Daniel Kiesa

When new health products—like TLD for HIV treatment or CAB-LA for HIV prevention—are introduced, excitement is high. But behind the scenes, a critical decision often makes or breaks early success: whether product supply is centrally “pushed”  or country-driven and “pulled.” 

In early rollouts, supply limitations are common. Manufacturers carefully scale production, balancing speed and quality while gauging uncertain demand. The natural response is often tight central control, sending product in small batch, short-term deliveries to increase future flexibility to respond to the highest demands. Central allocation of products based on global or donor priorities further reinforce this push-based model.

However, this centralized push model can inadvertently slow down access:

• Lack of Local Ownership: Without involving countries early in delivery planning, readiness gaps emerge. Products may arrive before systems are in place, delaying uptake.

• Measurement Challenges: Initial uptake can be difficult to track, creating uncertainty. Waiting for clearer data delays future shipments, causing a cycle of limited visibility and constrained product flow.

The introduction of CAB-LA illustrated these pitfalls. Centralized allocations arrived intermittently with limited advance visibility. Shipments stalled due to inadequate consensus among local stakeholders, including ministries of health. This slowed uptake and complicated future delivery planning.

A pull-based approach flips the model, empowering countries to actively request products based on their readiness: planned sites, projected usage, and timelines. These requests don’t have to be perfect, but they bring important advantages:

• Local planning and alignment: Ensures local consensus and readiness before product ships.

• Improved forecasting: Country-generated projections match growing production capacity with realistic delivery schedules.

• Better supply-demand matching: Plans translated into product quantities better align with manufacturing and procurement needs.

The successful scale-up of TLD demonstrated these benefits clearly. Countries submitted regular, 12-month delivery schedules, which helped align manufacturing scale-up and secure reliable supply. This planning enabled faster, more confident rollouts.

Early product introduction can still require centralized coordination since supply can be constrained  while capacity is increasing. Yet even limited centralized allocations can include structured, recurring requests from countries.  This enables programs to evolve as more data emerge, supporting smarter global allocation and better manufacturing anticipation.

Early product introduction is complex. Effective delivery planning is vital to the success of introducing novel health products in global settings. Pull-based approaches, especially when supported by strong local engagement and longer planning horizons, offer advantages in aligning supply with demand and supporting quality manufacturing scale-up.