Chapter 39 : Rationalizing Vaccination

Abstract:

The new prospects for immunization against a greatly extended portfolio of infections, and against cancers, point to a transformation in medicine far more extensive than the “antibiotic revolution” of the past. Drugs and vaccines have, of course, long been complementary approaches in controlling infectious diseases. Many antibiotics are declining in potency, just as the extreme crudity of an approach that kills commensal organisms, as well as intended targets is realized. As Columbia University public health specialist Jane Sisk and colleagues observed in the Journal of the American Medical Association, immunization to prevent pneumococcal bacteremia in elderly people is one of the few interventions that both improves patient well-being and saves medical costs. It is, however, the wide variety of emerging vaccines that illustrates the full scale of the transformation likely in the years ahead. One of the most heartening developments during recent years has been the discovery that certain new vaccines, previously validated in industrialized countries, have also been effective in parts of the world where poor nutrition and other problems might have rendered them less powerful. The ultimate step is the comprehensive identification of all genes associated with virulence and antigenicity through the sequencing of pathogens. Finally, the burgeoning revolution in vaccinology is surely the moment to coordinate our use of these potent prophylactics internationally. It makes little sense, for example, that virtually every member country of the European Union has a different policy or reimbursement schedule for influenza vaccination.