Design and Analysis of Pediatric Vaccine Formularies: Theory and Practice

摘要

Vaccination against infectious disease is hailed as one of the greatest public health achievements. However, the United States Recommended Childhood Immunization Schedule is becoming increasingly complex, often requiring numerous separate injections in a single pediatric visit. To address the issue of vaccine delivery complexity, vaccine manufacturers have developed combination vaccines that immunize against several diseases in a single injection. These combination vaccines are creating challenges such as how these vaccines should be administered to ensure that immunity is safely achieved. Furthermore, these vaccines are also creating a combinatorial explosion of alternatives and choices for public health policy-makers and administrators, pediatricians, and parents/guardians. This dissertation applies operations research methodologies to designing pediatric vaccine formularies that capture this combinatorial explosion of alternatives and choices and ensure that immunity is safely achieved. In particular, the dissertation presents three fundamental problems for designing pediatric vaccine formularies. The first problem models a general childhood immunization schedule to design a vaccine formulary that minimizes the cost of fully immunizing a child. The second problem models a general childhood immunization schedule to design a vaccine formulary that safely immunizes a child against several infectious diseases by restricting or limiting extraimmunization (i.e., extra doses of vaccine). These problems are vitally important since the cost of vaccinating a child contributes to the underimmunization of children, and extraimmunization poses biological risks, amplifies philosophical concerns with vaccination, and creates an unnecessary economic burden on society.