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fertility reduction). That some population growth will result from infant and child mortality reduction highlights the need for integration of agricultural and health planning to avoid food shortages.

The method of ranking in this report uses an aggregate or global perspective, but the actual benefits from new vaccines will not be distributed evenly among regions, countries, socioeconomic groups, ethnic groups, age groups, or other population subsets. The committee’s method can provide useful information about the distribution of potential benefits, but the committee recommends that relevant equity issues should be addressed in a broader political/public policy forum. The portfolio approach could help focus the decision-making process.

The proposed system treats each vaccine development project independently, but some projects may have a wider impact. For example, a pertussis vaccine that caused fewer reactions might help increase public confidence in immunization programs in general and decrease failure to complete recommended schedules. Specific diseases may also interact synergistically in causing mortality. These interactions are difficult to quantify, but they should be considered by those setting vaccine priorities.

Other nonquantifiable factors that might affect project rankings include the availability of alternative measures of disease control or treatment, the potential impact of epidemic disease on health care facilities, and the opportunity for complete eradication of a particular disease.

In implementing the program of accelerated vaccine development, decision makers periodically should review activity in the private sector to identify projects for which public-private collaboration might expedite development, and to identify industry-scientific disincentives to the development of high-priority vaccines. Additional governmental funding for these vaccines (e.g., for clinical trials) might make them attractive to commercial manufacturers.

In the ultimate selection of a portfolio of candidates for accelerated vaccine development, information obtained from the analysis described in Chapters 3, 7, and 9 must be integrated with the nonquantifiable considerations discussed here.

REFERENCES

Ashworth, A., and R.G.Feachem. 1985. Interventions for the control of diarrheal diseases among young children: Prevention of low birthweight. Bull. WHO 63:165–186.


Bloom, B. 1985. Personal communication, Albert Einstein College of Medicine, Bronx, New York.

Bongaarts, J., and J.Menken. 1983. The supply of children: A critical essay. Pp. 27–60 in Determinants of Fertility in Developing Countries, Vol. 1, R.A.Bulatao and R.D.Lee, eds. New York: Academic.


Cochrane, S.H., and K.C.Zachariah. 1983. Infant and child mortality as determinants of fertility: The policy implications. World Bank Staff Working Papers, No. 556. Washington, D.C.



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