MAPGuide: Equitable Access Toolkit

The Equitable Access Toolkit:
A Comprehensive Guide to Contract Provisions

At GHIAA, we focus on the role of agreements in supporting equitable access to medical products. A key element of our work involves searching for and analyzing global health agreements to identify how they address key issues that influence equitable access outcomes. We look at different types of agreements which can have an impact at different stages of product development and publish our analysis and copies of the related agreements on the open access MAPGuide platform. It’s a process that produces a wealth of information, but that information can be overwhelming. That’s where the Equitable Access Toolkit comes into play.

The Equitable Access Toolkit is a guide to promote and facilitate the inclusion of concrete and transparent equitable access provisions in global health agreements. The Toolkit builds on the hundreds of detailed provisions available in the MAPGuide agreement database, and is comprised of a series of straightforward commentaries providing explanations and examples of important issues. 

The Toolkit is currently centered on R&D funding agreements for medical products with the aim of supporting governments, philanthropic foundations and impact investors in assessing potential approaches to equitable access in their agreements.

How Can the Toolkit Help You?

A key driver behind the Toolkit is the recognition that there is no single, simple answer to the question of how product R&D funders can ensure equitable access to the products that they fund. The identification of ‘best practice’ terms requires consideration of the context and goals of a particular project. With this in mind, the commentaries and illustrative examples in the Toolkit present a range of options for addressing different issues to help funders evaluate what is appropriate and actionable for the specific circumstances of an agreement.

The Toolkit is also built on the principle that equitable access provisions must be supported by other terms in an agreement to enable funders to enforce, monitor, and measure the fulfillment of equitable access obligations. For this reason, we present key considerations for R&D funding agreements as a series of layers in the Equitable Access Pyramid. The top layer represents some of the core elements of equitable access: affordability, availability, and sustainability. The middle layer identifies the types of agreement provision that most directly address the achievement of these principles, which should be supported by a detailed access plan. Finally, the bottom layer of the pyramid addresses the need for supporting provisions that provide a funder with rights to continue a project if their development partner cannot or will not, as well as enabling the funder to monitor project progress and use of their funding.

Why Does it Matter?

The stark inequities in access to COVID-19 diagnostics, vaccines, and therapeutics are a clear illustration of what can happen when funding agreements do not include equitable access obligations. Indeed, a number of recent articles emphasize the need for such obligations, particularly when product developers receive public funding. The Toolkit provides practical insights into equitable access for practitioners and policy makers representing governments, other funders, and the broader global health community. By presenting concrete examples of how equitable access provisions can be, and have been, successfully implemented, the Toolkit provides a clear path for turning words into action.

What's Next?

Equitable access provisions need to extend beyond funding agreements to ensure that a final product is available and affordable when and where it is needed. We plan to add a new section to the Toolkit later in 2023, focusing on key considerations for licensing agreements. Our intention is that the Toolkit will evolve and expand over time based on user input and the availability of new agreements illustrating examples of alternative approaches. We welcome and encourage ongoing feedback and constructive dialogue about these materials and the associated challenges and opportunities for improving equitable access outcomes.

We invite you to review GHIAA’s Equitable Access Toolkit and let us know what you think!