Watch the market building panel recording.

 

Key Takeaways

• Market shaping worked — but the world has changed. The tools that expanded access over the past two decades delivered extraordinary results, but many of the assumptions that supported them are increasingly under strain.
• Market building starts with stronger foundations. Lasting access requires investment in critical infrastructure: capable institutions, flexible financing, data systems, workforce capacity, supply chains, and governments equipped to shape markets.
• Lower prices do not guarantee greater access. Affordable products can still fail to reach people without the financing, workforce, regulation, trust, and delivery systems needed to support them.
• Markets must reflect how people actually seek care. Trust, affordability, pharmacies, clinics, diagnostics infrastructure, and local realities often determine whether access to medicines, vaccines, diagnostics, and other innovations truly reach communities.
• Country ownership requires sharing power. Governments, civil society, and local actors must have a meaningful role in shaping markets, even when that requires slower timelines and new ways of working.
• The disruption is reaching the private sector, too. The forces reshaping donor-funded global health are also changing commercial health markets, creating uncertainty — and opportunity — for all players.
• The next phase will require broader coalitions. Building sustainable health markets will depend on stronger collaboration across governments, industry, investors, implementers, and other sectors.

“Those old paradigms, old norms that we all operated under, they’re being blown up. The solutions are changing. There are new market players, new types of entrance into the market, new rules, a new pace.” — Mary-Ann Etiebet, Vital Strategies

For more than two decades, global health has relied on a remarkably successful set of tools to expand access to medicines, vaccines, diagnostics, and other innovations. Through pooled procurement, advance market commitments, voluntary licensing, and other market shaping mechanisms, prices fell, access expanded, and millions of lives were saved.

But what happens when the assumptions behind those successes begin to erode?

That question sat at the center of a discussion at the Bay Area Global Health Alliance Annual Meeting. Moderated by Jessica Katz, Founder and CEO of The Partnerships Lab, the panel brought together Mary-Ann Etiebet, President and CEO of Vital Strategies; Jayasree Iyer, CEO of the Access to Medicine Foundation; Yasmin Chandani, CEO of inSupply Health; and Joanna Sickler, Vice-President of Health Policy and External Affairs at Roche Diagnostics.

Building on a recent PLOS Global Public Health publication analysis of market-shaping successes and lessons learned, the discussion began with Katz acknowledging that market shaping had delivered extraordinary results — including reducing HIV treatment costs from roughly $10,000 per person per year in the early 2000s to less than $40 today. Yet many of the conditions that enabled those gains are changing rapidly.

COVID exposed vulnerabilities in concentrated manufacturing, fragile supply chains, and unequal access to critical health products. Today, shrinking development assistance, growing fiscal pressures, geopolitical fragmentation, and increasing demands for country ownership are forcing a broader rethink of how health markets are built and sustained.

As the discussion unfolded, a common theme emerged: the challenge is no longer simply how to shape markets for individual products, but how to build integrated, resilient, and sustainable systems capable of supporting access over the long term. The conversation shifted from market shaping to market building, echoing in part the Alliance’s J.P. Morgan Healthcare Conference convenings in January (see here). 

While market shaping focused on improving how individual markets function, market building is concerned with something broader: the critical infrastructure that makes markets work in the first place. Institutions. Financing mechanisms. Data systems. Workforce capacity. Supply chains. Service delivery networks. Relationships. Trust.

As Etiebet put it, “How do we build the foundations for markets to work? It’s not about tinkering at the edges and building scaffolding, because if those original structures fall down, the scaffolding collapses as well.”

And this disruption is not confined to donor-funded global health. “The disruption that has come to the donor-driven global health ecosystem is also coming to — or coming for — the commercial-driven global health ecosystem,” Etiebet said. “Those old paradigms, old norms that we all operated under, they’re being blown up.”

New market entrants, direct-to-consumer health services, AI-enabled solutions, local manufacturing efforts, and changing consumer expectations are altering how health products and services are financed, distributed, and consumed. The old rules no longer fully apply.

Looking back at successful market shaping efforts across HIV, TB, hepatitis C, malaria, and Ebola, Iyer argued that the field often focuses on the mechanisms themselves while overlooking what made them possible. “None of the market shaping examples would have been possible without flexible mission-driven financing and sweat equity,” she said. “That ability of flexible, mission-driven financing was key.”

The discussion also challenged a long-standing assumption: that lower prices automatically translate into better access. Iyer noted that market shaping is often reduced to a conversation about price reduction. Yet cheaper products can still fail to reach people if the systems surrounding them are weak, she noted. 

