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Historically, vaccines have had an unmatched impact on improving public health. Looking ahead, what are the biggest obstacles and exciting opportunities in the field?

Contributors Respond

Marla Weston, PhD, RN, FAAN

Marla Weston, PhD, RN, FAAN

CEO, American Nurses Association

Read Marla Weston, PhD, RN, FAAN's bio

Read Marla Weston's bio

Vaccination is widely considered to be among the greatest public health achievements in history. The American Nurses Association (ANA) has a long-standing policy in support of immunizations and we recognize the vital role nurses and health care providers have in the continued effort to increase vaccination coverage.

Innovations in vaccine science continue to emerge; as recently, there was some exciting news related to the influenza vaccine.  A new influenza vaccine containing protein produced in an insect cell line will remove a major barrier to immunization for those with egg allergies.  And there is talk of a universal flu vaccine – a vaccine that could provide long-lasting protection against both seasonal and potentially pandemic influenza viruses. This is truly a public health dream.

As exciting as these advancements are, obstacles will still need to be addressed. One of the most commonly cited barriers to vaccination is misinformation. This is especially true during flu season, when myths surrounding the safety and efficacy of the vaccine surface year after year. Health care providers have an important stake in helping to promote immunizations through patient education. We have an opportunity, and a responsibility, to talk to our patients about the importance of immunizations and to directly address misinformation about vaccines.

ANA believes nurses have a professional and ethical obligation to be immunized. Increasing rates of influenza vaccination among health care providers is a priority for public health, patient safety, and healthcare quality. In 2010, Healthy People 2020 set a national objective of increasing the percentage of health care providers vaccinated annually against seasonal influenza, with a target of 90% by 2020.

We are making considerable progress toward reaching this goal. Last year, ANA conducted an influenza vaccination survey of over 5,000 registered nurses (RNs). The results revealed that 86.3% of RNs were vaccinated during the 2011-12 season. The survey also showed that RNs hold strong beliefs about the importance of influenza vaccination. This is especially good news because it demonstrates the potential of nurses to be advocates for immunization.

Nurses and other health care providers have a critical role in addressing obstacles head on and promoting vaccines through patient education (http://www.anaimmunize.org/). ANA applauds the considerable progress made and we look forward to continuing to be part of the effort to protect the population from vaccine preventable disease.

Christophe Weber

Christophe Weber

President, GSK Vaccines

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Read Christophe Weber's bio

No other health intervention is as simple, powerful and cost effective as a vaccine. In developed countries such as the United States, vaccinating the babies born each year saves $10 billion in direct medical costs and $33 billion in indirect costs. Vaccines have turned the tide against deadly diseases such as polio, small pox and neonatal tetanus, saving millions of lives.

Yet vaccines for some of the biggest health threats of our time remain elusive. Finding new vaccines against TB, HIV, cancer or dengue fever is scientifically challenging. How do you target a virus that attacks the immune system that should fight it, a human parasite that evades detection or cancerous cells with a vaccine?

Advances in science mean we may now be on the brink of another major breakthrough in vaccine science. GSK has spent almost thirty years cultivating a promising malaria vaccine candidate, RTS,S, which is now in late-stage trials in seven African countries. If ongoing trials and the required regulatory steps are completed successfully, it could be available from 2015 in certain African countries. A promising Sanofi vaccine candidate for dengue is currently in late-stage clinical trials. Given the huge burden of these diseases, if proven effective, the impact on public health could be dramatic.

Yet just as challenging as research for new vaccines is ensuring that the vaccines we already have are used to full effect. The recent resurgence of polio in Somalia reminds us that enough people need to be immunised or fragile gains can be lost. Around the world, 19,000 children still die every day from largely preventable causes.  

GlaxoSmithKline and some of our industry colleagues have joined a campaign led by Bill Gates which has the aim of delivering the full benefits of immunisation to all people, regardless of where they are born, who they are or where they live, by 2020.

Countries are faced with a range of different barriers to vaccination. It may be a shortage of healthcare workers, inadequate financial resources or in some areas a lack of information about disease and preventive vaccines. We are working to overcome each of these barriers in partnership with our industry, other business leaders, governments and non-governmental organizations.

