Strategic priority setting for vaccines policy and global health education

Abstract

Abstract Background Priority setting for new and existing vaccines is a complex but important task. Health outcomes or cost-effectiveness are not the only criteria for priority ranking of vaccine candidates. Real life prioritisation and development of new vaccines invariably involves balancing many programmatic features, including dosage requirements and cost (and their consequences on coverage and efficacy), developmental risk, interface with existing programmes (for example, vaccination schedules and capabilities), focus on special populations, and even the strengthening of homeland security or public health aid. We aimed to develop a software tool to assist in the process of ranking candidate vaccines. Methods SMART Vaccines (Strategic Multi-Attribute Ranking Tool for Vaccines) combines population-specific data about demographics, health burdens, costs of disease treatment, and design attributes of potential new vaccines to support a multi-attribute utility model. The software offers 28 total attributes (plus up to seven user-defined attributes) from which users can select and weight a subset (maximum of 10) to create SMART Scores to rank candidate vaccines. Sensitivity-analysis tools built into SMART Vaccines allow users to specify the most desirable target product profiles for a single disease, or the ranking of candidate vaccines across different diseases. The programme also allows users to add attributes to the model, and to specify the weights given to the seleted set of attributes used in evaluation of vaccine candidates. Findings Preliminary testing with a range of public health organisations and vaccine developers has demonstrated that the concept underlying SMART Vaccines can be expanded for comparisons between public health interventions (treatment versus prevention of disease options), and even to quite different uses such as vaccines for animal health. Interpretation Early uses of SMART Vaccines have demonstrated that the multi-criteria approach not only enhances transparency in public health decision making, but also allows incorporation of many influential factors that remain hidden or unrecognized in more traditional cost-effectiveness analysis. Furthermore, use of SMART Vaccines facilitates decision convergence when stakeholder interests have conflicting priorities. To bolster the further development of SMART Vaccines, we envision a user community with research universities, especially those with strengths in global public health, to act as the software host. Funding US Department of Health and Human Services, National Vaccine Program Office and Fogarty International Center, National Institutes of Health.