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dc.contributor.authorWilder-Smith, Anneliesen
dc.contributor.authorLongini, I.en
dc.contributor.authorZuber, P. L.en
dc.contributor.authorBärnighausen, T.en
dc.contributor.authorEdmunds, W. J.en
dc.contributor.authorDean, N.en
dc.contributor.authorSpicher, V. Massereyen
dc.contributor.authorBenissa, M. R.en
dc.contributor.authorGessner, B. D.en
dc.identifier.citationWilder-Smith, A., Longini, I., Zuber, P. L., Bärnighausen, T., Edmunds, W. J., Dean, N., et al. (2017). The public health value of vaccines beyond efficacy: methods, measures and outcomes. BMC Medicine, 15(1), 138-.en
dc.description.abstractBackground: Assessments of vaccine efficacy and safety capture only the minimum information needed for regulatory approval, rather than the full public health value of vaccines. Vaccine efficacy provides a measure of proportionate disease reduction, is usually limited to etiologically confirmed disease, and focuses on the direct protection of the vaccinated individual. Herein, we propose a broader scope of methods, measures and outcomes to evaluate the effectiveness and public health impact to be considered for evidence-informed policymaking in both pre- and post-licensure stages. Discussion: Pre-licensure: Regulatory concerns dictate an individually randomised clinical trial. However, some circumstances (such as the West African Ebola epidemic) may require novel designs that could be considered valid for licensure by regulatory agencies. In addition, protocol-defined analytic plans for these studies should include clinical as well as etiologically confirmed endpoints (e.g. all cause hospitalisations, pneumonias, acute gastroenteritis and others as appropriate to the vaccine target), and should include vaccine-preventable disease incidence and ‘number needed to vaccinate’ as outcomes. Post-licensure: There is a central role for phase IV cluster randomised clinical trials that allows for estimation of population-level vaccine impact, including indirect, total and overall effects. Dynamic models should be prioritised over static models as the constant force of infection assumed in static models will usually underestimate the effectiveness and cost-effectiveness of the immunisation programme by underestimating indirect effects. The economic impact of vaccinations should incorporate health and non-health benefits of vaccination in both the vaccinated and unvaccinated populations, thus allowing for estimation of the net social value of vaccination. Conclusions: The full benefits of vaccination reach beyond direct prevention of etiologically confirmed disease and often extend across the life course of a vaccinated person, prevent outcomes in the wider community, stabilise health systems, promote health equity, and benefit local and national economies. The degree to which vaccinations provide broad public health benefits is stronger than for other preventive and curative interventions.en
dc.format.extent9 p.en
dc.relation.ispartofseriesBMC Medicineen
dc.rights© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stateden
dc.subjectVaccine Efficacyen
dc.titleThe public health value of vaccines beyond efficacy: methods, measures and outcomesen
dc.typeJournal Articleen
dc.contributor.schoolLee Kong Chian School of Medicine (LKCMedicine)en
dc.description.versionPublished versionen
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