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TWO VIEWS ON ADVANCE MARKET COMMITMENTS

Friday, 15th of July 2011

TWO VIEWS ON THE ADVANCE MARKET COMMITMENT

One view from California:

http://www.landesbioscience.com/journals/vaccines/News-HV7-2-policy.pdf

One view from Kenya:

NEWS

Human Vaccines Volume 7 Issue 3

Why the AMC Matters

Frederick Were. Email: fwere@hcc.or.ke

Donald Light’s recent piece criticizing the Pneumococcal Vaccine Advance Market

Commitment (AMC) caught my attention just days before Kenya became the first developing country to benefit from the AMC. While I do not feel qualified to respond to his criticisms of the mechanism’s structure, as a pediatrician in my home country of Kenya for more than twenty years, I am qualified to say that I have witnessed far too many children lose their fight against pneumonia, the world’s leading killer of children. Furthermore, I firmly believe the AMC is going to make an enormously positive impact on families and children in my country by preventing much of this needless suffering and death.

Nearly one in 10 children born in Kenya die before their fifth birthday,1 a statistic to

which pneumonia is a significant contributor. The disease claims the lives of more than

30,0002 Kenyan children under age five per year. The burden of the pneumonia case load also places a tremendous strain on our medical system, as tens of thousands of children battling a preventable disease crowd our fragile public hospitals, often requiring choices to be made about who receives adequate care.

Dr. Light speculates on whether this is really an important disease to address by suggesting that funds be directed to other health interventions and questions the significant body of evidence on the efficacy and effectiveness of pneumococcal conjugate vaccines.

It has been shown, however, that the primary cause of severe pneumonia in Kenya

is the pneumococcus and that most of the circulating disease-causing serotypes will be

prevented by the newest pneumococcal conjugate vaccines.3,4

Each year, more than 14.5 million cases of serious pneumococcal disease occur, resulting in more than half a million deaths among children under five years of age worldwide, 95 percent of which occur in the developing world.5 A Kenyan child is 160 times more likely to die of pneumococcal disease than an American child.6 This gap is evidence of the great inequality in access to preventive measures like immunization. Historically, 15 or 20 years have passed before new vaccines reached the developing world, largely because of high costs and limited vaccine supplies. Thanks to the Advance Market Commitment (AMC), Kenya introduced PCV-10, an advanced-protection pneumococcal conjugate vaccine, this February—and within months of the US adopting a similar next-generation vaccine. Kenya has thus become one of the first of many developing countries to directly benefit from the support of the AMC.

Access to life-saving pneumococcal vaccines would have been impossible for us without this historic innovation. Tackling child mortality in my country and throughout Africa requires an approach to preventing and controlling the childhood diseases with the most significant disease burden—pneumonia and diarrhea—that encourages research and development, fosters investment and allows countries to access vaccines at affordable prices. The AMC is now doing just that.

While the AMC may have its critics, they won’t be among the children and families benefiting from the vaccine in my country, or the 19 other countries to which GAVI has already committed AMC funds. The AMC is taking a systematic approach to disease prevention—one that holds the promise of delivering vaccines to the most needy, as well as helping to strengthen critical health infrastructure that will ultimately enable a deeper and more seamless deployment for future immunization programs to battle other deadly infectious diseases in the future.

For families in developing countries like ours, the AMC promises to level the playing

field by finally open access to the most needed vaccines, providing for the first time an early opportunity to significantly reduce suffering, disease burden and child mortality.

References

1. http://data.worldbank.org/indicator/SI.POV.2DAY

2. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60549-1/fulltext

3. O’Brien KL, et al. Lancet. 2009; 374:893-902.

4. Johnson HL, et al. PLoS Med. 2010; 7:e1000348.

5. World Health Organization. World health statistics 2006. Geneva: World Health Organization; 2006. http://www.who.int/whosis/whostat2006.pdf. Accessed

September 6, 2009.

6. O’Brien KL, et al. Lancet. 2009; 374:893-902.