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Many diseases that disproportionately affect developing countries do not attract investment into research and development for new health tools – drugs, diagnostics and vaccines – because of the lack of a lucrative market for developed products.  In poor countries where the vast majority of patients cannot afford treatment, the incentives are insufficient for pharmaceutical companies to invest into R&D once compared with expected profits in rich countries.

At the same time, when a product targeting diseases that disproportionately affect developing countries already exists in developed countries, it may not be reaching patients in poor settings.  This can be for a number of reasons - because its price is unaffordable, because production is at insufficient levels, or because the tool is unsuited for developing countries because it was primarily developed with wealthy markets in mind (e.g. requires refrigeration or is too high tech).

An Advance Market Commitment (AMC) is a financial mechanism that claims to remedy some of these problems.  Where R&D is not happening, proponents of the AMC say it would work by creating incentives that should attract pharmaceutical investment.  When the product does exist in developed countries but delivery in developing countries remains unsatisfactory, the AMC would aim to stimulate the development of new vaccines specifically designed for the needs of developing countries, to create a subsidised market for the product through the commitment of donors, to accelerate access, and to finance the production scale-up. 

To date, no AMC has been proposed for the development of new drugs or new diagnostic tools.  However, a pilot project has been proposed by the GAVI Alliance (Global Alliance on Vaccines) to have an AMC to encourage the development and delivery of a vaccine for pneumococcus that answers the needs of the developing world.