The future of vaccines, immunisation concepts and practice

Vaccines have prevented more deaths, disability and suffering than any othe r medical discovery or intervention. Recent breakthroughs in immunology and genomics offer the prospect of the development of many new prophylactic an d therapeutic vaccines not only against infectious diseases but also for us e in conditions such as allergy, autoimmunity and carcinogenesis where malf unction of the immune system undoubtedly plays a role. These hopeful perspe ctives are however dimmed by several counterproductive societal trends that include the spreading-although unjustified-belief that vaccines are not sa fe and may even be unnecessary, escalating costs of vaccine research, devel opment, production and control that are exacerbated by political pressure o n selling prices and expensive lawsuits by 'victims' of vaccination who cla im excessive compensation. Negative media coverage of vaccine issues is adv ersely affecting acceptance of vaccination. In spite of these negative tren ds. vaccines should have a bright future, because it is increasingly being realised that prevention is not only better than cure but it is often also more cost-effective. A better understanding of the dynamics of microbial tr ansmission in populations is leading to more rational immunisation practice s on a global scale that could lead to eradication of several pathogens. At tention is being given to making vaccines more user-friendly through the de velopment of combined vaccines and the introduction of less invasive inocul ation techniques. (C) 2001 Elsevier Science Ltd. All rights reserved.