A multi-attribute approach for setting pediatric vaccine stockpile levels

Routine immunization is the most effective public health strategy to prevent the occurrence and spread of infectious diseases. An important factor impacting such effectiveness is the availability of a stable vaccine supply. Vaccine supply interruptions are likely and can prevent children from receiving a full course of vaccinations and hence, increase the risk of disease outbreaks. In the United States, public health officials have established the Pediatric Vaccine Stockpile Program (PVSP) as the best strategy to mitigate the impact of vaccine supply interruptions. The PVSP aims to maintain a six-month national supply of routinely administered pediatric vaccines. When deciding how many vaccine doses to order for the next fiscal year, public health decisionmakers must not only minimize the impact of potential vaccine shortages, but also, maintain or increase vaccine coverage rates while minimizing costs. This paper uses the relative importance of each pediatric vaccine to define a multiattribute utility function that models the conflicting interests of PVSP public health decision-makers when ordering vaccines for the next fiscal year. The aim of the resulting framework is to assist decision-makers in managing the PVSP. As an illustration, this paper explores the implications of optimizing a proposed expected utility function under budget constraints for hypothetical (albeit likely) vaccine supply scenarios, and the potential behavior of public health decision-makers.