Four years after we published Making Markets for Vaccines laying out a way for donors to make a binding commitment to purchase a not-yet-developed vaccine, the pilot Advance Market Commitment has been launched at the G8 Finance Ministers' Pre-Summit Meeting in Lecce, Italy. Six donors (Italy, the UK, Canada, Russia, Norway and the Bill & Melinda Gates Foundation) have worked closely with the GAVI Alliance and the World Bank -- along with many others who devoted countless hours to the design and implementation questions -- to make the policy proposal a reality. They have stuck with this project through thick and thin, and have demonstrated impressive fortitude despite current financial pressures within donor agencies.
Those who have followed this saga from the early days may ask, "Wasn't this already launched a couple of years ago?" Well, yes in principle, but this is the real launch -- the one that has the legal documents, the bank account and the institutional arrangements to back it up. With the legal structure now in place, $1.5 billion has been committed to pneumococcal vaccine that will benefit children in the developing world; those resources will be used to "top up" the price paid for doses of the vaccine during the phase of introduction into the developing world, providing a commercially viable return for the firms that are able to produce the appropriate product in adequate quantity. The sponsors have, in effect, made a market where none existed before, and expect that for-profit manufacturers will respond by building up capacity to meet the demand. (For more information, see the AMC website.)
For us at CGD, it has been a tremendous privilege to participate in moving the concept, put forth by Michael Kremer, to what we hope will be a very successful implementation. In some ways, this has mirrored the R&D stages that characterize the pathway from research lab to product in the market. Developing the AMC from the original idea (the "basic science") through to this point (akin to the moment of a product launch) has entailed a full range of technical, legal, implementation, finance and communication skills. The effort faced a series of go/no go milestones and the risk of failure at key moments. As with biomedical R&D, the policy R&D took a long time and decisions along the way were based on a blend of hard-nosed calculations of costs and potential benefits, on the one hand, and negotiation between the optimists and the pessimists, on the other.
Like pharmaceutical products, policy developments require "post-marketing surveillance," or careful and objective monitoring of the effects, both intended and not. A strong evaluation framework for the AMC has been put in place by the sponsors, and we (along with many others) will be watching with intense interest to see how multinational and emerging vaccine manufacturers, as well as developing country governments, respond. Ultimately, the value of the AMC must be judged based on its original goal: To significantly speed up access to life saving new vaccines for children in poor countries. For my part, happy as I am to see the well deserved celebrations in Italy, I'll save the champagne for the day when the first kids get their AMC-funded pneumo jabs.