The vaccine paradox

The next decade will likely bring astonishing successes in vaccine biology, discovery, and delivery. Justifiable confidence in this proposition led the Bill & Melinda Gates Foundation last year to pledge US$10 billion to a new Decade of Vaccines. For the world’s largest and most influential health foundation, vaccines are the number one priority. The foundation estimates that if vaccine coverage could be scaled up to 90%, the lives of 7·6 million children younger than 5 years could be saved between 2010 and 2019. If a malaria vaccine became available by 2014, this figure could rise by a further 1·1 million.

To address the opportunity the Gates Foundation has identified, we brought together some of the leading scientists working in vaccines today to set out the hopes and possibilities for the coming decade. As we gathered for our first meeting, broad optimism was tempered with caution. One contributor argued that “the present way we work will not sustain the next decade of vaccines”. Another said that despite the manifest successes of today’s vaccines, we had to face up to “a relative failure”. We have not created a sustainable environment for new vaccines to thrive. This Series on the new decade of vaccines explores why there is an unprecedented opportunity for vaccines, but also why we must choose a different trajectory for this future decade if those opportunities are to be fully realised.

In truth, the global prospects for vaccines seem fragile. Consider recent events. In October, 2009, the UK’s Sunday Express ran the front-page headline, “Jab ‘as deadly as the cancer’”. The report referred to the tragic death of a 14-year-old girl who had recently received a vaccine against cervical cancer. The link between the vaccine and her death was quickly proven to be incorrect. But sensational reporting risked inflaming public attitudes about the vaccine’s safety. In January, 2010, Thai public health officials faced questions after a woman who received the H1N1 influenza vaccine suffered a miscarriage. Although experts tried to reassure women that the vaccine was safe, authorities were forced to suspend vaccination programmes pending an inquiry. And in March this year, Japanese health officials suspended vaccines against pneumonia and meningitis after the deaths of four children, despite there being no reliable evidence to substantiate public concerns. The traditional response of public health to concerns about vaccine safety is usually to give confident reassurance to the public. This approach often succeeds. But with a more sceptical and questioning media, a more responsive way forward may be, for example, to anticipate public concerns by reporting background rates of possible adverse effects so that, if they do occur, the public (and media) are neither surprised nor alarmed.1