EA - An overview of market shaping in global health: Landscape, new developments, and gaps by Rethink Priorities

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: An overview of market shaping in global health: Landscape, new developments, and gaps, published by Rethink Priorities on September 6, 2023 on The Effective Altruism Forum.Editorial noteThis report is a "shallow" investigation, as described here, and was commissioned by GiveWell and produced by Rethink Priorities from February to April 2023. We revised this report for publication. GiveWell does not necessarily endorse our conclusions, nor do the organizations represented by those who were interviewed.The primary focus of the report is to provide an overview of market shaping in global health. We describe how market shaping is typically used, its recent track record, and ongoing gaps in its implementation. We also spotlight two specific market shaping approaches (pooled procurement and subscription models). Our research involved reviewing the scientific and gray literature and speaking to five experts.We don't intend this report to be Rethink Priorities' final word on market shaping, and we have tried to flag major sources of uncertainty in the report. We hope this report galvanizes a productive conversation within the global health and development community about the role of market shaping in improving global health. We are open to revising our views as more information is uncovered.Key takeawaysMarket shaping - in the context of global health - comprises interventions to create well-functioning markets through improving specific market outcomes (e.g., availability of products) with the end goal of improving public health. Market shaping interventions tend to be catalytic, timebound, and have a strong focus on influencing buyer and supplier interactions. [more]Market shaping interventions are used to address various market shortcomings. A commonly used framework to assess shortcomings in various market characteristics is some variation of the "five As": affordability, availability, assured quality, appropriate design, and awareness. [more]There is no commonly agreed upon set of interventions under the term of market shaping, but they can be broadly categorized by the main type of lever they use: reduce transaction costs (e.g., pooled procurement), increase market information (e.g., strategic demand forecasting), balance supplier and buyer risks (e.g., advance market commitments). [more]New developments have been taking place in the field in recent years: (1) New intervention types have been devised and implemented (e.g., ceiling price agreements); (2) there has been a drive toward institutionalization with the launch of several new organizations whose sole policy instrument focus is market shaping (e.g., MedAccess); (3) there is an increase in co-ownership with national governments in low- and middle-income countries (LMICs); (4) the field is increasingly experiencing diminishing returns as most of the "low-hanging fruits" have been picked, and projects are getting more complex with narrower indications and smaller health impacts. [more]Market shaping has recently seen both wins and disappointments. Recent wins include: (1) Results for Development's (R4D) amoxicillin dispersible tablets (amox DT) program; (2) ceiling price agreements for optimized antiretroviral (ARV) regimens; (3) a ceiling price agreement for HIV self test; (4) significant price reductions in vaccines achieved by Gavi. Recent disappointments include: (1) the continued price instability of malaria ACTs; (2) the failure of a uterotonic agent to be registered in Kenya; (3) the sole supplier of malaria rapid diagnostic tests (mRDTs) threatening to leave the market due to unsustainably affordable prices; (4) a tuberculosis (TB) drug in Brazil not being procured. [more]We describe three case studies of recent market shaping activities:The Affordable Medicines Facility - malaria (AMFm) was lau...