Table Of Contentee
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ting filesetbeen acci Establishing Priorities
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er bme t Part Two of a Two-Part Study by the
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original ed, and Division of Health Promoatniodn and Disease Prevention
he ain Division of International Health
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eakerte NATIONAL ACADEMY PRESS 2101 CONSTITUTION AVE., NW WASHINGTON, DC 20418
ge bry ins NbeOrsT aIrCeE d:r Tawhen pfrroomjec tth teh acto uisn tchiles soufb tjheec tN oaf ttihoinsa rle Apocratd wemasy aopfp Srocvieendc besy, tthhee GNoavtieornnailn gA cBaodaermd yo fo tfh Ee nNgaintieoenrainl gR, easneda rtchhe CInosutintcuitle, owfh Moseed miceinme-.
Paall The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
s. ent This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee con-
ed
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ginal typay have cNSaearrtevi,oi Tcrneehas'else IawVnrsoactchrikct, u iaontneneds D w oeehfd viuHcechelao attpilhotmihns, e. pununt bdalenircd ac Htoionentar laitshc tbR Naesose.ed aN wrcOah1s P-iAnariItt-ii2ac2tiep6da7 t8ainn. gdT Ahfueg nUedn.ecSdy. bASyeg rtehvneicc yNe sfa oAtirog Inrneatele mrInneasnttiitto uNntaeol .o D0f0 eA0vl0el0elor1gp-y0m 4ae-nnSdt5, ,It nhafrlesoocut gpiohruo tsvh ieDd Peisdue bavlsaieclus H,abelaelth
he oriors m fLinibarnacriayl osuf pCpoonrtg.ress Cataloging-in-Publication Data
m terr (Revised for vol. 2)
k, not froographic New PICvnraocecnlpcutaeidnrneeetsds d :bf eviovb.r el 1itloh.o geDp rmNaispeaehntaiitsoe.enss a aoln fId ni msintipdtuoetrxet.a onfc eA ilnle trhgey Uanndit eIndf Sectatitoeus—s Dvi.s 2e.a sDeiss.eases of importance in developing countries.
op
oy 1. Vaccines—Research—Government policy. 2. Communicable diseases—United States—Preventive inoculation. 3. Communicable
er bme t diseases—Developing countries—Preventive inoculation. I. Institute of Medicine (U.S.). Committee on Issues and Priorities for New Vac-
p cine Development. II. National Institute of Allergy and Infectious Diseases (U.S.)
ao
ps RA638.N49 1985 614.4'7'0973 84–62037
original ed, and IISSBBNN 00--330099--0033647994--89 ((vp.b k2.): v. 1)
he ain Printed in the United States of America
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ge bry ins Committee on Issues and Priorities for New Vaccine Development
Paall
s. ent SAMUEL L.KATZ (chair), Department of Pediatrics, Duke University Medical Center
ed
ting filesetbeen acci JMAA.AMJORESHSH NCA BHLLIEN AH,L D.EB,e EWpCaKerEtlmlRc,oe Dnmte eop Rfa rHetmseeaealnrtcht h oS fLe Hravbeioacrletasht,o BSriteeahstae, v Uoifon riCt aeandlid fK oHirnnegiaadl toHhm eEadltuhc aatnido nW, Uelnfiavreer Asigtye nocf yM, Bicehrikgealne,y Ann Arbor
al typhave TPUHRENOEDLOLR EW C.C.EHIOCPKPHINOF, FH, oDweparadrt Hmuegnht eosf MInteedrincaall MInesdtiitcuitnee, ,B Pertehsebsydtae,r iMand/.St Luke's Medical Center, Denver
ginay FRANCIS A.ENNIS, Department of Medicine and Molecular Genetics, University of Massachusetts Medical Center,
m the orierrors m HARVWEYo rVce.FstIeNrEBERG, Institute for Health Research, Harvard School of Public Health
k, not froographic MGRIEACRHUAARLIRDCD ET FR..KK.HEIUNILSGLCHEHAM,M AD,N iC,v Moisvieoirnncg kot ofI nnGs ateinotdug trBea upforhlrii cnT gMh,e Werdapaicseihuniteni,cg TtRouenfs,t esD aUr.Ccnh.iv, eMrseirtcyk Sharp & Dohme Research Laboratories
ooyp BERNARD ROIZMAN, Department of Microbiology and Biophysics, University of Chicago
er bme t HENRY R.SHINEFIELD, Department of Pediatrics, Kaiser Permanente Medical Group, San Francisco
p
paso JANE E.SISK, Office of Technology Assessment, United States Congress
he original ained, and LMCELIRALOTDOYDN WE C.AS.WLTTEEEVRIENSNS,S TK,E LIeNna, nbIeondrsaytit toIunrtyse t oiftofu rEt eHp oiedfa elEmththi Roicleoss,g eGya,re cTohrh,ge He Ntaoerwvwna r YUd onSrickvh eBorsoloilt oyodf CPuenbtleicr Health
m tret See Appendix G for further information on committee members.
