A Global Perspective on Vaccines: Priorities, Challenges and Online Information

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Background

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 the prolongation of life expectancy in high-income countries to a current average of 85 years, compared to 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 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, following 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 correlations between protection and the establishment of immune memory are becoming central issues. There are several important questions that remain to be addressed including:

1. How should vaccine trials be designed? 2. Is it acceptable to have minor side effects, for example 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 past decades (e.g. SARS, avian flu, Ebola and Zika), has demonstrated the essential need for a greater effort in being prepared for epidemic outbreaks. This also the case 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, currently causing 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 our readiness for pandemic events be effective? Is training for healthcare professionals (particularly in developing countries where these infections usually arise from) sufficient and appropriate? What will be the status of new technologies in vaccine R&D following the omics revolution?

ETHICS, LAW AND MEDIA: Vaccines are very effective, and can possibly eradicate the infectious agent, when a high proportion of a given population has been 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? - with 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 efficacy between developed and developing countries? 5. What are the ethical implications of public-private interactions with the industrial sector and 6. Whose role is it 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.

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