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not appear in the rank order, and no conclusions should be drawn regarding its position relative to the assessed contenders.

  1. The committee’s method can produce a priority ranking of candidate vaccines, but it is silent on the question of how many of the vaccines are worthy of development. The committee expressly refrained from equating dollars with the value of any health benefits.

  2. The analysis has no bearing on basic scientific research. It does not compare the value of further investment in basic scientific research with the benefits or costs of vaccine development.

  3. The analysis views costs and benefits from a societal perspective: it does not anticipate the source of funds for vaccine development, trials, or utilization, or the identity of those who will benefit from potential cost savings. Once the ranking of vaccine candidates has been completed, decision makers at the National Institute of Allergy and Infectious Diseases (NIAID) can determine the most effective distribution of the Institute’s funds among those candidates selected for accelerated development.

  4. The analysis recognizes only primary and secondary economic impacts of new vaccines on the medical care system. The primary impacts include costs of vaccine development, production, and administration; the secondary impacts deal with changes in the costs of care for patients who avoid having the disease in question or who develop side effects requiring treatment. (These impacts are sometimes called “induced costs and savings.”) The tertiary impacts, which are not considered in this analysis, involve changes in the costs of care for other diseases that the patient will get (eventually) or already has (for example, in immunocompromised patients) because the vaccine has prevented death due to the target disease.

  5. This analysis covers vaccine priorities for the population of the United States as a whole. (A separate assessment considers priorities for diseases of importance to less technologically developed countries.) The analysis regards vaccine benefits and costs irrespective of the population subgroups affected by particular diseases.

  6. The analysis treats each potential vaccine as an independent investment decision. Possible second-order dependencies among vaccines are not considered. For example, the analysis does not take account of the possible effect of an improved pertussis vaccine on the long-term acceptance of other childhood vaccines (see Chapter 8).


The basic strategy of the approach adopted by the committee is reductionist: each logical component of expected benefits and of expected costs is assessed separately, then the components are aggregated in a stepwise fashion for each disease-vaccine contender. The analysis distinguishes valued consequences, i.e., benefits and costs, from the probabilistic events that contribute to the likelihood of their occurrence. All component estimates are spelled out so they may be examined, questioned, and altered, if necessary.

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