Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Vaccine. 2020 Jun 26;38(31):4792-4800. doi: 10.1016/j.vaccine.2020.01.054. Epub 2020 Apr 3.
Investment in vaccine product development should be guided by up-to-date and transparent global burden of disease estimates, which are also fundamental to policy recommendation and vaccine introduction decisions. For low- and middle-income countries (LMICs), vaccine prioritization is primarily driven by the number of deaths caused by different pathogens. Enteric diseases are known to be a major cause of death in LMICs. The two main modelling groups providing mortality estimates for enteric diseases are the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle and the Maternal Child Epidemiology Estimation (MCEE) group, led by Johns Hopkins Bloomberg School of Public Health. Whilst previous global diarrhoea mortality estimates for under five-year-olds from these two groups were closely aligned, more recent estimates for 2016 have diverged, particularly with respect to numbers of deaths attributable to different enteric pathogens. This has impacted prioritization and investment decisions for vaccines in the development pipeline. The mission of the Product Development for Vaccines Advisory Committee (PDVAC) at the World Health Organisation (WHO) is to accelerate product development of vaccines and technologies that are urgently needed and ensure they are appropriately targeted for use in LMICs. At their 2018 meeting, PDVAC recommended the formation of an independent working group of subject matter experts to explore the reasons for the difference between the IHME and MCEE estimates, and to assess the respective strengths and limitations of the estimation approaches adopted, including a review of the data on which the estimates are based. Here, we report on the proceedings and recommendations from a consultation with the working group of experts, the IHME and MCEE modelling groups, and other key stakeholders. We briefly review the methodological approaches of both groups and provide a series of proposals for investigating the drivers for the differences in enteric disease burden estimates.
投资疫苗产品开发应遵循最新和透明的全球疾病负担估计，这也是政策建议和疫苗引入决策的基础。对于低收入和中等收入国家（LMICs），疫苗的优先排序主要取决于不同病原体导致的死亡人数。肠道疾病已知是 LMICs 的主要死亡原因。为肠道疾病提供死亡率估计的两个主要建模小组是西雅图华盛顿大学健康计量与评估研究所（IHME）和约翰霍普金斯彭博公共卫生学院领导的母婴流行病学估计（MCEE）小组。虽然这两个小组之前对五岁以下儿童的全球腹泻死亡率估计值非常接近，但最近 2016 年的估计值却有所不同，特别是对于不同肠道病原体导致的死亡人数。这影响了发展中疫苗的优先排序和投资决策 Pipeline。世界卫生组织（WHO）疫苗产品开发咨询委员会（PDVAC）的使命是加速急需的疫苗和技术的产品开发，并确保它们在 LMICs 中得到适当的靶向使用。在 2018 年的会议上，PDVAC 建议成立一个独立的专家工作组，探讨 IHME 和 MCEE 估计之间存在差异的原因，并评估所采用的估计方法的各自优缺点，包括对估计所依据的数据进行审查。在这里，我们报告了与专家工作组、IHME 和 MCEE 建模小组以及其他主要利益相关者的磋商的程序和建议。我们简要回顾了这两个小组的方法，并提出了一系列建议，以调查肠道疾病负担估计值差异的驱动因素。