Ultimately success in making vaccines accessible and in developing new vaccines will depend on building and expanding these partnerships in our community and around the world. Just as critical is ensuring that health remains a focus of governments everywhere, so the gains we make against disease are never lost. Only then can we ensure that the transformative effect that vaccines have had on global health in the past continues long into the future.

Roberta DeBiasi, MD

Roberta DeBiasi, MD

Faculty, Children's National Medical Center

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Over 25% of annual deaths worldwide each year are attributable to infectious diseases.  The success of vaccines in preventing previously widely circulating infectious diseases such as polio, smallpox, measles and diphtheria is one of the true miracles and success of modern medicine.  

However, obstacles to continued progress in eradicating vaccine-preventable diseases continue to exist.  Worldwide, over 20% of children don’t receive their primary vaccination series.  The reasons for this include lack of health service infrastructure, lack of access to primary care, worldwide armed conflict.   In addition to already recognized pathogens, newly emerging pathogens such as West Nile Virus, avian influenza, and the Middle Eastern respiratory virus (MERS) continue to present challenges for ongoing control of infectious disease burden to public health. Additional barriers include public perception on the safety of vaccines, influenced by the circulation of falsified data and a theory regarding risks of vaccination, as was the case with the now disproven link between MMR and autism. Despite rigorous and extensive testing for safety and efficacy, a single piece of widely circulated false information can have lasting impact on the public’s perception on vaccine safety; unfounded fears regarding safety may overshadow true ongoing risks of natural exposure to preventable and serious disease.  Once a disease is rendered rare by nature of a successful vaccine, the public rapidly forgets the extent to which the disease threatened the health  of the general public before the vaccine was available.  An excellent example is polio, which affected children every neighborhood in the United States annually, and for which entire hospital wards of iron lungs existed in children’s hospitals before a safe and effective vaccine was available. 

Despite these obstacles, there are unprecedented and exciting opportunities for vaccine development in our current era.   We now possess the knowledge and technology to apply molecular biology techniques to identify more effective vaccine targets, and design vaccines more quickly in response to emerging infectious threats to public health.  For instance cell-based technologies can now reduce the response time for development of a vaccine against pandemic strains of influenza.  Study of adjuvants, or additional components of vaccines that can improve the recipient’s immune response to the vaccine, is another area of intense focus and rapid progress.  Novel methods of delivering vaccines are being developed, that can improve the practicality of widespread vaccination in resource-poor settings Continued progress is being made toward development of effective vaccines against the world’s largest killers:  malaria, HIV and tuberculosis.  We must continue to support ongoing research and application of the most modern vaccine development technologies to effectively respond to recognized and emerging pathogens in a nimble and effective manner.

Robyn Swirling

Robyn Swirling

Outreach Coordinator, Advocates for Youth

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Read Robyn Swirling's bio

The HPV vaccine has the potential to have a dramatic impact on the health of young people and presents an exciting opportunity, if we can work with stakeholders to make the case that the HPV vaccine helps young people lead healthy and fulfilling lives. 

Robyn Swirling is the Online Organizing & Outreach Coordinator at Advocates for Youth. Advocates for Youth believes that all young people have the right to lead healthy lives, and therefore we have the responsibility to provide them with the tools and resources they need to make healthy decisions.  Robyn shares her thoughts about the HPV vaccine:

In February 2008, at 21 years old, my doctor called to tell me my most recent pap smear was abnormal and positive for HPV.  I had a colposcopy to see what was wrong, and another abnormal pap three months later. Then another colposcopy. Then surgery. Then more abnormal paps, colposcopies, biopsies, surgeries, and topical chemotherapy. I recently had my eighth colposcopy and am waiting to find out if the cancer has returned.

Because of the testing and treatment I receive, the cervical cancer and HPV will never be life-threatening for me. But each year approximately 4,000 women die of cervical cancer. And while this will likely never be fatal for me, my HPV infection has been far from consequence-free. Because of my treatment, carrying a pregnancy, if possible at all, will be a dangerous undertaking, potentially requiring an entire trimester of bed rest.

