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Failure to achieve timely uptake in target markets can put vaccines out of commission for extended periods, depending on procurement cycles and contract lengths.

Moreover, by maintaining full visibility of procurement processes worldwide, global tender managers will find it easier to monitor and measure associated key performance indicators (KPIs), or to enrich their tender forecasts, whether at the financial or the supply level.

Just ask yourself: are you really managing your tenders as effectively and seamlessly as you could do? Is everyone involved in tender management working together as fruitfully as they should be, and towards the same goals? Do you have full visibility of tender management across workstreams and countries worldwide?

Market-to-market variations

Meanwhile, pharmaceutical tendering at national or sub-national level in Europe is becoming more diverse and extensive. Among recent trends in European tenders have been an increase in direct negotiations with suppliers; expanding the scope of tenders, particularly to include large-molecule biopharmaceuticals coming under challenge from biosimilars; and value-based tendering involving considerations other than price.

Taking up the slack in emerging markets is by no means a given, though. In its recent report 2018 and Beyond: Outlook and Turning Points, the IQVIA Institute for Human Data Science noted that net spending on branded medicines in developed markets rose by 21%, from $326 billion to $395 billion ,over the last five years.

These difficulties may be aggravated in some markets by lack of clarity and transparency on, for example, timings and price points of tenders, as well as tacit or overt preference for local manufacturers.

Governments in these markets are increasingly concerned about the sustainability of drug budgets in the face of premium-priced speciality medicines in categories such as oncology, hepatitis C, rare diseases or, latterly, gene and cell therapies.

Jacob, R. H. and Peet, R. L. Poisoning of sheep and goats by Tribulis terrestris (caltrop). Aust Vet J 1987;64(9):288-289. View abstract.

Raos, M., Bumber, Z., and Kovac, K. [A bronchial polyp and foreign body in an adolescent]. Lijec.Vjesn. 2001;123(7-8):177-178. View abstract.

Santos CA Jr, Reis LO, Destro-Saade R, et al. Tribulus terrestris versus placebo in the treatment of erectile dysfunction: a prospective randomized, double blind study. Actas Urol Esp 2014;38(4):244-8. View abstract.

Special Precautions and Warnings

Bedir, E. and Khan, I. A. New steroidal glycosides from the fruits of Tribulus terrestris. J Nat Prod 2000;63(12):1699-1701. View abstract.

Wilkins AL, et al. Photosensitivity in South Africa. IX. Structure elucidation of a beta-glucosidase-treated saponin from Tribulus terrestis, and the identification of saponin chemotypes of South African T. terrestis. Onderstepoort Journal Veterinary Res 1996; 63:327-34. View abstract.

Baery N, Ghasemi Nejad A, Amin M, et al. Effect of vaginal suppository on bacterial vaginitis based on Persian medicine (Iranian traditional medicine): a randomised double blind clinical study. J Obstet Gynaecol. 2018 Nov;38(8):1110-1114. View abstract.

Sengupta G, Hazra A, Kundu A, Ghosh A. Comparison of Murraya koenigii – and Tribulus terrestris-based oral formulation versus tamsulosin in the treatment of benign prostatic hyperplasia in men aged >50 years: a double-blind, double-dummy, randomized controlled trial. Clin Ther 2011;33(12):1943-52. View abstract.