Symposium at USP highlights controversies in immunization
Vaccines will play a growing role in global public health, but controversies may impede their progress. That was the conclusion of four international experts at a symposium sponsored by University of the Sciences in Philadelphia, the fifth in a series on the future of health care.
Disparities in access, inconsistent funding, public misperceptions, and scientific roadblocks, such as the disappointing results of HIV/AIDS vaccine trials, all stand in the way of more widespread use of immunizations. On Monday, the United States Court of Federal Claims began hearings on claims that a formerly used vaccine preservative was linked to autism, despite numerous scientific findings to the contrary. At the same time, vaccines save millions of lives each year, mostly those of young children, and hold the promise of saving even greater numbers in the years ahead.
“The future of vaccines is key to the future of public health,” observed Dr. Robert Field, chair of USP’s Department of Health Policy and Public Health, which sponsored the symposium. “And the future of public health is key to the health and well being of the world’s population,” he added.
Moderator Dr. Arthur Caplan, chair of the Department of Medical Ethics at the University of Pennsylvania, noted that public policy and ethical issues surrounding vaccines have received surprisingly little attention. “When I asked the experts, no one knew of major work in this area, although the need certainly exists,” he commented.
Diseases such as polio, measles, and rubella have been nearly eradicated in the developed world, the panelists noted in pointing to some of vaccination’s greatest successes. “In basic terms, vaccines are good, disease is bad,” commented Dr. Alan Hinman, senior public health scientist at the Taskforce for Child Survival and Development, a project of Emory University and the Carter Center.
Among the challenges facing vaccination is the growing use of legal exceptions by parents to opt their children out of routine immunizations. “Philosophical exemptions for vaccines are necessary but they should be harder to get,” observed Dr. Paul Offit, chief of the Division of Infectious Diseases at Children’s Hospital of Philadelphia, and co-inventor of a vaccine against rotavirus.
The panelists saw selective vaccination of children as a new and growing threat that can let deadly infectious diseases re-enter communities. They pointed to recent outbreaks of measles and pertussis among unvaccinated children. Both of these diseases had largely disappeared after vaccines against them were introduced.
Looking to the future, the scientific challenges in developing new vaccines can be daunting, and the process can take 15 to 25 years, noted Dr. Stanley Plotkin, emeritus professor at the University of Pennsylvania School of Medicine, who has developed several vaccines, including one against rubella. “Anyone who discovers a vaccine has a dream,” he added. The future also holds the promise of new technologies, such as self-administered patches for delivering vaccinations, observed Dr. Thomas Vernon, retired vice president for public policy, public health, and medical affairs at Merck & Company.
“Amazing breakthroughs lie on the horizon,” concluded Dr. Field. “But we need to make sure that key players in government, industry, and academia keep talking to one another.”
Previous symposia sponsored by the Department of Health Policy and Public Health addressed the future of Medicare, Medicaid, public health, and drug safety. The next symposium in the series is planned for spring 2009. More information is available at this link