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also recognizes that various technical problems could interfere with the addition of these vaccines to the EPI. For example, antagonisms could exist between potential vaccine candidates and those already included in the WHO program. Moreover, changes may be made in the basic EPI as new and better vaccines are developed or as information on current vaccine use is refined. Further research will be needed to investigate the feasibility and desirability of substantially increasing the number of antigens administered at any one time.

SUMMARY

The expected health benefits from a vaccine depend, in part, on the proportion of the target population that actually receives it (which, in turn, affects the probability of acquiring the disease). Predicting utilization rates is complicated by various factors, including availability, cost, the health system capacity to deliver vaccine, statutory interventions, the target population, and provider and recipient acceptance.

Because delivery of vaccines would probably be achieved through the WHO-EPI, the committee assumed for the analysis that utilization rates of vaccine candidates would be uniform across target populations. (Actual decisions about whether to incorporate specific vaccines into EPI should be based on local assessments of disease burdens, resources, and other considerations.) Thus, utilization is not used to differentiate among vaccine candidates in this analysis. Methods described in the committee’s previous report can be adapted if utilization is expected to differ among vaccines.

REFERENCES

Adeniyi, J.D. 1972. Cholera control: Problems of beliefs and attitudes. Int. J. Health Educ. 15:238–245.

Azurin, J.C., and M.Alvero. 1971. Cholera incidence in a population offered cholera vaccination: Comparison of cooperative and uncooperative groups. Bull. WHO 44:815–819.


Becker, M.H., ed. 1974. The Health Belief Model and Personal Health Behavior. Thorofare, N.J.: Charles B.Slack.


Henderson, R.H. 1985. Personal communication. World Health Organization, Geneva.

Hingson, R. 1974. The impact of health beliefs on behavior during an immunization program in rural Haiti, 1972. Health Educ. Mono. 2:505–508.

Hingson, R., and N.Lin. 1972. Communication participation and individual receptivity to health innovations. Int. J. Health Educ. 16:5–14.

Hsu, F.L.K. 1955. A cholera epidemic in a Chinese town. Pp. 135–154in Health Culture and Community, B.Paul, ed. New York: Russell Sage Foundation.



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