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  • time after licensure to adoption in immunization programs future cost of development up to licensure

  • protective efficacy

  • incidence of adverse side effects

  • route of administration

  • number of doses

  • cost per dose

  • delivery requirements

  • technical difficulty of production

These factors have been incorporated into the calculations of potential health benefits and expenditures on vaccines. Chapter 5 presents in tabular form the specific estimates for each of the vaccine candidates, which are discussed in Appendixes D-1 through D-19.

Definition of Probable Vaccine Target Population

The determination of a probable vaccine target population for each vaccine was based on the age and geographic distributions of the relevant disease and the relative risk of illness. Whenever possible, the target population was matched with one already employed by the World Health Organization’s Expanded Program on Immunization (WHO-EPI) , for reasons discussed below.

Treatment of Vaccine Utilization

The benefits derived from a vaccine depend, in part, on the proportion of the target population that actually receives it, which may vary among vaccines. However, for the analysis described in this report, the committee assumed that the utilization rates would be uniform across target populations, because delivery would probably be achieved through the WHO-EPI. Its vaccination schedule recommendations are intended to be adapted to local conditions and constraints. WHO-EPI flexibility in this regard may establish new opportunities for optimizing the delivery of vaccines considered in this analysis (see Chapter 6). Actual decisions to incorporate specific vaccines into EPI should be based on local assessments of disease burden, resources, and other considerations. The methods used in the committee’s previous report (Institute of Medicine, 1985) can be adapted to situations in which utilization is likely to differ between vaccines. In this report, however, utilization is not used to differentiate among vaccine candidates.

Estimation of Time to Licensure, Time to Vaccine Adoption, and Delay of Vaccination Benefits: Discounting

Various vaccines require various amounts of time for development to licensure, and after licensure before wide incorporation into general



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