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Trust and Confidence in Vaccines: Tales of Three Vaccines, Lessons for Others

Public trust in vaccines and immunization programs is a dynamic and changing phenomenon. Seeming success in an immunization program can be disrupted by a confidence crisis more quickly than it can be rebuilt. Constant care and vigilance are needed to detect and address waning trust and confidence before they become a crisis. Fixing a crisis once does not mean that another one may not erupt—sometimes driven…

Vaccine Acceptance: Barriers, Perceived Risks, Benefits, and Irrational Beliefs

1 Introduction Vaccination is recognized as one of the greatest public health achievements of the last century, likely saving more lives in the last 50 years than any other health intervention. For continued success, however, high population vaccination coverage rates need to be attained and sustained. Immunization not only protects the individual, but also, in many instances, provides community protection against vaccine-preventable diseases through herd immunity. Sadly,…

Transitioning Immunization Into the Health Care System: Strengthening Routine Immunization in India

1 Introduction India has the largest birth cohort in the world (27 million children) but lags other countries of similar gross national income per capita on immunization coverage ( Exhibit 25.1 ). A third of the world’s roughly 27 million unimmunized children live in India. The proportion of children under 2 years of age who are fully immunized has increased by 1% a year and is estimated…

Introduction of Vaccines Into National Programs

1 Introduction The decision for a national government to adopt a population-based health intervention such as vaccines is a complex process involving political, economic, operational/logistics, and governance issues. There are as many variations of decisions as there are the number of countries and vaccines. Three important issues predominate: the financing and costs of the vaccine intervention, existing infrastructures on which to add a vaccine component, and…

Economic Considerations for the Development of Global Vaccines: a Perspective From the Vaccine Industry

In May 2012, the World Health Assembly approved the Global Vaccine Action Plan (GVAP) to achieve the Decade of Vaccines vision by delivering universal access to immunization. One of the ambitious goals set by the GVAP was to unleash vaccines’ future potential with the aim of developing and launching two new major vaccines by the end of this decade. In its assessment report from 2014, the…

Ethical Considerations in Vaccine Trials in Resource-Limited Settings

1 Introduction This chapter focuses on ethical concerns early in the life cycle of vaccines, namely trials designed to test safety, immunogenicity, and efficacy of vaccines in human participants. Vaccine trials involve many ethical complexities that stem from several features. These include that vaccine trials are frequently international projects involving organizations in high-income countries collaborating with those in low-resource settings; such trials are often implemented in…

Influenza Vaccines and Vaccination Strategies

1 Introduction Influenza is a communicable acute respiratory disease and one of the major infectious disease threats to the human population. Influenza virus affects individuals of all ages, causes repeated infections throughout life, and is responsible for annual worldwide epidemics of varying severity, commonly referred to as “seasonal influenza.” Influenza also causes periodic pandemics that are characterized by a novel virus strain to which the majority…

AIDS Vaccines

1 Introduction In 1984, coincident with the identification of HIV as the cause of AIDS, the US Secretary of Health and Human Services made an announcement indicating that a vaccine should be expected within the next few years. As we enter into the fourth decade of the AIDS epidemic, this has still not come to fruition. Global research efforts have revealed unprecedented obstacles to making a…

Major Global Vaccine Challenges: Recent Progress in Malaria Vaccine Development

1 Introduction Malaria is a major cause of human suffering caused by Plasmodia parasites, transmitted to humans via the bite of anopheline mosquitoes. While five Plasmodia species can infect humans, Plasmodium falciparum and Plasmodium vivax constitute major public health problems. Access to long-lasting insecticide-impregnated bednets, indoor residual insecticide spraying, use of appropriate diagnostic tools and efficacious artemisinin-derivative based combined therapies led to an estimated 50% reduction…

Tuberculosis Vaccines

1 Introduction Tuberculosis (TB) usually manifests as a lung disease. Diagnosis is often delayed because of the chronic nature of the disease, while 6 months of treatment is required for a cure. Many diagnostic and antimicrobial tools that are currently used for intervention represent relatively dated technologies. The causative pathogen, Mycobacterium tuberculosis (Mtb), has been remarkably successful in causing and sustaining a global pandemic. One third of…

