A public health team must choose between distributing an attenuated vaccine that requires a reliable cold chain and an inactivated vaccine that is heat-stable. Which trade-off analysis is correct for a low-resource setting with many remote clinics?

• A. Selecting the inactivated vaccine will always provide lifelong immunity even in remote settings and therefore is universally preferable regardless of booster need or host immune status.
• B. Selecting the attenuated vaccine is preferable because it never requires refrigeration, never risks reversion to virulence, and always induces stronger antibody responses than any inactivated formulation in all populations.
• C. Choosing the attenuated vaccine eliminates the need for boosters and adjuvants, is always safer for pregnant women due to lack of reversion risk, and eliminates cold-chain concerns because live vaccines are inherently heat-stable.
• D. Choosing the inactivated heat-stable vaccine reduces logistical costs and cold-chain failures and is safer for immunocompromised or pregnant patients, but it may require more doses and boosters and might elicit weaker cell-mediated immunity than the attenuated option.

Answer: (D)