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text the committee reiterates its conclusion that an improved pertussis vaccine merits unique treatment because of its potential for restoration of public confidence in immunization programs.

Scientific opinion differs on some of the judgments incorporated into the proposed method and uncertainty surrounds much of the data, e.g., disease incidence and efficacy. When data are unavailable, expert judgments are required. The attempt to be explicit about certain estimates should not be interpreted as indicating that a high degree of precision, unanimity, or certainty in comparisons is possible in this situation. Hence, additional sensitivity analyses are suggested (see Chapter 9) to provide further information on key elements which may alter decisions. These include study of alternative IME profiles and variation in other factors for individual vaccines such as the number of required vaccine doses or the probability of success. Assessments involving alternative assumptions on the choice of target population are also desirable; these would entail more extensive recalculation including reestimation of vaccine preventable illness.

Recommendation

Lack of data on some diseases and the variable quality of data for others are serious impediments to the development of a comprehensive priority selection scheme. The National Institute of Allergy and Infectious Diseases and other agencies should consider means of improving the epidemiologic data on which disease comparisons can be made.

Reference

White, L.J. 1983. Public decision-making with respect to atmospheric PAH sources and emissions. Pp. D1–D26 in Polycyclic Aromatic Hydrocarbons. National Academy of Sciences. Washington, D.C.: National Academy Press.



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