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The Advance Market Commitment scheme, formulated by the GAVI Alliance, aims to provide more vaccines to the developing world by fixing their price over a 10-year period. Is it going to deliver, what will be the result, and how did global health institutions and the big pharmaceutical companies manage to agree on such a deal? 

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Learn more about Advance Market Commitments from the GAVI Alliance.

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Segment 1

TITLE
Kill or Cure
VOICEOVER
In the summer of 2009, an historic agreement was struck to save millions of children from a deadly disease.
DR. JULIAN LOB-LEVYT [CEO, GAVI Alliance]
Each year, pneumonia kills more children than HIV, TB, and malaria put together.
VOICEOVER
The vast majority of victims are in the developing world, where there's no money to pay pharmaceutical companies for a vaccine.
BUSAYO OGUNBODE
My baby has pneumonia and the baby died because of the pnuemonia.
VOICEOVER
Now, the international community has agreed to fund a vaccine to prevent such tragedies in the world's poorest nations.
ANDREW JACK [Pharma Correspondent, The Financial Times]
It's creating a guaranteed market, a form of reassurance to those developing new vaccines, including those specifically for the developing world, that there will be a market at the end of the day.
VOICEOVER
Five nations and the Bill & Melinda Gates Foundation agreed to pay USD$1.5 billion in the hope of saving up to seven million lives.
TITLE
Drug Money
VOICEOVER
Dr. Orin Levine leads a team from the renowned Johns Hopkins Bloomberg School of Public Health in the USA, dedicated to providing a vaccine against the world's deadliest threat to children. His job takes him all over the globe in the fight against pneumococcal disease, which kills more children under five than any other illness.
DR. ORIN LEVINE [Johns Hopkins Bloomberg School of Public Health]
We have safe efficacious vaccines against a terrible disease that just aren't being applied. So, not only is it a huge disease, but it's a problem with a solution
VOICEOVER
Today Orin is visiting Rwanda, a country just emerging from a tragic recent past. Rwanda is staging a huge party and Orin is guest of honor.
DR. RICHARD SEZIBERA [Minister of Health, Rwanda]
Pneumonia is a leading cause of death among under fives in our country, accounting [for] over 25 per cent of all infant deaths.
VOICEOVER
The Rwandan minister of health is presiding over a ceremony to mark the introduction of a vaccine to prevent pneumococcal disease.
DR. RICHARD SEZIBERA
We as a government are determined to make sure that children attain their fifth birthday, their 10th birthday, their 40th birthday, and -- why not -- their 70th birthday.
VOICEOVER
The minister inaugurated a program to distribute the vaccine for free. A doctor, he delivered the ceremonial jab himself. The project was launched by the Rwandan Government and GAVI, an alliance of international organizations, countries, and companies dedicated to spreading the benefits of vaccines and immunization. Dr. Levine's team helped GAVI make the case for the deal.
DR. ORIN LEVINE
Today is a historic moment because today with the access to pneumococcal vaccines that's been given Rwandan children, we're going to begin the first program through the GAVI Alliance to prevent this important disease in low-income countries.
VOICEOVER
In cooperation with GAVI, pharmaceutical company Wyeth donated enough doses of the pneumococcal vaccine Prevenar to immunize all Rwandan infants under the age of one.
JIM CONNOLLY [Head of Vaccines, Wyeth]
This is our personal opportunity to make a difference in this world and we have an opportunity with Prevenar to dramatically change the course of the disease that is a significant killer of children and adults on a worldwide basis.
VOICEOVER
Wyeth's gesture is cause for celebration in Rwanda but it's only a first step. The Rwandans have been given a vaccine widely used in rich nations. It protects against seven strains of the disease. Developing nations ideally need a more powerful vaccine. And another 70 of world's poorest nations eligible for GAVI help, don't have a pneumococcal vaccine at all. In Nigeria, two-year-old Olajumoke lies seriously ill with pneumonia. Without a vaccination, doctors rely on increasingly ineffective antibiotics to treat the illness. She's watched over by her mother, Blessing, who's desperately anxious. Pneumococcal disease kills 1.6 million people every year, and nearly 1 million are children under five. So what exactly is this threat to the world's infants? Pneumococcal bacteria lurks in the back of the throats of 80 per cent of all people. If it breaches a natural barrier formed by mucus, it can cause pneumonia or meningitis, both potentially lethal. The need for a vaccine is much greater in the developing world where more than 98 per cent of fatal cases occur. But it's up to the pharmaceutical industry to develop vaccines, at substantial cost. The industry, historically, has sold its goods to those countries who can pay the most.
ANDREW JACK
In order to recoup hundreds of millions of dollars that the drug companies have put into developing these products, they've tended to focus therefore on maximizing the returns, having high prices, concentrating on the large, developed markets of North America, Western Europe, and Australia and Japan.
VOICEOVER
A free market in vaccines has failed to address the needs of the majority of people in the world. The situation was even worse 10 years ago.
SHANELLE HALL [Director, Supply Division, UNICEF]
We had global shortages of even the basic vaccines: tetanus, measles, DTP. I remember a year, we were short by 80 million doses and I mean this was for 70 to 80, 90 countries, and we were in the midst of a major departure of many of the big pharma companies from producing vaccines for developing countries.
DR. JULIAN LOB-LEVYT
There was a market failure for public goods, global public goods, and a vaccine is a classic global public good.

