Master Alliance Provisions Guide (MAPGuide)

Incorporating Access Plans & Principles
into Funding Agreements

As shown in GHIAA’s Equitable Access Pyramid, there are many agreement provisions that need to work together to support the achievement of a funder or PDP’s equitable access policy. In addition to provisions addressing product access matters such as affordability and availability, and operational matters such as governance and reporting, funders can reinforce the equitable access objectives of an agreement through the inclusion of: 

1. Provisions setting out a specific set of guiding equitable access principles; and 

2.  An access plan which details the actions that the developer will take to meet its commitments.

1. Equitable Access Principles

Provisions that set out the underlying equitable access principles for a funding agreement often include a definition of access according to the funder’s policy. This definition might be tied to a particular product or field of use depending on the funder’s mission and the purpose of the agreement.

Examples from the MAPGuide

“Global Access” means: (a) the knowledge and information gained from the Project will be promptly and broadly disseminated; and (b) the Funded Developments will be made available and accessible at an affordable price (i) to people most in need within developing countries, or (ii) in support of the U.S. educational system and public libraries, as applicable to the Project.

Related Definitions:

Source: this is the standard Global Access definition referenced in the Bill & Melinda Gates Foundation’s Global Access Statement. These provisions can be found in a number of the Foundation’s grant agreements such as this one with Arsanis for the preclinical development of a monoclonal antibody treatment for respiratory syncytial virus infections.

[Funder] is committed to achieving equitable access to the results of all [Funder]-supported programmes pursuant to the “Equitable Access Policy” referenced in [Funder]’s Third Party Code. Equitable Access means that a Project Vaccine is available first to populations at risk when and where they are needed at affordable prices.

Source: taken from a development funding agreement between CEPI (Funder) and Novavax (Developer) for a COVID-19 vaccine. Read in context.

The Recipient acknowledges that the objective of the Project is to ensure that the Health Products are made widely available, as quickly as possible and on a continuing basis, at an affordable and sustainable price, to the Public Sector seeking to supply them to LMICs and in sufficient quantities to meet the needs of LMICs (the “Access Objective”). The Recipient will make best efforts to ensure that the Health Products are developed and commercialised in a manner which is consistent with the Access Objective.

Source: taken from the sample terms and conditions for Unitaid (Funder) funding for Recipients (Developer) under the UnitaidExplore program. Read in context.

The mission of [Funder] is to accelerate the development of a [disease] vaccine for pediatric indications and ensure its availability, affordability and accessibility for the developing world. The objective of the [Funder] [disease] program is to reduce the number of deaths and hospitalizations of children in the developing world due to [disease] infection through advanced development and introduction of safe, affordable and efficacious new [disease] vaccines.

Source: taken from a development funding & collaboration agreement between PATH (Funder) and Aridis (Developer) for the formulation development of a rotavirus vaccine. Read in context.

Certain key purposes of the Investment are to provide relief to the poor and distressed, improve the health of those living in Low and Lower-Middle Income Countries (as defined by the World Bank and if approved by the Global Access Committee) (“Target Countries”), and educate health practitioners and public health officials on cost-effective technologies that will improve the health and safety of poor and low-income individuals globally (the “Global Health Objectives”).

Source: taken from a global health agreement between the AXA Prime Impact Master Fund (Funder/Investor) and Revelation Biosciences (Developer) for the development of a therapeutic for allergic rhinitis and a diagnostic for respiratory virus infections. Read in context.

2. Access Plans

An access plan sets out the actions that a product developer will take in order to ensure equitable access to a safe and efficacious final product. These plans can include considerations related to a number of the building blocks of equitable access, including achieving a cost of goods that meets affordability requirements, developing a product with an appropriate profile for target countries, manufacturing sufficient volume of the product to meet demand and obtaining the required regulatory approvals. The activities detailed in the access plan can be used to identify key project milestones and performance metrics against which the impact of a funded project can be monitored and measured.

