I don’t think it is actually a pessimistic paper for the pro-AMC case. The top-line result of “only 6 cents of additional R&D spending per dollar” is just part of the story. My summary of that paper:
Finkelstein finds large benefits (billions of dollars worth) from the increases in coverage paid for at only moderate (in the tens of millions $ range) cost. This is the “static benefit” of increasing vaccine coverage given the generally large benefits of higher vaccination rates.
Finkelstein looks at Hepatitis B and the flu vaccine more closely and basically concludes (A) that the induced increase in R&D for Hep-B was useless because the existing vaccine was already excellent (90% efficacy, few side effects), so it couldn’t be much improved upon, but (B) that the flu vaccine R&D was very useful, somewhere in the billions range, because it likely caused the development of the newer flu vaccine, which is apparently quite a bit more effective. This is the “dynamic benefit” of increased R&D causing an improvement in vaccine efficacy.
I think the take-away is that if AMC’s act like the instrument Finkelstein uses here, we shouldn’t expect an AMC to stimulate a lot more private pharma investment, but they could still be very cost-effective if they resulted in an efficacious vaccine or if they sped up rollout. Notably, speeding up rollout is basically what Finkelstein found happened with the Hepatitis B vaccine.
So AMC’s could still be very cost-effective if the vaccine developed is effective and/or roll-out is sped up, as in the GAVI Pneumococcus AMC case.
Another factor is that Finkelstein examined the effects of increased revenue on already existing vaccines, while the proposed AMC’s would mostly be focused on new vaccines.
My guess is that if Finkelstein found a big dynamic benefit from more R&D in the flu vaccine case just by a moderate increase in vaccine efficacy, then going from 0 efficacy (no vaccine) to moderate/substantial efficacy (new vaccine with vaccine efficacy of 75%) would yield large dynamic benefits. But I might be misunderstanding this part- not super confident in this.
I don’t think it is actually a pessimistic paper for the pro-AMC case. The top-line result of “only 6 cents of additional R&D spending per dollar” is just part of the story. My summary of that paper:
Finkelstein finds large benefits (billions of dollars worth) from the increases in coverage paid for at only moderate (in the tens of millions $ range) cost. This is the “static benefit” of increasing vaccine coverage given the generally large benefits of higher vaccination rates.
Finkelstein looks at Hepatitis B and the flu vaccine more closely and basically concludes (A) that the induced increase in R&D for Hep-B was useless because the existing vaccine was already excellent (90% efficacy, few side effects), so it couldn’t be much improved upon, but (B) that the flu vaccine R&D was very useful, somewhere in the billions range, because it likely caused the development of the newer flu vaccine, which is apparently quite a bit more effective. This is the “dynamic benefit” of increased R&D causing an improvement in vaccine efficacy.
I think the take-away is that if AMC’s act like the instrument Finkelstein uses here, we shouldn’t expect an AMC to stimulate a lot more private pharma investment, but they could still be very cost-effective if they resulted in an efficacious vaccine or if they sped up rollout. Notably, speeding up rollout is basically what Finkelstein found happened with the Hepatitis B vaccine.
So AMC’s could still be very cost-effective if the vaccine developed is effective and/or roll-out is sped up, as in the GAVI Pneumococcus AMC case.
Another factor is that Finkelstein examined the effects of increased revenue on already existing vaccines, while the proposed AMC’s would mostly be focused on new vaccines.
My guess is that if Finkelstein found a big dynamic benefit from more R&D in the flu vaccine case just by a moderate increase in vaccine efficacy, then going from 0 efficacy (no vaccine) to moderate/substantial efficacy (new vaccine with vaccine efficacy of 75%) would yield large dynamic benefits. But I might be misunderstanding this part- not super confident in this.