Ch:lpter

Vaccines and the

Eradication of Smallpox
Looking Back
"Ring :lrollnd the rosy I A po cket full of posies I Ashes,
:lshes I We :111 f.111 down!"

Who isn't f.1rnili:lr with thi s c hildh ood so ng? M:lny people
mi ght be surprised that this verse (i'om the 1600s refers to
an outbre:lk of the plague th:lt dev:lst:lted mu ch of western
Eu rope, Hum:lns :Ire still vulnerable to infecti ous dise:lses
that through history have run rampant and kill ed V:lst
ntllube rs of people , The plague and smallpox did just th:lt
through 1lluch of the Dark and Middle Ages. New viruses
such as HI V and SAltS threaten humans in this centur y.
The development of v:lccincs, th e refo re, is one of man's

/)r. EriU'llf(l )('II/I('r
inocultilill.1? 1I rhild
11';11, m((il/ill lIirus
IlIken frolll II (011'.
greatest achievements. Vaccines protect people frolll f.1tal
diseases, incre:lse life expect:lncy and spa re coulltl ess
millions from p:lin :lnd sutTerin g.
Th\! word I/{/(Cill(' comes fronl "vaca," Latin for cow. In
1796 in Clollcestershin.:, Engbnd, ])1'. Edwa rd Jenne r
6 .'vhle'tnn,·, Ch'pt", I VJ'Cln~S Lnokmg Balk

discovered the first vacci ne for slll:lllpox. Jenner used Illatc-

ri:l.l from a skin pustu le which contained live III1Crillil1 Ilints, a
vi rus believed to be spread by cows to milk1mids, ca usi ng
cowpox . Milkmaids who contrac ted cowpox, a mild disease
in humans , seemed to be inHllune to smallpox, a virulent
di seast~ in humans. Jenner inoculated 24 children with the
vllaillia virus and, like the milkmaids, th ey became immune
to sma l1pox. Despite its success, th e smallpox vaccine never
became widespread enough to fully COll trol the disease
until late ill the 20th century. It was especially problelllatic
in the tropics, where slispensions eQuId Ilot be kept cool
enough to be effective.

In 1895, Loui s Pasteur developed the second vaccillt!, this

one for rabies, a groundbrc:l.king achievement. As the first
example of a pathogen being altered for a th erapeutic
purpose, Pasteur's success opened the door to the field
of imlllunobiology. That same year, Emil von l3 ehring of
M arburg Univt!l"sity in Germ:lI1y introduced the diphthe ri a
vaccim:. Three other vaccines - for typhoid, chole ra and
plague - were also developed late in the 19th century, bur
their use was not widesp read at the beginning of th e 20th
century. Too many impoverished countri es Iud no pllblic UHlis HWl'ur
health infrastructure, and the costS of vacci ne distribution
were prohibitive.

Although smallpox was sti ll widely prevalent in the United

States at th e beginning of the 20th century, it was by 110
means th e o nly infeCtious disease to affect the American
population. In 1920, for exam ple, 469,924 cases of measles
resul ted in 7,575 deaths. That same year, nearly 148,000
diphth eri:l. cases resulted in more than 13,000 deaths and
107,473 pertussis cases resulted in more than 5,000 deaths.

The development of the polio vaccine in 1955 had a

radical impact on the use of vacci nes in the United States.
Parents were eager to protect their chi ldren from the "iron
lung" disease, and Congress appropriated funds to inoculate
school children with the polio vaccine. The U.S. governm ent
then began a major push to promote the use of vacci nes .
Today, most Americans don't think twice about vaccination.
Children routinely undergo a seri es of vacc inations from
birth through e:uly childhood. Th ese include vacci nltions
against diphth eria, pertussis. tetanus, poliomyel itis, measles,
mumps, rubella, chicken pox and H fll'lIIopllilrl s illjlIlW'::fI(, /955 polio 1'I1(eillillioll.
 type b (H ib). SOllie of these vaccines - Illeasles, Illumps
and rubella (MMR), for example - have beell combined
and ca ll be administe red in one dose.

