University of Oxford Department of Paediatrics, John Radcliffe Hospital, Oxford, UK.
Lancet. 2011 Jul 23;378(9788):348-59. doi: 10.1016/S0140-6736(11)60407-8. Epub 2011 Jun 12.
Vaccines against microbial diseases have improved the health of millions of people. In the next decade and beyond, many conceptual and technological scientific advances offer extraordinary opportunities to expand the portfolio of immunisations against viral and bacterial diseases and to pioneer the first vaccines against human parasitic and fungal diseases. Scientists in the public and private sectors are motivated as never before to bring about these innovations in immunisation. Many societal factors threaten to compromise realisation of the public health gains that immunisation can achieve in the next decade and beyond--understanding these factors is imperative. Vaccines are typically given to healthy individuals and safety issues loom high on the list of public concerns. The public needs to regain confidence in immunisation and trust the organisations responsible for the research, development, and implementation of vaccines. In the past, by use of a judicious amalgam of knowledge and empiricism, successful vaccines were largely developed by microbiologists who identified antigens that induced immune responses to conserved pathogen components. In the future, vaccines need to be developed against deadly diseases for which this strategy is often not feasible because of the extensive antigenic variability of relevant pathogens. High microbial diversity means that immunity after natural infection is often ineffective for prevention of disease on subsequent exposure, for example in HIV infection and malaria. Additionally, vaccines need to be generated to protect the people who are most vulnerable because of age or underlying diseases. Thus, in the future, a much deeper understanding of the immunological challenges--including the diversifying role of host genetics and environmental factors, leading perhaps to more personalised approaches-will be the touchstone for rational design and development of adjuvants that result in novel safe and effective vaccines.
针对微生物疾病的疫苗已经改善了数百万人的健康。在未来十年及以后，许多概念和技术科学进步为扩大针对病毒和细菌疾病的免疫接种组合以及开拓针对人类寄生虫和真菌疾病的首批疫苗提供了非凡的机会。公共和私营部门的科学家以前所未有的动力推动这些免疫创新。许多社会因素有可能危及未来十年及以后免疫接种所能实现的公共卫生收益——了解这些因素至关重要。疫苗通常用于健康个体，安全问题是公众关注的首要问题。公众需要重新对免疫接种建立信心，并信任负责疫苗研究、开发和实施的组织。过去，通过巧妙地结合知识和经验主义，成功的疫苗主要由微生物学家开发，他们确定了诱导针对保守病原体成分的免疫反应的抗原。在未来，需要针对致命疾病开发疫苗，因为由于相关病原体的抗原性广泛变异，这种策略通常不可行。微生物多样性高意味着自然感染后的免疫通常不能有效预防随后暴露时的疾病，例如在 HIV 感染和疟疾中。此外，需要生成疫苗来保护因年龄或潜在疾病而最脆弱的人群。因此，未来，对免疫挑战的更深入理解——包括宿主遗传学和环境因素的多样化作用，可能导致更个性化的方法——将成为合理设计和开发佐剂的试金石，从而产生新型安全有效的疫苗。
