Private and public sector investment in research and development pertaining to new vaccines and improved use of existing vaccines is considerable. Most research and development is focusing on vaccines likely to have the greatest effect in the developed world and the best financial return; however, by means of public-private partnerships for product development, foundations have stepped in to support vaccine research and development for diseases for which the greatest burden occurs in developing countries.
New vaccines are being developed that could be incorporated into EPI schedules, including vaccines that protect against rotavirus, S. pneumoniae, malaria, cervical cancer associated with human papilloma virus, HIV/AIDS, and dengue. New and improved vaccines are also being developed to protect against meningococcal infections in infancy and Japanese encephalitis (NIH 2000). WHO recently created the Initiative for Vaccine Research Department to facilitate global coordination of research and development efforts for these and other vaccines.
In compiling data for this chapter, we noted a number of key gaps in knowledge that could usefully drive a research agenda and contribute to more evidence-based policy making in the future (Fox-Rushby and others 2004). First, little is currently known about how and why delivery costs change with increasing numbers of vaccinations and at higher coverage rates and whether economies of scale can be achieved. Little is known about the relative cost-effectiveness of different strategies to increase coverage given different baseline coverage rates. This issue relates to other questions of the optimal timing for introducing new vaccines and of how decisions should vary given different epidemiological and economic settings. Future research should therefore consider the extent to which cost-effectiveness analyses need to be repeated for every country or context or whether (and how) estimating and validating relationships across countries and accounting for uncertainty in estimates of costs and effects are possible.
Second, more attention needs to be given to measuring effect. For example, even though the coverage of single antigens required to reach particular levels of FICs should be accounted for, economic evaluations need to move beyond such indicators of output to measuring effect on the quantity and quality of life. In evaluating different schedules, methodological research needs to focus on how to incorporate the combined effects of multiple vaccinations in this respect. Remarkably few studies have considered the effect on nonhealth benefits, such as economic growth and welfare. The larger the package of vaccinations considered, the more important this question becomes.