Clu"/d wilh Ihl' rrrl

bh)/(hy pa/Iern (if
measles.

Child Ildl!,~ i/lo(lIhllrd 1<111(1)'.

What CX;lCrly is a vaccine, and how is it made?

A vacci ne is formally defined :IS "a preparation of killed,
weakened, or fully infectious microbes that is given to
produce or increasc immunity to a particular d isease."
It call be given as an injection or in a form that can be
swallowed (such as the polio vaccine). Vaccine researchers
are inventing other means of safely and effectively
delivering vaccines. such as nasal sprays.
Child u/jlll //lumps
bt".fi>r(· 1'<I((i/l(' WIlS
Vaccines f:lll into three broad catego ries:
il/lrm/rucd i/l 196 7.
• Live (Attenuated) Vaccine. This rype of vaccine uses a
liw, although weakened, version of the virus; it usually
provides lifelong immunity to the recipient . Measles,
nHimps and rubella vaccines are examples of the ltve
V:lCClnC type .

• Killed (Inactiv:ltcd) V:lccinc. This vacc illL' uses a

p:lthogen exposed to Formaltll,:I chemical that kills
its genetic material, kaving just its shell. This form of
vaccination usu ally requires several mjections. The
typhoid and Hib vaccines arc examples.
• Toxoid Vaccine. This type of vaccine llses protein tOXIllS
that have been secreted by pathogenic bacteria bur are
inactivated. Th ese vaccin es also require several injec-
tions; diphtheria and tetanus vaccines are examples.

Since 1900, vacc ines have been developed and licensed

against 21 other diseases, wi t h ten limited to selected
populations at high risk accord in g to residence, age,
medical condition or risk behaviors. At the start of the
21st century, the vaccine-delivery system in the Umted
States has evolved into a collaboration of alllevel~ of
government (federal, state, local) and public and private
health care providers. The system continues to harness
th e latest technological advances. [)
 Case Study
Eradication of Smallpox

The story of vaccincs begins with smallpox . Over

thousa nds of years, hundreds of millions of people
contracted the disease. The Illummified body of Pharaoh
Ramcsses V of Egypt, who died in 1157 Be, shows a
pustular rash, the earliest physical ev idence of sm:dlpox.
During the next thousand years, traders carried the dis-
C:lSt' from Egypt to India, and from there it swept into

Chim. It re:tched Japan by the 6th century ;llld Europe

by the [ [th century, spread by recurnillg crusaders. In th e
20th century alone, an estim:lted 300 million people :Ire
believed co h:lVe died from it. Although sJllallpox was
declared eradicated in 1980, the threat that it might be
distributed by a terrorist has created fear.

Smallpox was particularly co ntag iou ~ and deadly in

populations exposed for the first time to explore rs fi'olll

, Europe. It paved the way for Spanish conquests in Latin

America. ~ Historians say that smallpox ll1ade the
Sp:lt1ish conquest of Mexico possiblt· when Cortes and
Historians say
his c/lllqllis/adors unintentionally introduced it to the Aztec
that smallpox
population in Techotitlan in 1520. Sm:lllpox rav:lged the
made th e Spanish
Aztecs, who had no natural immunity. CorteS and his men
conquest of
then proceeded to co nquer a vastly weakened Aztec
Mexico possible
em pire. During the French :lnd Indian War, Lord Jeffrey
when Cortes and
Amherst deliberately infected blankets with smallpox and
his (ollqllisladl>rS distributed them to Ind ians ou tside Fort Ticonderog:l , the
introduced it to
first known eX:l Tllpl e of germ warfare.
the Aztec popula-
tion in Techotitlan Smallpox afft"cts only humans. Transmission occurs when
in 1520. the II(/r;o/a "ims (an orrlwpoxllirus) is inhaled in droplets
or aerosols from the respir:ltory tract. Transmission also
occurs through cOntact wi th skin lesions of infected
patients or their bedding or clothing. The lIlcubation
period laStS St"ven to 17 days, with an average of 12 d:lYs.
The dise:lsc presents first w ith feve r for two to four days,
followed by a rash lasting for w~eks. The rash evolves
slowly from papules to vesicles, then pustules and finally
scabs, all at the samc stage in any onc arca" Transmission
occurs mainly during the rash phJse Jnd diminishes as the
lesions sClb. Historica lly, Jbout 50 percent of ullvJ cc inaccd
funily members became infected. T he mortality rate was
20 percent to 30 percent in unvacc inated populations, but
lllany survivors were left with severe scarring and so me
with blindness .

