Implementation: Vaccine Promise And Pitfalls

Parents worldwide, frightened by reports of a possible linkbetween the measles-mumps-rubella (MMR) vaccine and autism,refuse to have their children vaccinated, leaving them unprotectedagainst deadly diseases and threatening to disrupt the "herdimmunity" that protects entire societies. Commercial vaccinemanufacturers have focused on the lucrative "travelers’market" for enteric disease but have neglected the specificneeds of the developing world, where 5,500 children die eachday as a result of such illnesses. In October 2004 reports surfacedthat Chiron, which manufactures half the U.S. supply of influenzavaccine, cannot ensure the safety of the vaccine produced inits Liverpool facility, sparking fears of a global pandemic.The preceding vignettes illustrate the delicate balance thatpolicymakers must maintain for science and technology to fullyrealize their promise in keeping infectious diseases in check.The papers in this section describe how countries have grappledwith balancing the available science with their economic, political,and regulatory processes.

First, Patricia Danzon and her colleagues focus on economicimpediments to vaccine production and implementation in industrializedmarkets. Their prime example is the flu vaccine, for which highfixed costs, uncertain returns, a single or limited number ofproducers, and the high cost of compliance with regulationscontributed to the U.S. flu vaccine shortage of 2004. Next,Julia Milstien and colleagues focus on the risk/benefit ratiosused by many industrialized countries in evaluating vaccinesfor their populations and for developing countries. They chargethat the regulatory and programmatic decisions that protectindustrialized countries have led to a dangerous rigidity inglobal vaccine practices.

The next group of papers examine the U.S. and U.K. experiencesmore closely. James Colgrove and Ronald Bayer (and Richard Epstein’sPerspective) highlight the two countries’ varying experienceswith the MMR vaccine, which caused political and social upheavalin the United Kingdom but not in the United States. Next, DavidSalisbury’s paper and Gary Freed’s Perspective depictin greater detail the differences in operation, procurement,and implementation of vaccines in the United Kingdom.

Finally, Sarah Landry and Carole Heilman illuminate the advancesin immunology and biotechnology that hold great promise forvaccine development. Research on new, safer, and more stabledelivery systems for vaccines is taking place, including ediblevaccines grown in potatoes. Landry and Heilman’s paperis a clarion call for countries to reevaluate their regulatoryand economic policies regarding vaccines. As the research movesforward, it will have little impact on global health if we cannotfind the political will to implement the discoveries.

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Implementation: Vaccine Promise And Pitfalls