Andrew Witty's paper (Jari 2011) admirably outlines the barriers preventing access to medicines and boldly calls for "'out-of-the-box' solutions" that "can last for decades." But the important initiatives Witty highlights-including advance market commitments, public-sector funding, and technology transfers-are mostly one-off investments.One proposal that perfectly fits Witty's call for enduring solutions is the Health Impact Fund. Pharmaceutical companies would have the option of registering any new product with the funtl, thereby agreeing to sell the product globally at cost. In return, for ten years the product would receive a share of the fund's annual reward pools, which would be distributed according to registered products' health impact, measured by leading epide-miological methods.
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