The global medicine-access crisis is not simply a failure to balance innovation and affordability. It reflects a deeper system in which shareholder-driven pharmaceutical governance and fragmented donor structures undermine public health and block the shift toward more equitable value creation.
Every year, millions of preventable deaths in the Global South could be averted with timely access to affordable medicines. While achieving equitable pharmaceutical access is widely recognized as a critical global health challenge, the mechanisms for doing so remain contested. Prevailing debates focus narrowly on reconciling R&D incentives with access, overlooking deeper structural and political determinants.
This paper argues that the misalignment between innovation incentives and public health needs is a systemic outcome of an innovation regime in which large pharmaceutical corporations allocate resources based on financialized business models designed to maximize shareholder value (MSV). We term this “predatory value extraction” (PVE) governance and argue that addressing the access challenge requires structural reform oriented toward “progressive value creation” (PVC) governance as its antithesis.
The paper surveys the structural shortcomings behind persistent medicine access gaps in the Global South, then examines how PVE governance has undermined governments, international agencies and other stakeholders working on access initiatives. By tracing the financing of global health initiatives, we show how fragmentation, limited coordination, and donor funding dependencies entrench PVE-driven agenda-setting and exacerbate misaligned priorities in global health. We conclude by outlining steps that policymakers can take to shift the pharmaceutical industry’s dominant corporate governance model from PVE toward PVC.
