The New England Journal of Medicine February 4, 2021 pp393-396 |Perspective|A Half-Century of Progress in Health: The National Academy of Medicine at 50| “Vaccine Innovations-Past and Future” by Julie L. Gerberding, M.D., M.P.H., and Barton F. Haynes, M.D.
We will need vaccines as part of medical strategy to arrest pathogenic viruses and other microbes that cross from the animal to human population. This image from FT.com shows "Where novel infectious diseases are mostly likely to emerge."
Read the article and hear audio for free at NEJM.org
Summary of Article
See the figure below for full detail on “innovative vaccines deployed in the past five decades” and their impact on eliminating suffering and death in America and beyond. “The incidence of vaccine-preventable diseases among U.S. children has decreased dramatically” due to in part to getting the vaccine in arms with a “high vaccine-coverage rate among kindergarteners exceeding 90% in all but two states…”. In America, vaccines led to erradicating smallpox (1971), poliomyelitis (1994) and congenital rubella syndrome (2015). Beyond America “immunization programs in low-income countries saved an estimated 23.3 million lives.” Total eradication of small pox worldwide happened in 1980 and “global cases of paralytic polio have decreased by 99.5% from the estimated 350,000 cases in 1988.” Less obvious is liver disease and cancer caused by Hepatitis B that since the first vaccine was approved in 1986 has “not only…reduced rates of the infection in many countries but was also the first vaccine to reduce cancer risk.”
Behind the scenes anticipating the need for vaccines to actually vaccinating a population involves “incentives for vaccine development, ... financing of vaccines and improving access.” In “2010 the Affordable Care Act” ensured free access to vaccines that are "recommended, by the CDC’s Advisory Committee on Immunization Practices, for children and adults up to age 26". Similar support is needed on a global basis.
As “vaccines are usually administered to healthy people maintaining the highest safety standards isn’t only an ethical imperative but is also essential to sustaining public trust.” Sadly, “the story of vaccine progress has been punctuated by both real and misguided safety concerns for as long as vaccines have been in use.” “Enduring mistrust stemming from a discredited study that associated childhood vaccination with autism has been linked to recent outbreaks of measles in the United States.” Going forward “sustaining both vaccine safety and trust in vaccination will become increasingly complex.” Some of these concerns will relate to broader manufacturing in less regulated regions of the world, a lessor ability to monitor safety surveillance and responding to “emerging infections [that] may require rapid availability of new vaccines before comprehensive safety studies are complete.”
Going forward “vaccines against a range of infectious agents will need to be developed.” “More than 1.5 million as yet unknown viruses are estimated to exist in animals worldwide, and 38-50% are candidates to spread to humans.” Surveillance and “virus discovery programs are, therefore important, and they may be able to predict pandemics.” “When pandemics emerge, rapid responses are necessary.” Passive immunizations, using convalescent sera, when available in suitable form can be used to treat patients before vaccines become available. As shown with COVID-19, “current strategies for vaccine design rely on new technologies that lead to a deeper understanding of the immune system and of host-pathogen interactions.” These more basic scientific advances has reduced the time to develop a vaccine by many years. As we have all witnessed, tt was “less than 1 year. [that] the first COVID-19 vaccine” was developed, proved safe, effective and with emergency use authorization put into arms worldwide. “The future holds great promise for vaccine-mediated control of global pathogens, but providing affordable access to effective vaccines for everyone could benefit from them remains an important challenge.”
"FDA Licensure Dates for Selected Innovative Vaccines since 1970" from ibid
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