Coordinating Office for Terrorism Preparedness and Emergency Response, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop K-10, Atlanta, GA 30329-4018, USA.
Vaccine. 2010 Aug 31;28(38):6318-32. doi: 10.1016/j.vaccine.2010.06.095. Epub 2010 Jul 16.
Pediatric vaccine stockpiles have been in place in the U.S. since 1983 to address the potential disruption in supply of routine pediatric vaccines. Increases in the number of vaccines recommended for pediatric and adolescent patients have increased the cost of stocking and maintaining the stockpile. Based on a spreadsheet-based model (VacStockpile) we developed, we estimated potential supply shortages of 14 stockpiled vaccines as of August 1, 2008 and its health and financial impacts under various shortage and stockpile scenarios. To illustrate the implications of policy options, we compared "high" to "low" stockpile scenarios. The high stockpile scenario ensures a 6-month vaccine supply to vaccinate all children according to recommended schedules. The low scenario comprised of 50% of the high scenario or existing stocks, whichever is smaller. For each vaccine, we used a weighted average of five shortage scenarios ranging from 0% to 100%, in 25% increments. Demand for each vaccine was based on current distribution or birth cohort size. The probabilities of shortages were based on number of manufacturers, market stability, history of manufacturing problems, and production complexity. CDC contract prices were used to estimate costs. Expert opinion and literature provided estimates of health impacts due to shortages. Applying the probabilities of shortages to all vaccines in a single year, the "low" scenario could cost $600 million, with 376,000 vaccine-preventable cases occurring and 1774 deaths. The "high" scenario could cost $2 billion, with an additional $1.6 billion initial stocking, and result in 7100 vaccine-preventable cases occurring and 508 deaths. Based on the assumptions in the model, there is the potential for large differences in outcomes between the scenarios although some outcomes could potentially be averted with measures such as catch-up campaigns after shortages. Using the VacStockpile policy makers can readily evaluate the implications of assumptions and decide which set of assumptions they wish to use in planning.
自 1983 年以来，美国一直在储备儿科疫苗，以应对常规儿科疫苗供应中断的潜在情况。推荐给儿科和青少年患者的疫苗数量增加，增加了储备和维持库存的成本。根据我们开发的基于电子表格的模型（VacStockpile），我们估计截至 2008 年 8 月 1 日，14 种储备疫苗可能出现供应短缺，并在各种短缺和库存情况下评估其对健康和财务的影响。为了说明政策选择的影响，我们将“高”和“低”库存方案进行了比较。高库存方案确保有 6 个月的疫苗供应，以按照推荐的时间表为所有儿童接种疫苗。低方案包括高方案的 50%或现有库存，以较小者为准。对于每种疫苗，我们使用了五个短缺方案的加权平均值，范围从 0%到 100%，间隔为 25%。每种疫苗的需求都基于当前的分配或出生队列规模。短缺的概率基于制造商的数量、市场稳定性、生产问题的历史和生产的复杂性。我们使用疾病预防控制中心的合同价格来估计成本。专家意见和文献提供了由于短缺而导致的健康影响的估计。将所有疫苗在一年内的短缺概率应用于模型，“低”方案可能会花费 6 亿美元，发生 376000 例疫苗可预防的病例和 1774 例死亡。“高”方案可能会花费 20 亿美元，需要额外的 16 亿美元初始库存，导致发生 7100 例疫苗可预防的病例和 508 例死亡。根据模型中的假设，尽管采取追赶活动等措施可能会避免某些结果，但在不同方案之间存在潜在的巨大结果差异。政策制定者可以使用 VacStockpile 快速评估假设的影响，并决定他们希望在规划中使用哪一组假设。
