Advancing global health access through market shaping: Cases and learnings

New health products have contributed to major improvements in public health, but many clinically effective interventions still face delays in reaching low- and middle-income countries (LMICs). Market shaping approaches have emerged as a set of tools designed to address such access gaps by influencing prices, supply, and demand. Drawing on practitioner experience and illustrative cases, this paper examines how market shaping mechanisms have been used to expand access to pharmaceutical products in LMICs. We review examples including dolutegravir, rifapentine-based tuberculosis preventive therapy, pretomanid for drug-resistant tuberculosis, the RTS,S malaria vaccine, and Rwanda's hepatitis C program, alongside ecosystem-level interventions such as revolving funds and initiatives to strengthen regional manufacturing. Across these cases, we suggest generalizable lessons and describe trade-offs related to donor dependence, supplier concentration, and timing of interventions. The paper identifies priorities for empirical research to assess the performance, risks, and applicability of market shaping tools as global health needs and resource environments evolve.