Noting that survivors enjoyed lifelong immunity from any

recurrence of the disease, physicians in China and IndiJ in
the 10th century began to experiment with inoculation.
[ n a process called variola/ion, these physicians introduced
pm from smallpox pustules on infected people into non-
infected people. Usually, the person who was 1I10culated
would develop only a few pustules and a fever. However,
111 up to twO percent of the cases , J virulent or aggress ive

form of the disease developed, causing death. Nonetheless,

the odds were great that an inoculated person would sur-
vive and, thereafter, enjoy lifelong immunity. Th e idea of
vario/ario1l spreJd to Europe. ~ [n a i:1motls case in ,.
1721, Lady Mary Wortley Montagu, a smallpox survivor
In 172I,smallpox
left with unsightly pockmarks, lea rn ed of ImriolaliOIl while
survivor, Lady
her husband was posted to Constantinople as the British
Momagu, learned
ambassador. She inocu lated her children and persuaded
of variolation while
the Princess ofW;des to do the same. In f:1ct, Edward
in Constantinople.
jenner, the discoverer of the smallpox vaccine, had been She inoculated
so inoculated. her children and
In 1796, Dr. j enner vacc inated 24 children with pus he persuaded the
had extracted from a milkmaid's cowpox pustul e. First, Princess of Wales
he experimented with james Phipps, an eight-year-old to do the same.
boy, by introducing the cowpox strain through :I cut in
the arm. After purposely exposing the young boy to
smallpox, Je nner followed the boy's status closely and
concluded that the introduced vaccillia lIirlls confe rred
illllllLllllty from smallpox. Next,jenner inoculated his
own 11 - month-old son with the same result. The cowpox
vaccine proved effec tive with all 24 children, co nfer ring
lifelo ng immunity from smallpox. By tod:ly's sta ndards,
Jenne r's experiments on human subjects would not be
considered e thi cal. Fortunately, the fact dut his cowpox
vaccine worked is not in di spute, and his discove ry would
protect millions of lives in the future.
Sm:t!lpox continued to appel!" in outb reaks throughout
[ht' world into the 20th century. In fact, a deadly smallpox
outbreak in the United States between 1900 and 1904
caused an average of 48 , 164 cases in each of those years
and resulted in an av(::rage of 1,528 deaths annually. D ue
to improved tracking and containment, outbreaks of the
severe form of the disease (va rio/I! " ldjOT) ended abruptly
in 1929 in the U.S.; outbreaks of I!ario/a III;I/(Ir, the milder
form , declined in the 1940s with the last U.S. case report-
ed in 1949.

Om,' scare in New York City in 1947 resulted in the

city vacc Lnating more than six 1l1l11ion residents. A
Mexican busi nessman who traveled by bus to the city,
Un:lware th at he was incubating smallpox, spread thc
disease to 12 people, two ofwho LTl dicd, including him.

Nelll \~)rkers Ii"e IIp Ior iIlO(U/lllioll iu 194 7.

Fearing the worst in the densely populated city, health
atLthOflties took no chances and ordered the mass vacc i-
nation, which took place within one month at hundrcds
of stations iLl hosp itals, police stations and firehouses .

