Background Based on the 2021–2030 WHO Neglected Tropical Diseases (NTDs) Roadmap, schistosomiasis elimination as public health challenge will require treatment of all populations at risk, as well as development of innovative products such as a pediatric medication to target specifically preschool-aged children. Access to treatments for NTDs is currently based primarily on philanthropic donations from pharmaceutical companies which have significantly contributed to decrease endemicity while ensuring access to targeted populations. However, new access models to provide innovations are a prerequisite to ensure long-term sustainable and equitable access to all at country level, strengthening country ownership and empowerment in the fight against NTDs.

Methods Together with international stakeholders, the Pediatric Praziquantel Consortium is elaborating the various elements of an innovative procurement-based mechanism addressing the “4 As” of an access framework based on Availability, Affordability, Accessibility and Acceptability of the potential new pediatric treatment option, once it will be registered.

Results This is a new access path in the NTD community with many gaps to fill. Some elements have been already defined such as the establishment of a high-quality local manufacturing ensuring adequate production, a tailored regulatory approach allowing introduction of the product in countries, and a pricing structure leading to affordability. However other elements such as the demand path, the procurement mechanism and its funding remain critical gaps to be addressed with the support of the countries and international stakeholders.

Conclusion Innovations needed to address the WHO 2030 Elimination agenda will also require an innovation in their accessibility as today this aspect of the value chain is the new valley of death hampering the translation of NTD R&D into impact.