About this Research Topic
Vaccines have been one of the most important medical discoveries of the last three centuries. Thanks to their development, millions of deaths have been avoided. Together with improved hygiene and antibiotics, vaccines have significantly contributed to prolongment of life expectancy in high-income countries to a current average of 85 years, compared to the 47 years in 1900. However, the continued success of vaccination has recently been hampered due to changes in the perception of vaccines within society. Therefore, there is a critical need to better understand (i) what has been achieved by vaccination thus far and (ii) what it is important to further develop vaccines in a world where increased population, aging, travel, urbanization and climate change favor the emergence, evolution and spread of old and new pathogens.
In this Research Topic, we aim to gather a series of Review, Mini-Review and Perspective articles that discuss numerous questions and problems associated with vaccines. The future of vaccine development needs to take in account changing perspectives within our society and that the acceptance of preventative medicine may also change in the years to come. The following main issues and related questions will be addressed in the attempt to predict the future of vaccines:
ASSESSING VACCINE SAFETY AND EFFICACY: Historically, vaccines were tested in inmates, orphans and soldiers. Today’s trials involve only volunteers that, after vaccination, can be challenged with specific microbes (when the infection can be halted by drugs) or are simply exposed to the natural epidemic. The importance of correlates between protection and of establishment of immune memory are becoming central issues. There are several important questions that remain to be addresses including:
1. How should vaccine trials be designed? 2. Is it acceptable to have minor side effects, for instance due to adjuvants, in exchange of higher efficacy? and 3. What is the minimal protection level that should be required for approval by regulatory authorities?
EMERGING AND RE-EMERGING INFECTIONS: The rapid spread of severe infections in the last decades (e.g. SARS, avian flu, Ebola and Zika), has demonstrated an essential requires a great effort in obtaining epidemic preparedness also for unknown infections. Infections that were believed to be under control are now coming back. Antimicrobial resistance is the most rapidly growing problem in health, as it already causes 700,000 deaths per year and the forecast for 2050 is 10 million deaths, more than cancer today. With this in mind, can vaccination be a solution for the failure of antibiotics that we are increasingly facing? Will the global efforts to innovate preparedness for pandemic events be effective? Is training for healthcare professionals (particularly in developing countries where the infections usually arise from) sufficient and appropriate? What is the status of new technologies in vaccine R&D after the omics revolution?
ETHICS, LAW AND MEDIA: Vaccines are very effective, and can possibly eradicate the infectious agent, when a high proportion of a population is immunized. This phenomenon, defined as herd immunity, makes it important to vaccinate the maximum proportion of people as possible. This has several implications including: 1. Where does the responsibility lie? - governments and their agencies, pharmaceutical companies, doctors, the public, parents, individuals etc.? 2. Is the enforcement of vaccination by law an effective means to obtain maximal protection within society? 3. In the age of fake news, how can we assess the accuracy and reliability of information around vaccines that society is exposed to? 4. What is the difference of trust in vaccine effectiveness between developed and developing countries? 5. What are the ethical implications of public-private interactions with the industrial sector and 6. Whose role is to produce vaccines at an affordable price for the whole world?
Keywords: Vaccine, Vaccination
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.