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Advance Market Commitment

Definition
An Advance Market Commitment (AMC) was originally envisioned as a financial mechanism that aims to overcome the lack of research and development (R&D) for medical needs that primarily affect developing countries.  When R&D is lacking because drug companies don’t see a lucrative market to develop new products, proponents of the AMC model say it would work by creating the incentive of a guaranteed market funded by donors to attract pharmaceutical investment. 
The first AMC, however, served a somewhat different purpose, and was used instead to address the lack of access in developing countries for a product originally developed for wealthy markets.  In this case, the AMC created a subsidised market for the product and financed the scale-up of production in order to accelerate access to a vaccine needed in the developing world. 
So has the AMC model lived up to its promise?
An AMC in Action: the Pneumococcal Vaccine
To date, no AMC has been proposed for the development of a totally new drug, diagnostic or vaccine. But a pilot AMC was launched by the GAVI Alliance in 2009, paid for by Italy, the UK, Norway, Russia, Canada and the Bill & Melinda Gates Foundation, with the aim to accelerate the roll-out in developing countries of a vaccine for pneumococcal disease.  Earlier versions of the vaccine had been available in wealthy markets for over a decade, but the AMC paid for producers to supply the vaccines for developing countries within a year of pre-qualification by the WHO.  
Introducing PCV in developing countries is a critical step that can prevent millions of bouts of illness and countless deaths in children.  Kenya was one of the first African countries to receive the pneumococcal conjugate vaccine (PCV) in February 2011, and Médecins Sans Frontières (MSF) began vaccinating children with PCV in Kenya as soon as the product was launched.
Looking beyond the hype
MSF has been following the pneumococcal vaccine AMC through its successive designs.  Our analysis shows that the AMC has not paid enough importance to ensuring competition from developing country producers, even though such competition can lower vaccine costs.  In fact, the AMC is proving to be a real windfall for two multinational pharmaceutical companies – GlaxoSmithKline (GSK) and Pfizer/Wyeth – who are each receiving a significant subsidy, funded by donor governments, in order to secure their participation in the scheme.  Expensive vaccines mean that fewer children get vaccinated.
Although the introduction of the pneumococcal vaccine in Africa should be celebrated, MSF is advocating for efforts to find long-term pricing solutions for vaccines so that countries can continue to afford and implement improved vaccination coverage.
 

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RT @joanna_keenan: Chan: we must look to innovation - it must to be simple, easy to use and low cost @WHO #WHA65