SMART Vaccines: A Decision-Support Tool for Prioritizing New Vaccines

Ranking Vaccines cover

Guruprasad Madhavan and Kinpritma Sangha.

Context: In 2010, the National Vaccine Program Office of the Department of Health and Human Services released the National Vaccine Plan whose first goal is to "develop new and improved vaccines," and the first implementation priority is "to develop a catalogue of priority vaccine targets of domestic and global health importance." As part of their strategic plan, NVPO commissioned the Institute of Medicine in 2010 to conduct a study that would provide a framework for prioritizing new preventive vaccines of domestic and global importance. The IOM study is proceeding in two phases. The phase I report was released in May 2012. It provided the conceptual underpinning and blueprint of Strategic Multi-Attribute Ranking Tool for Vaccines or SMART Vaccines—a software tool that is under development in the committee's ongoing phase II work.

Earlier Reports: Two previous IOM studies on vaccine prioritization provided ranked lists of different vaccines. The two-volume IOM study New Vaccine Development, released in 1985 (diseases in the U.S.) and 1986 (diseases in the developing countries), prioritized vaccines based on infant mortality equivalents. The 2000 report Vaccines for the 21st Century focused entirely on the U.S. population and, unlike the 1985-1986 report, used an efficiency measure for ranking vaccines: incremental cost per incremental quality-adjusted life year saved ($/QALY), a measure derived from a classic welfare economics model.

Software Features and Potential Users: SMART Vaccines significantly expands the single criterion framework of the earlier IOM prioritization efforts to include a broad range of criteria that influence decision making in vaccine development. Users are offered a choice of up to 29 attributes drawn from broad categories including health burden considerations, economic considerations, demographic considerations, public concerns, scientific and business considerations, programmatic considerations, and policy considerations. SMART Vaccines integrates computed attributes with qualitative attributes entered by the user to provide a value score that compares one vaccine opportunity against one or more other candidates.

SMART Vaccines does not "make decisions." It is intended to be used as a decision-support tool and only that. SMART Vaccines is expected to be used for facilitating discussions about attributes and values among diverse users, helping them to converge upon mutually beneficial priorities and collaborations. Potential users of and audiences for this model include decision makers from the institutions funding and pursuing basic research, vaccine manufacturers, and philanthropic organizations with interests in improving global health; ministers of health, commerce, and finance and other high-level government officials at the country, state, and regional levels; international health agencies; and nongovernmental alliances of interested parties.

Ongoing Work and Challenges: As part of phase II work, the IOM is enhancing SMART Vaccines Beta, testing its use with three additional vaccine candidates of domestic and global importance, and further improving the user interface as part of the development of SMART Vaccines 1.0. SMART Vaccines requires substantial data inputs from users. In some cases, depending on the vaccine and population for which the model is employed, the data required to drive the model may be sparse or unavailable. The usefulness of SMART Vaccines will rely upon concerted data collection and future software enhancements.

Feedback and Reference: Please send us your feedback and comments to For screenshots and public meeting videos, please visit the project webpage at The PDF of the phase I report Ranking Vaccines: A Prioritization Framework can be downloaded from, the National Academies Press website. The phase II report is expected to be released in the last week of September 2013.

Guruprasad Madhavan is a senior program officer and study director, and Kinpritma Sangha is a research associate and data manager for the SMART Vaccines project at the Institute of Medicine of the National Academy of Sciences in Washington, DC. Large portions of the text presented in this brief have been excerpted from the phase I report and edited for brevity.

We are happy to have the chance to welcome Guruprasad Madhavan at the World Vaccine Congress & Expo in April. He will be part of the opening keynote plenary session on the 16th April. For more info click here.

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