The PCV AMC pilot finished in 2020, though the contracts with manufacturers extend until 2029¹. This final evaluation aimed to look back at the whole of the PCV AMC pilot, bringing together the findings, conclusions and lessons learned to generate recommendations.

The primary objective of this evaluation is to assess to what extent and how the PCV AMC pilot has achieved its overarching impact goal of reducing rates of morbidity and mortality from pneumococcal disease in developing countries.

METHODS

The evaluation used a mixed-methods, theory-based approach. It drew on interviews with 71 experts, review of over 80 documents, and analysis of data from Gavi, UNICEF SD, the Vaccine Impact Modelling Consortium (VIMC), and Institute for Health Metrics and Evaluation (IHME). Uptake of three other vaccines available through Gavi (Hib/Penta, rota and HPV) was used as counterfactuals for what might have happened without the PCV AMC pilot.

MAIN FINDINGS AND CONCLUSIONS

• Objective 1: R&D

  • The evaluation did not find evidence that the PCV AMC pilot accelerated new product R&D amongst those in the pipeline, despite one new TPP-compliant PCV product coming to market during the PCV AMC pilot. Taking a broader interpretation of ‘accelerating’ new product R&D, the PCV AMC pilot was successful at signaling the value of the LMIC PCV market. 

  • The PCV AMC pilot was very successful at driving presentation innovation, in terms of Multi-Dose Vials (MDVs). These were key to scaling up supply and driving down cost per dose in LIC and LMIC markets.

• Objective 2: Vaccine supply

  • The PCV AMC pilot achieved the objective of scaling up PCV supply in Gavi-73 markets – especially between 2010 and 2015/6 – by increasing manufacturer confidence in market demand.

  • The PCV AMC pilot was not successful at avoiding supply shortage issues common for antigens in Gavi-73 markets – there were significant supply shortages in the first three or four years of the PCV AMC pilot. 

  • The Gavi/UNICEF demand forecasts were structurally optimistic, and this has led to a reduction in confidence amongst manufacturers.

  • The PCV AMC pilot was relatively ineffective at driving price competition, likely due to the late entry of SII’s PCV10 and the subsidy design. The PCV AMC was designed under the assumption that a new product would reach the market earlier in the pilot. As this did not happen, the price competition within the PCV AMC was less than originally assumed.

• Objective 3: Vaccine uptake

  • The PCV AMC pilot achieved the objective of accelerating vaccine uptake, though it is plausible demand for PCV would have been high without an AMC, on account of the disease burden and context. 

• Objective 4: Impact and effectiveness

  • The PCV AMC pilot was perceived to be a success by almost all stakeholders, which is hugely important given that that making and stabilizing markets is as much about confidence, trust, and signaling as about legal agreements and vaccine procurement.

  • The PCV AMC pilot likely was successful at driving higher coverage of PCV than has been seen with other antigens. This increased coverage led to more lives saved.

¹ The subsidy associated with doses purchased through the PCV AMC pilot will have been distributed substantially before 2029

Documents

Gavi PCV AMC pilot: 2nd outcomes and evaluation

• Final report: English | French
• EAC Final Assessment
• Summary EMR

Previous Evaluations of the Gavi PCV AMC

• PCV AMC Baseline study 1 April 2011
• PCV AMC pilot outcomes and impact evaluation 6 March 2013
• PCV AMC process and design 6 March 2013