Vaccines at Crossroads
Adel Mahmoud
Vaccines and immunization were voted as the top public health achievements of the 20th Century in a 1999 survey of workers in the field. The reasons are obvious to many who live in developed countries where vaccine-preventable diseases have decreased dramatically. But in spite of its remarkable success in stemming infectious diseases, the overall status of vaccination is spotty. In Fact, the total global effort is inadequate to address the multifaceted threats of infectious diseases. Furthermore, vaccine discovery, development and deployment for the needs of the developing world are lagging. The crucial question is, why?
A better understanding of the nature and evolution of human-microbe interplay is a necessary first step. Microorganisms are cohabitants of this earth, as microbiologist Joshua Lederberg amply argued for more than two decades. The war metaphor - we vs. them - has failed not only because of development of resistance but more importantly because prevention and control need comprehensive multifaceted approaches. Antibiotics and other entities that were once tools in the arsenal are being met with resistance. Nevertheless, prevention and control of infectious diseases has been accomplished in many parts of the world where vaccines played a central role.
