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New vaccines

3.56 Fifty years ago, in this country, there were measles epidemics every other year. Hundreds of thousands of children were affected. Even in the second half of the twentieth century, there were more than 100 deaths associated with many such epidemics. Epidemics of paralytic poliomyelitis affected thousands of individuals before the development of safe and effective vaccines.

Parents of today's children have never seen a child crippled with polio and wearing calipers. Many of the young general practitioners of today may never have seen a case of measles. Epiglottitis (acute and lifethreatening blockage of the airway from haemophilus influenzae b) is no longer feared by paediatricians and anaesthetists. These gains have come from safe and effective vaccines, made available to all children, irrespective of their background or social circumstances.

3.57 In its 1993 report 'Investing in Health', the World Bank identified childhood vaccination as one of the most costeffective health strategies; furthermore, new vaccines were recognised as one of the most valuable areas for investment in health research.

3.58 Over the next decade it is highly probable that research and development will produce new generations of vaccines. Indeed, as the benefits of new genetic technologies are increasingly successfully applied, the pace of emergence of new vaccines may well accelerate. Not only will there be new vaccines, but many will be combined. Harnessing this change will require a carefully managed relationship with the research community and the vaccine industry.

3.59 In the short term the major developments could be:

  • More vaccines combined into new 'multivaccines' to reduce the number of injections or clinic visits;
  • Introduction of new conjugate pneumococcal vaccines to protect young children and the elderly from pneumococcal septicaemia, meningitis, pneumonia and ear infections, with the potential to reduce the annual toll of 22,000 hospital admissions and 3000 deaths caused by pneumococcal infection;
  • A move to injectable rather than oral polio vaccine as paralytic poliomyelitis is eradicated world-wide and the risk of importation of wild poliovirus disappears. This change will maintain protection against poliomyelitis but avoid the risk of vaccine associated cases that can follow the use of oral polio vaccine;
  • More widespread use of existing vaccines to protect against chickenpox and hepatitis B.

3.60 Over the next decade the research and development breakthroughs are likely to be:

  • A vaccine against Group B meningococcal infection;
  • A vaccine against rotavirus gastroenteritis - the commonest cause of diarrhoea in children;
  • A more effective vaccine against tuberculosis;
  • A vaccine against HIV infection;
  • A vaccine against respiratory syncitial virus which is a significant cause of morbidity and mortality in adults as well as children;
  • The development of safe and effective vaccination against malaria.

3.61 The United Kingdom already has world-leading levels of computerisation of our immunisation information systems. These now need to be brought up to the sophistication of information management that is the norm in industry and commerce. For example, each individual dose of vaccine could be bar-coded and then tracked from manufacture to use, with telemetered information on its progress. This would be linked with the computerised individual health record allowing identification of immunisation status (and lack of immunisation), tracking of coverage and suspected adverse event monitoring, payment of providers, and ordering of next doses of vaccines and scheduling of appointments.

3.62 As parents have fewer experiences of previously common infectious diseases, so their perception of their seriousness diminishes and fears about diseases are replaced with fears about vaccine safety. These societal changes, along with the increasing access to the internet with its information without quality control, mean that paternalistic  recommendations will no longer serve an increasingly questioning population. Along with high quality vaccines there will need to be high quality information materials that are easily found, comprehensible to all readerships, engaging and truthful.

3.63 For both new vaccines and new vaccinations, the UK is already foremost in the world with a dedicated Vaccine Evaluation Consortium. The benefits from such a consortium were clearly demonstrated by the rapid development and introduction of meningococcal C vaccine. Similarly, the UK has world-leading research/monitoring of parental knowledge and attitudes about immunisations and vaccine preventable diseases. This tracking is given high priority in the designing of communication materials and promotion of immunisation, being sensitive to parental opinions rather than preconceptions or prejudices of health communicators.

Linking these two topics is the need to actively research any new safety concerns. The new techniques of record linkage are particularly important in demonstrating whether there is significant risk that can be attributed to vaccinations.

3.64 It is important that clear plans are in place for people of this country to achieve the potential benefits of vaccination to eradicate some infectious diseases entirely, to reduce illness caused by infections and to save lives from infectious diseases that currently kill. As part of this infectious diseases strategy, vaccine policy is one of the priorities for action.

Continuing to secure the benefits of safe, effective vaccines in the future - action required

  • Extending the use of existing vaccines to larger numbers of people - in particular influenza vaccine and pneumococcal vaccine;
  • Continuing to maintain high levels of coverage in the childhood immunisation programmes;
  • Switching from oral polio immunisation to the injected form when global progress on polio eradication is at an appropriate point;
  • Introducing available and soon to be available vaccines according to epidemiological needs and cost effectiveness, e.g. varicella vaccine, pneumococcal conjugate vaccine;
  • Stepping up research and investment to bring forward new vaccines to prevent large or serious infectious disease problems, in particular meningococcal Group B vaccine, a vaccine against respiratory syncitial virus (one of the commonest causes of chest infection and hospital admission) and rotavirus gastroenteritis;
  • Contributing to international research to develop a vaccine against HIV infection;
  • Establishing a system to track vaccines using new technologies such as bar-coding;
  • Designing new materials for the public and parents on vaccines which will be address their needs for information and will be made as widely accessible as possible through opportunities such as the internet.

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