A Perspective on Vaccine Evaluation Research in Canada: Past and Future

THE 1990s WlLL BE NOTEWORTHY POR A RENAISSANCE IN vaccine use. a mong other major developments in infectious diseases . The technology tree will yield its long-awaited fru it in increasing numbers and variety. providing a cornucopia of new vaccination options for infants and children. Governments intent upon contro ll ing the cos ts of health care can be expected to seize upon many of these new vaccines to implement new programs of disease prevention. There is little doubt that good vaccines we ll used are the most cost effective measure in modern medicine. We believe that vaccines represent the very best of high technology because their boWed magic is available to all, even the youngest tyke in the most remote vi ll age. In 1992. change already is afoot. Conjugate vaccines for prevention of HaemophiLus injiuenzae type b infections have made their debut in programs in virtually every province and territory. The innovation of conjugating bacterial polysaccharide to selected protein carriers allowed the age barrier in responsiveness to polysaccharide to be broken . The new programs. beginning at two months of age, can virtually eradicate H injluenzae type b infections within a few years. New programs are being organized to deliver recombinant hepatitis B vaccines to children, protecting them in advance of the peak risk in early adulthood. British Columbia initiated such a program for all grade 6 students in autumn 1992. the first province to do so. Many addition a l vaccines will be licen sed du ring this decade. The list will include a vaticella vaccine, inactivated hepatitis A vaccine, oral typhoid vaccine and acell u lar pertussis vaccines al l products that have already been licensed in some developed countries. Based upon studies now in progress, it is likely that the list will also include rotavirus and respiratory syncytial virus vaccines. The list of candidate products early in development. including human immunodeficiency virus vaccines, is too long to enumerate. Consumers, especially parents of young child ren, wi ll expect these new vaccines to be safe and convenient. Will ingness to accept the frequent occurrence of minor s ide effects (as with whole cell pertussis vaccine) or rare risks of serious adverse effects (as with oral poliovirus vaccine) already is diminishing. As less familiar and feared microbes are targeted, parents will demand convenient mixing of new vaccines with established ones a complex technological challenge. The abili ty to manufacture all components of a combination vaccine will become pat-amount, forcing manufacturers into cooperative a lliances and eliminating countryspeciJic products or formulations. Wilh so many changes predictably ahead, it is timely