Segment 2

VOICEOVER
Historically, developing countries have had to wait 15 to 20 years for prices to fall after R&D costs have been recouped before they can afford to provide vaccines for their children. Since 2005, Dr. Orin Levine and the GAVI Alliance have been working on an ambitious program to speed up the provision of vaccines to poorer nations, starting with an injection to protect against pneumococcal disease. Today, he's on a research trip to Nigeria.
DR. ORIN LEVINE
I'm a parent. I've got two daughters. They both got pneumococcal vaccine. Why should children who just happen to be born in an African country be denied access to a life saving vaccine for that reason? One of the most important things that we can do during our visit here in Nigeria is to hear directly from the pediatricians who take care of children with pneumonia and pneumococcal disease, to hear from the parents and families who've been affected.
VOICEOVER
He's visiting University College Hospital in the city of Ibadan, where Olajumoke lies ill. He's meeting with senior pediatricians at the hospital.
DR. ORIN LEVINE
Do children in Africa deserve access to these life-saving pneumococcal vaccines as much as children in the West?
PROFESSOR ADEGOKE FALADE [Senior Consultant Pediatrician, UCH]
I feel upset, because I think that vaccine is needed more in developing countries like Nigeria than in Europe and North America where it's not an immediate problem today.
PROFESSOR KIKELOMO OSINUSI [Head of Pediatrics, UCH]
There are some conditions that make children in this country, in Nigeria, particularly susceptible to pneumococcal disease. We now have a critical mass of children who have some immune depression or whose immunity is not good enough.
VOICEOVER
On the emergency ward, Orin meets Blessing and her two year old daughter Olajomoke.
DR. ORIN LEVINE
What was she like when you brought her here. Why were you worried for her?
BLESSING
When I came here she was convulsing, so maybe I get scared. She ... she was unconscious. Because I was being transferred from a clinic. So she was unconscious but still convulsing when I get here.
VOICEOVER
When Orin revisits the following day, Blessing is still there. She's now been at her daughter's bedside for six days and nights. The lengthy stay has cost her 30,000 naira [NGN]. That's a very substantial sum of money. Ninety per cent of Nigerians live on less than 10,000 naira per month.
BLESSING
It's very difficult for me to get the money to take care of her. Sometimes I'll borrow. I'll do all kinds of things to get the money.
VOICEOVER
But Blessing is praying that she won't have to pay a much higher price: the life of her daughter. In part two: the new initiative that could spare millions of children like Olajumoke their suffering.
TITLE
Kill or Cure

