Exploring the costs and benefits of shifting from a just-in-time to a just-in-case approach (Wysocki and Lueck, 2006), and the use of incentives, cost-sharing contracts, accounting rule modifications, and other mechanisms to align societal public health objectives with private manufacturing choices are among many areas that warrant more research and innovation.

Changes in the Global Context

As noted above, it has become nearly impossible to neatly separate domestic and global vaccine issues because of porous borders and emerging infectious diseases on the one hand, and the global vaccine marketplace on the other hand.

The committee believes it is important that drafters of the update to the National Vaccine Plan pay special attention to the evolving global vaccine and immunization issues, in particular to industry views of the global marketplace as a more viable market for their vaccine products than the United States (Milstien et al., 2006). There is current tension between developing products for the U.S. market and focusing on global needs. For example, different serotypes of a disease-causing agent may be prevalent in different geographic areas, and some vaccines are developed to target serotypes found in the United States and exclude those that affect developing countries (Cutts et al., 2005; Klugman et al., 2003; Milstien et al., 2006).


This letter report contains the committee’s initial guidance to the National Vaccine Program Office and its partners as they draft the update to the National Vaccine Plan. Based on the committee’s review of the 1994 plan and the process to develop it, and our knowledge about changes since 1994, we identified four process and six content areas to bring to NVPO’s attention. The committee also made six recommendations. The committee underscores the preliminary nature of the guidance provided in this letter report. The committee’s continuing work, including reviewing the evidence and receiving the input of national stakeholders, will form the basis for more detailed recommendations on priorities in the update to the National Vaccine Plan.

The committee thanks you for the opportunity to assist the National Vaccine Program Office as it coordinates the drafting of the update to the National Vaccine Plan.

Claire V. Broome,


Committee on the Review of Priorities in the National Vaccine Plan

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