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Many people see an effective preventive AIDS vaccine as the best solution to the HIV/AIDS pandemic. Ten years ago many scientists had hoped that a vaccine would be available by now. Most scientists are still optimistic that vaccines will be developed and many candidates are being tested. Strategies to implement HIV/AIDS vaccination need to be developed to be ready when vaccines do become available. The nature of those programs will depend on the characteristics of each vaccine. How much does it cost? How effective is it? How long does protection last? The answers to these and other questions will help determine issues such as: What will be the impact of the vaccine on the epidemic? Who should be vaccinated? Will an AIDS vaccine be more cost-effective than other prevention measures? Will other measures still be necessary? What will happen to the epidemic if vaccination leads to riskier behavior? How much funding will be needed? Stover, Garnett, Seitz, and Forsythe use two computer simulation models to investigate the effects of various vaccine characteristics and implementation strategies on the impact and cost-effectiveness of vaccines in different contexts. A simulation model is applied to data from rural Zimbabwe and the iwgAIDS model is applied to Kampala (Uganda) and Thailand. The models are used to investigate the effects of efficacy, duration, cost, and type of protection on impact and cost-effectiveness. The models also show the merits of targeting public subsidies to various population groups: all adults, teenagers, high-risk groups, and women of reproductive age. The impact of vaccines on the epidemic is compared with the impact of other prevention interventions such as condom use and behavior change. Finally, the models are used to explore the extent with which behavioral reversals may erode the positive benefits of the vaccine. A highly effective, long-lasting, inexpensive vaccine would be ideal and could make a major contribution in controlling the HIV/AIDS pandemic. But vaccines that do not attain this ideal can still be useful. A vaccine with 50 percent efficacy and 10 years duration supplied to 65 percent of all adults could reduce HIV incidence by 25 to 60 percent, depending on the context and stage of the epidemic. Better efficacy and longer duration would provide even more impact. Programs focused on teenagers or high-risk populations have less overall impact but would provide significant benefits at much less cost than those reaching all adults. Behavioral reversals could erode much of the benefits of vaccination programs so it will be important to combine vaccination with continued messages about the importance of safe behaviors. The cost of the vaccines is not known at this time. At a cost of USD 10 or USD 20 per person vaccinated, the cost per infection averted would be as low or lower than other prevention interventions. Higher costs for the vaccines and the need for many booster shots could reduce the cost-effectiveness significantly. This paper-a product of Public Services, Development Research Group-is part of a joint research project with the European Commission on "The Economics of AIDS Vaccines in Developing Countries." The authors may be contacted at j.stover@tfgi.com, g.garnett@ic.ac.uk, s-seitz@uiuc.edu, or s.forsythe@tfgi.com.

AIDS HIV --- Aids Vaccine --- Aids Vaccines --- All --- Clinical Trials --- Disease Control and Prevention --- Effects --- Epidemic --- Epidemics --- Health, Nutrition and Population --- HIV --- HIV/Aids --- Infection --- Infections --- Population Policies --- Public Health --- Safe Sex --- Sexually Transmitted Disease --- STD --- Treatment --- Vaccination Campaigns --- Vaccination Programs --- Vaccine --- Vaccines

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Economic policy and planning (general) --- Infectious diseases. Communicable diseases --- Uganda --- AIDS (Disease) --- Socioeconomic Factors --- Sociology --- Slow Virus Diseases --- HIV Infections --- Social Sciences --- Immunologic Deficiency Syndromes --- Virus Diseases --- Lentivirus Infections --- Sexually Transmitted Diseases, Viral --- Population Characteristics --- Retroviridae Infections --- Immune System Diseases --- Health Care --- Anthropology, Education, Sociology and Social Phenomena --- Diseases --- Sexually Transmitted Diseases --- RNA Virus Infections --- Acquired Immunodeficiency Syndrome --- Social Conditions --- Public Health --- Health & Biological Sciences --- Communicable Diseases --- Living Conditions --- Condition, Living --- Condition, Social --- Conditions, Living --- Conditions, Social --- Living Condition --- Social Condition --- Acquired Immune Deficiency Syndrome --- Acquired Immuno-Deficiency Syndrome --- AIDS --- Immunodeficiency Syndrome, Acquired --- Immunologic Deficiency Syndrome, Acquired --- Acquired Immuno Deficiency Syndrome --- Acquired Immuno-Deficiency Syndromes --- Acquired Immunodeficiency Syndromes --- Immuno-Deficiency Syndrome, Acquired --- Immuno-Deficiency Syndromes, Acquired --- Immunodeficiency Syndromes, Acquired --- Syndrome, Acquired Immuno-Deficiency --- Syndrome, Acquired Immunodeficiency --- Syndromes, Acquired Immuno-Deficiency --- Syndromes, Acquired Immunodeficiency --- CD4-Positive T-Lymphocytes --- HIV-1 --- AIDS Arteritis, Central Nervous System --- Infections, RNA Virus --- Infection, RNA Virus --- RNA Virus Infection --- Virus Infection, RNA --- Virus Infections, RNA --- STDs --- STIs --- Sexually Transmitted Infections --- Venereal