Overview
The State Department’s recently released “america First Global Health Strategy” marks a significant shift in U.S. global health engagement. This first-of-its-kind roadmap outlines a move towards declining U.S. financial support for global health programs, with an increasing expectation that partner countries will assume greater financial obligation. A central component of this strategy focuses on health commodities – essential medicines, vaccines, and supplies – with the U.S. committing to cover 100% of costs in Fiscal Year 2026, followed by a phased reduction in funding as countries are expected to co-invest more. to facilitate this transition, the U.S. intends to leverage pooled procurement mechanisms, a departure from its historical reliance on direct, standalone procurement channels. The decision of whether to establish a new mechanism or integrate into existing ones is a critical one. A recent review of eight global and regional procurement platforms assessed their longevity,geographic reach,product offerings,and existing U.S. involvement to inform this decision. The analysis reveals a diverse landscape of options, with established platforms offering significant potential for collaboration and efficiency.
Notably, these mechanisms frequently enough extend beyond simply providing commodities, encompassing diagnostics, supplies, and devices as well.
| Table 1: Summary of Procurement Mechanisms | |||||
| Institution/Program | Type of Institution | Geographic Scope | Years Operational | Health Product Area | Used by U.S. Government? |
| Gavi, the Vaccine Alliance (Gavi) | Independent, public/private | Global | 25 | Vaccines | Yes, indirectly |
| Global Drug Facility (GDF) | Hosted by UN/Hybrid Model | Global | 24 | TB | yes, directly |
| Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) | Independent, public/private | Global | 18 | HIV, TB, Malaria | Yes, indirectly |
| Pan American Health Association (PAHO) Revolving Fund and Strategic Fund | Inter-governmental/UN | Regional | 48 | Vaccines, Medicines | No |
| the united nations Children’s Fund (UNICEF) Supply Division | Inter-governmental/UN | Global | 63 | Vaccine, Medicines | Yes, directly |
| The United Nations Population Fund (UNFPA) supply Division | inter-governmental/UN | Global | 18 | Reproductive health | No |
| African Union’s Medical Supplies Platform (AMSP) | inter-governmental | Regional | 5 | COVID-19; some other products | No |
| Organisation of Eastern Caribbean States Pharmaceutical Procurement Service (OECS PPS) | Inter-governmental | Regional | 39 | Medicines | no |
| Note: In most cases, these mechanisms also provide diagnostics, supplies, and devices.See Appendix for more details. | |||||
Introduction
The State Department’s recently released “America First Global Health Strategy” represents a pivotal moment in U.S. global health policy. Following a period of uncertainty, the strategy provides a roadmap for future engagement, prioritizing a shift towards greater self-reliance among partner countries. This approach is particularly evident in the strategy’s focus on health commodities – the essential tools for combating major diseases – where the U.S. commits to full funding in FY 2026, with a planned reduction in subsequent years as countries increase their co-investment. A key element of this transition is the exploration of pooled procurement mechanisms, a move away from the customary U.S. model of direct procurement through contracts like the Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM). This shift presents both challenges and opportunities, particularly as procurement responsibilities now reside with the State Department, an agency with limited prior experience in large-scale health commodity procurement.The recent partnership between the U.S., the Global Fund, and Gilead to provide Lenacapavir, a long-acting HIV prevention medication, exemplifies a potential new model, leveraging the Global Fund’s platform for procurement and distribution.
