From pertussis to tuberculosis: what can be learned?

Following the introduction of whole-cell pertussis vaccines into the general population, the number of cases of Bordetella pertussis disease declined dramatically. As disease incidence declined, the public's concern for pertussis as a national health problem gradually waned. However, a shift in paradigm occurred, and various groups and the media began to voice their concerns regarding adverse events associated with whole-cell vaccines. These events provided an impetus for the expedited development of safer and as efficacious subunit acellular vaccines. Effective public health leadership, public advocacy, scientific ingenuity, and collaborative interactions between government, academia, and industry culminated in the licensure of acellular pertussis vaccines. In this article, emphasis is placed on conceptualizing how a national public health agenda was implemented that allowed better insight into various public health concerns related to the development and use of acellular pertussis vaccines, concerns that were eventually translated into concrete actions. Knowledge of the environment in which this occurred may play a major role in relating the pertussis experience to tuberculosis vaccine development.