The marketing of Gardasil and similar prototypes in the pipeline illustrates that pharmaceutical companies and biotech companies are engaged in vaccine research.

With the advancement of molecular biology and genetics, vaccine development continues to grow at an exciting rate. New and improved subunit vaccines that promise to offer increased safety and high efficacy are being studied. Additionally, novel strategies for vaccine delivery, especially the elimination of needles, as well as the combination of multiple vaccine components to different pathogens into a single vaccine delivery (of note, the MMR and the DPT vaccines) hold great promise. Yet, resistance to immunization among some groups of individuals persists. Indeed, vaccine development has had its share of political drama and controversy over time.

The American antivaccination movement, for example, focused on the concept of “inalienable rights,” and its proponents argued that vaccination opposed the laws of nature and religious laws. Aggressive campaigns to repeal vaccination requirements were held in numerous states. Some antivaccination activists went so far as to argue that smallpox was not contagious, and a few tried to prove this by intentionally exposing themselves to the disease, usually with disastrous results. Taking a lead role in the antivaccination movement were the patent medicine manufacturers, who feared (probably correctly) that vaccination laws would ruin their business.

Whenever a new vaccine was introduced, including diphtheria and typhoid fever in the 1920s, polio in the 1950s, and measles, rubella, pertussis, hepatitis, and most recently HPV in the later part of the 20th century, groups opposed to vaccination would appear on the scene.

Vaccination and school policy
The public health initiative to create school laws requiring vaccination began in the 1960s and I970s, after the polio epidemic of the 1950s. By 1963, 20 states required immunization as a requirement for school entrance, and this number grew to 29 by I970.[8] Many of these laws were created and enforced to protect against measles, in particular. Data showed that states with school immunization laws had 40 to 51 percent lower rates of measles than states without such laws.[51] These findings were compelling and provided the impetus for the remaining states to enact and enforce school immunization laws. As these laws are state based, variations exist in requirements and enforcement.

By 2006, all states allowed medical exemptions, 48 had a provision for religious exemptions, and 19 permitted “personal belief” exemptions.[52] “Personal belief” exemptions refer to religious, philosophical, and any other undetermined exemptions that are not medical. Interestingly, a study looking into the effect of such exemptions on disease outbreaks found that states with personal belief exemptions” had a 27 percent higher rate of new pertussis cases than states without such an exemption.[53] Moreover, enforcement of school vaccination laws varied significantly at the local school level. Schools with simplified or inexplicit exemption claim procedures, as well as schools allowing philosophical exemptions, had increased exemption rates and higher risk of disease outbreaks.

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Tony Rosen, MPH, MD
Tony Rosen, Division of Geriatric Medicine and Gerontology, Weill Cornell Medical College, Cornell University, New York, New York;

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REFERENCES

1. Barquest N, Domingo P. Smallpox: the triumph over the most terrible of the ministers of death. Ann Internal Med. 1997;127:627.
2. US Centers for Disease Control and Prevention. Ten great public health achievements in the twentieth century, 1900-1999.
3.   Parker AA. Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States. New Engl J Med. 2006;355:1184.
4. Okonek BAM, Peters PM. Vaccines: how and why
5. Baxby D. Vaccination: Jenner’s Legacy. Berkeley, UK: Jenner Educational Trust; 1994. 6. Parish HJ. A History of Immunization. Edinburgh, UK: Livingstone; 1965.
6. Gross CP, Sepkowitz K. The myth of the medical breakthrough: smallpox, vaccination, and Jenner reconsidered. Int J Infect Dis. 1998;3:54-60.
7. Salmon DA,  et al.  Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future. Lancet. 2006;367(9508):436-442.

Full References  »