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4,000 lives per year. The expected number of lives saved per year is 1,000 in both cases.

In Table 3.1 a potential expenditure necessary to achieve the potential health benefit is listed for each project. In reality the net costs associated with a vaccine may be negative (i.e., a savings might be realized) if the treatment costs averted by its use (not included in the expenditure estimates) outweigh the expenditures on vaccines and their administration.

The committee proposes that the potential global health benefit of a vaccine take precedence in determining its initial ranking for accelerated development priority. The affordability of the benefit, represented by the relevant expenditures on vaccines, can also be entered into the decision process if desired, along with a variety of further nonquantifiable considerations (discussed in Chapter 8). Since the expenditures on vaccines do not represent net costs, the committee favors using the information provided by the ranking on this criterion as a secondary input into the decision-making process.

The priority ranking of vaccine candidates for accelerated development on the basis of potential health benefits is a straightforward process. The spacing of the numerical values may permit grouping of vaccines into clear categories. Depending on the degree of confidence decision makers have in estimates incorporated into the calculations for vaccine candidates that achieve nearly equivalent health benefit values, it may be necessary to resort to other criteria, for example, affordability or availability of other control measures to inform choices. In either case, decision makers should examine the nonquantifiable considerations outlined in Chapter 8 to guide the final selection of priorities. The calculation procedures outlined in this report are an aid to—not a substitute for—the final process of informed decision making.

The process for ranking vaccines in order of desirability depends on the type of constraint that limits the number of candidate vaccines that may be selected. One constraint for NIAID, for example, could be the total funds available to the agency for investment in new vaccines. In this case the ranking process would need to account for the anticipated investment required from NIAID for each candidate vaccine. This might influence the number of accelerated development projects pursued, the particular projects pursued, or both. These are issues best decided by NIAID policymakers; the proposed method merely informs the decision process.

“Affordability” or willingness to pay to achieve benefit can be incorporated into the decision process in one of two ways. First, adjustments can be made to the health benefit values to reflect the effect of various levels of financial resource constraints; this may affect the rankings. This procedure is illustrated in Chapter 9. Second, costs may be considered as equal in importance to benefits.

If decision makers wish to incorporate the costs of vaccine development and use into the ranking process as a decision criterion equally important to the potential health benefit, then rankings can sometimes be developed based on the concept of dominance of one investment over another. If vaccine x is better on one dimension



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