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es crer, c ROY WIDDUS, Study Director and Director, Division of International Health
ML filowev GENURTIHQRUIEET BA IRCK.BHEOANDD,, CDoinrescutlotar,n Dt ivision of Health Promotion and Disease Prevention
Xh
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ge bry ins FAKHRY ASSAAD, Division of Communicable Diseases, World Health Organization, Geneva
Paall NATTH BHAMARAPRAVATI, Mahidol University, Thailand
es. dent CHARLES C.J.CARPENTER, Department of Medicine, Case Western Reserve University
ting filesetbeen acci FKSECADORETLRT MI CHO.AJ CLOSHHTNAESVAOEDNZ, ,-H PHEeoOaflNft,mh I Sanncd-iueLsnatcrRieaos cPDhaierva, ieIsnsitocaontar, plT oFhraear tmRedoacckeueftieclale, rF FISouOnMdaEtiXo,n Mexico
al typhave ADETOOrKgUaNnBiOza tOio.nLUCAS, Special Programme for Research and Training in Tropical Diseases, World Health
originmay ARNOLD S.MONTO, School of Public Health, University of Michigan
he ors FRANKLIN A.NEVA, National Institute of Allergy and Infectious Diseases, National Institutes of Health
m terr S.RAMACHANDRAN, Department of Science and Technology, Government of India
k, not froographic JDJOOOHNNNAAS BL SD.RA SLO.KSB,B HTIENhPSAe, RNSDaa, ltIkino Isnntaistltu iIttneus tfetoi tfruo Htre e Boaiflo tChlo hRgiilecdsa eHla Sercatuhltd,h iH easanrdv aHrdu mScahno Doel voef lPopumbleicn tH, eNaaltthional Institutes of Health
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p
paso JULIA WALSH, Harvard Medical School
original ed, and KTHEONMNEATSH H W.WARERLELNER, ,H Deeapltahr tSmceiennt coefs TDriovpiiscioaln P, Tubhlei cR Hocekaletfhe,l lHera rFvoaurdn dSacthioonol of Public Health
he ain
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es crer, c JOHN E.NUTTER, Chief, Office of Program Planning and Evaluation
L filwev BERNARD TALBOT, Deputy Director, National Institute of Allergy and Infectious Diseases
XMho C.DAVID WISE, Chief, Evaluation Section, Office of Program Planning and Evaluation
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us ACKNOWLEDGEMENTS v
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he ors document. A list of those to whom the committee is particularly indebted appears as Appendix H. It is possible
m terr that some individuals may have been omitted from this list by oversight. If this has happened, the committee
k, not froographic offers its sincere apologies.
