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IOM committee mulls future direction

Committee on vaccine development issues report, new software to determine what's next


We live in a time of such potential for vaccine development that it's difficult to know where to put resources. However, those decisions could make a huge difference in numbers of lives saved and costs avoided, among other things.

As the Institute of Medicine (IOM) report Ranking Vaccines: A Prioritization Framework—Phase I: Demonstration of Concept and a Software Blueprint shows, most vaccines have been created within living memory, and the last 2 decades have been rich with introductions, from cholera to rotavirus vaccine.

The report also estimates that manufacturers in wealthier countries invest $500 to $900 million over 10 to 15 years to develop 1 new vaccine.

So where should the resources be targeted now? With differences in development costs, for example, should someone tackle a vaccine for immunity for 1 year from influenza or for 5 years from influenza or for a lifetime from tuberculosis?

Should we emphasize benefits for pregnant women, children, or adults? Should the targets be diseases of poverty, emerging infections, or diseases affecting people with chronic conditions?

At the request of the Department of Health and Human Services, IOM has actually created software to help analyze the many factors. The next step will be to get feedback from stakeholders on the model and to test more vaccine candidates with it.

The software, called SMART Vaccines, will use data and other user-supplied entries to compare different potential vaccines according to attributes such as cost effectiveness, numbers of cases and premature deaths prevented, health care costs saved, and work productivity gained.

Among other steps, the user will make crucial decisions on which of 29 attributes to consider and in what order to rank them with a drag-and-drop function.

Users will also be able to change their priorities instantly to see how that changes the scores for the potential vaccines.

Charles Phelps, PhD, University of Rochester professor and a key developer of the model, noted that previous IOM reports on vaccine priorities used single characteristics for ranking their importance. In one case it was health benefit, and in another it was efficiency benefit.

With this model, Phelps said, "We wanted something that would allow people to bring in a wider array of attributes of vaccine programs and we wanted users to be able take their own perspectives in setting out their priorities."

"SMART Vaccines is intended to serve only as a decision-support tool for vaccine prioritization and not to be used as a decision maker," stressed the report.

A manufacturer, a wealthy country, a developing country, and an organization such as the Pan American Health Organization may all use the tool to come up with different priorities, the report indicated.

Because the IOM Committee on Identifying and Prioritizing New Preventive Vaccines for Development wanted the model to be as transparent as possible so that people can understand what is happening, Phelps said the hope is that the software will lead stakeholders to fruitful conversations about where their differences lie and also create interest in gathering more data where it is needed.

The SMART Vaccines Beta, on which the current IOM report is based, is not available for public use, but SMART Vaccines 1.0 will be released to the public sometime next year after completion of phase 2 of the work, when it will be fully operational.

The committee is beginning phase 2 now and plans a workshop to gather public feedback in September.

The report, along with software screen shots and a Webinar, is available free at http://www.iom.edu/reports/2012/ranking-vaccines-a-prioritization-framework-phase-I.aspx.

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