Table 1.

Priority Activities as Expressed in the Vaccine Development Technology Roadmap for Group A Streptococcus Vaccines

Key Strategic Areas	Proposed Priority Activities
Research	Improve global estimates of disease burden and better characterize the epidemiology of GAS infections
	Further describe the spectrum of natural disease history
	Drive improved understanding of GAS-related secondary immune-mediated diseases
	Define the consequences of GAS-associated antibiotic use, and estimate the impact of vaccine use on antibiotic use and antimicrobial resistance–related morbidity and mortality
Vaccine development	Pursue antigen discovery efforts, increasing the number of pipeline vaccine candidates
	Develop consensus guidance about the appropriate use of safety monitoring tools in candidate vaccine trials
	Characterize immunological surrogates/correlates of protection
	Define appropriate pivotal clinical trial design adapted to near-term and long-term strategic goals
Key capacities	Define appropriate use of available and future animal models for GAS vaccine safety and efficacy evaluation according to their relevance for human responses
	Develop clinically relevant human GAS experimental infection model(s) to support early vaccine proof-of-concept evaluation
	Establish GAS expert research centers in LMICs with Good Clinical Practices trial research capacity and appropriate regulatory and ethical oversight; establish baseline rates of efficacy and safety outcomes
	Access low-cost vaccine manufacturing under current Good Manufacturing Practices for late-stage development and commercial production
	Develop standardized immunoassay platforms that meet quality requirements
Policy, commercialization, and delivery	Establish cost-effectiveness and develop research and implementation financial investment scenario(s) to support appropriate funding and policy decision making at the global and national levels, considering the full scope of costs and benefits
	Ensure availability, affordability, and acceptability of a functional, cost-effective delivery platform for immunization
	Develop effectiveness and safety vigilance platforms for postimplementation surveillance

Abbreviations: GAS, group A Streptococcus; LMICs, low- and middle-income countries.