If financing was one form of critical infrastructure, governments and institutions were another. Etiebet argued that the future will require stronger national capabilities and a faster shift toward governments shaping markets themselves. She also pointed to data as an increasingly important asset, describing it as “the new currency” on which modern markets run.

Yet perhaps the most grounded perspective came from Chandani, whose work supports governments and health systems across East Africa. If global health is serious about building stronger markets, she argued, governments, civil society organizations, and emerging local actors must have a meaningful role in shaping them. It is not simply transferring responsibility, but sharing decision-making authority.

“If we’re trying to build these ecosystems and build these markets of the future, are we willing to slow down a bit?” Chandani asked. “We have to make space for people to join this ecosystem and participate meaningfully and that takes time,” she said. “Which means some of our results may take time too.”

Chandani challenged participants to think about markets from the perspective of the people navigating them, emphasizing the importance of a human-centered approach. Drawing on examples from family planning and primary care, she argued that access depends on much more than whether a product is available — or even affordable. 

“Access and equity can be lost,” said Chandani, if markets are not built around the human-centered perspective. Markets are ultimately experienced by patients, families, providers, and communities, not just procurement systems. For innovations to reach those who need them, Chandani emphasized that market-building efforts must account for trust, convenience, provider behavior, financing, supply chains, and where people actually seek care.

Sickler made the same point from the diagnostics perspective. Diagnostics, she noted, are often treated as “100% product” when in reality they are closer to “50% product and 50% service” — reinforcing the point that building healthier markets requires investing in the systems around products, not simply lowering their price. A test may be affordable, but without trained staff, maintenance systems, financing, supply chains, and reliable delivery channels, it still may not reach patients.

That perspective led to a broader call for renewed collaboration across sectors. “The only path forward is together,” Sickler said.

While she pointed to strong collaboration between public and private sectors in many countries, she expressed concern that trust and dialogue across the broader global health ecosystem have deteriorated. She specifically cited the Alliance as one of the few forums that continues to bring together stakeholders from across sectors in constructive ways. “I think this forum [the Alliance] has always been one that has provided that,” she said, referring to cross-sector engagement. 

Rebuilding trust, understanding different perspectives, and acting in good faith, Sickler argued, will be essential if the sector hopes to navigate an increasingly uncertain future. Other panelists also suggested that the next phase of market building will require broader coalitions than those that defined earlier market-shaping efforts. Regulatory policy, trade, financing, industrial strategy, technology, and private-sector investment are increasingly shaping health outcomes, bringing new actors — and new relationships — into the conversation.

By the time Katz closed the discussion, a picture of a sector confronting a larger transition emerged — from an era focused on optimizing access within existing systems focused on products to one increasingly concerned with the broader critical infrastructure and more honest public-private collaboration needed to build resilient, country-owned markets capable of withstanding a more fragmented and resource-constrained future.

If market shaping helped global health scale, the panel suggested that market building — and the critical infrastructure that underpins it — may determine whether it can endure.

 

See more on the Alliance’s 2026 Annual Meeting. Learn more about the Alliance’s work on financing and investments.

 

Speaker Bios

Yasmin Chandani, CEO, inSupply Health

Yasmin Chandani, CEO of inSupply Health, has spent over twenty years supporting and advising national governments, NGOs and multilateral partners in the strategy, design, implementation and measurement of strong, sustainable supply chains for health. Yasmin has served as a director of multi-country, multi-year initiatives, including the SC4CCM (Supply Chains for Community Case Management) Project and the USAID | DELIVER project. Yasmin is a supply chain thought leader who is known for her rigorous attention to quality and her persistent emphasis on capacity development and systemic institutionalization. She has a successful track record in contextualizing and adapting innovations such as mHealth, UAVs and data-driven quality improvement approaches for building people-centered, responsive supply chains.

