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Commentary on the National Vaccine Advisory Committee

Walter A. Orenstein, MDDr. Walter Orenstein
Chairperson, National Vaccine Advisory Committee

The major focus of the National Vaccine Advisory Committee (NVAC) over the past 25 years has been on enhancing the use of licensed and recommended vaccines. The measles white paper issued by NVAC in 1991 was a major turning point that provided what would ultimately be the foundation for the current immunization system for children.  In addition, NVAC developed standards of practice for providers of childhood and adult vaccines and issued guidance on how to overcome financial barriers to receipt of childhood vaccines.  While NVAC will continue to contribute in these areas, other areas that will come into focus for this committee include assuring progress is made on prevention of vaccine-preventable diseases globally and incentivizing development of new vaccines and vaccine technologies that are considered high priority.
Improving delivery of currently recommended vaccines in countries throughout the world as well as development and incorporation of new vaccines into developing country immunization programs is critical to decrease the substantial infectious disease burdens in these countries.  Improving global immunization is vital from a humanitarian perspective, and will play a role in our own domestic health security.  Recent outbreaks linked to measles importations from other countries vividly illustrate the risks the United States faces for importation of viruses into the country from other countries resulting in outbreaks.  In 2013, 159 cases of measles have been reported so far (as of August 24). Of these, 157 (99 percent) were associated with importations (2 cases had an unknown source but presumably were import related since indigenous transmission of measles has been eliminated in the United States). Import-associated cases were linked to 42 importations by 23 returning U.S. residents and 19 visitors to the United States from 18 countries. These are sobering numbers that increasingly cannot be ignored, as this represents the highest number of cases in 15 years. Five of the six World Health Organization Regions have set targets for eliminating measles in their regions within the next few years and polio eradication, too, presents an important, urgent calling. Failure to meet the polio eradication goal in the next few years creates the risk of a major global polio resurgence.  

NVAC has developed a comprehensive report on Global Immunizations which outlines the current role of the U.S. Government as well as future direction, goals, and recommendations. The NVAC report focuses on six key areas:

  1. Tackling time-limited opportunities to complete polio eradication and to advance measles mortality reduction and regional measles/rubella elimination goals.
  2. Strengthening global immunization systems.
  3. Enhancing global capacity for vaccine safety monitoring and post-marketing surveillance.
  4. Building global immunization R&D capacity.
  5. Strengthening capacity for vaccine decision-making.
  6. Coordination of HHS global immunization efforts.

Moreover, the report calls for a coordinated effort by multiple U.S. Department of Health and Human Services departments to deliver an annual report to Congress on progress in these areas. The United States directly benefits from strong, effective global immunization systems by reducing the risk of disease importations, strengthening global surveillance for infectious diseases, and contributing to overall global economic growth and stability through supporting immunization innovation, facilitating developing country markets, and taking steps to ensure a healthier world.

Advancements in the development of new vaccines and vaccine technologies could ultimately lead to the prevention of even more infectious disease burdens.  NVAC will soon look at what government efforts are needed to facilitate the development of vaccines, which are considered high priority.  Though vaccine and vaccine technology developments primarily happen in the private sector, there are important ways the government can and should be incentivizing the development of new vaccines (e.g., HIV, malaria) as well as new vaccine technologies and delivery methods (e.g., microneedle patches) that have the potential to increase immunogenicity, ease delivery, reduce wastage, expand temperature ranges and reduce the overall burden on the vaccine delivery systems in the United States and abroad.

These two areas, global immunizations and vaccine science innovation, are vital areas for NVAC to give close attention and unwavering support in coming few years.  At the same time, NVAC will continue to work to assure optimal use is made of existing vaccines within the United States to reduce the disease burden that could be prevented by vaccines.