Vaccines Against Parasites

Infectious diseases caused by parasites are major causes of morbidity and mortality in the poorest countries of Asia, Africa, and Latin America. Among the most prevalent infectious diseases commonly referred to as “neglected,” 11 are caused by helminthic and protozoan parasites, which along with malaria affect more than 1 billion people and cause more than 1 million deaths annually. Unfortunately, there is as yet no safe,…

New Approaches for Needed Vaccines: Bacteria

1 Background Bacteria are still one of the most common causes of infection, associated with a range of different diseases in humans and important veterinary animals. The emergence of antibiotic resistant microbes (ARM) means that the threat bacteria pose to human health is unlikely to diminish in the near future. Thus, the design of new or improved bacterial vaccines remains high on the global health agenda,…

Antiviral Vaccines: Challenges and Advances

1 Introduction Vaccination is the most effective means of preventing and controlling viral infections. The eradication of smallpox and the significant progress made toward polio eradication are clear examples of the great impact of antiviral vaccines. However, viral infections remain a major public health threat and a significant cause of death. Most of the antiviral vaccines introduced over the past century were empirically developed. Poliomyelitis, measles,…

Rotavirus Vaccines

Rotavirus is the leading cause of severe childhood gastroenteritis worldwide, accounting for about one-third of diarrhea episodes requiring hospitalization. Although rotavirus is equally prevalent worldwide, the vast majority of rotavirus deaths occur in developing countries, because of suboptimal access to health care. Orally administered live attenuated vaccines have been developed to provide protection against rotavirus. Two licensed rotavirus vaccines have been available since 2006 and have…

Human Papillomavirus Vaccines

1 Introduction Human papillomaviruses (HPVs) are a large group of viruses that infect both cutaneous and mucosal squamous epithelia and have an exclusively intraepithelial infectious cycle. More than 170 HPVs have been isolated from clinical biopsies; they are classified by DNA sequence and numbered in the sequence in which they were isolated for example, HPV 1, HPV 2 etc. About 30–40 HPV types regularly or sporadically…

Pneumococcus, Pneumococcal Disease, and Prevention

1 Introduction First isolated in 1880 by Pasteur in the saliva of a patient with rabies, Streptococcus pneumoniae (also known as the pneumococcus) has been branded as the “captain of the men of death” by William Osler, for the nefarious role this organism plays in causing the demise of so many people particularly among the elderly. While certainly evocative, this description does not fully capture the…

New Challenges for Pertussis Vaccines

1 Historical perspective The effort to control pertussis through vaccination has been ongoing for more than 100 years, since the first description of the causative bacterium, Bordetella pertussis . The whole-cell pertussis vaccine, produced by heat killing and chemical detoxification came into use in the 1930s and became a routinely used vaccination in the 1940s. With its widespread use, reported cases of pertussis declined dramatically to…

Maternal Immunization: Protecting Vulnerable Populations

1 Introduction Immunization of pregnant women to protect both the mother and infant from infection is a unique strategy to prevent disease in high risk, vulnerable populations. This approach, utilized for decades to prevent puerperal and neonatal tetanus, is increasingly considered as an immunization strategy worldwide. Morbidity and mortality due to infections during pregnancy and the first few months of life contribute substantially to overall mortality…

Vaccination and Autoimmune Diseases

1 Introduction At a time when vaccines save annually millions of child’s lives, it is paradoxical that in many industrialized countries more public attention is given to the possible risks of adverse effects of vaccination than to its beneficial effects. This attitude often leads to reducing vaccination coverage in some countries or particular communities and may result in disease outbreaks. Autoimmune diseases, that is, diseases caused…

How Vaccine Safety is Monitored

1 Introduction Safety expectations for vaccines are high because they are administered to healthy and sometimes vulnerable populations such as pregnant women, infants, and the elderly. Also, vaccines are endorsed or required by most governments, further raising safety expectations. Although no biologic or medical intervention is perfectly safe, vaccines are generally very safe and the risks of side effects are almost always greatly outweighed by the…