Some funding agreements refer specifically to the creation of an access plan or strategy, whereas others integrate this concept into broader product development, manufacturing and supply, or marketing plans. Initial plans are incorporated into some funding agreements as an annex, but other agreements take the approach of requiring the developer to establish a plan at a later stage (for example, reaching a certain clinical trial phase). In either case, both the funder and developer should consider the need for an access plan to be a living document which evolves along with the product development process. Review and update of this living document is often the responsibility of the joint project steering committee or a similar governance body.

Access plans are usually treated as confidential documents that are not publicly shared and are redacted from any agreements disclosed in accordance with SEC filing or freedom of information requirements. One exception to this is Stewardship and Access Plans related to funding agreements with CARB-X which will be published on CARB-X’s website (see example below).

To further define Your Global Access commitments, You are required to complete a Global Access Strategy and any other Global Access activities and documentation listed in the Reporting & Payment Schedule. The Global Access Strategy should address the following concepts with respect to all Funded Developments: (a) identification of Background Technology at the outset of the Project and any Funded Developments created during the Project and specific strategies to ensure access to such Funded Developments and Background Technology; (b) agreements and/or procedures for transfers of materials and data among Project Collaborators or third parties relevant to the Project; (c) reporting processes for the creation of Funded Developments to both the Project management team and to the Foundation as well as the publishing and dissemination of the knowledge and information gained from the Project; (d) strategies to secure, manage and allocate intellectual property rights associated with the Funded Developments or Background Technology in a way that ensures Global Access while providing incentives for future potential private sector participation; and (e) anticipated development, commercialization and sustainability strategies during and after the Project to ensure that Global Access can be met.

Source: taken from a grant agreement between the Bill & Melinda Gates Foundation (Funder) and Arsanis (Developer) for the preclinical development of a monoclonal antibody treatment for respiratory syncytial virus infections. Read in context.

The [Developer] will work with the [Funder] to develop (by the time of completion of Phase II clinical trials) and execute a manufacturing and supply plan that will enable to be met the reasonably expected demand in Developing Countries for any Products. […] The manufacturing and supply plan could involve the use of manufacturing partners and support from donors, and the specific level and allocation of funding responsibilities in such plan will be decided as mutually agreed in good faith in writing by the parties based on a fair allocation of the expected benefits between Developing Countries and developed countries.

Source: taken from a strategic relationship agreement between the Bill & Melinda Gates Foundation (Funder) and Arsanis (Developer) in connection with an $8 million investment by the Foundation to support a Staphylococcus aureus antibody development program. Read in context.

When its Product enters Phase III trials (or Phase IIb trials, if they are intended as the pivotal trials to support registration, or otherwise, when the [Developer] is preparing a Product that is not a therapeutic or preventative for First Approval as defined in Section [x] below), the [Developer] shall create and provide to the [Funder] within ninety (90) days, a plan reasonably describing how it intends to meet the above stewardship and access obligations for the Product, (the “Stewardship and Access Plan”). The Stewardship and Access Plan shall not include confidential business information and shall include:

(i) Strategy to support access and stewardship (e.g. proposed reliable production with sufficient capacity, supply systems, the broad approach to product labelling, and the broad approach to ensure economic barriers to access are as low as reasonably possible);

(ii) Identifying obstacles and constraints to access and stewardship;

(iii) Exploitation strategy for Project IP Rights, including whether it is planned for the Project IP Rights to be transferred to a third party;

(iv) Strategy to ensure marketing approvals are received for key territories in a timely manner; and

(v) Strategy for monitoring effectiveness of access and stewardship, including proposed metrics to measure success.

The Subrecipient shall update the Stewardship and Access Plan and provide it to the PTE when the Product is first approved by any of the FDA, EMA (or national authorities), or Japan’s PMDA (the “First Approval”). After First Approval, the Stewardship and Access Plan shall be updated if there are significant market or product changes, or if events so require. The Subrecipient shall use best reasonable efforts to comply with its Plan at all times.