A resolution proposcd by a delegate from the forllLa

USSR at the 11th World Health Assembly in 1958 and
passed by the assembly ill [959 paved the way for a
worldwide etTort to eradicate smallpox. In 1966 at
the 19th World Health Assembly. the World Health
Organization (W HO) called upon all the world's govern-
ments to support and give financial bac ki ng to a newly
created Global Smallpox Eradication Campaign.

Why did sm allpox, of all diseases, become a c:mdidare for World Hcaltll
Or~I!i1l1izl1lioll ill
world wide e rad ica tion? All important reason was that it
GCI/ellil.
rema in ed a powerful kill er throughout the world . In the
year prior to the start of the WHO eradication program,
an estimated 15 million people coml<lcted the disease and
an estim ated two million people died from it. Smallpox
lent itself to the possibi li ty of complete eradica ti on for
other reasons as well.
• Only humans are hosts: no animal reservoir exists,
so smallpox canno t jump from animals to humans.
• A prompt antibody respo nse allows ex posed people
to be protected.
• The vacc ine is ve ry inexpensive, easy to adm inister,
does not require refr igeration, and provides
lon g-term protection.
• Smallpox has no subclinical infection, o r hidden
ca rrier state, to contend with. The disease is always
overt and can, therefore, be traced and contained .
The Global Smallpox Eradicatio n Campaign became a
worldwide public health program like no othe r. The
W HO chose Donald Ainslie (D. A.) Henderson to head
th e campaign. He moved to Geneva, Switzerland, from
Atlanta, where he had headed th e CDC's Infectious
Diseases Sur veillance Unit .

D.A. Henderson was born in [928 in Ohio, attended

Oberlin C oll ege, and graduated from the University of
Rochester's medical school. Immediately after, he joined
th e Epidemic Intelligence Service (E IS) at C DC and con-
tinu ed his career there. His work in conta ining vanOllS O.A. N elli/as,}//
infectious diseases in th e United States and in hot spots
throughout the world had earned him internatiOlul
acclai m. He pioneered improved methods for disease
control that em phasized better reporting of infectious
 diseases so that control measures co uld begin sooner to
control the diseases. This became th e most Illlportant
stra tegy in smallpox eradication - surveillan ce to deteer
cases as early as possible and vaccination of all co nta cts
of pati ents by spec ialized teams so that th e outbreak
would not spread.

[n [967, th e campaign got under way using D.A.

H enderso n's methods. Th e WHO worked w ith health
worke rs in all th e infeocd cOllntries to form surve illan ce
tcams read y to trac k down smallpox outbreaks and arm ed
with " recognition ca rds" that explained th e disease simply.
As th e number of smallpox cases decreased, the tea ms
offered rewards to encourage reporting. Th e earliest
successes ca me in western and central Afri ca . Smallpox
turned out to spread less readily than had pn.:viously been
thought, ~ and th e world bq,,<r1l1 to und erstand that
prompt detec tion and contain ment could lead to the
... and the world
eradica ti on of the disease . Althou gh the weste rn Afri can
began to under-
countries reporting en demi c cases at the beginning of the
stan d that prompt
ca mpaign were am ong th e poarl'st in th e world and had
detection and
heavy infection rates, all bur one of them became free of
containment
smal lpox within three years. I3razil reco rded the last case
could lead to the
in th l' Wl'stern H emi sphere in April [971. Well-executed
eradication of the
eradi cation program s eliminated smallpox transmi ssio n in
disease.
East Pakistan (now Bangladesh) in 1970 and in In donesia
and Afghanistan in 1972. In eastern and south ern Afri ca,
smallpox had been c1iminated ill all but three countries
by the end of 197 1.

The introdu ction of potent, fre eze-dried vaccine and

the bifurca ted needle had remarkable effects on smallpox
preva lence, eve n in countries where eradi cation programs
stalled. T he fi'eezc-dri ed version solved the problem of
th e vaccine losin g potency in the heat of th e tropics . The
bifurca ted needl e, whIch was easy to transport, silllplrfi ed
administering the vaccine.

