult essential medicines in 15 countries and compare procurement prices and stock-out reports with the countries' own prior tenders and with non-participating peers.
Maturity
being tested at scale
Who has to act
policy
Cost to try
Large (over $50M)
Years to first evidence
3
Bottlenecks it attacks
  • Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.
  • Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.

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