Hema Srinivasan, formerly the Chief Access Officer of MedAccess, a leader of CHAI’s market shaping work, and a former country director for a major pharma company, joins host Inder Singh to discuss how market shaping in global health has evolved to use more formal tools like volume guarantees. They discuss when and how volume guarantees should and should not be used, how they can help address the high-price, low-volume trap to dramatically lower prices and expand access to critical health products, and other use cases including ensuring supply security or incentivizing supply expansion.

The Market Shapers Podcast is a production of Inder Singh and is produced by University FM.

This interview was recorded in July 2026.

Escaping the high-price, low-volume trap

09:48: It's core to the way any manufacturing organization runs its business. If you reduce uncertainty around how much you're going to produce, if you maximize the scale at which you're producing, you will save costs, and you can pass those on to the customer. And in the case of global health, that often becomes self-fulfilling. So, reducing that high-price, low-volume trap can become quite catalytic, where we would often see this issue where the price is really high, the volumes are low. We know if the price came down, the volumes would be quite a bit higher, and everyone would win. But the supplier doesn't see enough in the market to say, ‘Let me reduce the price and hope for the best.’

The credibility test every market shaper has to pass

35:19: You can't build a market-shaping success story just based on credibility with the public health community or credibility with the buy side of the market. You really need credibility with the suppliers and we tried to do a lot without that. That didn't work so well.

How do you know a volume guarantee is the right tool?

10:33: If we see the enabling environment is there for uptake and there are just these few critical market-related barriers that we can solve for that unlock that equation, then, we can implement a volume guarantee, and it can have massive impact. But the trick is really spending the time to understand is the market-related barrier what's really holding back access, and not something like developing a whole new product that isn't available today or doing a ton of health worker training work for many, many years. I think those other barriers to access always exist, but if they are much more important than the price or the supply, a volume guarantee won't be successful.

• Hema’s Bio | MedAccess
• Connect with Hema on LinkedIn

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Aaron Patillo was a key member of the Clinton Health Access Initiative's (CHAI) original drug access team. Based in Beijing, he brokered deals with pharmaceutical companies that helped slash the price of HIV/AIDS medicines and expand access to treatment for millions.

Aaron sits down with host Inder Singh to talk about how CHAI got suppliers to cooperate by opening their books, how the team used cost-plus pricing negotiations to ensure sustainable access to medicines while dramatically reducing prices, and how CHAI pushed costs even lower by going upstream in the supply chain.

Aaron and Inder also swap stories from the early days at CHAI, reflecting on how its culture enabled remarkable achievements— major price reductions in short periods of time—when market shaping was still an untested idea.

The Market Shapers Podcast is a production of Inder Singh and is produced by University FM.

This interview was recorded in April, 2025.

Why the lowest price isn't always the best solution

12:33: [Inder Singh] Why did you not just take what you could get? Because I think people from the outside world looking in would be like, "Whoa, heck, get the lowest price you can," right? It's going to improve access. Why was that important?

12:44: [Aaron Patillo] It was really important because we were focused on the sort of long-term molding of the, of these markets, right? I mean, President Clinton very eloquently put multiple times, these were markets that looked like a jewelry store, with very low, low volumes and very high margins. And our goal was to try, try to push these into ones that looked much more like grocery stores, high volumes and, and low margins. And so to do that, even if we could get a big win on margin at zero or negative margin, that would be ultimately like a short-term win. And we're interested in having this really be a sustainable improvement to the marketplace that we were making.

Long-term solutions over short-term wins

12:02: This is not charity, and we want this to be like a long-term, viable, sustainable business decision, and very specifically, that has a profit margin for them. So, we weren't looking for handouts or these short-term results. Even if we could get what felt like, kind of, an easy win and they're willing to agree at any price, we actually said, "No, that's not how we're operating here. We need this to be, like, sustainable from a business point of view for you, the company."

The ground rules for market-shaping partnership

19:36: We didn't just go out and establish partnerships with whoever we could find. This was a very well-vetted process. But it was very clear these are the ground rules and you'll have these improvements in volume in a way that you could not bring to bear just yourselves with throwing added marketing dollars at this, for instance, right? These were unlocking components of this that wasn't just a dollar allocation game in any way. A lot of these suppliers found that hugely useful and information they wouldn't have otherwise.

• Aaron Pattillo | LinkedIn
• Initiative for Medicines Access and Knowledge

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