This isn’t what parents think will happen when they deny their children access to the HPV vaccine, but it should be. Three-fourths of sexually active people between the ages of 15 and 49 will contract HPV at some point. For most people it clears up on its own without causing any problems, but for some of us it doesn’t. Both of the current HPV vaccines protect from strains 16 and 18, which together cause an estimated 70 percent of cervical cancers and pre-cancers, as well as other HPV-related cancers, and one vaccine protects against the strains of HPV that cause the majority of genital warts.

I was 19 when Gardasil first became available, and I got the first shot of the vaccine as soon as possible with my mother’s blessing and insistence. I was already sexually active, but we couldn’t know if I’d already been exposed to the HPV strain that has caused this cancer. That’s why it’s so important for parents to stare down the potential consequences of HPV, talk to their children honestly and openly about their sexuality and the risks of HPV and other STIs,  and have their children – girls and boys, both - vaccinated around 11-12 years old as the CDC recommends.

Parents cannot anticipate when their children will become sexually active and become at risk for HPV, but the science is clear that HPV vaccination early, before young people become sexually active, is the most reliable way to protect against cervical cancer and genital warts, as well as other HPV-related cancers. For the sake of public health and so others don’t have to go through what I have, I hope more parents will vaccinate.

Tom Frieden, MD, MPH

Tom Frieden, MD, MPH

Director, Centers for Disease Control and Prevention

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Read Tom Frieden's bio

Nelson Mandela once said, “Immunization is the most powerful of all preventive health measures for children and is central to human rights and poverty alleviation. It is the right of every child to be given this kind of protection.”

Vaccination is one of the greatest public health achievements of the past 100 years. It is a safe, highly effective, and low-cost method of preventing certain infectious diseases and protecting the world’s children from diseases, disability, and death. In terms of health improvement, only clean water and overall economic development can do more.

According to the World Health Organization, every year vaccination saves the lives of more than 3 million children under the age of five in the world and protects millions more from diseases and disabilities.

Thanks to vaccination, many diseases that once threated the lives of children are now a thing of the past. Smallpox, which used to kill millions of people worldwide every year, has been eradicated and polio is on the verge of being eradicated. Other diseases such as measles, rubella, and congenital rubella syndrome have been eliminated in the Americas. Measles vaccines alone have prevented more than 10 million deaths globally since 2000.

Yet, despite progress in reducing child deaths from vaccine-preventable diseases, 2.6 million children still die before their fifth birthday each year worldwide because they don’t get vaccinated.

Ensuring children everywhere get the life-saving vaccines they need so they can grow up to lead healthy and productive lives requires commitment, partnership, and support on a global level. It requires public and private partners including national governments, non-governmental agencies, and private industry to work together every step of the way so that every child in every community gets the needed vaccines.

Global partnerships are extraordinarily effective. They led to the success of the meningitis A conjugate vaccination campaign in Africa’s “meningitis belt,” where the 100th million person was vaccinated in December of 2012 against this devastating disease.

In the United States, public and private partners have worked together on one of the most successful public health initiatives: the Vaccines for Children (VFC) program. The federally funded program provides vaccines at no cost to eligible children. It protects children from diseases, eliminates health disparities, and saves lives.

This week marks the 20th year anniversary of the VFC program. As we celebrate this tremendous milestone, we need to rededicate ourselves to working together to ensure that every child everywhere gets protected by vaccinates.

Three of the biggest challenges on the U.S. and global front have been:
· Reaching the most hard-to-reach people all over the world.

· Vaccine acceptance, whether because parents no longer know of the devastating impacts of diseases preventable by vaccines, or from myths/misperceptions.
· Establishing effective clinical systems to support patients and providers.

The most exciting opportunities include:
· Expansion of coverage so more people are able to access life-saving vaccines.
· Using technology to improve and modernize systems for immunization delivery (registries; monitoring of program and performance).
· Scientific advances that are bringing new approaches to product development and delivery (e.g. adjuvants, alternate delivery methods)
· Partnership models (public-private partnerships, extending benefits of vaccines to those who need it the most).