1. Introduction
    Effective, high-quality medicines that are accessible and affordable for those in need are critical to success in the fight against infectious diseases. This paper briefly presents some of the barriers to increased access to drugs. It then highlights a shifting emphasis in innovative drug access partnership initiatives from grant-making to niche efforts aimed at reshaping market dynamics for increased access to life saving medicines.
2. Barriers to access - the need for innovation and sustainable, predictable financing
    Many barriers are blamed for the lack of access to medicines by vulnerable populations, including the poorest of the poor. These barriers include:
       • " the need for reliable drug demand and supply forecasting;
       •" the reluctance of industry to invest in research and development of drug formulations tailor-made for specific vulnerable groups such as infants, young children and pregnant women; and
       •" the lack of high-volume drug orders (backed by predictable, long-term donor financing) that can lower overall prices per unit.
3. Partnership initiatives to increase access to drugs:
    To foster lower drug prices, increased innovation and greater access, stakeholders in different sectors have sought new international mechanisms to provide drugs for impoverished and vulnerable populations. There is widespread recognition of the importance of joint involvement by developing countries, communities, donors and international agencies. In this context, a new framework for intensified collaboration through "partnership", has been emphasized, particularly in the last decade.
    Five partnership initiatives to increase access to drugs are discussed in this paper. The three initiatives that took shape in 2000-2006 focused initially on increasing access to drugs through grants, procurement services and focused technical support. Two other initiatives developed since 2006 emphasize new approaches to shape market dynamics, develop innovative funding sources and change the paradigm for drug development/production via use of international intellectual property agreements. One of these recent initiatives, UNITAID, is described in more detail to highlight how innovative niche partnerships are overcoming barriers to increase access to HIV/AIDS, tuberculosis and malaria medicines.
4. Conclusion
    Significant barriers have stymied efforts to provide effective and quality treatment to millions in need. These barriers, however, are not insurmountable, but do require strategic thinking and pooled efforts to reduce transaction costs, negotiate larger, longer-term drug purchases, strengthen developing country drug manufacturing capacity and catalyse production of treatment formulations specially designed for groups such as children. Partnerships such as those discussed above have evolved from a focus on grant making to new approaches that are reshaping market dynamics to ensure greater access to treatment for people in need.

    The views expressed in this paper are those of the author alone and do not necessarily represent the position or the stated policy of the World Health Organization.