The new decade of vaccines

The Lancet this week launches its latest Series—on the new decade of vaccines. The Series is timed to coincide with the pledging conference for the GAVI Alliance, taking place in London next Monday, June 13. This Series brings together some for the world's foremost experts in vaccine science to look at what needs to take place to realise the tremendous potential of vaccines during the next decade. The Series consists of five papers, a call to action, and five Comments.

In the call to action that concludes the Series, Professor Richard Moxon (University of Oxford and John Radcliffe Hospital, Oxford, UK) and colleagues identify four key elements that need to be prioritised to take full advantage of new opportunities to reduce the burden of vaccine preventable diseases. Firstly, the need for intensified research and development, including financing and prioritising of phase 3 trials. The authors say: "We need to find the requisite funds for the research and development of about 20 improved or novel vaccines in the next decade and beyond. Most important are vaccines for tuberculosis, AIDS, and malaria, but several tropical diseases are inexcusably neglected, including leprosy, trachoma, onchocerciasis, lymphatic filariasis, leishmaniasis, and common helminthic infections such as hookworm. We must also consider vaccines beyond classic infections, such as insulin-dependent diabetes, cancers, and degenerative diseases."

Secondly, they call for advocacy at the highest level to mobilise the donor community. Thanks to organisations such as UNICEF and GAVI, vaccines have a distinguished track record in advocacy. But such movements have been inconsistent. Stronger leadership is needed over the longer term, not just time-limited efforts. The authors say: "Any successful movement in global health needs a defining idea around which to mobilise. For vaccines, the idea is simple: vaccines save lives, prevent suffering, and create wealth. For example, if the GAVI Alliance was fully funded (with an additional $3•7 billion), 4 million lives could be saved between now and 2015, through immunisation programmes that reach more than 240 million children worldwide."

Thirdly, they call on developing countries to shoulder more of the responsibility of financing vaccination programmes, especially as many of them increase in wealth. The authors say: "Most developing countries accord too low a priority to health in their budgets. They must be persuaded to take more of the burden themselves on behalf of their poorer citizens. Ultimately, expansion and sustainment of access to the benefits of immunisation requires ownership of the programme by developing-country governments and the communities that they serve."

Finally, the authors call for an expanded effort in communicating benefits of vaccines, aimed at the general public, decision makers, and relevant health professionals. They say: "The challenge is that between development of a vaccine and its public consummation there is a so-called black box within which a multiplicity and heterogeneity of human factors must be negotiated to realise the public health gains of immunisation. If trust and confidence in vaccines is not secure, our efforts to advocate increased resources to make possible the necessary research, development, and supporting clinical investigation will be a bridge too far. Clearly we do not have answers to many basic questions. What is needed? What motivates people to be immunised? What deters them?"

They conclude: "We have the knowledge base, expertise, and methodology with which to investigate what needs to be done to increase public trust and confidence in immunisation… There is a way forward and we need to grasp the opportunity."

Professor Richard Moxon, University of Oxford and John Radcliffe Hospital, Oxford, UK. T) +44 (0) 7768894703 E) richard.moxon@paediatrics.ox.ac.uk

The Lancet Press Office. T) +44 (0) 20 7424 4949 E) tony.kirby@lancet.com