The Stewardship and Access Plan will be a non-confidential document and will be publicly posted on the [Funder] website.

Source: taken from the template CARB-X (Funder) cost-reimbursement agreement with subrecipients (Developer) for the early stage development of antibiotics, vaccines, and rapid diagnostics against bacterial threats. Read in context.

Within six (6) months of the Effective Date or such longer period as may otherwise be agreed in writing (including by email), the Parties shall agree a detailed Manufacturing and Supply Plan for the supply of the Drug Product through the JSC. The Manufacturing and Supply Plan shall be based on the following principles: 

the Parties shall develop a detailed forecasting, supply, access and implementation plan for the supply of the Drug Product and define related operational supply chain management processes to ensure availability and access of the Drug Product in the Field with the consultation, as appropriate, of one or more funding agencies or partners, e.g., the World Health Organisation; […]

Source: Taken from a collaboration agreement between DNDi/GARDP and Entasis for the development of Gonorrhea medication. Read in context.

Within [timing] the [Developer] shall deliver to [Funder]  a Marketing Plan which will describe the [Developer]’s planned activities to make the Product available for stockpile in accordance with the definition of “Market” or otherwise in preparation for an Outbreak or Increased Outbreak Preparation Need. […]. The [Developer] shall review and, where appropriate, update the marketing plan at least once every calendar year and will deliver to [Funder], not less than one (1) month prior to the commencement date of the revised marketing plan, the revised marketing plan together with an update on the implementation of the marketing plan.

Source: taken from an anonymized product development funding agreement. Read in context.

The Global Access Coordinator, who shall initially be [Name] (or another person mutually agreeable to the [Developer] and [Funder]), will lead the Company’s efforts to market the Products to Global Health Purchasers in Target Countries and to ensure overall customer success in Target Countries, in accordance with a plan to be prepared by the Global Access Committee on or prior to [date – 3 months after effective date] (the “Global Access Plan”). The activities of the Global Access Coordinator, which activities shall be consistent with the Global Access Plan, shall be overseen jointly by the [Developer]’s senior management and the Global Access Committee.

Source: taken from a global health agreement between the AXA Prime Impact Master Fund (Funder/Investor) and Revelation Biosciences (Developer) for the development of a therapeutic for allergic rhinitis and a diagnostic for respiratory virus infections. Read in context.

Commitment to Equitable Access. [Funder] is committed to achieving equitable access to the results of all [Funder]-supported programmes pursuant to the “Equitable Access Policy” referenced in [Funder]’s Third Party Code. Equitable Access means that a Project Vaccine is available first to populations at risk when and where they are needed at affordable prices. For clarity, it is [Funder]’s intention that the price of a Project Vaccine shall be commercially sustainable to the manufacturer.

Project Vaccine Registration. [Developer] shall cooperate with [Funder], and at [Funder]’s cost, take such actions as are mutually agreed to register Project Vaccines in countries identified as priorities. If [Developer] is not the license holder for purposes of registration in a given country, then [Developer] shall be responsible for ensuring that its Subawardee facilitate such registrations as requested by [Funder]. [Developer] shall utilize WHO pre-qualification or similar registrations systems to the extent available.

Global Allocation. It is the Parties’ expectation that a global allocation and purchasing entity (the “Global Allocation Body”) shall be constituted within six (6) months after the Effective Date of this Agreement to purchase, allocate, and direct the distribution of COVID-19 vaccines including Project Vaccine. [Developer], will negotiate, in good faith a separate agreement or purchase order to supply Project Vaccine as may be required by the Global Allocation Body in such agreement or purchase order to the Global Allocation Body during the Pandemic Period and after the Pandemic Period for LMICs. For the purposes of this paragraph “Pandemic Period” means the period of time between the date that WHO declared COVID-19 to be a PHEIC [Public Health Emergency of International Concern] (that is, 30 January 2020) and the date that WHO declares the PHEIC to have ended including any period of a COVID-19 pandemic re-emergence as declared by the WHO.