Unfortunately, se tbacks did o ccur. In 1972, refugees

TIl<' bifirmUl'd lIt'n/lt-. returnin g to Bangladesh after it~ war for independence
rl'iri(h simplUIt'd ailrnill- rei ntrodu ced the disease. In Botswana, introduction of
iStriliiOIl t~r r/,c P,,(riIlC. the di sease from South Afi'ica crea ted all epide mi c, and
in Iran, Iraq and Syria, cases we re imported, and epidemics
occu rred. However, by late 1973 o utbreaks had been
contai ned except in Bangladesh. That year, Intensified
campaigns began in the five countries with remaining
endem ic cases - Bangladesh, India, Nepal, Pakistan and
Ethiopia. India alone repo rted 64 percent of the cases
wo rldwide.

By 1976, only Ethiop ia remained with smallpox, and

all attention turned to it. The milder strain, variola
lIIillor, spread tenaciously across a vast, sparsely settled
region made destitute by civ il war. The last outbreak was
finally contained in the Ogaden D esert in August 1976.
~ H owever, an affec ted nomad population had already ,
migrated into Somalia, and it was there that the last
However, an
kn own outbreak occurred on October 26, 1977.
affected nomad
[n 1980, th e W H O declared smallpox eradicated. The population had
steps taken to get to that pOlllt illustrated how the surveil- already migrated
lance and co ntainm ent programs could be adapted to into Somalia, and
individual countr ies to allow teams to succeed in ve ry it was there that
different populations. The combination of a persistent, the last known
coordinated international effort, spearheaded by the outbreak occurred
on October 26,
WHO, :md innovative approac hes at local levels led to
1977.
success. Lessons learned from the eradication campaign
are relevant in the 21 st century as th e threat of weapon-
ized smallpox forces the public health community to
confron t a scourge it hoped had been co nqu ered. D
 15

Vignette
HibVaccine

The story of the I-lib vaccine demOllstr:ltes how the painstaking work
of research scie ntists in their laboratories can have immediate and
profound impact 011 se rious bacterial diseases in very young children.
For years, se rious infection with the bacteria Ha elllophilus illjlllellz ae
type b (Hib) had led to complications in infants and young child ren
under the age of five. Invasive Hib disease was the leading cause of
epi glotitis and bacterial meningitis in very yO LLn g children . About five
pe rcent of ch ildren who developed H ib meningitis died; and in 35
percent of the children who survived, serious complications occurred.
These included neurological problems, such as seizures, deafness and
mental retardation. A speci:tl vaccine would be needed to produce
antibodies in ve ry young, vulne rable children under the age of five,
thereby immunizing th em against the disease. An estimated 20,000
cases of Hib disease occurred annually in the United States before
the vaccine appeared.

The Hib vaccine emerged from groundbrea king research in the

1960s by Porter Anderson, David Smith and Richard [nsel at Stro ng
Memorial Hospital of the U niversity of Rochester. The first study
took place in Finland in 1975 with more than 100,000 inf:-l.Ilts and
children vaccinated with a polysaccharide product, with mixed
results. While the trial vacclllc worked in old er children, it did not
work in Infants, whose immune systems failed to produce protective
antibodies.

