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The process involved a number of iterations of selection, review, and revision. At an international workshop in Washington, D.C., on August 1–3, 1984, a draft list of infectious diseases prevalent in the developing world was reviewed and revised. This list was the starting point for candidate selection and is shown in Table A.1.

About 40 diseases were chosen from Table A.1 by the workshop participants as major health problems in the developing world. These diseases are listed in Table A.2. Some diseases were included in this list as models because vaccine prospects had been carefully reviewed in the committee’s prior assessment.

A working group at the workshop then assessed the state of knowledge on these diseases in three areas: disease mechanisms, protective mechanisms, and protective antigens. A simple scoring system was used (+/++/+++), and on the basis of scores, pathogen/disease entities were assigned to one of three categories: good prospects for the technical feasibility of vaccine development, promising prospects, or insufficient knowledge to evaluate prospects. Based on these judgments, candidates were either included in the full assessment, excluded from it, or subjected to further review by a committee subgroup which consulted with experts on relevant vaccine development efforts.

Appendixes D-1 through D-19 describe the prospects for immunizing against the candidate pathogens, and the supplement to this volume describes prospects and knowledge gaps for a range of diseases prevalent in the developing world and for which accelerated development efforts are not feasible or appropriate at this time.

For a number of the pathogens considered in the supplement, vaccine development prospects are such that their exclusion from consideration was a difficult decision. Because of rapid technologic advances in the vaccine development field, the state of knowledge and vaccine development prospects for these potential candidates should be regularly reviewed.

Table A.3 lists the pathogens for which the vaccine development prospects were reviewed in the committee’s first report. For various reasons, these pathogens were not included as primary contenders in the assessment of vaccine priorities for important diseases in the United States, although some are now included in this analysis.

REFERENCE

Institute of Medicine. 1985. New Vaccine Development: Establishing Priorities, Volume I. Diseases of Importance in the United States. Washington, D.C.: National Academy Press.



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