The Advance Market Commitment Pilot for Pneumococcal Vaccines: Outcomes and impact evaluation

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This report presents the findings of the Outcomes and Impact evaluation for the Pilot Advance Market Commitment (AMC) for Pneumococcal Vaccines. This evaluation was conducted in 2015 by The Boston Consulting Group.

This evaluation assesses the extent to which the Advanced Market Commitment (AMC) pilot has achieved its stated objectives and the overarching goal to “reduce morbidity and mortality from pneumococcal disease by accelerating the development, availability and uptake of pneumococcal conjugate vaccines (PCVs)”. The AMC pilot was started in 2005 and officially launched in 2007 with a collective US$ 1.5 billion commitment from the Bill and Melinda Gates Foundation, Canada, Italy, Norway, Russian Federation and United Kingdom.

Objectives

This evaluation is an outcomes and impact evaluation that measures the progress made against each objective and the overarching goal of reducing morbidity and mortality from pneumococcal disease.  It also captures lessons learned in the pilot.

  • Objective 1: Accelerating the development of pneumococcal vaccines that meet developing country needs
  • Objective 2: Bringing forward availability of effective pneumococcal vaccines for developing countries
  • Objective 3: Accelerating vaccine uptake by ensuring predictable vaccine pricing for countries

Methods

This evaluation builds upon a significant body of data, analysis and evidence that has been generated by Gavi and its partners over the past 10 years. The independent evaluation team conducted a desk review of relevant documents, interviewed representatives from diverse entities (Global health experts, manufacturers, NGOs, academics, funders, in-country representatives, to name a few); and utilized a number of detailed analytical methods, including analysis of counterfactuals, to draw conclusions regarding the achievement of the pilot.

Summary of findings:

Overarching goal: reducing morbidity and mortality from pneumococcal disease

  • Introduction of pneumococcal vaccines (PCVs) through the AMC pilot has accelerated immunisation coverage against pneumococcal disease across 53 countries to when the report was completed.
  • 49 million children have been fully immunised with 3 PCV doses between 2009 and 2014.
  • 6 to 7.5 million pneumococcal disease cases have been averted and 14 to 17 million DALYs saved through 2015.
  • PCV’s have averted an estimated 230,000 to 290,000 deaths of children under five years old (U5) through 2015 and it is estimated that over 3 million U5 deaths will be averted by 2030.
  • AMC pilot contributed to helping increase supply availability and uptake of PCV in developing countries.

Objective 1: Accelerating the development of pneumococcal vaccines that meet developing country needs

  • AMC pilot stimulated demand and brought forward supply to developing countries but had very little influence on accelerating Research and Development (R&D) outcomes, in particular vaccine licensure (when PCV was selected for the AMC pilot, 2 candidates compliant with the AMC Target Product Profile (TPP) were already in advanced stages of development).
  • AMC has not succeeded in accelerating the development timelines of other manufacturers (companies with earlier-stage candidates have faced significant technical and regulatory challenges).
  • Two positive R&D effects:
    • It proved that there would be a large low-income country market after the conclusion of the AMC.
    • The creation of this market stimulated the development of other presentations specifically for Gavi markets by existing suppliers.
     

Objective 2: Bringing forward availability of effective pneumococcal vaccines for developing countries

  • Pfizer and GlaxoSmithKline (GSK) made investment decisions to further expand capacity to serve Gavi markets in response to AMC and its supply agreements. These decisions were affected by the long-term demand stimulated by the AMC and supply agreements.
  • There have been persistent and notable supply shortages over the past five years (in the context of unprecedented vaccine demand), however they were rectified more quickly than would have happened without the AMC.

Objective 3: Accelerating vaccine uptake by ensuring predictable vaccine pricing for countries

  • PCV10 and PCV13 became available in Gavi countries just one year after they were available in developed countries.
  • Higher number of country introductions than Haemophilus influenzae type b (Hib) and Rotavirus (Rota) in the analogous time period.
  • Accordingly, access and coverage in this time period exceeded that of Hib and Rota vaccine by three to four times.

Other considerations

  • While AMC played an important role in accelerating supply availability, Gavi country demand and PCV coverage, these positive outcomes were aided by many other factors (e.g. PneumoADIP, Gavi’s Accelerated Vaccine Introduction initiative, strong WHO recommendation for PCV preceding the AMC).
  • It is not possible to attribute these results exclusively to the AMC.

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