Vaccination is widely regarded as one of the great public health achievements of the twentieth century. The deadly scourge of smallpox was eradicated (CDC, 1997). Polio remains in only a handful of countries worldwide, and measles, mumps, rubella, diphtheria, tetanus, and Haemophilus influenzae type b are all in decline (CDC, 1999a, 2006; WHO, 2005a). New technologies and novel approaches to vaccine development have the potential to expand greatly the number of diseases that can be prevented or ameliorated by vaccines in the twenty-first century. Two new rotavirus vaccines have recently been developed that have the potential to reduce the morbidity and mortality of this ubiquitous infection worldwide. Two new Human Papilloma Virus (HPV) vaccines that prevent infection by the serotypes responsible for most cervical cancers will reduce the incidence of the most common cancer of women throughout much of the world. Promising results in the development of a malaria vaccine have led to recent major new investments to accelerate its development and distribution (PATH, 2005). Recent advances in the science of tuberculosis detection and efforts to develop more effective vaccines against the disease hold out hope that an old enemy may once again be forced to retreat (Hampton, 2004).

The success of widespread immunization has had major effects on human societies. Reductions in disease prevalence as a result of vaccination have contributed to increases in child survival, decreases in morbidity and long-term disability as well as their associated societal and health-care costs, and, in turn, increases in economic productivity. Since their earliest days, vaccination efforts have also raised, and continue to raise, important issues with which all societies must grapple - issues such as individual rights versus public good; risks and benefits of intervention versus doing nothing; equity and social justice in ensuring benefits accrue to all, not just an elite few; priority-setting and decision-making

in the utilization and distribution of limited resources; and the political, social, financial, and institutional realities of creating and carrying out public health policies, and developing and disseminating new technologies.

In this chapter, we briefly the review the history of vaccines and public health immunization programs and then present the complex fabric of the modern vaccine enterprise and its effects on society, with a focus on the social, political, and economic dimensions that influence disease prevention today.

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