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New Vaccine Development: Establishing Priorities: Volume II, Diseases of Importance in Developing Countries (1986)
Board on Population Health and Public Health Practice (BPH)

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. "9. Findings, Conclusions, and Recommendations." New Vaccine Development: Establishing Priorities: Volume II, Diseases of Importance in Developing Countries. Washington, DC: The National Academies Press, 1986.

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New Vaccine Development: Establishing Priorities, Volume II, Diseases of Importance in Developing Countries

This model was developed to assist the National Institute of Allergy and Infectious Diseases (NIAID) and the U.S. Agency for International Development (AID) in their decision making. The priorities identified by this model are not appropriate for all circumstances, but it is hoped that the model or some modification of it may be useful to other groups, both in the United States and elsewhere, that are faced with similar resource allocation problems.

The Central Analysis

The central analysis described below incorporates the following:

vaccine and development characteristics described in Chapter 5, including predictions on the target population, efficacy, and vaccine cost

  • estimates of the burden of each disease, derived as described in Appendixes B, C, and D-1 through D-19

  • the assumption that utilization rates would not differ among vaccine candidates (because delivery of vaccines would probably be through the World Health Organization Expanded Program on Immunization [WHO-EPI])

  • estimates of the number of new entrants to the respective target populations, as described in Appendixes D-1 through D-19 and summarized in Chapter 7, Table 7.1

  • times to licensure and adoption, delay of vaccination benefits presented in Chapter 7, Table 7.2

    calculations of each vaccine candidate’s potential health benefits and associated expenditures as described in Chapters 4 and 7

  • a 5 percent discount rate for future health benefits and costs

  • a perspective, for illustrative purposes only, on the undesirability of various morbidity conditions and mortality, derived from the median values of responses from a range of health professionals in developing countries

  • independent consideration of each disease and the development of each vaccine candidate (for each target population)

  • expression of health benefits in units considered equivalent in undesirability to the death of an infant (i.e., infant mortality equivalents, see Chapter 4)

FINDINGS

The results of the central analysis (Chapter 7) are shown in Tables 9.1 and 9.2.

The range of potential benefits from the various vaccine candidates, viewed as present-day investment options, is considerable,

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Front Matter (R1-R16)
1. Summary (1-18)
2. Priority Setting for Health-Related Investments: A Review of Methods (19-29)
3. Overview of the Analytic Approach (30-43)
4. Comparison of Disease Burdens (44-62)
5. Predictions of Vaccine Development (63-75)
6. Assessing the Likely Utilization of New Vaccines (76-81)
7. Calculation and Comparison of the Health Benefits and Differential Costs Associated with Candidate Vaccines (82-105)
8. Additional Issues in the Selection of Priorities for Accelerated Vaccine Development (106-120)
9. Findings, Conclusions, and Recommendations (121-142)
Appendix A: Selection of Vaccine Candidates for Accelerated Development (143-148)
Appendix B: The Burden of Disease Resulting from Acute Respiratory Illness (149-158)
Appendix C: The Burden of Disease Resulting from Diarrhea (159-169)
Appendix D-1: The Prospects for Immunizing Against Dengue Virus (170-177)
Appendix D-2: The Prospects for Immunizing Against Escherichia coli (178-185)
Appendix D-3: The Prospects for Immunizing Against Hemophilus influenzae Type b (186-196)
Appendix D-4: The Prospects for Immunizing Against Hepatitis A Virus (197-207)
Appendix D-5: The Prospects for Immunizing Against Hepatitis B Virus (208-222)
Appendix D-6: The Prospects for Immunizing Against Japanese Encephalitis Virus (223-240)
Appendix D-7: The Prospects for Immunizing Against Mycobacterium leprae (241-250)
Appendix D-8: The Prospects for Immunizing Against Neisseria meningitidis (251-266)
Appendix D-9: The Prospects for Immunizing Against Parainfluenza Viruses (267-274)
Appendix D-10: The Prospects for Immunizing Against Plasmodium spp. (275-286)
Appendix D-11: The Prospects for Immunizing Against Rabies Virus (287-298)
Appendix D-12: The Prospects for Immunizing Against Respiratory Syncytial Virus (299-307)
Appendix D-13: The Prospects for Immunizing Against Rotavirus (308-318)
Appendix D-14: The Prospects for Immunizing Against Salmonella typhi (319-328)
Appendix D-15: The Prospects for Immunizing Against Shigella spp. (329-337)
Appendix D-16: The Prospects for Immunizing Against Streptococcus Group A (338-356)
Appendix D-17: The Prospects for Immunizing Against Streptococcus pneumoniae (357-375)
Appendix D-18: The Prospects for Immunizing Against Vibrio cholerae (376-389)
Appendix D-19: The Prospects for Immunizing Against Yellow Fever (390-402)
Appendix E: Questionnaire for Assessing Morbidity-Mortality Trade-Offs (403-411)
Appendix F: Technical Notes (412-412)
Appendix G: Biographical Notes on Committee Members (413-417)
Appendix H: Additional Sources of Advice to the Committee (418-419)
Appendix I: Contents of Supplement to Volume II (420-420)
Appendix J: Preface to Volume I (421-422)
Appendix K: Contents to Volume I (423-423)
Index (424-432)