Title -- Copyright -- Acknowledgments -- Preface -- Abstract -- Contents -- 1 Summary -- Selection of Candidates -- Determination of Health Benefits -- Disease Burden Estimates -- Infant Mortality Equivalence Values -- Total Disease Burden Values -- Vaccine Characteristics -- Predictions of Vaccine Development -- Definition of Probable Vaccine Target Population -- Estimation of Vaccine Utilization -- Estimation of Time to Licensure, Time to vaccine Adoption, and Delay of Vaccination Benefits: Discounting -- Estimation of vaccine Preventable Illness -- Calculation of Expected Health Benefits for Each Vaccine -- Cost Calculations -- Calculation of Morbidity Costs Averted by the Vaccine -- Vaccination Program Costs -- Integration of Costs -- Interpretation of Health Benefit and Net Cost Rankings -- Findings, Conclusions, Recommendations -- Recommendation -- Reference -- 2 Priority Setting for Health Related Investments: A Review of Methods -- Methods for Project Ranking and Selection -- Multiattribute Accounting -- Multiattribute Scoring -- Decision Analysis With Multiple Objectives -- Cost-Effectiveness and Cost-Utility Analysis -- Benefit-Cost Analysis -- Selection of an Approach -- Issues in Project Ranking Methodologies -- Sources of Estimates -- Sequential or "Lexicographic" Methods -- Interdependence Among Projects -- The "Portfolio" Question -- Summary -- References -- 3 Overview of the Analytic Approach -- Method -- Interpretation of Results -- Guidelines -- Definition of Dominance -- Step 1 -- Step 2 -- Step 3 -- Step 4 -- Summary -- 4 Comparison of Disease Burdens and Costs -- Elements of the System for Comparing Morbidity and Mortality Burdens Arising From various Diseases -- Trade-Off Values -- Expression of Morbidity and Mortality Burdens -- Procedures Used in Deriving Disease Estimates -- Limitations of the Current Estimates.

Value Judgments in Quantifying Morbidity and Mortality -- IME Perspectives used in This Study -- The Effect of Adopting Other IME Perspectives -- Comparison of Direct Costs Resulting from Diseases -- Scope of Cost Calculations -- Procedures -- Findings -- Limitations of the Proposed System -- Summary and Conclusions -- Recommendations -- References -- 5 Predictions on Vaccine Development -- The Need for Predictions -- Selection of Candidates -- Vaccine Candidates and Target Populations -- Predictions on Vaccine Development -- Probability of Successful Development -- Cost of Development -- Time to Licensure -- Comments -- Predictions on Vaccine Characteristics -- Efficacy -- Adverse Reactions -- Production Technology, Delivery Requirements, and Cost/Dose -- Number of Doses and Route of Administration -- Conclusions -- 6 Assessing the Likely Utilization of New Vaccines -- Vaccine Availability -- Statutory Interventions -- Determinants of Lay and Provider Attitudes Toward New Vaccines -- The Health Belief Model -- Provider Acceptance -- Predicting Utilization of New Vaccines -- Scoring of Determinants of Acceptance by Patients and Providers -- Aggregation of Component Scores into an Overall Score -- Aggregation of Lay and Provider Weighted Scores -- Translation of Acceptance Scores into Anticipated Use Rates -- Alternatives to the HBM Approach for Predicting Anticipated Use Rates for New Vaccines -- Limitations of the Approach -- Conclusions and Recommendations -- References -- 7 Calculation and Comparison of the Health Benefits and Costs Associated with Candidate Vaccines -- Procedures -- Vaccine Characteristics -- Target Population -- Vaccine Preventable Illness -- Trends in Disease Burden and Population Numbers -- Adverse Reactions -- The Time at Which Health Benefits and Cost Savings Associated With the Vaccines Will Occur -- Costs -- Results.

Health Benefits -- Costs -- References -- 8 Additional Issues in the Selection of Priorities for Accelerated Vaccine Development -- Equity Considerations in the Calculation of Disease Burdens and Vaccine Benefits -- Lives vs. Cases vs. Days -- The Aggregate Nature of the Disease Burden Calculations -- The Portfolio Approach for Ranking vaccines for Research and Development Support -- The Pertussis Vaccine Problem -- Industry Interest and Activity: The Respective Roles of the Public and Private Sectors -- Findings, Conclusions, and Recommendations -- References -- 9 Findings, Conclusions and Recommendations -- The Central Analysis -- Findings -- Sensitivity Analyses -- Adoption of Age-Neutral Versus Committee Median Perspective -- Discount Rate -- Alternative Development Scenario -- Alternative Utilization Scenario -- Low Vaccine Cost Scenario -- Conclusions -- Discussion -- Recommendation -- Reference -- APPENDIXES -- Appendix A SOME EXAMPLES OF THE APPLICATION OF PROJECT SELECTION METHOD -- Allocating Resources to Medical Technologies -- Priorities for Biomedical Research -- Selection of Chemicals for Toxicity Testing and Regulation -- Priorities for Hazardous Waste Sites Under Superfund -- References -- Appendix B PATHOGENIC AGENTS FOR WHICH ACCELERATED VACCINE DEVELOPMENT DOES NOT APPEAR APPROPRIATE -- Judging the Feasibility of Accelerated Vaccine Development -- Accelerated vaccine Development and Basic Research priorities -- Pathogens not Included on the Slate of Candidates -- Acquired Immune Deficiency Syndrome Agent -- Adenovirus (respiratory disease) -- Anaerobic Bacteria -- Chlamydia -- Entamoeba histolytica -- Epstein-Barr Virus -- Escherichia coli -- Giardia lamblia -- Hospital Acquired Infections (gram-negative bacteria) -- Non-A, Non-B Hepatitis (NANBH) -- Histoplasma capsulatum -- Human Papilloma Virus -- Kawasaki Disease Agent.

