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Additional Issues in the Selection of Priorities for Accelerated Vaccine Development

The selection of candidates for accelerated vaccine development requires consideration of several non-quantifiable factors in addition to the potential benefits described in previous chapters. These factors encompass both ethical issues and questions about private sector incentive structures.

Equity Considerations in the Calculation of Disease Burdens and Vaccine Benefits

The methods used to compare disease burdens (Chapter 4) and vaccine benefits (Chapter 7) intentionally incorporate the opportunity for individuals to attach different weights to events that occur at different ages through the infant mortality equivalence mechanism. These weights have a direct effect on both disease burden values and calculations of possible reductions in morbidity and mortality. For example, if the death of one child less than one year of age is considered to be equivalent to the deaths of ten persons over age 60, then a disease that kills 1,000 young infants annually would impose the same disease burden as another disease that kills 10,000 elderly persons annually.

The model allows decision makers to assess the impact of different infant mortality equivalence trade-offs. For those individuals who may be uncomfortable with any suggestion that one life is worth more than another, Chapters 4 and 7 also illustrate the use of an “age-neutral” perspective.

Lives vs. Cases vs. Days

The age-neutral perspective used in this report is neutral with respect both to morbidity and mortality. It would be possible, however, to construct a perspective in which all deaths were considered equal, but morbidity was weighted differently for different age groups. For example, days of hospitalization in adult life might be weighted more heavily than days of hospitalization in childhood. Use of the infant mortality equivalence scheme allows decision makers to vary trade-off values within age groups as well as among them.

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