Vaccine Safety: Current and Future Challenges

Abstract

Immunizations are responsible for preventing death and disability from disease and are among the most cost-effective and widely used public health interventions. However, it is also recognized that no vaccine is perfectly safe or effective. Some people will experience side effects from vaccines, and a few may not experience a complete immunologic response to a vaccine, leaving them susceptible to disease. Sustaining high vaccine coverage rates may become more of a challenge as people question the limitations of vaccines and new parents no longer see or hear about the diseases from which vaccines protect them. In the future, maintaining public support for immunizations will be critical for preventing outbreaks of vaccine preventable diseases. In this chapter, we will focus on the importance of vaccine safety research; current gaps and limitations in knowledge in the field of vaccine safety; how vaccine safety is monitored; the vaccine injury compensation program; vaccine risk communication, and helpful resources for specific questions about vaccine safety. The Importance of Ongoing Vaccine Safety Research Vaccine adverse event reports include health events caused by vaccines (i.e., true adverse reactions) and those that are not caused by vaccines (associated only by coincidence). In maturing immunization programs, (figure 1) close monitoring and timely assessment of suspected vaccine adverse events are critical to prevent loss of confidence, decreased vaccine coverage, and return of epidemic disease. 1,2 This has been experienced in several countries for pertussis, 3 and more recently, diphtheria. 4 There are several key considerations for supporting and maintaining an active vaccine safety program. First, a higher standard of safety is generally expected of vaccines than of other medical interventions because, in contrast to most pharmaceutical products, which are administered to ill people for curative purposes, vaccines are generally given to healthy people to prevent disease. Public tolerance of adverse reactions related to products given to healthy people, especially healthy babies, is substantially lower than to products administered to people who are already sick. 5 This lower risk tolerance by the public for vaccines translates into a need to investigate rarer

Exempting Schoolchildren From Immunizations: States With Few Barriers Had Highest Rates Of Nonmedical Exemptions

“…Vaccination decisions and rates have historically been tied to the prevalence of vaccine-preventable diseases at the population level. 27,28 This phenomenon would likely operate in favor of the proponents of Oregon's exemption bill, given the state's high pertussis rate, and should be considered in any evaluation of the multifactorial effects of Oregon's vaccine-related public health interventions.…”

Epidemiology of vaccine hesitancy in the United States

“…In today's world, smallpox has been eradicated due to a successful vaccination program and vaccines have effectively controlled many other significant causes of morbidity and mortality. Consequently, fear has shifted from many vaccine-preventable diseases to fear of the vaccines 6 Many sociocultural changes have contributed to vaccine hesitancy. 4,7 Trust in large corporations that manufacture vaccine and the government that widely purchases and promotes vaccines are at all-time low levels.…”

How to Communicate With Vaccine-Hesitant Parents

“…1,2,7,9,[13][14][15] The latter viewpoint has gained popularity as vaccines have reduced disease incidence and disease-associated mortality; the devastating consequences of polio, pertussis, and measles are not apparent. 16 Parents (and HCPs) also may have a tendency to selectively grade individual diseases in terms of their importance; studies have revealed, for example, that some parents are skeptical of the need for varicella vaccine. 1,9,13 In addition, as the vaccine schedule becomes more comprehensive and complex and has the ability to protect against more diseases in the first few years of life, some parents worry about the number of injections a child may receive at a single visit, and others are concerned that the immune system is "overloaded," a view that has been refuted scientifically.…”