For decades, global health procurement - on which over six billion people depend - has mostly relied on one system: centralized multilateral institutions pooling donor funding to purchase and distribute medicines across low- and middle-income countries. While this model has delivered significant successes in certain regions and therapeutic areas, it has simultaneously perpetuated inefficiencies, including bureaucratic hurdles, misaligned priorities, inflexible procurement processes, and an unsustainable reliance on external philanthropic funding.