Trans. R. Soc. B (2011) 366, 2756-2758 dol:10.1098istb 2011.0075 Review Twenty-f

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Trans. R. Soc. B (2011) 366, 2756-2758 dol:10.1098istb 2011.0075 Review Twenty-first century vaccines Rino Rappuoli Novartis Vaccines and Diagnotics, Via Fiorentina 1, 53100 Siena, Italy In the twentieth vaccination has been possibly the greatest revolution in health. Together with hygiene and antibiotics, vaccination led to the elimination of many childhood infectious diseases and contributed to the increase in disability-free life expectancy that in Western societies rose from 50 to 78-85 years (Crimmins, E. M.&Finch, C. E. 2006 Proc. Nad Acad. Sci. USA 103, 498-503 Kirkwood, T. B. 2008 Nat. Med 10, 1177-1185). In the twenty-first century, vaccination will be expected to eliminate the remaining childhood infectious diseases, such as meningococcal meningi- tis, respiratory syncytial virus, group A streptococcus, and will address the health challenges of this century such as those associated with ageing, antibiotic resistance, emerging infectious diseases and poverty. However, for this to happen, we need to increase the public trust in vaccination so that vaccines can be perceived as the best insurance against most diseases across all agers Keywords: vaccines; vaccination; infectious diseases 1. THE NEED TO INCREASE PUBLIC against a particular target disease and it is a paradox. CONFIDENCE IN VACCINATION characteristic of a wealthy society. There is a false per Until very recently, vaccines had been developed ception that some diseases are not or are no longer les to be an entirely benign infection and forget high toll of morbidity and mortality it can cause: following the Pasteur example of inactivating and iniect- dangerous. For example, many people co ing the micro-organisms causing the diseases [1]. These meas primitive technologies, mostly developed during the the first half of the twentieth century, led to crude vaccine measles epidemics do occur today in European because the rejection of vaccination has resulted in insufficient vaccination coverage. Similarly, countries preparations that have nevertheless been very successful in the conquest of diseases. associated with some safety concerns. For instance, although it was instrumental in the eradication However, they were often of the 1796, and was associated with in mouse brain owing to vaccine-related autoimmune major epidemic of diphtheria in Russia owing to disruption of the health system in the case, the smallpox yaccine was essentially developed former USSR and a reduced level of vaccination there was a This prejudice against vaccines has fostered the cases of generalized vaccinia, encephalitis and myocard- ception that vaccines are great but dangerous, and throughout the entire twentieth century, people regu itis. The first rabies vaccine, grown cells, was associated with the occasional induction of encephalitis o vaccination all those diseases of unknown cause. For instance, in the absence of a larly attributed to 2]. Even known cause of the rise of autism, many people con vaccine, developed during cluded that it had to be caused by vaccination. First, the Sabin oral poliomelitis vaccine the 1950s, was associated in one case per million with they asso paralytic disease in vaccinees and contacts. the other first generation vaccines were exert a significant reactogenicity. Therefore, it was associated autism with measles, mumps and Some of rubella vaccination; then, when that was disproved also known to scientifically, others associated autism with the use of a mercury compound used until recently thimerosal, quite understandable that some public fears were ssoci- to maintain the sterility of vaccines [3]. Now, even ated with vaccination during the first part of the after the association of thimerosal with autism has twentieth century been scientifically disproved, there are still some Although, none of these vaccines is used any longer, fundamentalists who refuse to accept the scientific evi- at least in Western countries (table 1), there is still a dence and insist that autism is caused by vaccination. deficit of public trust which is hampering the optimal Another example is war veterans. When they come back from the drama of the war with various health control of some diseases. This is owing to the perception that vaccines are great tools problems, such as in the case of the Gulf War [4], to fight fatal diseases but may occasionally be danger- people like to attribute their disabilities to vaccines ous. This is enhanced when the risk of infection is rather than to the brutality of the war. Similar clinical decreasing as a result of generalized vaccination pictures were observed in the soldiers fighting in the American Civil War, at a time when vaccines (except for one) did not exist. Another phenomenon that has happened during the past century is the increase of One contribution of 16 to a Discussion Meeting Issue 'New vaccines for global health allergies in developed countries: being of unknown cause, many have associated it with vaccination. 2756 This journal is 2011 The Royal Society

Explanation / Answer

As the saying goes, prevention is better than cure, prevention and wellness will not only help an individual remain healthy but also save them from future illnesses that would cost them more. Although the awareness about vaccination is better than before, still there are people who do not consider vaccination for several reasons such as religious, economical and cultural. There is another major reason for not considering vaccines that is the belief that vaccines are dangerous. Some people fear that taking a vaccine would land them in big health issues. On the other hand there few other people who think that certain diseases are not too dangerous and that they can treat it if it comes. One of the most important things is about preventing any future illnesses by taking vaccines and the other side is about maintaining one's physical and mental wellness through exercises and positive and healthy life style. So, in order to protect children from dangerous and communicable diseases, it's always better to administer the recommended vaccines and help the children develop a healthy lifestyle.

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