The World Is Moving Forward Without Us

Advance Market Commitment (AMC) is a new market-based financing mechanism that accelerates the delivery of life-saving vaccines for children worldwide.
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Two weeks ago the Gambian Minister of Health, Dr. Mariatou Jallow, administered the first dose of pneumococcal vaccine available in her country to a child at a rural clinic outside the capital of Banjul. This marked the groundbreaking first step in the rollout of the Gambia's national pneumococcal immunization program. The program was made possible by an initial donation of the vaccine from its commercial manufacturer and will be continued through an Advance Market Commitment (AMC), a new market-based financing mechanism that accelerates the delivery of life-saving vaccines for children worldwide. The pioneering idea for the AMC was born in the United States, the brainchild of American global health experts, and yet the United States was on the sidelines observing instead of leading the launch of the first mechanism of this kind.

The debut AMC, which is funded by the governments of Italy, the United Kingdom, Canada, Russia and Norway and the Bill & Melinda Gates Foundation, contributes $1.5 billion to fight pneumococcal disease, a leading cause of pneumonia, meningitis, sepsis and other life-threatening ailments, and the world's leading vaccine-preventable child killer. More importantly, it provides a new market-driven instrument for accelerating access to scientific innovations.

Traditionally it has taken up to 20 years for new vaccines to reach children in developing countries. The AMC can fix this inequity. Through the pneumococcal AMC, and with the support of the GAVI Alliance which administers it, children in Rwanda and the Gambia are benefiting from pneumococcal vaccines even before children in wealthy countries such as Austria and Japan. What's more, the mechanism is spurring development and deployment of two newer vaccines that extend protection against strains of pneumococcal disease most common in the developing world. Thanks to such advances, the accelerated use of pneumococcal vaccination is projected to save 5 to 7 million lives by 2030.

The AMC concept is a simple one. If a company develops a new vaccine, and the world's poorest countries demand it, then the AMC uses funds from rich nations to buy the vaccine at an initial price that covers the company's investments and risks. The company is then obligated to provide the vaccine to poorer countries at much lower, pre-established prices. Thus, the AMC provides a market where previously there was none, encourages investment in targeted research and development, and rewards specific outputs -- in this case, doses of a life-saving vaccine.

Donor countries and foundations can now spur innovation in two important ways. They can pursue a dual strategy of providing critical, direct and indirect subsidies -- known as push mechanisms -- to partnerships that develop new products for global health needs, and provide financing measures like the AMC -- known as a "pull" mechanism -- to use market forces to encourage research and development.

New vaccines developed through AMCs can improve health and survival throughout the developing world, and in doing so also strengthen families, economies and nations. Why? Healthy children are more likely to attend school and are better able to learn. Healthy workers are more productive. More productive economies mean greater stability in developing countries and improved security in the West.

To have a chance of defeating deadly infections like pneumonia, HIV/AIDS, malaria, and tuberculosis, we need innovations like the AMC. Every passing day science brings us closer to medical solutions for preventing these diseases, but without a market solution to accompany them these life-saving technologies will continue to be out of reach for millions of the world's poor.

So the innovation must not stop with the pneumococcal AMC. Imagine the benefits if the same acceleration can be achieved with future vaccines against AIDS, tuberculosis, or malaria. The global fight against infectious diseases needs the same winning combination of science and political will that the AMC brings. And it needs U.S. leadership.

When it comes to providing aid, developing innovations and making bold steps that change the course of history, the United States is usually on the front lines. The U.S., however, is noticeably absent from the roster of donor countries participating in the pneumococcal AMC. In 2005, Sens. John Kerry (D-MA) and Richard Lugar (R-IN) proposed the Vaccines for the New Millennium Act, which would have used AMCs to foster the development of vaccines and provided economic incentives for companies to invest in them. Unfortunately that bill never made it into law. However, with their leadership, the bill reauthorizing the President's Emergency Plan for AIDS Relief (PEPFAR) last year encouraged U.S. participation in AMCs and authorized technical assistance for countries preparing to introduce new vaccines.

President Obama and our Congress can move the United States from the sidelines to the frontlines of this issue by calling for new AMCs to tackle infectious diseases, and then backing those calls with financial support. In the process, they can support medical innovation using a cost-effective approach to foreign aid, save millions of lives and re-establish U.S. leadership in driving innovative, results-based solutions. Science is one of the comparative advantages of our knowledge-based economy, and focusing on our prowess in providing better tools to address diseases of poverty is one of the best forms of foreign aid.

Lives are at stake, and time is of the essence. The opportunity to change the way we fight global killers is one the U.S. cannot afford to miss.

This post was co-authored by Orin Levine Associate Professor, International Health, Johns Hopkins Bloomberg School of Public Health, and Co-chair, Sabin Vaccine Institute's Pneumococcal Awareness Council of Experts (PACE). Seth Berkley is the President and Chief Executive Officer, International AIDS Vaccine Initiative.

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