Legionella spp. (Legionnaire's disease) -- Mycobacterium tuberculosis -- Mycoplasma pneumoniae -- Neisseria meningitidis Group B -- Rhinovirus -- Rickettsia rickettsii (Rocky Mountain Spotted Fever) -- Shigella spp. -- Staphylococcus aureus -- Streptococcus Group A -- Streptococcus mutans -- Streptococcus pneumoniae -- Treponema pallidum (syphilis) -- Treponema-like Spirochete of Lyme Disease -- References -- Appendix C PROSPECTS FOR IMMUNIZING AGAINST BORDETELLA PERTUSSIS -- Disease Description -- Pathogen Description -- Host Immune Response -- Magnitude of Disease Burden -- Vaccine Target Population -- Suitability for Vaccine Control -- Vaccine Preventable Illness -- Vaccine Preventable Illness Values -- Possible Reduction in Morbidity and Mortality (PRMM) -- Adverse Reactions -- Prospects for Vaccine Development -- Anticipated Vaccine Utilization -- Lay Acceptance -- Provider Acceptance -- Cost of Illness -- Costs Related to Adverse Effects of Current Vaccine -- References -- Appendix D PROSPECTS FOR IMMUNIZING AGAINST COCCIDIOIDOMYCOSIS -- Disease Description -- Pathogen Description -- Host Immune Response -- Magnitude of Disease Burden -- Uncertainty in the Disease Burden Estimates -- Calculation of Comparative Total Disease Burden Values -- Target population -- Suitability for Vaccine Control -- Vaccine Preventable Illness Estimates -- Vaccine Preventable Illness Values -- Possible Reduction in Morbidity and Mortality (PRMM) -- Prospects for Vaccine Development -- Anticipated Vaccine Utilization -- Lay Acceptance -- Provider Acceptance -- Cost of Illness -- Cost of Total Disease Burden -- References -- Appendix E PROSPECTS FOR IMMUNIZING AGAINST CYTOMEGALOVIRUS -- Disease Description -- Description of the Pathogen -- Host Immune Response -- Magnitude of Disease Burden -- Congenital Cytomegalovirus Infection.

Perinatal Cytomegalovirus Infection -- CMV Mononucleosis and Other Febrile Illnesses -- Post-Transfusion infection -- CMV and Organ Transplantation -- Patients with Malignancies -- Uncertainty in the Disease Burden Estimates -- Calculation of Comparative Total Disease Burden values -- Vaccine Target Populations -- Congenital and Perinatal Infection -- High-Risk Individuals -- Suitability for Vaccine Control -- Congenital Infections -- High-Risk Individuals -- Vaccine Preventable Illness -- Live Attenuated Vaccine for Nonpregnant Adolescent Females -- Live Attenuated Vaccine for High-Risk Individuals -- Glycoprotein Vaccine for Normal Children -- Vaccine Preventable Illness Values -- Possible Reduction in Morbidity and Mortality (PRMM) -- Prospects for Vaccine Development -- Anticipated Vaccine Utilization -- Live Attenuated Vaccine for Nonpregnant Adolescent Females -- Live Attenuated Vaccine for High-Risk Individuals -- Glycoprotein Vaccine for Normal Children -- Cost of Illness -- Cost of Total Disease Burden Congenital and Perinatal CMV infection -- References -- Appendix F PROSPECTS FOR IMMUNIZING AGAINST HEMOPHILUS INFLUENZAE TYPE b -- Pathogen Description -- Host Immune Response -- Magnitude of Disease Burden -- Uncertainty in the Disease Burden Estimates -- Calculation of Comparative Total Disease Burden Values -- Vaccine Target Population -- Suitability for Vaccine Control -- Vaccine Preventable Illness Estimates -- Vaccine Preventable illness Values -- Possible Reduction in Morbidity and Mortality (PRMM) -- Prospects for Vaccine Development -- Anticipated Vaccine Utilization -- Lay Acceptance -- Provider Acceptance -- Cost of Illness -- Cost of Total Disease Burden -- References -- Appendix G PROSPECTS FOR IMMUNIZING AGAINST HEPATITIS A VIRUS -- Disease Description -- Pathogen Description -- Host Immune Response -- Disease Burden Estimates.

Uncertainty in the Disease Burden Estimates.