In 1985, after further trial and error, th e vaccine was made available
as a polysaccharide-protein conjugate product for use in children
aged 18-24 months. In 1987 after furt her developme nt , the vaccine
was licensed fo r children aged 18 months, and in 1990 was finally
licensed for children aged two months. By 1993, the Ce nte rs for
Disease Control and Prevention reported a remarkable 95 pe rcent
reduction in invasive Hib disease in the Unitcd States. [n 1997,
Merck & Co. introduced a combination vaccine - Hib and Hepatitis
B - that reduces the number of ltljections req uired in the first 18
months of life from IS to as few as 11.1n 1998, only 125 cases of
Hib disease among children less than five years of age were repo rted.
In less than a decade, the H ib vaccine had nearly eliminated invasive
Hib disease among very young children. a
16 Mllc>wllcs Chaplcr I Vaccmes Lookmg Ah~ad

Looking Ahead
Advances in Vaccine Research
The need for new vaccines and new vaccine technologies
has never been gre:tter III light of the events of September
II, 200 I. Vaccines arc likely to be the only practical means
of protection in the event that biological weapons of mass
destruction are unleashed on an unsuspecting population.
Weapons that use diseases to kill la rge Ilumbers of people,
that can be readily transmitted person to person - anthrax,
smallpox. and plague being the foremost threats - ca ll for
new types of second-generation vaccines to be developed
and stockpiled .

Currently, only small amounts of anthrax vaccine are pro-

duced in the U nited States with use limited to those in the
military. Planning is in progress, however, to produce large
quantities of a more modern vacclI1e that cou ld be used in
the general population in case of a serious threat or attack .

[11 August 2003, D.A . H enderson, who now serves as a

se lll or adv iser at the Center for Biosecurity, University
of Pittsburgh Medical Center, and Dean Emeritus at the
Bloomberg School of Pu blic Health at Johns Hopkins
University, addressed th e issue of preparedness to deal with
a possible small pox rdease. "Preparedness is mllch bette r
than it was at 9/11," he said. "We have ample vaccine and
needles, a better-educated public health and medical COIll-
mllnity, most hospitals have negative pressure examination
rooms and some areas are prepared for large-scale vaccina-
tion should that be necessary. In all, 700,000 in the military
and so me 40,000 civilia n health workers have now been
vaccinated, far fewer in the Civilian sector than we believe
desi rable. Work remains to done, but progress in moving
toward a full prepa redness has been gr:ltifying."

[n the United States, .. :111 estimated 11,000 births ,

each day place stress on the vaccin e-delivery system . Each
... an estimated
newborn currently requires a se ri es of between 15 and 19
11 ,000 births each
vaccine doses in the first 18 months of life . New combina-
day place stress
tion vacc ines may reduce that number to 11, but as addi-
on the vaccine-
tional vaccines are developed, the numbe r of doses may
delivery system.
well rise again. Parents tend to value immunization, a sign
of public trust that all successful vaccine programs co unt
 all. Adverse results, although rare, still occur, however. :l.l1d
surveillance to detect these events l11ust continue, along
with research imo possible risk f:,ctors and their manage-
Illent. For each new vaccine program, an accompanying
public-inform:ltioll campaign is essential. Professional and
advocacy groups must be kept informed every step of the
way, as Illust legislators, educators and the media.

[n 1998, an article in Tflr uw(el suggested dlat the

MMR (measles, mumps, rubella) vaccine might be linked
to inc rC:lscs in autism. As D.A. Henderson points Ollt, how-
eve r, " I, for one, am fully pe rsuaded by several studies that
demonstrate conclusively there is no relationship between
MMI"t and autisl11 .TIl e problem: poor science in the first
place and a press eage r to publicize the spect3cular.
Regrettable." After the Lwrc/ article, some parents refused
the MM R vaccine for their children, and this eventually
resulted In measles outbreaks that would h:lVe been pre-
vented. Concerns over adverse events must be b:llanced
with the knowledge ell:lt v:lccines avert misery. Many a

, gr:lndp:lrent owes a long life not just to cle:lll W:lter. but

also to remarkable advances in v:lccines . ~ Vaccines
have saved Illore lives than any surgical technique or any
Vaccines have medic:ltioll, including antibiotics.
saved more lives
than any surgical D espite th e success of smallpox eradic:ltiol1, many diseases
technique or that vaccines prevent still persist, especi:llly in developing
any medication, countries. Polio, measles and rubella are still threats to
including millions of children and adults worldwide. According to
antibiotics. the W H O, infectious diseases were the leading causes
of death worldwide in 1996, with 17 million deaths :lIlnu-
ally compa red to tell million from heart disease and seven
million fi·om cancer. Even ill the United States and other
industrialized coulltries, infectious diseases caused 18
percent of deaths.

