Clinical Review

Science, medicine, and the future: Vaccines and vaccination

BMJ 1997; 315 doi: (Published 13 December 1997) Cite this as: BMJ 1997;315:1595
  1. Paul-Henri Lambert, chiefa (,
  2. Claire-Anne Siegrist, Headb
  1. a Vaccine Research and Development, Global Programme for Vaccines and Immunisation, World Health Organisation, 1211 Geneva 27, Switzerland
  2. b WHO Centre for Neonatal Vaccinology, Departments of Pediatrics and of Pathology, University of Geneva, 1211 Geneva 4
  1. Correspondence to: Dr Lambert


    Vaccines and vaccination are at a turning point. Recent advances in microbial genetics and in immunology have greatly increased our understanding of microbial pathogenesis and of host defence mechanisms. As a result, within the next 10–15 years, a whole set of new preventive vaccines should become available. These will not only be used to prevent infectious diseases but also for preventing neoplasms such as stomach and endocervical cancer. Also under development are therapeutic vaccines to treat autoimmune diseases and allergic disorders. This review outlines some of the advances in biology, development of new vaccines, and vaccination strategies and discusses the factors that will determine the extent of their use in the future.

    Disease prevention and therapy through vaccination

    Although vaccination has been shown to be the most effective way to prevent infectious diseases, its major impact on public health has been restricted to the control of certain human diseases such as smallpox, poliomyelitis, neonatal tetanus, diphtheria, pertussis, and measles. The eradication of smallpox was the first result of the appropriate use of vaccination at a global level, but efforts made in the past 20 years by the WHO Expanded Programme on Immunisation to increase coverage with routine childhood vaccines (from 5% to about 80%) have probably saved over three million lives annually.

    Vaccines currently in clinical use have been developed through relatively simple, largely empirical approaches, but new vaccine strategies are emerging based on an understanding of microbial pathogenesis and host defence mechanisms. More than nine million deaths could be prevented annually through the use of vaccines against a few important infectious diseases such as pneumonia, meningitis, diarrhoeal diseases, tuberculosis, malaria, and schistosomiasis.1 We may even dream of an AIDS vaccine. In addition, since the introduction of hepatitis B immunisation and its proved preventive effects against liver cancer,2 the benefit of vaccination should be …

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