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Additional comments with the series, including 'is immunisation child protection?' and 'the last mile in global poliomyelitis eradication'

Lancet

In a Comment, Professor Helen Rees, Chair of the WHO Strategic Advisory Group of Experts on Immunization, Geneva, Switzerland, and from the University of Witwatersrand, Johannesburg, South Africa and the London School of Hygiene and Tropical Medicine, UK, and Professor Shabir A Madhi, from the South African National Institute of Communicable Diseases and the University of the Witwatersrand, say that it cannot be business as usual in the new decade of vaccines. They argue that immunisation policy and strategies must be a priority for action and financing by WHO, but that WHO alone cannot influence the complexities of immunisation. They conclude: "There must be dialogue with various stakeholders, including civil society, governments, the private sector, and donor agencies. Only with this dialogue could the partnership envisaged in the Decade of Vaccines become a powerful force seeking newer and bolder actions than before, in the knowledge that the value of a life is equal worldwide."

Professor Helen Rees, WHO Strategic Advisory Group of Experts on Immunisation, Geneva, Switzerland, and the London School of Hygiene and Tropical Medicine, UK. T) +27 11 358 5402 E) hrees@rhru.co.za

Several other Comments are published with the Series. Professor Adam Finn (University of Bristol) and Professor Julian Savulescu (University of Oxford) compare failure to vaccinate with child abuse. They say: "Some parallels can be drawn between immunisation and child protection. The first relates to communication. Child abuse and many vaccine-preventable infections are prevalent but are largely invisible or, at least, not widely known about. Hand in hand with this unawareness, there is a fundamental and widespread lack of understanding of these two areas of child welfare and their complexities."

They add that the analogy with child abuse is clear when the imminent risk to the child is high without intervention, such as a newborn baby of a woman infected with hepatitis B. It becomes less clear in countries where particular infections are rare--often because of widespread immunisation. In that situation, the actual risk of remaining unimmunized might be quite small. The authors conclude: "Just as we owe it to our children and their children not to destroy the environment in which they will live, we also owe it to them to pass on an environment in which they can be unexposed to the entirely avoidable risks of many infectious diseases. The moral imperative is clear and the question is not whether to do it, but how."

Professor Julian Savulescu, University of Oxford, UK. T) +44 (0) 7525 758878 E) julian.savulescu@philosophy.ox.ac.uk

Professor Adam Finn, University of Bristol, UK. T) +44 (0) 7771763937 / +441173420172 E) adam.finn@bristol.ac.uk / Helen.Barr@bristol.ac.uk

Public-private collaboration in vaccine research is discussed in a further Comment, written by Dr Juhani Eskola and Dr Terhi Kilpi, National Institute for Health and Welfare, Helsinki, Finland. They say: "Vaccine companies need partnerships with the public sector to develop new vaccines that benefit public health. The involvement of the public sector in vaccine research not only directs development towards public health goals, but also ensures that research seeks to answer questions relevant to public health decision makers."

Dr Juhani Eskola and Dr Terhi Kilpi, National Institute for Health and Welfare, Helsinki, Finland. Please e-mail to arrange interview. E) juhani.eskola@thl.fi / terhi.kilpi@thl.fi

In the final Comment in the Series, Professor Zulfiqar A Bhutta, Aga Khan University, Karachi, Pakistan, discusses the last mile in global poliomyelitis eradication. Pockets of disease remain in Nigeria, India, Pakistan, and Afghanistan. But issues must be addressed to tackle these last reservoirs, among them that more research is needed on the polio vaccine's effectiveness, or lack of, in population subsets. Professor Bhutta says that the vertical eradication programme delinked from other health services "is possible but frought with the risk of failure". Parts of Africa, Pakistan and Tajikistan are seeing some re-emergence of infection thanks to low overall immunisation rates.

Professor Bhutta concludes: "All resources and collective wisdom should be combined to ensure that the last mile in the race to eradicate poliomyelitis is the very last mile that we ever run in the quest to relegate poliomyelitis to the corridors of history."

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Professor Zulfiqar A Bhutta, Aga Khan University, Karachi, Pakistan. T) +92-300-8236813 E) zulfiqar.bhutta@aku.edu

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