The State Department’s recently released “America First Global Health Strategy” – the first roadmap for what comes next for U.S. global health engagement – charts a path of declining U.S. support over time as recipient countries increasingly take on financial responsibility for programs. It includes a focus on health commodities, as frontline services, stating that the U.S. will continue to support 100% of their costs in FY 2026, with declining funding thereafter as countries are required to provide progressively higher co-investment. To support this transition, the U.S. will establish or contribute to one or more pooled procurement mechanisms, marking a departure from current practice where most commodities have been provided by the U.S. through its own stand-alone, managed channels, with limited support to external pooled procurement entities. Whether the U.S. chooses to create a new pooled procurement mechanism or shift to existing ones will be a key decision point going forward. To help inform this decision, we reviewed eight global and regional pooled procurement mechanisms to identify their key characteristics, including their operational longevity, geographic reach, range of products offered, whether the U.S. already uses to mechanism, and other components. As this review shows, there are several existing pooled procurement platforms with significant longevity, broad geographic reach, offering a range of commodities, allowing access to countries that have transitioned off donor support, and in which the U.S. already participates to varying extents. There are also others with a narrower scope or in which the U.S. does not participate. Summary measures are provided in Table 1. Detailed information is provided in an Appendix.
Note: In most cases, these mechanisms also provide diagnostics, supplies, and devices. See Appendix for more details.
The State Department’s recently released “America First Global Health Strategy” offers the first roadmap for what comes next for U.S. global health engagement, following months of significant uncertainty and disruption. The strategy focuses on a subset of U.S. global health areas – HIV, TB, malaria, polio, and global health security – and is largely anchored to time-bound, bilateral agreements that aim to move most partner countries toward full self-reliance. A key feature of the strategy is its emphasis on health commodities, noting that the U.S. spends approximately $1.3 billion per year directly on commodities for HIV, TB, malaria, and polio (with some additional funding provided to several multilateral organizations). According to the strategy, the U.S. will continue covering 100% of these commodity costs in FY 2026, with declining funding thereafter, as countries are required to provide progressively higher co-investment. To support this transition, the U.S. intends to establish or contribute to one or more pooled procurement mechanisms. Pooled procurement refers to the consolidation of demand across multiple buyers with the goal of obtaining lower prices, reduced transaction and administrative costs, streamlined quality assurance, and more predictable markets, all of which can help improve better access. It is one tool in a larger “market shaping” toolbox that may include other activities such as demand forecasting, market analysis, and technical assistance, among others.
Shifting to pooled procurement for health commodities would mark a departure from current U.S. practice which has historically been carried out through U.S. stand-alone and managed supply chain contracts (with only some funding provided to external pooled procurement mechanisms both directly and indirectly). Until recently, this work was overseen and managed by the now-dissolved USAID. Procurement responsibilities have since moved to the State Department, which has not carried out large-scale health commodity procurement before (see Table 2 and Box 1). Whether the U.S. chooses to create a new pooled procurement mechanism or shift to existing ones will be a key decision point going forward (the recently announced partnership between the U.S., the Global Fund, and Gilead to provide Lenacapavir – a long acting medication for pre-exposure HIV prevention – to a subset of countries, in which the U.S. will support procurement for its implementing partners through the Global Fund’s platform, offers a potential new model in this area). To help inform this decision, we reviewed eight pooled procurement mechanisms operating at the global and regional levels to identify their key characteristics. For each mechanism, we examined years of operation, governance, financing models, geographic scope, product portfolios, eligibility, price transparency, annual expenditures, and other components.
The landscape of existing pooled procurement mechanisms is diverse, with variations in geographic scope, product lines, eligibility, financing, governance, and other characteristics.
As this review shows, there are several existing pooled procurement platforms with significant longevity, broad geographic reach, offering a range of commodities, allowing access to countries that have transitioned off donor support, and in which the U.S. already participates to varying extents. Looking ahead, key considerations for U.S. policymakers may include:
