Company:MedAccess

MedAccess Guarantee Ltd

Industry	Global health, development finance
Founded	2017
Headquarters	London, UK
Key people	Helen Rees (Board chair), Michael Anderson (CEO)
Number of employees	22
Website	www.medaccess.org

MedAccess is a social finance company based in London. It is capitalized with $200 million, enabling it to provide loans and financial guarantees designed to increase access to health products, including vaccines, therapeutics, and diagnostic tests, for patients in low- and middle-income countries.

MedAccess’ finance reduces market risks facing manufacturers and procurers. One of its most commonly used tools is a volume guarantee. In return for guaranteed sales, manufacturers provide long-term price reductions and assurances of supply security. MedAccess’ guarantees also aim to strengthen markets. Patients benefit from lower costs and more availability as new manufacturers enter the markets while existing manufacturers reduce their prices to compete for market share.

The company had provided nine guarantees by the end of 2022. The guarantees support access to health products that tackle COVID-19, HIV, malaria, syphilis, and tuberculosis, particularly in Africa and South Asia.

History

The early 2000s saw renewed global focus on improving access to lifesaving health products. New financing mechanisms such as Gavi, the Vaccine Alliance, the Global Fund to fight AIDS, Tuberculosis and Malaria, and Unitaid increased access to products against major killer diseases like HIV and childhood pneumonia.

Although these organizations succeeded in increasing access to products in many countries, market failures continued to hamper efforts to scale up access to a broader range of healthcare products around the world. The Department for International Development, with design inputs from the Bill & Melinda Gates Foundation and the Clinton Health Access Initiative, developed initial concepts for a new capital fund to support market shaping activities. The UK's then-CDC Group (now British International Investment) incubated the concepts and developed a company limited by shares.

MedAccess was founded as the Credit Facility for Access to Medicines in November 2017. BII provided initial paid-in capital of $200 million (over two tranches) and remains the company’s sole shareholder. MedAccess is part of BII’s Catalyst Strategies, which accept greater risks in return for higher development impact.

Michael Anderson was appointed CEO in November 2017. Anderson, a former director-general at DFID and CEO of the Children’s Investment Fund Foundation, had previously served as the UK Prime Minister’s envoy for the creation of the UN Sustainable Development Goals.

The company changed its name to MedAccess Guarantee Ltd in 2018. It is not-for-profit, with all surpluses from capital investments and fees reinvested into its transaction pipeline.

Transactions

Disease area	Partner	Description
HIV, Viral Hepatitis, HPV	Hologic	In July 2018, MedAccess announced its first volume guarantee agreement with Hologic, Inc. As part of Hologic’s Global Access Initiative, the guarantee is increasing access to viral load testing for HIV and viral hepatitis using the Hologic’s Panther System. In return for the guarantee, Hologic agreed to an all-inclusive price of $12 per test. This was the first time a manufacturer had committed to all-inclusive pricing, which covers installation, training and maintenance. This led to a significant market shift as major procurers such as PEPFAR changed their tender requirements to include all-inclusive pricing.
Malaria	BASF	In October 2019, MedAccess and the Bill & Melinda Gates Foundation announced a volume guarantee to increase access to BASF’s dual action mosquito nets. The nets, which combine a new class of insecticide, called chlorfenapyr, with traditional pyrethroids are at the forefront of efforts to tackle resistance amongst mosquitos. In March 2022, a study from Tanzania showing the nets to be highly effective at reducing malaria incidence in areas of higher mosquito resistance, potentially leading to substantial cost savings for countries was published in the Lancet.
COVID-19	UNICEF	Responding to the COVID-19 pandemic, in July 2020 MedAccess announced a $50 million guarantee to support UNICEF’s procurement of essential COVID-19 products and other health supplies was announced. The guarantee helped UNICEF to respond quicker to requests from countries who risked missing out as supply shortages led to market volatility and higher prices.
Malaria	Gavi	In August 2021, MedAccess, GlaxoSmithKline and Gavi, the Vaccine Alliance announced a financing agreement to ensure continued production of antigen for RTS,S – the world’s first malaria vaccine. Production was at risk of being halted ahead of policy and funding decisions. The World Health Organization recommended the vaccine for widespread use in Africa in October 2021 and Gavi’s Board approved an initial investment of US$155.7m to support the malaria vaccine introduction, procurement and delivery between 2022 and 2025.
Latent Tuberculosis	Macleods	In August 2021, MedAccess and CHAI announced a volume guarantee to increase access to Macleods’ 3HP latent tuberculosis treatment. 3HP is a short-course preventive treatment for latent TB, taken over three months. This makes it easier for patients to complete the course compared to older, less tolerated treatments that could take 12–18 months. The agreement will help ensure stable supply for countries as part of the Global Fund and Unitaid’s IMPAACT4TB partnership, led by the Aurum Institute.
HIV and syphilis	SD Biosensor	In November 2021, MedAccess and CHAI announced a volume guarantee to increase access to dual rapid diagnostic testing for HIV and syphilis. The guarantee enabled SD Biosensor to lower its price below $1 per test, the first time sub-$1 price had been offered. Testing rates for syphilis are significantly below those for HIV in many countries. The dual test enables countries to leverage existing HIV testing infrastructure to test pregnant women for a syphilis, a disease that causes more than 210,000 stillbirths and new-born deaths every year.
COVID-19	Gavi	In April 2022, MedAccess, Gavi and the Open Society Foundations announced a $200 million risk sharing facility to support the COVAX cost-sharing mechanism. The facility supports COVAX's efforts to help 92 of the world's lowest-income countries to procure additional COVID-19 vaccine doses, over and above doses provided through the COVAX Advance Market Commitment, to increase vaccination rates and meet national coverage targets. MedAccess and the Open Society Foundations each provided guarantees of up to $100 million for the facility.
HIV	Wondfo	In July 2022, MedAccess, Wondfo and CHAI announced an agreement to increase access to the Chinese manufacturer's HIV self-test. Announced on the eve of the International AIDS Society's 2022 conference in Montreal, the agreement saw Wondfo reduce the price of the test to $1, making it the lowest priced WHO prequalified HIV self test on the market.
Malaria	SD Biosensor	In September 2022, MedAccess, SD Biosensor and PATH announced a partnership to expand access to G6PD testing. The test is an important part of care for people with P. vivax malaria. Although effective treatments are available for people with P. vivax malaria, they can be harmful to people who are G6PD deficient. In the absence of G6PD testing, healthcare workers are often cautious, prescribing lower doses taken over longer periods or, sometimes, not prescribing at all. G6PD testing is essential for advancing progress towards P. vivax malaria elimination.

