A new paper in PLOS Neglected Tropical Diseases examines how global health funding patterns can shape access to the novel fixed-dose combination (FDC) of ivermectin and albendazole, the first new soil-transmitted helminth (STH) treatment in decades. Unlike the treatments currently in use, the FDC may not be donated.

Co-authored by researchers from Bridges to Development and the Mundo Sano Foundation as part of the STOP2030 Consortium’s Work Package 5, the study draws on a structured review of 35 sources on donation programs, financing and supply, complemented by two global datasets: WHO’s Service Availability and Readiness Assessment (SARA) on essential medicine availability, and the World Bank’s indicators on health expenditure.

The analysis surfaces a structural mismatch: the infrastructure for sustaining access to essential medicines is weakest in precisely the geographies where the STH burden is highest. In low-income countries such as Burundi, Burkina Faso and Mali, the proportion of health facilities with sustained, affordable availability of core essential medicines was 0% during the assessed periods.

Underpinning this misalignment is chronic underfunding, with public healthcare spending sitting below the 15% budget target in every WHO region, and health systems in lower-income countries leaning heavily on out-of-pocket payments and external aid. Notably, no pooled or coordinated global financing mechanism currently exists for NTD medicines.

“Having an effective treatment, like the FDC, is necessary but not sufficient. If health systems cannot procure and distribute it, it will not reach the people who need it most,” explained Israel Wuresah, co-author of the publication and a researcher at Bridges to Development. “We have an opportunity to embed sustainability strategies and integrate country ownership from the start.”

A new tool for multiple diseases

The FDC is a mango-flavoured, orodispersible tablet developed by Liconsa Labs, also a partner of the STOP2030 consortium. It removes the need to weigh or measure every patient for ivermectin dosing, enabling an operationally simpler one-pill-per-person strategy for mass drug administration campaigns.

The FDC also targets all the STH species considered in WHO’s 2021-2030 NTD Roadmap, including Trichuris trichiura and Strongyloides stercoralis. It has received a positive scientific opinion from the European Medicines Agency under the EU-M4all procedure for treating STH and lymphatic filariasis (LF), was licensed by Ghana’s FDA in late 2025, by Honduras’ ARSA in early 2026 and is on the path to WHO prequalification.

Because it may not be donated, the FDC is expected to be supplied at a cost and quantity that is sustainable for the manufacturer while aligned with its public health commitments to public sector co-investors in its development. This shift, the authors argue, creates both challenges and opportunities.

The STH and LF medicine donation programs have expanded access effectively, but they do not provide a clear pathway to national financing or sufficient incentives for investing in data systems that can demonstrate when medicines are no longer needed, the paper points out. In contrast, a non-donation model for a product like FDC, that offers programmatic efficiencies and broader efficacy, may offer an opportunity to reset relationships by embedding sustainability plans and stronger targeting of medicines, integration, and country ownership from the start.

The publication forms part of the STOP2030 consortium, co-funded by Global Health EDCTP3, which is currently evaluating the safety and effectiveness of the FDC in mass drug administration settings. Partners include Liconsa, KEMRI, Ghana Health Service (GHS), the Wellcome Sanger Institute, ISGlobal, Mundo Sano and Bridges to Development.

Reference: Wuresah I, Brooks A, Kubal N, Gold M, Krolewiecki A, Jacobson J. Implications of global health funding patterns for implementation of a novel soil-transmitted helminth and lymphatic filariasis medicine: Ivermectin/albendazole fixed-dose combination. PLOS Neglected Tropical Diseases. 2026.