The move towards pooled procurement is driven by the potential for cost savings, improved efficiency, and greater market stability. However, it requires careful consideration of existing mechanisms and their suitability for U.S. needs. The U.S. has historically utilized a mix of direct procurement and indirect contributions to pooled mechanisms, but a more strategic approach is now being considered. This article delves into the characteristics of eight prominent pooled procurement mechanisms, analyzing their strengths, weaknesses, and potential for integration into the new U.S. global health strategy.
| Table 2: U.S. Procurement mechanism by Health Area Before January 2025 | ||
| Health Area | Direct/Targeted | Indirect/General contributions |
| HIV | GHSC-PSM | Global Fund |
| TB | GHSC-PSM for TPT; GDF | Global Fund |
| Malaria | GHSC-PSM | Global Fund |
| Vaccines, including polio vaccine | Gavi | |
| Maternal and child health/nutrition | GHSC-PSM; UNICEF | |
| family Planning | GHSC-PSM | |
| Other Public Health Threats | GHSC-PSM; UNICEF | Gavi |
Box 1: U.S. Government Health Commodity Procurement Before January 2025
For decades, the U.S. government has been a major purchaser of health commodities, expanding its support to encompass a wide range of products and programs, including the landmark PEPFAR and President’s Malaria initiative (PMI). Initially focused on family planning in the 1960s, U.S. procurement efforts broadened to include commodities for HIV, tuberculosis, malaria, maternal and child health, outbreak response, and a thorough suite of vaccines. This procurement was historically carried out through three primary channels:
- Direct procurement via USAID’s Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM), which handled the bulk of U.S. commodity purchases.
- Targeted funding to multilateral organizations like UNICEF and the Global Drug Facility (GDF) for specific commodities.
- Indirect contributions to broader multilateral organizations, such as Gavi and the Global Fund, which then procure commodities independently.
This frequently enough resulted in parallel procurement efforts, with both direct U.S. purchases and indirect support through organizations like the Global fund funding the same commodities. in early 2025,the main GHSC-PSM contract was temporarily paused due to a foreign aid stop-work order,but has since been reinstated to support HIV (including TB prevention),malaria,and select maternal and child health programs. Notably, procurement of family planning commodities has been discontinued. with the dissolution of USAID, procurement responsibilities have shifted to the State Department, which is now tasked with managing these complex supply chains. Furthermore, the U.S. has temporarily halted contributions to Gavi, adding another layer of complexity to the procurement landscape.
Characteristics of Existing Mechanisms
The existing pooled procurement landscape is remarkably diverse.Each mechanism possesses unique characteristics regarding its operational history, geographic reach, product range, governance structure, and financing model. Understanding these nuances is crucial for the U.S. as it navigates its new procurement strategy.
- Years Operational/Longevity. A significant strength of many of these mechanisms is their established track record. Five of the eight reviewed have been operational for over two decades, demonstrating resilience and the development of robust systems for vendor management, quality assurance, auditing, forecasting, and broader market shaping. UNICEF, with over six decades of experience, is the longest-standing, followed by PAHO with nearly five decades. Gavi and the Global Fund, established in the early 2000s, have quickly become major players. The African Union’s Medical Supplies Platform (AMSP), while relatively new (established in 2020 in response to the COVID-19 pandemic), is evolving rapidly and is intended to serve as the foundation for the proposed African Pooled Procurement Mechanism (APPM).
- Geographic Reach.The mechanisms vary in their geographic focus.Five – Gavi,GDF,the global Fund,UNICEF,and UNFPA – operate globally,serving countries across all regions and aligning with the U.S.’s existing partner network. The remaining three – PAHO,AMSP,and OECS PPS – focus on regional procurement,serving member states within the Americas,Africa,and the Eastern Caribbean,respectively.
- Governance/Type of Organization. Governance structures also differ. Five mechanisms are intergovernmental, governed by member states (UNICEF, UNFPA, PAHO, AMSP, OECS PPS), with three falling under the UN umbrella.Gavi and the global Fund stand out as independent public-private partnerships, governed by multi-stakeholder boards representing governments, the private sector, and civil society.The GDF operates as a hybrid model, hosted by the UN but with a multi-stakeholder board.Currently, the U.S. participates in the governance of all these institutions except for AMSP and OECS PPS, which are limited to their regional members.
