The affordability, availability, and financing of medicines and other health commodities has always been a central issue for the Global Fund to Fight AIDS, Tuberculosis, and Malaria, its donors, recipient countries, and affected communities. Given the significant amount and proportion of Global Fund grant funding that goes to health commodities procurement, the strategic and operational components of their procurement and price strategies, and the availability of suppliers and access to their products, are key to ensuring availability and affordability of medicines. Current and proposed policies have created a growing concern that the Global Fund is fundamentally altering its approach to access to medicines. There appears to be a progressive rollback of its previous position of the promotion of generic competition as a key driver for lowering costs to a more opaque, centralized, collaborative approach with both generic producers and originators that risks reducing individual country ownership and threatening the continued supply of low-cost generic production. In addition, given the increasingly global spread of patenting, it is critical to also explore additional ways to challenge (and overcome) the high prices of new medicines.In light of these concerns, advocates should explore whether and how to expand and connect activities in relation to the Global Fund and access to medicines issues more broadly. To help promote that debate, this paper provides a preliminary identification of five areas that illustrate these concerns, and where the Global Fund's present or future policies could either enhance or limit the potential to use generic competition, rights-based advocacy, and/or its public purchasing power to lower the price of medicines.
