New Vaccine Development Establishing Priorities: Volume II, Diseases of Importance in Developing Countries (1986) / Chapter Skim
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8. Additional Issues in the Selection of Priorities for Accelerated Vaccine Development
8. Additional Issues in the Selection of Priorities for Accelerated Vaccine Development
Pages 106-120
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From page 106... ...
allow different weights in the infant mortality equivalence scale to be placed on events that occur at various ages. These weights directly affect both disease burden values and calculations of the possible health benefits of vaccine candidates.
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From page 107... ...
However, those making decisions about vaccine priorities for developing countries might wish to explore the effects of various trade-offs in the ranking process. Effect of Infant Mortality on Fertility Control One example of a value judgment that could affect vaccine programs for developing countries is the belief that reducing infant and child mortality has a lower priority than alleviating adult morbidity, because the former simply perpetuates population growth and increases pressure on resources.
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From page 108... ...
One method for going beyond a single, global burden-of-illness comparison is to construct individual disease burden profiles for specific regions, countries, or other groupings, for example: major regions, such as Latin America, Africa, or Southeast Asia specific countries major regions within countries the poorest nations or groups middle-income developing nations women These multiple burden-of-illness profiles might not lead directly to new public policy recommendations, but they would serve as a reminder that the global profile developed here is an aggregate that obscures differential effects in definable regions, countries, or population groups. The multiple profiles also could help decision makers decide whether to devote special attention to the needs of specific regions or the more vulnerable groups, however those groups were defined.
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From page 109... ...
High chronic carriage rates in southeast Asia, and sub-Saharan Africa Endemic in tropical Asia, Australia, and New Guinea Tropical areas of India, southeast Asia, Pacific Islands, and Latin America Meningitis belt across sub-Saharan Worldwide Africa, Nile River valley Worldwide Sub-Saharan Africa, south and south east Asia, tropical Central and South America, Pacific Islands, and New Guinea Developing countries Worldwide Worldwide Developing countries Developing countries Worldwide Worldwide Caribbean 1963, 1969; Central America 1977; Polynesia and Micronesia 1963, 1979 Industrialized countries Industrialized countries Industrialized countries Vibrio cholera Endemic in south and southeast Asia, Occasional epidemics in Africa southern Europe and the Middle East Yellow fever virus Tropical South America, sub-Saharan Africa
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From page 110... ...
vaccines at an early stage of development that require significantly more basic study before any large scale clinical or field trials would be possible (e.g., respiratory syncytial virus)
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From page 111... ...
public confidence in immunization programs. Although the fear of adverse effects from the pertussis vaccine may be less in the developing world, in part because of the greater threat represented by the disease, it is likely that such effects cause concern and may lead to failure to complete recommended immunization schedules.
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From page 112... ...
The committee evaluated the situation for the two vaccines presently perceived to be the most in need of improved temperature stability, namely poliomyelitis vaccine and measles vaccine. The committee judged that the prospects for substantial improvements in either of the vaccines in the near future were not promising.
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From page 113... ...
OTHER DIEASE CHARACTERSTICS RELEVANT TO ESTABLISHING PRIORITIES Alternative Disease Control Measures The method devised ranks vaccine candidates on the basis of their potential health benefits. It does not address the relative benefits of disease prevention, control, or treatment by approaches other than immunization.
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From page 114... ...
Epidemiologic and Clinical Features The proposed system for calculating a vaccine's potential health benefits uses average annual incidence rates to develop disease burden estimates. This process might understate the importance of certain diseases that occur in epidemic form and produce severe clinical symptoms.
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From page 115... ...
For example, epidemiologic and demographic studies suggest that mortality reduction may be a prerequisite for fertility reduction in developing countries. If a long-term view is taken, this finding contradicts the suggestion that programs to reduce infant and child mortality should receive low priority because they contribute to undesirable population growth and increase pressure on scarce resources (although some growth may occur in the delay between mortality and
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From page 118... ...
prophylaxis might be interrupted or ceased Rabies virus Low Low Respiratory syncytial virus High Moderate to high Rotavirus High, disaster/mass migration situations, High populations of low socioeconomic status Salmonella typhi High, disaster/mass migration situations, High mostly water borne Shigella spp. High, low socioeconomic areas, endemic in High tropical areas Streptococcus Group A Pharyngitis: high; others: low, except Low under conditions of crowding Streptococcus pneumonias Moderate Moderate Vibrio cholera High in areas where protected water High, may be disruptive to medical supplies not available, disaster/mass services migration situations Yellow fever virus High High
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From page 119... ...
. 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.
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From page 120... ...
1984. Mortality reduction, fertility, decline, and population growth: Towards a more relevant assessment of the relationship among them.
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