Pandemic Period Production and Supply. During the Pandemic Period, Awardee shall:

(a) produce Project Vaccine as described in the Work Package(s), if not greater;

(b) provide the JMAG with a regularly updated [***] statement of its actual capacity and a forecast of its planned capacity for manufacturing of Project Vaccine;

(c) provide the JMAG with [***] advance written notice of each manufacturing run for the Project Vaccine;

(d) supply up to [***] of the quantity of the Project Vaccine produced for purchase by the Global Allocation Body pursuant to Clause [x – Global Allocation Body] during the Pandemic Period. For clarity, Awardee may not allocate or obligate Project Vaccine doses to other third parties during the Pandemic Period that conflicts with its obligations under this Clause [x]; and

(e) discuss in good faith with JMAG how to achieve its requirements for doses of Project Vaccine, including any potential increase in Awardee’s manufacturing capacity.

Post-Pandemic Period Production and Supply. After the Pandemic Period, Awardee shall continue to produce and supply Project Vaccine for purchase as required by the Global Allocation Body pursuant to Clause [x – Global Allocation Body].

Pricing Objectives. The Parties acknowledge that the price of the Project Vaccine is critical to achieving Equitable Access during the Pandemic Period. Accordingly, Awardee agrees that its pricing shall be reasonable to achieve Equitable Access for populations in need of a Project Vaccine as well as an appropriate return on investment for vaccine manufacturers that make on-going supply commercially sustainable. The Parties acknowledge that the availability of pandemic insurance as described in Clause [x] shall be a relevant cost factor in Equitable Access. For clarity, the purchase of Project Vaccine by the Global Allocation Body or by any other purchasing agent(s) designated by CEPI shall be considered to have satisfied the pricing requirements for Equitable Access.

Costs and Sales. Consistent with the commitments in Clauses [x to x – above], Awardee shall:

(a) provide written [***] updates to the JMAG regarding its COGs for Project Vaccines and discuss relevant product development decisions that could affect COGs; and

(b) sell the Project Vaccine doses to the Global Allocation Body during and after the Pandemic Period pursuant to Clause [x – Global Allocation Body].

Information about Production, Supply, Pricing and Sales. Upon written request by [Funder], Awardee shall provide reasonable information about its COGs, production, supply, pricing and sales of Project Vaccine sufficient to evaluate whether such activities meet the Equitable Access Policy.

Audit of Cost of Goods. No more than [***] and at [Funder]s reasonable cost, [Funder] shall have the right to review or to designate an external auditor (which shall be an internationally recognized certified public accounting firm, not engaged on a contingent basis) to review Awardee’s financial records relevant to the information provided in Clause [x – information about production, supply, pricing and sales]. Such audits will be conducted during normal operating hours in a manner to minimize disruption to Awardee’s business. In event that the audit concludes that the COGs and production, allocation, supply or pricing of Project Vaccine doses are not substantially in accordance with the achievement of Equitable Access as described in Clause [x – commitment to equitable access], then Awardee shall: [***]. The provisions of this Clause [x] shall apply to any Sub-Grant Awardees and Trusted Collaborators.

Manufacturing in Multiple Countries. Awardee shall use [***] to establish operational manufacturing facilities in one or more geographically dispersed manufacturing sites as described in the Work Packages.

Equitable Access Plan. The foregoing commitments regarding Equitable Access shall constitute the “Equitable Access Plan.” This Equitable Access Plan shall be reviewed by JMAG no less than annually and shall take into account changes in COGs over time, production yield and volume and production economics. The Equitable Access Plan shall be regularly updated during the term of this Agreement.

Source: taken from a development funding agreement between CEPI (Funder) and Novavax (Developer) for a COVID-19 vaccine. Read in context.

Related Commentaries

Access plans are a key tool for ensuring the achievement of the equitable access objectives of a product development funding agreement, in particular:

Author: Bridie Telford

First publication date: November 21, 2022