Diseases --- Disease, Sexually Transmitted --- Disease, Venereal --- Diseases, Sexually Transmitted --- Diseases, Venereal --- Infection, Sexually Transmitted --- Infections, Sexually Transmitted --- STI --- Sexually Transmitted Disease --- Sexually Transmitted Infection --- Transmitted Infection, Sexually --- Transmitted Infections, Sexually --- Venereal Disease --- Venereology --- Reproductive Tract Infections --- Population Heterogeneity --- Population Statistics --- Characteristic, Population --- Characteristics, Population --- Heterogeneity, Population --- Population Characteristic --- Statistics, Population --- Sexually Transmitted Disease, Viral --- Viral Sexually Transmitted Disease --- Viral Sexually Transmitted Diseases --- Viral Venereal Diseases --- Venereal Diseases, Viral --- Disease, Viral Venereal --- Diseases, Viral Venereal --- Venereal Disease, Viral --- Viral Venereal Disease --- Infections, Lentivirus --- Infection, Lentivirus --- Lentivirus Infection --- Community-Based Distribution --- Contraceptive Distribution --- Delivery of Healthcare --- Dental Care Delivery --- Distribution, Non-Clinical --- Distribution, Nonclinical --- Distributional Activities --- Healthcare --- Healthcare Delivery --- Healthcare Systems --- Non-Clinical Distribution --- Nonclinical Distribution --- Delivery of Dental Care --- Health Care Delivery --- Health Care Systems --- Activities, Distributional --- Activity, Distributional --- Care, Health --- Community Based Distribution --- Community-Based Distributions --- Contraceptive Distributions --- Deliveries, Healthcare --- Delivery, Dental Care --- Delivery, Health Care --- Delivery, Healthcare --- Distribution, Community-Based --- Distribution, Contraceptive --- Distribution, Non Clinical --- Distributional Activity --- Distributions, Community-Based --- Distributions, Contraceptive --- Distributions, Non-Clinical --- Distributions, Nonclinical --- Health Care System --- Healthcare Deliveries --- Healthcare System --- Non Clinical Distribution --- Non-Clinical Distributions --- Nonclinical Distributions --- System, Health Care --- System, Healthcare --- Systems, Health Care --- Systems, Healthcare --- Diseases of Immune System --- Immune Diseases --- Immunological Diseases --- Immune Disorders --- Immune System Disorders --- Immunologic Diseases --- Disease, Immune --- Disease, Immune System --- Disease, Immunologic --- Disease, Immunological --- Disorder, Immune System --- Immune Disease --- Immune Disorder --- Immune System Disease --- Immune System Disorder --- Immunologic Disease --- Immunological Disease --- Infections, Retroviridae --- Infections, Retrovirus --- XMRV Infection --- Xenotropic MuLV-related Virus Infection --- Xenotropic Murine Leukemia Virus-related Virus Infection --- Retrovirus Infections --- Infection, Retroviridae --- Infection, Retrovirus --- Infection, XMRV --- Infections, XMRV --- Retroviridae Infection --- Retrovirus Infection --- XMRV Infections --- Xenotropic MuLV related Virus Infection --- Xenotropic Murine Leukemia Virus related Virus Infection --- Viral Diseases --- Viral Infections --- Virus Infections --- Disease, Viral --- Disease, Virus --- Diseases, Viral --- Diseases, Virus --- Infection, Viral --- Infection, Virus --- Infections, Viral --- Infections, Virus --- Viral Disease --- Viral Infection --- Virus Disease --- Virus Infection --- Science, Social --- Sciences, Social --- Social Science --- HIV Coinfection --- HTLV-III Infections --- HTLV-III-LAV Infections --- T-Lymphotropic Virus Type III Infections, Human --- Coinfection, HIV --- Coinfections, HIV --- HIV Coinfections --- HIV Infection --- HTLV III Infections --- HTLV III LAV Infections --- HTLV-III Infection --- HTLV-III-LAV Infection --- Infection, HIV --- Infection, HTLV-III --- Infection, HTLV-III-LAV --- Infections, HIV --- Infections, HTLV-III --- Infections, HTLV-III-LAV --- T Lymphotropic Virus Type III Infections, Human --- Disease, Slow Virus --- Diseases, Slow Virus --- Slow Virus Disease --- Virus Disease, Slow --- Virus Diseases, Slow --- General Social Development and Population --- Factors, Socioeconomic --- High-Income Population --- Land Tenure --- Standard of Living --- Economic and Social Factors --- Social Inequalities --- Social Inequality --- Social and Economic Factors --- Socioeconomic Characteristics --- Characteristic, Socioeconomic --- Factor, Socioeconomic --- High Income Population --- High-Income Populations --- Inequality, Social --- Living Standard --- Living Standards --- Population, High-Income --- Socioeconomic Characteristic --- Socioeconomic Factor --- Tenure, Land --- Economics --- Deficiency Syndrome, Immunologic --- Deficiency Syndromes, Antibody --- Deficiency Syndromes, Immunologic --- Immunologic Deficiency Syndrome --- Immunological Deficiency Syndromes --- Antibody Deficiency Syndrome --- Antibody Deficiency Syndromes --- Deficiency Syndrome, Antibody --- Deficiency Syndrome, Immunological --- Deficiency Syndromes, Immunological --- Immunological Deficiency Syndrome --- Syndrome, Antibody Deficiency --- Syndrome, Immunologic Deficiency --- Syndrome, Immunological Deficiency --- Syndromes, Antibody Deficiency --- Syndromes, Immunologic Deficiency --- Syndromes, Immunological Deficiency --- Antibodies --- Acquired immune deficiency syndrome --- Acquired immunodeficiency syndrome --- Acquired immunological deficiency syndrome --- HIV infections --- Immunological deficiency syndromes --- Virus-induced immunosuppression --- Economic aspects --- Social aspects --- deficiency