90% CI: (70,90)
Quality Scale Rating
“On a ‘scale of journals’, what ‘quality of journal’ should this be published in?: Note: 0= lowest/none, 5= highest/best”
90% CI: (2.5, 4.5)
See here for a more detailed breakdown of the evaluators’ ratings and predictions.
Advance Market Commitments (AMCs) are a promising and already burgeoning area for global health aid for new vaccines and therapies, and have been widely used and discussed in the short time since their initial proposal. They also have been suggested as promising to speed up response for urgent needs during an emerging disease pandemic, making them potentially relevant for reducing global catastrophic biorisk.
This paper reviews recent uses and theory about AMCs, and in addition to a more general review, it seems useful to consider some of the claims more critically, and then to consider the relevance for key global priorities. I therefore begin with a review of the contents and claims, including a critique, then discusses relevance to global health and to pandemic preparedness and response.
As an overview of Advanced Market Commitments, the paper is excellent. It addresses many key points about the theoretical economic justification, provides data on the brief but very successful history of AMC usage in the past 2 decades, and the issues with the design which have been identified and are still relevant. The last section, especially the discussion of distant technological targets, has a number of implications, however, which are not fully explored - and which are critical to applications of the paper.
In both the initial theoretical section and the final section, the paper discusses use of AMCs for theoretically distant targets. The issues with doing this are discussed, however, the scope of the paper means that alternative approaches are not explored. They note that AMCs are intended to “supplement, not replace, direct R&D support.”
To discuss why the limitation in the scope of the paper to AMCs is problematic, it is useful to more clearly explain the conceptual framing the paper uses, “Push” and “Pull” funding. Push funding includes grants, scientific research funding, and other mechanisms which lead to but do not actually require production of the final product. This is designed to pay for innovation and research, but leaves the actual production to the market, with attendant market failures, which the paper discusses. Pull funding includes purchases and Advanced Market Commitments, and is designed to get the final product produced. But other mechanisms, such as prizes and option-based guarantees do not fit neatly into this framing, and are therefore unfortunately ignored. They also address very different parts of the potential market failure, and it seems likely that many of the issues which exist for AMCs to address technologically distant targets are better addressed using a combination of approaches, and AMCs may play a limited role.
As I have argued elsewhere, there are a variety of tools other than AMCs, including prizes, more direct public-private partnerships, and the proposed options-based guarantees. While the last category is most appropriate for urgent but technologically distant targets, the other two provide more of a spectrum. They also provide different tradeoffs, for example, because prizes do not need to pre-select the number of firms. An analysis of the appropriate tool for different future needs would therefore be even more useful.
The relevance of AMCs for global priorities is therefore mixed. They are appropriate and very sorely needed for continued and expanded use in global health and disease elimination campaigns. As the paper notes, they have likely already saved 700,000 lives, though how counterfactual this estimate is remains unclear - but they have the potential to be used further, and save an order of magnitude more lives in the near term. They also have potential to accelerate vaccines for known pandemic-potential pathogen threats, including use for universal influenza vaccines to address novel influenza, and similarly for pan-betacoronavirus vaccines. The optimal strategy presumably involves a mix of different tools, but policy considerations for which approach to use will also be critical, and the track record of AMCs is a significant advantage.
On the other hand, for technologically more distant targets, it seems the paper oversells the usefulness of AMCs compared to the alternatives. Most critically, the use of AMCs for novel diseases seems far more limited than other avenues. In the event of a novel disease pandemic, as COVID-19 showed, funding availability and advanced purchases were not the key constraints for getting vaccines developed. Instead, the slow nature of the testing and approval processes were critical, and AMCs typically do not provide direct marginal incentives for speed. Additionally, the relative lack of investment in manufacturing capacity to speed up availability was critical.
On the other hand, if combined with general research funding for programs like the proposed “prototype pathogen” research, which would develop candidate vaccines for critical viral families, then AMCs could be made more useful, though it remains unclear why they would be preferred to more direct funding and purchases.