Segment 3

VOICEOVER
For the past two years, the GAVI Alliance has been working with donor governments to provide a pneumococcal vaccine for the developing world. They came up with a plan known as the "advance market commitment" or AMC. It's designed to guarantee pharmaceutical companies a market for the vaccine in poorer countries. In the summer of 2009, GAVI chief executive Julian Lob-Levyt announced that funds were finally in place.
DR. JULIAN LOB-LEVYT
This has been an astonishing international collaboration of political leadership, technical participation at the individual level, financially within the markets, with industry, and with public health community. It really is a very historic moment.
SHANELLE HALL
Now through the AMC we have an innovative approach to ensure the necessary quantities of pneumococcal vaccines are produced for children in developing countries at an affordable price.
VOICEOVER
Italy, the UK, Canada, Russia, Norway, and the Bill & Melinda Gates Foundation signed a deal to provide USD$1.5 billion for the vaccine. And GAVI will contribute a further USD$1.3 billion. Unicef, the World Health Organization, The World Bank and the Johns Hopkins Bloomberg School of Public Health helped GAVI to construct the initiative, designed to appeal to both profit-driven companies and the recipient nations.
DR. JULIAN LOB-LEVYT
There've been some extremely smart economists working out of Harvard who've, you know, made almost a lifetime's work in The World Bank and elsewhere to really research the model and see how it works.
ANDREW JACK
The AMC is essentially designed as a financial incentive to vaccine manufacturers to say: if you develop vaccines that are relevant to those in the developing world, to the world's poorest, there will be a market for those products, so you don't have to worry that you'll spend tens or maybe hundreds of millions of dollars developing something, and then find that none of these poorer countries are willing or able to pay for them.
VOICEOVER
The architects of the AMC reckon they're tackling the world's most immediately pressing cause.
DR. JULIAN LOB-LEVYT
The two biggest killers of children at the moment are pneumonia and diarrheal disease and pneumonia is by far the biggest killer, it's a no-brainer quite frankly.
DR. ORIN LEVINE
If we have a serious, common, and preventable disease, shouldn't that be at the top of our to-do list in global health?
VOICEOVER
Orin's now visiting another mother whose baby son also contracted pneumonia.
BUSAYO OGUNBODE
The baby is two months old. The baby started with a cough, no, with catarrh and a cold. The cough is very serious. He's two months old. If he's coughing he will be straining all his body like this, all his body was stiff. You know, I'm a woman. So if something is draining my baby, it means the thing is draining me. You understand what I say.
DR. ORIN LEVINE
I do, I'm a parent also. You feel when your children are sick
BUSAYO OGUNBODE
I feel the pain. When he's coughing, I feel the pains. And I couldn't sleep. He was always crying in the middle of the night, so that's why I took him to hospital
VOICEOVER
Busayo and her husband spent nearly 50,000 naira on a hospital bill for their baby.
BUSAYO OGUNBODE
We go through a lot of stress. We borrowed, we sell a lot of things, because we are not OK. We borrowed ... we beg, even beg. We did not think about the money, but we were trying to save the baby's life. The baby died because of the pneumonia. So you go through a lot of stress before the baby die. I would spend a lot of money to save the baby's life, but the baby died. So we lost the baby, sure.
DR. ORIN LEVINE
See, it's unconscionable to me that the technologies that we've helped to develop are reaching only the children who can afford them, who are arguably the children who need them the least, and failing to get to the children who need them the most.