The world has seen infectious diseases both old and new
contin ue to emerge rather tlun decline as it enters the
21 st century. Mabria has risen dramatically. thanks in part
to resistant strains, as has gonorrhea, tuberculosis and
typhoid - diseases that had been previously controlled
with standard antimicrob ial therapy. Devastating diseases
such as Ebola hacmorrhagic fever, hepatitis C, H IV / Al DS,
Lyme, monkeypox. SAI"tS and West Nile virus, havt'
:lppe:1red suddenly. Until there are effective vacei ncs, these
18 Mtl~51One, Clur!er J Vaccmes Lookmg Ahead

unexpected diseases will continue to affect various

populations around the worl d.

Vaccines now in development to fight infectious diseases

include vaccines against additional serotypes of pneumo-
coccal and meningococca l infections, influenza, parain -
fl uenza and respiratory sy ncytial virus (RSV). Another
exciting area of research is therapeutic vacc ines aga inst
noninfectious diseases, such as ca ncer. Experimental vac-
cines to fight cervical cancer caused by human papillorna
virus and other cance rs are cu rrently being resea rched in
clinical trials. Othe r promising vaccines in deve lopmenc
include those to fight autoimmune diseases, gastric ulcers,
and rheumatic heart disease as a result of Group A strepto-
coccal infectioll. T rials arc also llllder way for vaccines to
preve nt H IV infection , the ca use of acqui red immunod efi -
ciency syndrome (AIDS). ... Hopeful developments may ,
soon make trials possible for vaccines to fight Al zhei mer's
Hopeful deve lo p-
and breast ca ncer, two devastating diseases that affect large
ments may soon
numbers of people.
make ttials possi-
Tht" reccnt declaration by the WHO to eradicate polio ble fo r vacc ines to
globally by 2005 prom ises relief for a large part of the fight Alzhe imer's
world's population. While polio was eliminated fr0111 and breast cancer,
th e Western Hemi sphere through vaccination in 1991 , two devastating
the disease is still endemic in three countries of Asia :l.Ild diseases t hat affect
four Others In Afn ca, but all have mounted vaccination large numbers or
campaigns to stop the disease. By 2010, vaccines against people.
several types of meningitis , pneumonia, as well as rotavirus-
caused diarrhea and human papilloma vi rus (the ca use of
cervical cancer) should be introduced. In the future, vac-
cines against AID S, malaria and pulmonary tuberculosis
may begin saving lives, and measles should be controlled
throughout the globe as well. Thanks to advances in vac-
cine technology, inf.l1lts may well be protected th roughout
their lives against many of the pathogens that threaten their
health today. Developments under way promise on e day to
provide lmmllllologic protection against conditions such
as asthma , multiple sclerosis and diabetes.

In the last quarter of the 20th century alone, new vaccine-

delivery technology made rapid strides. Modern biotechnol-
ogy gave rise to conjugate vaccines, live vector vaccines, new

dCIIf/ojll'd II) ill/protlC
!'<lrdll(' dC/illfry.
acljuvJnts, genome- based proteomic vaccines, DNA vaccines
and recombinant scrams. New dcliVt:ry approaches have
included transgenic plantS ;111d transcutaneous immunization.
As vaccines prevent diseases, it follows lhat the marc people
arc vaccinated against preventable diseases, the more health
systcms Can marshal resources to fight diseases that arc nO[
preventable. This is why the invention of new vaccines and
new technologies for vaccine delivery are so vi tal. Not only
w ill he:ilth care systems be more successful at fighting dis-
ease, t he world's population will enjoy marked Improve-
ments in ove rall health.
P h olo c re d its
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