The successful implementation of mass immunization programs and the subsequent eradication or reduction of smallpox, polio, measles, pertussis, meningococcal meningitis, diphtheria, mumps, rubella, and tetanus are among the most notable public health achievements of the 20th century. Yet, the path to the eradication of diseases by means of vaccination has not always been smooth. Efforts to develop an effective vaccine against tuberculosis (TB) so far have not been completely successful. The BCG vaccine is used in many countries, but not in the United States. The parasites responsible for malaria continue to challenge those working on a vaccine for this deadly disease that kills more than 1 million people worldwide each year and infects more than 300 million children a year.[70] Attempts to develop an HIV vaccine to target the retrovirus that causes this disease as well as a vaccine against malaria have so far ended in failure.

Other challenges remain. Pharmaceutical firms and biotech companies have little incentive to develop vaccines because the revenue potential is low, regulatory barriers are high, and the exposure to litigation is high should it be shown that adverse events are associated with the vaccine. For example, Warner Lambert (now Pfizer) stopped making Fluogen vaccine for influenza in 1998 primarily because of regulatory obstacles and financial loss. Some opine that this led to the flu vaccine shortage in the United States in 2004.[71] Although the number of vaccines administered has risen dramatically in recent decades, this increase probably is due to government mandates rather than economic incentives. Researchers and policy makers are calling for a different approach to motivate vaccine producers, including offering tax credits or guaranteed purchase, as well as other mechanisms to ensure an adequate vaccine supply and a financial return.[72]

Providing vaccines to the world is a necessary public health challenge that cannot be lost. Despite the monumental successes in vaccine development, the burden of infectious disease remains an important global concern. Fragmented delivery systems and difficulties in tracking and verifying immunization coverage, too, need to be addressed. Minimizing the difficulties in producing, distributing, and administering vaccines and ensuring the safety of the vaccine products should be every government’s top priority for disease prevention.

Tremendous success has been achieved in eradicating smallpox, polio, and other childhood diseases, diarrheal disease remains one of the leading causes of death in the 21st century, especially among poor children primarily in the developing world. In the developed world, children with severe viral diarrhea usually can be saved by the timely administration of intravenous fluids. In poor countries, they usually die. The rotavirus shots already are routine for babies in the Untied States and other developed countries. But, for those who are unvaccinated, the disease can and all too often does turn life-threatening and deadly. Seemingly intuitive, managing to vaccinate every child is not easy.

The shots are expensive, the vials must be refrigerated (quite difficult in areas without electricity), and the ability to transport the vaccine to those in greatest need is more often than not challenging. Despite the difficulties, in early 2009, the WHO issued a recommendation that shots against rotavirus be given to every child in the world. Even if only a handful of countries implements a vaccination program, that would be a step forward in addressing a disease that kills 500,000 children a year. It is incumbent on all governments to ensure that the means and the resources be made available to build on the progress already made to eradicate vaccine-preventable diseases and thereby eliminate unnecessary human suffering worldwide.

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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  »

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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;

###

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  »