Vaccine preventable disease incidence as a complement to vaccine efficacy for setting vaccine policy

Bradford D. Gessner, Daniel R. Feikin

Research output: Contribution to journalReview articlepeer-review

24 Scopus citations


Traditionally, vaccines have been evaluated in clinical trials that establish vaccine efficacy (VE) against etiology-confirmed disease outcomes, a measure important for licensure. Yet, VE does not reflect a vaccine's public health impact because it does not account for relative disease incidence. An additional measure that more directly establishes a vaccine's public health value is the vaccine preventable disease incidence (VPDI), which is the incidence of disease preventable by vaccine in a given context. We describe how VE and VPDI can vary, sometimes in inverse directions, across disease outcomes and vaccinated populations. We provide examples of how VPDI can be used to reveal the relative public health impact of vaccines in developing countries, which can be masked by focus on VE alone. We recommend that VPDI be incorporated along with VE into the analytic plans of vaccine trials, as well as decisions by funders, ministries of health, and regulatory authorities.

Original languageEnglish (US)
Pages (from-to)3133-3138
Number of pages6
Issue number26
StatePublished - May 30 2014
Externally publishedYes


  • Cholera
  • Epidemiology
  • Haemophilus influenzae type b
  • Hib
  • Immunization
  • Malaria
  • Pneumococcus
  • RTS,S
  • Rotavirus
  • Streptococcus pneumoniae
  • Vaccine
  • Vaccine effectiveness
  • Vaccine efficacy

ASJC Scopus subject areas

  • Molecular Medicine
  • General Immunology and Microbiology
  • General Veterinary
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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