Segment 4

VOICEOVER
The AMC will come too late for millions like Busayo and her baby. But with funds secured, the process of inviting pharmaceutical companies to bid for contracts under the AMC has begun. Unicef is handling purchase of the product.
SHANELLE HALL
We're seeing a number of applications, which is fantastic, both from the multinational companies and also from emerging market companies, which is very healthy.
VOICEOVER
It was crucial to set up competition between the companies.
DR. JULIAN LOB-LEVYT
You absolutely need competition in this world whether it's drugs or vaccines or soap powder, in order to get the best product and to get it at the best price.
VOICEOVER
And there's another vital objective which GAVI has set. Current pneumococcal vaccines were developed to guard against varieties of the disease found in rich countries. GAVI is seeking more powerful vaccines to protect against other strains which threaten the poorer nations. The aim is to prevent 80 per cent of infections worldwide. So how has the pharmaceutical industry responded to the challenges and opportunities? The Wyeth corporation, which gave away its seven-strain vaccine to Rwanda, is keen to get involved in the broader plan to sell the improved version to all the poorest countries.
JIM CONNOLLY
Companies like Wyeth and other pharmaceutical companies have an obligation to make their products available to as wide a population ... With financing mechanisms like the AMC, we think there's a way that's both affordable from a country's perspective and sustainable from a shareholders perspective, and I think we can strike the right chord from a pneumococcal vaccine perspective.
VOICEOVER
Wyeth and two other pharmaceutical companies, GSK [GlaxoSmithKline] and the Serum Institute in India, are developing pneumococcal vaccines which could be used for the AMC, if they meet standards required by the World Health Organization. In a statement, GSK said that it would review the terms and conditions of the AMC and consider whether to deliver a pneumococcal vaccine to developing countries under the framework. Under the AMC, GAVI will sign 10-year deals, paying USD$7 per shot for the first 20 per cent of vaccinations provided. This will allow the companies to recoup the cost of new factories and manufacturing equipment. After that, the price falls to USD$3.50 for the rest of the contract.
DR. JULIAN LOB-LEVYT
Once those research and development costs have been absorbed, that vaccine is provided to the poorest countries in the world as at near to production costs as is technically feasible.
VOICEOVER
So is the industry now interested more in doing good and less in making money?
ANDREW JACK
All of the big companies have started saying that we can and we should morally and economically make medicines available more affordably to the poor. And in the process we can make some money, we can make this sustainable, but above all many more patients can benefit
VOICEOVER
Orin makes his last visit to Blessing and Olajomoke.
DR. ORIN LEVINE
Have you seen any progress in this child since the last couple of days?
DOCTOR
Yes, we have. Initially we had to feed her with a tube and we've been able to take that out. She's feeding by cup and spoon now. And she's very much alert and she's doing very well. She's done very well.
BLESSING
I am very very happy that she has made it and she has responded to the medicines which have been given to her.
VOICEOVER
Blessing and Olajumoke have gone through a terrible ordeal. But it's so much worse for all the millions of families whose children don't recover. The AMC may offer real hope that a solution is to hand, but much needs to be done before the first child is injected. The pharmaceutical companies need to develop the vaccines to meet the necessary standard, and the recipient countries need to demonstrate the ability to distribute the vaccines. But Dr. Orin Levine believes the challenges can be overcome.
DR. ORIN LEVINE
The AMC could be delivering life-saving pneumococcal vaccines to children in the poorest countries of the world as early as the end of 2009 or early 2010.
VOICEOVER
The AMC will lead ultimately to the vaccination of one billion children, saving seven million lives by the year 2030. And that's not all.
DR. JULIAN LOB-LEVYT
If this model works it should be applied to other vaccines for other diseases and perhaps for drugs to treat other diseases, so this is an innovative instrument. Potentially this could be saving millions of lives, now affected by tuberculosis, by malaria, and so that's the second reason to be quite excited by this pilot
VOICEOVER
The hope is that the AMC will ensure that children like these and millions more like them will grow up to fulfill all their dreams and ambitions.
DR. ORIN LEVINE
What else, what else does somebody want to be when they grow up?
CHILDREN
A doctor! / A nurse, a nurse! / Doctor!
DR. ORIN LEVINE
A nurse, a lot of doctors, and nurses. Really. Doctors ... Nobody wants to be a football player?
CHILDREN
Yes!
VOICEOVER
So how welcome would a pneumococcal vaccine be in the countries which need it?
PROFESSOR KIKELOMO OSINUSI
A lot of time will be saved for treatment of other conditions, and many other savings would be carried out: the cost of looking after the children, the time of the parents who stay in the hospital with children, and all the anguish of losing the children. I think I will be very happy, when ... if this is introduced into the country.
DR. ORIN LEVINE
What would you say if I told you that in a few years we think there's going to be a vaccine that could prevent the kinds of pneumonia that took the life of your baby? How would you feel about that?
BUSAYO OGUNBODE
I would be very happy if such a thing could happen.
TITLE
[end credits]
TITLE
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