Implications of global health funding patterns for implementation of a novel soil-transmitted helminth and lymphatic filariasis medicine: Ivermectin/albendazole fixed-dose combination

Background: Medicine donation programs have been central to neglected tropical disease (NTD) control, particularly for soil-transmitted helminths (STH), but growing concerns about sustainability, supply continuity, and country ownership highlight the need for new access models. A novel fixed-dose combination (FDC) of ivermectin and albendazole, recently endorsed by the European Medicines Agency, offers programmatic advantages over monotherapy. Unlike some existing treatments, the FDC may not be donated. This paper examines how the current drug donation landscape for STH shapes the prospects for future supply and financing of the FDC. Methods: Evidence for this paper was synthesized from a structured review of peer-reviewed and gray literature, supplemented by expert consultation. Data drawn from WHO’s Service Availability and Readiness Assessment (SARA) database on essential medicine availability, estimates of public health spending, and the World Bank’s World Development Indicators on health expenditure support the qualitative reports from sampled sources. Findings were interpreted within a framework examining three interrelated determinants of sustainable access: facility-level availability of essential medicines, health financing patterns, and existing donation models. Results: The analysis involved the review of 35 sources on essential medicine availability, financing, and supply of critical medical products, and medicine donation. SARA data showed striking gaps in essential medicine availability in health facilities, with some low- and lower-middle-income countries (LICs, LMICS) reporting zero facilities with sustainable availability. On health financing, African and Asian countries are spending only about half of what is called for in targets. Low- and lower-middle income countries remain heavily dependent on external aid and out-of-pocket spending, in stark contrast to high- and upper-middle and high-income countries where domestic public financing predominates. Further, no pooled or coordinated global financing mechanism currently exists for NTD medicines, leaving supply fragmented and reliant on donations. Existing donation programs for albendazole, mebendazole, and ivermectin have achieved wide-scale coverage and impact but have not fostered sustainable domestic procurement or integration into primary health care systems. Conclusions: Introduction of the FDC in the absence of donation schemes poses significant financing and supply challenges, especially for LICs and LMICs where essential medicine availability is already limited. However, it also presents an opportunity to reset NTD access models by embedding sustainable financing strategies, such as pooled procurement, tiered pricing, and primary health care integration, from the outset. Early planning with manufacturers, donors, and governments will be essential to ensure equitable access and country ownership of this novel treatment. Author summary: Medicine donation programs have been essential for controlling neglected tropical diseases by enabling mass treatment in many low- and middle-income countries. They can also mask weaknesses in sustainable access to and utilization of medicines.