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Amid the current debate over the devastating impact of recent aid cuts on global health programmes, the question of non-profit development of health tools for public health needs has received little attention. Both the global health landscape and the market-based pharmaceutical research and development (R&D) system are undergoing radical shifts, which will impact the alternative medical R&D model that has successfully delivered new diagnostics, treatments and vaccines on a not-for-profit basis over the last two decades. We urgently need to find new approaches to continue to deliver medical innovations for populations neglected by the market-based R&D system.