TY - JOUR T1 - Market-driven, value-based, advance commitment (MVAC): accelerating the development of a pathbreaking universal drug regimen to end TB JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2019-002061 VL - 5 IS - 4 SP - e002061 AU - Kalipso Chalkidou AU - Adrian Towse AU - Rachel Silverman AU - Martina Garau AU - Ganesh Ramakrishnan Y1 - 2020/04/01 UR - http://gh.bmj.com/content/5/4/e002061.abstract N2 - Summary boxTuberculosis (TB) is the world’s deadliest infectious disease; without a significant technological breakthrough, current trajectories suggest that the world will not achieve the Convergence 2035 targets for TB until 2074, almost 40 years later than originally projected.Research and development investments for TB are dominated by public sources and total only one-third of estimated need, with private investment small and declining.To crowd in private investment, we suggest a new model—the market-driven,value-based advance commitment (MVAC)—wherein high-burden middle-income countries (MICs) would offer advanced purchase commitments for a prespecified breakthrough treatment regimen.Through use of early health technology assessment, an emerging practice and capability in many large MICs, the MVAC would ensure that country purchase commitments reflect local needs, value and ability to pay for innovation.A multilateral development bank would underwrite the MVAC commitments, increasing their credibility to private industry without requiring countries to put aside funds in advance.Discussion with developing country policymakers, industry, development banks and development partners suggest fertile ground for the MVAC approach, but high-level political commitment is still needed.Tuberculosis (TB), an infectious disease primarily affecting poor and neglected populations, kills an estimated 1.6 million men, women and children each year).1 Our existing arsenal of tools is insufficient to address this enormous burden. Current treatment cycles are long and toxic, causing some patients to discontinue treatment, acquire drug resistance and spread a drug-resistant pathogen to others. Treating drug-resistant cases takes even longer, is more expensive and less effective. More extensive forms of drug resistance are developing and spreading quickly. On the current trajectory, the world will not achieve the Convergence 2035 targets for TB until 2074, almost 40 years later than originally projected (see figure 1).Figure 1 New cases of tuberculosis per 100 000 people. Source IHME. BRICS, Brazil, Russia, India,China and South Africa; HTA, health technology … ER -