In low-income countries, infectious diseases still account for a large proportion of deaths, highlighting health inequities largely caused by economic differences. Vaccination can cut health-care costs and reduce these inequities. Disease control, elimination or eradication can save billions of US dollars for communities and countries. Vaccines have lowered the incidence of hepatocellular carcinoma and will control cervical cancer. Travellers can be protected against "exotic" diseases by appropriate vaccination. Vaccines are considered indispensable against bioterrorism. They can combat resistance to antibiotics in some pathogens. Noncommunicable diseases, such as ischaemic heart disease, could also be reduced by influenza vaccination. Immunization programmes have improved the primary care infrastructure in developing countries, lowered mortality in childhood and empowered women to better plan their families, with consequent health, social and economic benefits. Vaccination helps economic growth everywhere, because of lower morbidity and mortality. The annual return on investment in vaccination has been calculated to be between 12% and 18%. Vaccination leads to increased life expectancy. Long healthy lives are now recognized as a prerequisite for wealth, and wealth promotes health. Vaccines are thus efficient tools to reduce disparities in wealth and inequities in health.

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Ciguatera fish poisoning, found throughout the world in warm waters, is the most common type of marine biotoxin ingestion. A polymorphous disease caused by toxins produced by coral reef dinoflagellate(s) and which concentrate up the food chain, ciguatera poses important health, nutritional, economic, and social problems for inhabitants of endemic areas. Despite considerable recent study and progress, the ecology and pathophysiology of the disease remain relatively little understood. Areas in which progress has been made include identification of the causative organisms and toxins and, to a lesser extent, treatment of affected persons. It has become clear that a variety of disturbances of the ecology of coral reefs may be associated with outbreaks of ciguatera. This paper reviews broadly the current knowledge of ciguatera, particularly the ecological, clinical, and socioeconomic aspects.