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original typmay have New TVhaics cvinoelu Dmeev eislo tphme esnetc. oTnhde rfeiprsotr tr efproomrt dtheael tI nwsittihtu tvea cocfi nMese dfoicri ndeis'se aCseosm omf iitmtepe oortna nIscseu iens tahned U Pnriitoerdi tSietsa tfeosr.
he ors The purpose of this volume is to help in setting priorities for the accelerated development of vaccines against
m terr diseases prevalent in developing countries. The background of the study and the committee's approach were
k, not froographic oIpnhusattlsiitenu etodef ointfh tAeh lepl erprorgjeyefc aatc neod nt oI n dVfiesoceltauisomeuses oID,f i wsiemhaispceohsr ,it saw nrhceiepc rhiinn p terdodev viined leoAdpp impnegan jodcroi xuf unJnt. rdTiienhsge, vpfoarorl ujteahcbetl eow vafeisnr aailnnli cteiifaaftloe rdstu .b pFypo otrhr tte h weN asaset icoaonlnsaodl
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er bome ty proviIdne dt hbey stheceo Un.dS .p Ahagseen coyf fothre I nstteurdnya,t iothnea l cDoemvmeliotpteme emnta.de particular efforts to draw on the expertise and
p
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ps opinions of individuals who have worked extensively in public health fields in developing countries. Consultants
original ed, and fcroonmtr ibsuevteedr avli epwasrt bs yo mf atihl eo rw teolrelpdh oanttee.nded a meeting of the committee in August 1984, and many others
he ain Any group assessing vaccine development—whether for disease afflicting the United States population or
m tret mankind in general—would be sorely remiss if it omitted consideration of acquired immune deficiency
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ea the committee believed that comparison of AIDS vaccine prospects with those of other advanced candidates for
es crer, c accelerated vaccine development would have been premature.
L filwev In the ensuing year remarkable progress has been made, largely because of the powerful molecular and
XMho cellular biotechnologies that have emerged from basic biomedical research. Yet, significant questions remain
m g, before the prospects for vaccine development can be assessed clearly or its priority relative to other diseases
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eakerte The committee gratefully acknowledges the assistance provided by its consultants (listed above) and other
ge bry ins Iandsvtiistuertes olifs tMede dinic iAnep psetanfdf ihxe Had. eIdt bayls oR owyi sWheisd dtuos .t aTkhee p aasrstiisctualnacr en aonted oadf vtihcee coof ntthien uNeadt ieoxncael llIennstt itsuutpep oofr tA ollfe rtghye
s. Paallent and Infectious Diseases project officer, C.David Wise, is also gratefully acknowledged, as is that provided by
ed George T.Curlin, of the Public Health Service, on behalf of the Agency for International Development.
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original typmay have accelTerhaitse dr edpeovrte ldoepsmcreibnet so af vmaectchionde sd aegsiaginnestd dtois eaaisde sg oovfe rinmmpeonrtta dneccei siino nd emvaekloeprsin ign ceosutanbtrliisehs.i nTg hper imoreittiheosd f oisr
he ors based on a quantitative model in which vaccine candidates are ranked according to their potential health benefits
m terr (reduction of morbidity and mortality). The model also provides the capacity to utilize “affordability”
k, not froographic (dwecililsiTinohgnen emaspsap ktroion pagca. hyB fueoscrea sbu etshneee ftsihtae)m aisen fa(o isrnumcpoapmtlieopmnle etiens) t aiinrnycf oocmrrmitpealretiitooenn .a tnhda t bceocualuds eth tehoer emticeathlloyd b ee nutaseilds , inin o sthoemr em ientshtoadnsc eosf,
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original ed, and evaluTatheed ccoemrtaminit tneeo nbqeulainevtiefisa btlhea tc ofninsaidl esrealteiocntiso nd isocfu spsreido riitni etsh es hroeuplodr t,b eb umt naodte inafctoerrp odreactiesdio inn tmo athkee rsm ohdaevle.
he ain These include the goals of the agency and its schedule for achieving them, considerations of equity or intent in
m tret the distribution of benefits, the opportunity and need for the agency to exert influence on development, the
oe
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ea The method was applied to 29 vaccine candidates for 19 diseases of importance in the developing world
es crer, c where new or improved vaccines were judged technically feasible within the next decade. (A prior assessment
L filwev considered vaccines for diseases of importance in the United States). Costs and benefits are viewed from a
XMho perspective for the developing world as a whole. The committee did not address the issues of balance between
m g, basic scientific research and vaccine development, and it expressly refrained from placing a monetary value on
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