London School of Hygiene & Tropical Medicine

Vaccines are one of the best investments in health, with immunisation programmes responsible for saving millions of lives around the world and helping reduce child mortality rates by guarding against killer diseases including polio and measles and enabling the eradication of smallpox.

More than 200 years after Edward Jenner made his breakthrough on the inoculating effect of cowpox against smallpox in 1796, scientists are working hard to develop new vaccines against infectious diseases such as malaria, tuberculosis and HIV. Fresh momentum on the important role played by immunisation was provided in December 2010 when global health leaders committed to making the next 10 years the Decade of Vaccines to ensure discovery, development and delivery of vaccines around the world, especially to the poorest countries. But the future holds a number of challenges such as increasing access to, and paying for, both existing and newer vaccines and ensuring public trust in vaccines.

Experts at the London School of Hygiene & Tropical Medicine have contributed to a new series of papers published in The Lancet looking at every aspect of vaccines and exploring the challenges of ensuring this lifesaving medical technology reaches the people who need vaccines in the future. The series highlights developments expected over the coming decade for both infectious diseases and chronic conditions; issues surrounding production, distribution, access and uptake; future financing and funding gaps as new vaccines emerge; and the need for greater understanding of the psychological, social and political factors which affect public trust in vaccines and uptake.

One of the papers - Addressing the vaccine confidence gap – examines cases where people have lost confidence in vaccines including the polio vaccines boycott in Nigeria in 2003 and the impact of a 1998 paper – which was subsequently retracted – suggesting a link between the MMR vaccine and autism. According to the authors, public concerns about vaccines are not merely about safety but are also about policies and recommendations, costs and new research findings. While anti-vaccination groups have existed for as long as the vaccines themselves, in today’s world of fast-moving communications they can greatly increase their influence by using social networking and the internet. Attitudes to vaccines are driven by a complex set of factors and the academics call for more research to gain a better understanding of the reasons for vaccine acceptance or rejection in order to help sustain or restore confidence in vaccines.

Lead author Dr Heidi Larson, senior lecturer at LSHTM who is heading a study into issues around public trust in vaccines, says: “The vaccine community demands rigorous evidence on vaccine efficacy and safety and technical and operational feasibility when introducing a new vaccine, but has been negligent in demanding equally rigorous research to understand the psychological, social and political factors that affect public trust in vaccines.”

New funding methods are also needed to finance the increasing number of new vaccines, which are likely to be more complex and expensive than those which have been so effective in the past, according to another paper in the series – titled The future of immunisation policy, implementation, and financing and co-authored by LSHTM’s Professor Brian Greenwood. This is reiterated in a Comment accompanying the series (with contributions from Prof Greenwood and Professor David Heymann) with a call to action for the new decade of vaccines, to fill the funding shortfall in order to build on the many vaccine success stories to date with intensified research and development, advocacy to mobilise donors, increased compliance by developing countries and an expanded effort in communicating the benefits of vaccines. LSHTM Honorary Professor Helen Rees has also contributed to a Comment, saying that it cannot be business as usual in the new decade of vaccines and arguing that immunisation policy must be a priority for action and financing by WHO, but that WHO alone cannot influence the complexities of immunisation.

Meanwhile, a separate Lancet Review co-written by five LSHTM experts compares innovative vaccine financing mechanisms that have made it possible for new conjugate vaccines to be supplied to developing countries at lower cost. Led by Dr James Hargreaves, the authors also discuss issues faced by the Global Alliance for Vaccines and Immunisation (GAVI) ahead of its funding replenishment meeting in London next week.