Mary-Ann Etiebet, President and CEO, Vital Strategies

Dr. Mary-Ann Etiebet is President and CEO of Vital Strategies, a global public health organization that partners with governments and other stakeholders to advance long-term solutions for the growing burden of non-communicable disease and injury. A recognized global health innovator and leader in health equity, Dr. Etiebet previously served as the Lead and Executive Director of Merck for Mothers, Merck’s $650M global health initiative created to help end preventable maternal deaths. Under her leadership, Merck for Mothers increased access to high-quality and respectful maternal health care for more than 50 million women in more than 70 countries. Dr. Etiebet later served as Merck’s Associate Vice President for Health Equity, developing the company’s first enterprise-wide health equity strategy, developing partnerships to improve health outcomes for underserved communities, and driving efforts to increase access to health in low- and middle-income countries. Dr. Etiebet began her career as an Assistant Professor in the Division of Infectious Disease at the University of Maryland School of Medicine, where she led the development of their PEPFAR-supported HIV/AIDS public health and clinical service delivery programs that reached over 70,000 people across Nigeria. Later, at New York City Health and Hospitals, she was responsible for implementing Medicaid and Medicare delivery systems and value-based payment reforms. Dr. Etiebet earned her M.D. and MBA from Yale University. She completed her medical training at New York-Presbyterian Weill Cornell and New York Presbyterian Columbia University Medical Center, becoming board-certified in Internal Medicine and Infectious Diseases. She is a member of the Board of Directors at the Center for Global Development. She has also served on numerous global health advisory councils, including the World Bank’s Global Financing Facility Investors Group, the World Health Organization’s Partnership for Maternal, Newborn and Child Health, the United Nations Population Fund High-Level Commission, and the World Economic Forum’s Global Future Council.

Jayasree Iyer, CEO, Access to Medicine Foundation

As CEO, Jayasree K. Iyer sets the Foundation’s strategy for assessing the efforts of healthcare companies to ensure their products reach more people around the world. In her discussions with global industry leaders, she engages them on the practical, effective steps they can take to develop, scale up and supply essential health products to the people living in low- and middle-income countries (LMICs) who account for approximately 80% of the global population. Since 2015, Jayasree has led the expansion of the Foundation from a small initiative into a dynamic, changemaking organisation that produces rigorous research and insights on urgent issues of access and affordability across five essential healthcare sectors. Jayasree’s expertise lies in engaging with CEOs and other high-level stakeholders on the biggest issues in access and health, highlighting key opportunities and challenging companies to step up access initiatives as part of their business operations. In her role as the Foundation’s CEO, Jayasree also connects the organisation’s research insights with people, companies and global health organisations that are working to improve access to medicine. She addresses complex, contentious topics such as drug pricing and intellectual property (IP) management, as well as how to align industry research priorities with the areas of greatest need to people globally, including the development of replacement antibiotics and child-friendly medicines. Before joining the Foundation, Jayasree developed and managed a large portfolio of public-private partnerships between the pharmaceutical industry and its partners, totalling a budget of over €100 million. These partnerships addressed cancer, immunology and neglected tropical diseases. Jayasree is an infectious disease scientist by training and holds various postgraduate degrees (Masters and PhD), from the Johns Hopkins School of Hygiene and Public Health and Nanyang Technological University in Singapore.

Joanna Sickler, Vice-President, Health Policy & External Affairs, Roche Diagnostics

Joanna Sickler is Vice-President, Health Policy & External Affairs at Roche Diagnostics. Joanna’s background spans diagnostics, pharmaceuticals, and NGOs, with a focus on public health, implementation science, and health policy to optimize medical value. Previously at Roche Diagnostics, she served as senior director of medical affairs, leading global medical strategy and clinical impact studies for point-of-care molecular tests, with a strong focus on respiratory diagnostics and pandemic response. Prior to joining Roche at Zyomyx, she led market access strategy, policy, and the post-approval clinical study program to support the launch of the company’s first product, a point-of-care CD4 test for use in limited resource settings. Previously, as part of the Access Programs leadership team at the Clinton Health Access Initiative (CHAI), she developed models and led advocacy for global procurement interventions to ensure the sustainability of the children’s HIV drug market. She partnered with Ministries of Health throughout Africa to support the HIV Guidelines revision process and assess the cost impact of changes. She holds Masters in Public Health and Masters in Business Administration degrees from the University of California, Berkeley. She received her Bachelor of Arts degree from Wesleyan University and is currently pursuing her Doctorate in Public Health at Johns Hopkins University.

Jessica Katz, Founder and CEO, The Partnership Lab

Jessica Katz is the Founder & CEO of The Partnership Lab, where she designs and delivers cross-sector partnerships that create health impact and sustainable business value. With over a decade at the intersection of global health and the private sector, she has advised companies, multilaterals, and foundations on partnership strategy, market-shaping, and private sector engagement. Previously, she was a Partner at Rabin Martin, advising leading pharmaceutical, technology and CPG companies, and later led private sector fundraising and engagement at Gavi, the Vaccine Alliance. Jessica founded The Partnership Lab to help organizations move cross-sector partnerships from alignment and intent into practical, scalable delivery.