Innovative finance tools

MedAccess uses innovative finance tools to immediately increase access to health products and shape markets in the longer term. Guarantees are approved by an investment committee based on needs assessments, impact analysis and partner alignment.  

Volume guarantees

A volume guarantee is a legally binding contract that sets out a maximum price in return for assured sales volumes. It provides procurers with confidence that sufficient supply of the product will be available at a ceiling price, while providing manufacturers with assurance that they will not suffer losses should sales volumes not meet anticipated demand.

If product sales are less than the agreed upon target, MedAccess will either purchase the shortfall volume or make a payment to the supplier to compensate for losses due to the shortfall.

Procurement guarantees

Procurement guarantees enable procurers to enter into purchasing agreements that would otherwise have been out of reach due to individual organizations’ procurement and disbursement rules.

MedAccess enters into an agreement with a procurer to support its procurement or market shaping activity. A call can be made by the procurer if there is a shortfall in demand for the product or products covered by the guarantee.

Purchasers benefit from the terms agreed upon by the procurers and the manufacturers in the form of improved value for money, reduced lag time, and quality assurance on purchased products. Patients benefit from faster and wider availability of affordable high-quality health commodities.

Loans and loan guarantees

In May 2021, the MedAccess Board agreed to expand the company’s mandate to include loans, working capital and loan guarantees.

Development impact

MedAccess uses a bespoke development impact framework to assess the impact of its transactions. The company uses the tool to calculate potential additional impact compared to the current standard of care in terms of lives changed, money saved, and markets shaped.

In its 2021 Annual Report, MedAccess reported its guarantees contributed to:

• 554,000 people living with HIV who were not virally suppressed knowing their viral load after being tested using the Panther platform
• 8.6 million cases of malaria being averted over the lifetime of Interceptor G2 mosquito nets provided through the BASF guarantee
• 101,000 additional people living with HIV completing 3HP treatment for latent TB
• Procurement and distribution of more than 75 million vaccines through UNICEF, including COVID-19 vaccines and other vaccines against serious childhood illnesses

MedAccess projects that its guarantee for SD Biosensor’s dual rapid diagnostic test for HIV and syphilis will lead to at least 285,000 pregnant women receiving a syphilis diagnosis and 51,500 miscarriages and stillbirths being avoided. It also projects that its HIV self test agreement will lead to an additional 8.1 million people being tested for HIV.

In November 2022, MedAccess estimated that guarantees provided in its first five years have enabled healthcare products to reach more than 375 million people in more than 90 countries.

Impact of COVID-19

Global health organizations including the Global Fund have reported COVID-19 reversed decades of gains against diseases such as HIV, TB and malaria. MedAccess’ guarantees helped to ensure essential healthcare products continued to be available and the company reported minimal disruptions to supply in its 2020 Annual Report.

See also

• Foreign, Commonwealth and Development Office
• British International Investment
• Clinton Health Access Initiative
• Gavi, the Vaccine Alliance
• Bill & Melinda Gates Foundation
• Unitaid
• Innovative Vector Control Consortium