Vaccine independence, local competences and globalisation: lessons from the history of pertussis vaccines.

In the context of global vaccine politics 'vaccine independence' has been defined as the assumption of financial responsibility for vaccine procurement. This paper suggests 'the possibility of vaccine choice' as an alternative meaning for the term. How far does local competence in vaccine development and production provide that possibility? Coupled to the national vaccination programme, such competence enabled the Netherlands to make use of a polio vaccine (Inactivated Polio Vaccine, or IPV) that it was felt best met national needs even though the rest of the world had switched to the alternative attenuated vaccine (generally known as Oral Polio Vaccine, or OPV); by the 1970s IPV was no longer commercially available. Over the past 20 years major changes in vaccine politics have occurred. Does the earlier conclusion regarding local competence still hold? The more recent example of pertussis (or whooping cough) vaccines, where again controversy surrounds the relative merits of alternative vaccines, permits the question to be posed anew. Results of our analysis from the Netherlands suggest, first, that the pressure to conform has become greater, and second, that the taken-for-granted globalism of today's vaccine system is in need of critical examination.