- Eligibility: Eligibility criteria vary based on organizational mandates and policies.Intergovernmental mechanisms primarily serve member states, while Gavi and the Global Fund prioritize countries based on income levels and epidemiological needs. However, both Gavi and the Global fund also extend access to countries that have transitioned beyond traditional donor funding, allowing them to procure through the mechanisms using their own resources. Several mechanisms also accommodate non-governmental organizations and private sector entities acting on behalf of eligible countries.
- Product Portfolio: The breadth of product portfolios varies significantly. UNICEF, PAHO, and the OECS PP offer broad portfolios encompassing a wide range of health areas. Others, like the Global Fund (HIV, TB, malaria), GDF (TB), Gavi (vaccines), and UNFPA (reproductive health), specialize in specific disease areas. AMSP is currently focused on COVID-19-related products but aims to expand its offerings. All mechanisms provide related supplies and equipment alongside commodities, and some offer procurement services. There’s a trend towards expanding product portfolios, as seen with PAHO’s inclusion of non-communicable disease commodities and wambo.org, the Global fund’s platform, which integrates catalogs from other organizations.
- Financing: Financing models range from self-sufficiency to heavy reliance on donor funding. PAHO and the OECS PP are self-financed through member state contributions. Gavi, GDF, and the Global Fund depend heavily on donor funding, though they also allow countries to utilize their own funds. UNICEF and UNFPA rely on a mix of donor funding and member state contributions.
- Pre-financing/Lines of Credit. Addressing liquidity constraints for low-income countries is critical. UNICEF, UNFPA, and PAHO offer pre-financing lines of credit to facilitate timely procurement.UNICEF’s Vaccine Independence Initiative and Middle-Income Countries’ Financing Facility (supported by Gavi) provide flexible credit lines. UNFPA’s Reproductive Health Bridging Fund offers interest-free financing, and PAHO’s regional Revolving funds provide similar support. The Global Fund is exploring the implementation of a pre-financing mechanism to address barriers to self-procurement.
- Price Negotiation/Transparency and Quality Assurance. A key advantage of pooled procurement is its ability to negotiate lower prices through aggregated demand, volume guarantees, and advance market commitments. Most mechanisms (excluding OECS PP) publicly disclose pricing data and product catalogs, promoting transparency. All prioritize quality assurance through supplier pre-qualification, adherence to WHO standards, and rigorous product testing.
- inter-connectedness Across Mechanisms. These mechanisms are not isolated entities. Synergies exist, with UNICEF often procuring vaccines for Gavi, the Global Fund utilizing the GDF for TB products, and PAHO leveraging Global Fund-negotiated prices for antiretrovirals. This interconnectedness reflects efforts to maximize efficiency and leverage existing infrastructure.
- Expenditures & Fees. Annual expenditures vary significantly, ranging from millions to billions of dollars. UNICEF ($3 billion), the Global Fund ($2.5 billion), and Gavi ($1.8 billion) represent the largest procurement mechanisms. Though, direct comparisons are challenging due to interconnectedness – for example, a significant portion of UNICEF’s spending is funded by Gavi for vaccine procurement. details on administrative fees is limited, with UNICEF and PAHO being the primary sources of publicly available data.
Looking Ahead
The analysis of these pooled procurement mechanisms reveals a diverse and capable landscape. As the U.S. implements its “America First Global Health Strategy,” several key considerations will be paramount.Policymakers must carefully assess the alignment of existing commodity portfolios with U.S. priorities, explore various modes of participation (direct procurement, funding country purchases, or a combination), address barriers to country participation (such as pre-payment requirements), and evaluate the potential for supporting emerging regional mechanisms, particularly in Africa.The success of this new strategy hinges on a strategic and collaborative approach to procurement, leveraging the strengths of existing mechanisms while ensuring accountability and efficiency.
Ultimately, the shift towards pooled procurement represents a significant opportunity to strengthen global health security, promote self-reliance among partner countries, and optimize the use of U.S.resources. A well-informed and strategic approach will be essential to realizing these benefits.
