Abstract
Markets for life-saving vaccines often do not generate the most desired outcomes from a public health perspective in terms of product quantity, quality, affordability, programmatic suitability and/or sustainability for use in the lowest income countries. The perceived risks and uncertainties about sustainably funded demand from developing countries often leads to underinvestment in development and manufacturing of appropriate products. The pilot Advance Market Commitment (AMC) for pneumococcal vaccines (Pneumo AMC), launched in 2009, aims to remove some of these market risks by providing a legally binding forward commitment to purchase vaccines according to predetermined terms. To date, 14 countries have already introduced pneumococcal vaccines into their national immunisation programmes through the AMC with a further 39 countries expected to introduce before the end of 2013. Due to its innovative nature, the Pneumo AMC inevitably carries risks and will require careful independent evaluations of its design, processes and impact. While evaluations are scheduled from the third year of implementation onwards, this document is a first attempt to take stock of the experience to date and to encourage a constructive debate about the Pneumococcal AMC. It provides a starting point to inform discussions about the potential applications of the AMC concept to other vaccines or health interventions and helps to advance considerations of AMCs in alternative fields, such as agriculture or clean energy. Indeed, testing the concept and its feasibility is one of the key objectives of the pilot AMC.