7 Questions for UNITAID Director Lelio Marmora

By Sandy Garcon, Communications Manager, PSI 

UNITAID’s executive director discusses the importance of developing and unlocking markets to accelerate innovations in growth.

 1. Impact: Why are markets systems important to the poor?

LM: The poorest people are typically the most vulnerable in society, and often the most directly affected by changing or underdeveloped market conditions – be it a change in prices, or the availability of a given health product. Stable, sustainable markets, where health products are available, adapted, quality-assured and affordable, are therefore a powerful tool for the benefit of the poor.

2. Impact: What does it mean for a market to work? How does that apply to the health field?

LM: For a health market to work, it must be effective across a number of dimensions. Innovative health products, quality-assured by a regulator, must be available, affordable and fit for purpose. Within countries, demand and adoption are vital. The supply chain must reliably deliver the product from manufacturer to end user.

3. Impact: What are the key features, and what’s distinctive about UNITAID’s approach?

LM: UNITAID aims to maximize the effectiveness of the global response by catalyzing access to better health products. This means enabling countries and partners to allocate resources efficiently by supporting improved access to innovative products, which are of a higher quality or fit the specific needs of different groups.

We make time-limited investments to catalyse access to better health products and approaches. We’re operating in a part of the value chain where few other organizations work. We connect innovators to end users, and scale up the use of innovative public-health tools through our partners. We bring partners together to demonstrate solutions to public-health problems, and are focused on long-term sustainability. One example is through demonstrating a better health product or approach that ultimately leads to transition and scale-up by key funding partners and governments.


UNITAID Executive Director Lelio Marmora. Photo Credit: WHO

4. Impact: What are the common market failures you see in low- and middle-income countries?

LM: Just as there are many factors that make a market work, there are many factors that can make it fail.

A lack of demand for a product in-country; lack of a suitable product for specific conditions in countries; a lack of evidence to secure the political will to adopt a given health policy; a company unwilling to adapt their products to markets with uncertain conditions: the challenges are diverse and numerous.

5. Impact: How can developing country governments, the private sector and NGOs complement each other to design appropriate solutions that make markets work for the poor?

LM: This is at the core of UNITAID’s business model. We enable and encourage collaboration between the key actors to identify opportunities, develop solutions and implement them. At an operational level, we bring actors together to identify opportunities. UNITAID identifies areas for intervention that: best reflect our expertise in addressing commodity-access issues, offer strong potential public health impact, are feasible in terms of the availability of innovation, and demonstrate an optimal use of our resources. The best, we fund, with a view to large-scale implementation through our partners. So bringing these disparate groups together is a key part of our operating model. This is where UNITAID adds value.

6. Impact: What role should international donors have? How should donor roles change in the future?

LM: International donors will continue to have a critical role meeting global health goals. Over last 15 years, huge resources have been channeled to global health and great progress has been made. But we have reached a critical juncture: though there is still a huge health agenda to support, international funding will not continue to grow at the rates we have seen in the past. So we need to adjust to that change.

Part of this will involve graduating countries off direct-donor support so they can take greater ownership of their health infrastructure. Donors can continue to provide technical support for the most critical areas of need. But they should also focus on accelerating access to innovation and efficiency. Eventually we may see donors working at smaller scales of investment, but taking greater risks to push technologies further.

7. Impact: How can market-based solutions accelerate the implementation of comprehensive, universal health coverage by 2030?

LM: Universal health coverage includes financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all. Markets are critical to achieving this aim. You can’t provide such coverage to the poorest people without fixing the underlying market failures. Incentives to manufacturers, governments, and the end users themselves, can go a long way to help reach this goal.

HIV Self-Testing

Fewer than 50 percent of all people living with HIV worldwide are aware of their status. Increased HIV testing, particularly in areas where HIV prevalence is highest, would bring those infected into treatment and achieve epidemic control. With funding from UNITAID, PSI and its partners are working to catalyze the market for HIV self-testing and reach more people who face limited access to conventional testing. The multi-year UNITAID/PSI HIV Self-Testing AfRica (STAR) project is generating vital information on how to safely and effectively deliver HIV self-testing, how to generate demand and how HIV self-testing can improve public health. The project will generate evidence to inform WHO normative guidance and support development of national-level policies on HIV self-testing. The data will also inform estimates of market size, encourage market entry among potential manufacturers and inform the future scale-up of HIV self-testing globally.

Consortium Partners: WHO, London School of Hygiene and Tropical Medicine and University College London
In-Country Research Partners: Malawi-Liverpool-Wellcome Trust Clinical Researhc Programme, ZAMBART and CeSHHAR Zimbabwe.

This article is part of an ongoing conversation about #MakingMarketsWork in Impact Magazine No. 22 “Are We Thinking Big Enough” issue. Join in the conversation with @PSIImpact.