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1 Page 1 of 5 Global Health Policy Search results February 12, 2007 Incentives for Better Health around the World Posted by Ruth Levine Search Contact Us Site Map Home Initiatives Research Topics Publications Opinions Events Experts Blogs About Us Invest *This post is co-authored by Michael Kremer and Ruth Levine co-chairs of a CGD working group on Advance Market Commitments that wrote the 2005 report, Making Markets for Vaccines: Ideas to Action There were no fireworks when several wealthy countries announced Friday in Rome that they were making an advance market commitment to help pay for a life-saving vaccine for children in poor countries. But there should have been. These countries including Italy, Canada, Norway, Russia and the United Kingdom are breaking new ground by committing in advance to help finance the purchase of vaccines against pneumococcal disease (pneumonia, meningitis, and other killers), which annually claims the lives of up to one million children a year. By promising in advance to pay for life-saving vaccines once they are produced, these countries are creating incentives for biotechnology and pharmaceutical companies to produce vaccines appropriate for use in poor countries, and to sell them at affordable prices. Estimates from the World Bank and the Global Alliance for Vaccines and Immunizations (GAVI), who have worked closely with donor governments to hammer out the design of the innovative financing program, suggest this pneumococcal commitment could prevent an estimated 5.4 million childhood deaths by Why is an advance market commitment needed? An effective vaccine is currently available in the U.S. (under the Prevnar brandname), but at around $60 for each of the three doses required, it is too

2 Page 2 of 5 expensive for the poorest countries, and it needs to be adapted to prevent the strains of disease that are common in developing countries but not the industrialized world. Normally it takes 10 to 15 years for a vaccine introduced in the U.S. to become widely available in the developing world. While maximizing the benefits of the funding commitments depends on important contractual details, the pay for results approach can shorten this lag and help to ensure that the vaccine will be adapted to suit the patterns of disease and health care systems of poor countries. Just as the U.S. market provided incentive for pharmaceutical companies to develop a vaccine to cover the disease strains most common in North America, an advance commitment strengthens incentives for firms to finish the work necessary to adapt the vaccine for global use, and to make large numbers of doses of the vaccine available to poor countries at lower prices. By linking a defined payment to a final product, advance commitments encourage investors to provide researchers with support to do whatever they can to ensure that the final vaccine is a usable product. In addition, because funding is open to all comers, firms feel the heat of potential competition spurring them to develop the best possible vaccine in the shortest period of time. We recently co-chaired a Working Group convened by the Center for Global Development and supported by a grant from the Bill & Melinda Gates Foundation which brought together a group of public health professionals, economists, top pharmaceutical lawyers, and individuals with in-depth knowledge of the vaccine industry. The Working Group concluded that an advance commitment could effectively stimulate greater private sector investment in the development of new vaccines appropriate for use in poor countries, and accelerate their adoption. Putting in place this type of commitment for a pneumococcal vaccine is a vital step forward and is a pathbreaker for the use of advance commitments to encourage R&D on more distant and technologically challenging vaccines, such as for malaria and HIV. The goal of an advance commitment for a vaccine at an earlier stage would be different and more ambitious, and because the scientific and regulatory hurdles are more substantial the appropriate total value of a commitment would be larger. Advance market commitments for vaccines are a smart way to save millions of lives. We congratulate the donors who are supporting the pneumococcal disease vaccine advance market pilot for having the courage and conviction to try something new, for asking themselves why not? and then proceeding to give it a try. And we hope that the international community will be encouraged by this example to undertake advance market commitments for other urgently needed vaccines, and indeed for other health products for which there are compelling human needs but no commercially viable market. 2 Comments February 9, 2007 Launch of AMCs in Rome Posted by Gordon Brown at the launch of the AMC Greetings from Rome, where Italy, Canada, Russia, Norway and the UK, with the World Bank, GAVI and the Gates Foundation, have launched the first Advance Markets

3 Page 3 of 5 Commitment. The first AMC will target pneumococcal disease, costing about $1.5 billion and expected to prevent more than 5 millions deaths by Governments will create an incentive for private sector investment in the development and production of life-saving vaccines, by guaranteeing to pay for a suitable vaccine, meeting international standards, when it is developed. The agreement includes long run sustainability by ensuring that the vaccine will be available to developing countries at low prices once the Advance Market Commitment is exhausted. This proposal, originally made by Michael Kremer, was developed by a Working Group convened by CGD. That group coined the term Advance Market Commitment, and set out the main elements of the policy that has now been announced. This is a remarkable tale of how an idea developed by a brilliant academic has entered into the highest levels of policy, leading to discussion at G7 Finance Ministers meetings and culminating in today s announcement. There can be few examples of academic research translating into practical policies in such a short time. For more details about the launch and the background, see below. More Comment February 7, 2007 Advance Market Commitment for Vaccines To Be Announced in Rome Posted by Lawrence MacDonald Reuters reported Wednesday that a group of wealthy countries including Italy, Britain, Canada and Norway will announce in Rome on Friday a $1.5 billion advance market commitment to purchase vaccines to prevent pneumococcus, which kills more than a than a million kids each year in the developing world, through illnesses such as pneumonia and meningitis. The report quoted the Italian economics ministry as saying that the program aimed at saving millions of lives in the poorest countries and supporting their economic growth with new methods. More Comment Global Health Policy is a group blog discussing the issues facing the donor community on everything from HIV/AIDS financing to pharmaceutical R&D to broader health systems concerns. Comments are strongly encouraged, and suggestions for new posts can be sent to us here.

4 Page 4 of 5 Search Go Monthly Archives Select Month Categories Select Category Tags AMC AMFm ART Center for Disease Control CIDA GAVI Global Fund Health Systems Irish Aid Hunger Task Force Malaria nutrition OECD Oxfam PEPFAR Performance Based Incentives Peter Boone RBM Ruth Levine Swine flu TB the World Food Programme UNAIDS UNICEF USAID White House WHO Women's Health World Bank World Bank MAP Zhauguo Zhan Popular Posts Value-Added Communication views Making Markets for Merit views Sharing Knowledge: the Gl views The Business of AIDS Vacc views UK Statement of Policy on... 8 views Most Recent Comments Anne-Emanuelle Birn on Reflections on NYT Magazine Special Issue on Gender: Three Questions to Guide the New Crusade Emel Buzluk on A Promising Senate Initiative on Neglected Diseases Grant Rhodes on Making Markets for Merit Goods Tom Bollyky on Potential U.S. Supreme Court Case on Nigerian Drug Trial Presents Mixed Picture for Global Health Lesu Waqaniburotu on Wedding Bells for GAVI, the World Bank and the Global Fund? Blogs & Other Useful Resources Global Health Policy Research Network Bill & Melinda Gates Foundation Ethics of Vaccines Global Bioethics Blog Global Health and Foreign Policy Blog

5 Page 5 of 5 Global Health Council GlobalHealthFacts.org GlobalHealthReporting.org Global Health Report Health Affairs Malaria Matters PAHO Director s Blog Technology, Health & Development Translator By N2H 2009 Center for Global Development Massachusetts Avenue NW, Washington DC

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