The pilot AMC is an innovative funding mechanism with the overarching goal to reduce morbidity and mortality from pneumococcal diseases. In June 2009, the governments of Italy, the United Kingdom, Canada, the Russian Federation, Norway and the Bill & Melinda Gates Foundation launched the pilot AMC with a collective US$1.5 billion commitment.
The pneumococcal AMC is designed to:
- accelerate the development of vaccines that meet developing country needs;
- bring forward the availability of effective pneumococcal vaccines - through scaling up of production capacity to meet developing country vaccine demand;
- accelerate vaccine uptake - through predictable vaccine pricing for countries and manufacturers;
- test the AMC concept for potential future applications.
This evaluation is a process and design evaluation intended to offer insights and lessons to the international development community by appraising the design process, design decisions, and implementation of the pilot Pneumococcal AMC to date. The Terms of Reference (TOR) for this evaluation were developed in collaboration with AMC stakeholders.
The purpose of the evaluation was to assess the design process, design elements and implementation to date.
It is important to note that this evaluation forms part of the broader Monitoring and Evaluation (M&E) framework for this pilot AMC. This framework is based around four key components:
- a Baseline Study (completed in 2010 );
- an annual monitoring report published on the Gavi website each year from 2010 ;
- an independent Process and Design Evaluation;
- independent Impact Evaluations to be undertaken every four years starting from 2014.
Dalberg built upon insights from the AMC Baseline Study, annual monitoring reports, all formally published documents within and outside of the AMC Secretariat, as well as the internal documentation of Gavi and the AMC Secretariat. Methods employed include the following:
- Desk review of documentation;
- Mapping of design process and decision-making;
- Comparing actual versus planned outcomes and timelines;
- Leveraging case studies and comparators;
- Reviewing existing economic models and analyses;
- Key informant interviews;
- Quantitative analyses;
- Scenario modeling;
- Review of original design process assumptions.
FINDINGS AND RECOMMENDATIONS
Overall, the evaluators conclude that the pilot AMC has been implemented as designed and has demonstrated the ability of the international development community to design, establish and administer an AMC.
The evaluation assesses key design elements of the AMC such as the Pilot’s pricing structure, its legally binding commitments on donor pledges, its limited purchase guarantees on long-term procurement contracts, and its target product profile.
The evaluators found that while there are some areas for improvement and key lessons to be learnt for the development of any future AMCs, this Pilot is on track for progressing towards its overarching objective and that the design process and design elements have contributed, at least in part, to increasing the supply and uptake of PCV. In addition to a small number of recommendations for improving the pneumococcal AMC, the report also provides some recommendations based on lessons learned for future AMCs or market shaping initiatives .
The Secretariat’s responses to a number of the key findings are outlined in the Management Response.