. "8. Additional Issues in the Selection of Priorities for Accelerated Vaccine Development." New Vaccine Development: Establishing Priorities: Volume II, Diseases of Importance in Developing Countries. Washington, DC: The National Academies Press, 1986.
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New Vaccine Development: Establishing Priorities, Volume II, Diseases of Importance in Developing Countries
Lives Versus Cases Versus Days
The infant mortality equivalence scheme allows decision makers to vary trade-off values within age groups as well as among them. It would be possible to construct a perspective in which all deaths were considered equal, but morbidity was weighted differently for various age groups. For example, days of hospitalization in adult life might be weighted more heavily than days of hospitalization in childhood. Analyses with such perspectives would be valuable in evaluating the stability of the final rankings under various assumptions.
The Aggregate Nature of the Disease Burden Calculations
Infant mortality equivalence values assigned to specific morbidity category/age group combinations do not differentiate with respect to sex, race, ethnic origin, socioeconomic class, place of residence, occupation, or life-style. However, diseases occur more frequently in some regions than in others, and within countries the incidence or prevalence of diseases varies across population groups.
This analysis uses an aggregate “global” perspective in its ranking methodology. The committee does not imply that this is the only feasible approach; other organizations might find alternative perspectives better suited to their needs.
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. Table 8.1 shows that many of the diseases under consideration are not globally or uniformly distributed.
Another method to meet the needs of specific groups might involve the portfolio approach described below.
