The global procurement landscape of leishmaniasis medicines

Ensuring access to essential medicines for leishmaniasis control is challenging, as leishmaniasis is a very small and unattractive market for pharmaceutical industry. Furthermore, control programmes are severely underfunded. We conducted an analysis of global procurement of leishmaniasis medicines for the past 5 years in order to shed light on the current leishmaniasis market landscape and supply and demand dynamics. We estimated global demand of each leishmaniasis medicines, the amount of each medicine required to treat all reported cases, based on the number of cases reported to WHO and the first-line treatment regimen used in each country. Procurement data were obtained from procurement agencies, international organizations, WHO, national leishmaniasis programmes and manufacturers. Expert interviews were conducted to have a better understanding of how medicines were procured and used. The comparison of estimated need and procurement data indicated discrepancies in supply and demand at global level as well as in the most endemic countries. The extent of the gap in supply was up to 80% of the needs for one of the leishmaniasis medicines. Mismatch between supply and demand was much wider for cutaneous leishmaniasis than visceral leishmaniasis. This study presents a current picture of procurement patterns and imbalance in global supply and demand. Addressing improved access and supply barriers requires concerted and coordinated efforts at the global and national levels. Priority actions include setting up a procurement coordination mechanism among major procurers, partners and national programmes where forecasting and supply planning is jointly developed and communicated with manufacturers. In addition, continuous engagement of manufacturers and advocacy is critical to diversify the supplier base and ensure quality-assured and affordable generic medicines for leishmaniasis.Author summary: Even though more than 1 billion people are at the risk of leishmaniasis infection, one of the neglected tropical diseases, there is limited access to essential medicines for the treatment of leishmaniasis. We compared the procurement data collected from major procurers with the global needs estimated from the number of cases reported to WHO and the first-line treatment regimen used in each country for the past 5 years to better understand the market landscape and supply and demand dynamics. The results showed imbalances and mismatches in supply and demand at global and national levels. Improved coordination among national leishmaniasis control programmes, procurers, manufacturers and partners is needed to address access barriers. This should include proactive engagement of manufacturers to secure uninterrupted supply of quality-assured medicines, setting up the procurement coordination mechanism with major procurers for the development of joint forecasting and market shaping interventions, and promoting high-level advocacy.