Vaccines as tools for advancing more than public health: perspectives of a former director of the National Vaccine Program office.

With application of new technologies and licensing of new vaccines, vaccines will soon be better by several orders of magnitude. Yet barriers impede the introduction and wide use of new vaccines. Most of the diseases for which we will have vaccines in the future have not evoked enthusiasm from public health professionals, but not consumer demand, despite ongoing high rates of disease and death. Furthermore, the public's attention turns from the now rarely occurring vaccine-preventable diseases to reports of fears and confirmed adverse events associated with the same vaccines that so effectively continue to prevent disease. New vaccines will be held to a much higher standard; thus we will need more capacity for disease studies, vaccine trials, and surveillance systems. Vaccines and immunization programs contribute to the societal fabric and are an expression of social responsibility. Vaccine research and implementation programs must have the foundation and capacity to keep pace with evolving scientific and societal realities so that their broad benefits can be fully realized.