The prevention of disease through vaccination with efficacious and safe vaccines is one of the most cost-effective public health interventions. (1) However, often the markets for vaccines do not generate the most desired outcomes from a public health perspective in terms of product quantity, quality, affordability, programmatic suitability and/or sustainability, particularly when it comes to serving the poorest populations. Economic factors may hinder or delay the clinical development of candidate products as well as prevent manufacturing of licensed vaccines at sufficient scale to respond to these needs. Manufacturers face competing interests when making investment decisions and they perceive demand from developing countries as very uncertain. While the need for and the willingness to adopt new vaccines exist, resources to sustainably fund such products are often missing. Manufacturers thus find this market segment very risky and less attractive. An Advance Market Commitment (AMC) for vaccines aims to make the market for vaccines in developing countries more attractive through a legally binding commitment to purchase vaccines according to predetermined terms. As some of the risks are removed, the vaccine industry is encouraged to increase investments to stimulate the development and manufacture of target products.
Different models have been designed to create market-oriented incentives to support the development and introduction of appropriate health technologies for developing countries. Many have remained academic exercises, but the AMC moved from theory to practice with a pilot AMC for pneumococcal vaccines launched in 2009. While it is still early to assess the efficiency and effectiveness of this pilot, this paper discusses lessons learnt on moving from the theoretical concept to implementation. It provides a starting point to inform discussions and encourage debate about the potential applications of the AMC concept to other interventions.
The pilot AMC
An AMC for vaccines gained public attention with a report by the Center for Global Development in April 2005. (2) The report proposed to create incentives for commercial investments in research, development and manufacturing of vaccines for developing countries through a legally binding pledge by donors to pay a certain price for a new vaccine if it is developed and desired. (2)
A pilot AMC for pneumococcal vaccines was announced in February 2007 and formally launched in June 2009 with a joint pledge of 1.5 billion United States dollars (US$) by the Governments of Canada, Italy, Norway, the Russian Federation and the United Kingdom of Great Britain and Northern Ireland, and the Bill & Melinda Gates Foundation. (3) The key design features and the functioning of the AMC for pneumococcal vaccines are described in Box 1. The GAVI Alliance, a public-private partnership created to increase access to immunization in poor countries, and The World Bank co-led the design of the pilot and they implement it together with the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO). By placing the AMC on its balance sheet, The World Bank effectively guaranteed US$1.5 billion in AMC funding for the purchase of pneumococcal vaccines. (5) Meanwhile, the GAVI Alliance serves as the secretariat for the AMC and has committed to support eligible countries to purchase the product. Some of the expected benefits of the AMC are outlined here.
Box 1. Design and functioning of the Advance Market Commitment for
The pilot Advance Market Commitment (AMC) offers a legally binding
commitment to support the market of targeted pneumococcal vaccines
with US$1.5 billion of funds for which vaccine manufacturers can
bid. Interested manufacturers compete over successive tenders to
supply a share of the annual forecasted demand of vaccines (which
is expected to increase over time and reach around 200 million
doses per year at peak). …