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Tawde PP, Quazi Z, Gaidhane A, Choudhari SG. Developments and Trends of Immunization in India: A Narrative Review. Cureus 2024; 16:e66547. [PMID: 39252742 PMCID: PMC11381579 DOI: 10.7759/cureus.66547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/08/2024] [Indexed: 09/11/2024] Open
Abstract
Immunization is a critical component of public health, and it undergoes various trends and developments over time. Immunization is considered one of humanity's most remarkable journeys. It has helped save countless lives and will help save more if the goals of the 2030 Immunization Agenda (IA2030) are achieved. India is home to one of the largest global immunization programs. Immunization trends refer to the patterns and changes in the development of vaccines, the use of vaccines, and vaccination programs within a nation. There have been various trends in vaccine development and immunization in India. Trends can be influenced by various factors, including vaccine coverage, new vaccines, vaccine hesitancy, advances in medical science, technological innovations, public-private partnerships, public health policies, and public awareness. India has the world's largest immunization program regarding the number of vaccinations delivered, the recipients, the geographic spread, and the human resources required. In this review, we give an overview of various trends in immunization in India dating from the ancient era. A search of the PubMed, Scopus, and Google Scholar databases from 1945 to February 2024 was done to conduct a narrative review. This review includes English-language publications. This narrative review was conducted to summarize the government of India's actions and strategies for immunization and vaccine development and also to trace the trends in immunization in India. It covers various vaccination programs of the Indian government and measures that were made to fight vaccine hesitancy and to enhance vaccination coverage such as developing vaccination roadmaps, scheduling vaccinations, utilizing digital health technology, monitoring vaccinations, and developing creative techniques. India has the world's largest Universal Immunization Program, vaccinating around 29 million pregnant women and 26.5 million infants annually. These trends reflect India's ongoing commitment to immunization as a component of public health policy and efforts to address existing and emerging health challenges.
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Affiliation(s)
- Pratik P Tawde
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Zahiruddin Quazi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhay Gaidhane
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sonali G Choudhari
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Salalli R, Dange JR, Dhiman S, Sharma T. Vaccines development in India: advances, regulation, and challenges. Clin Exp Vaccine Res 2023; 12:193-208. [PMID: 37599804 PMCID: PMC10435768 DOI: 10.7774/cevr.2023.12.3.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/02/2023] [Accepted: 05/05/2023] [Indexed: 08/22/2023] Open
Abstract
One of the most significant medical advancements in human history is the development of vaccines. Progress in vaccine development has always been greatly influenced by scientific human innovation. The main objective of vaccine development would be to acquire sufficient evidence of vaccine effectiveness, immunogenicity, safety, and/or quality to support requests for marketing approval. Vaccines are biological products that enhance the body's defenses against infectious diseases. From the first smallpox vaccine to the latest notable coronavirus disease 2019 nasal vaccine, India has come a long way. The development of numerous vaccines, driven by scientific innovation and advancement, combined with researcher's knowledge, has helped to reduce the global burden of disease and mortality rates. The Drugs and Cosmetics Rules of 1945 and the New Drugs and Clinical Trials Rules of 2019 specify the requirements and guidelines for CMC (chemistry, manufacturing, and controls) for all manufactured and imported vaccines, including those against coronavirus infections. This article provides an overview of the regulation pertaining to the development process, registration, and approval procedures for vaccines, particularly in India, along with their brief history.
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Affiliation(s)
- Rakshita Salalli
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Jyoti Ram Dange
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Sonia Dhiman
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Teenu Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
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Wang J, Bai Y, Zhu J, Wang X, Liu J. Vaccination in the childhood and awareness of basic public health services program among internal migrants: a nationwide cross-sectional study. BMC Public Health 2023; 23:1257. [PMID: 37380970 DOI: 10.1186/s12889-023-16147-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Vaccination is proved to be one of the most effective and efficient way to prevent illness and reduce health inequality. Studies about association between vaccination inequalities in the childhood and awareness of basic public health services program among internal migrants in China are lacking. In this study, we aimed to explore the association between migrants' vaccination status between 0 and 6 years old and their awareness of the National Basic Public Health Services (BPHSs) project in China. METHODS We included 10,013 respondents aged 15 years old or above of eight provinces from 2017 Migrant Population Dynamic Monitoring Survey in China, a nationwide cross-sectional study. Univariate and multivariable logistic regressions were used to assess vaccination inequalities and the awareness of public health information. RESULTS Only 64.8% migrants were vaccinated in their childhood, which is far below the goal of national requirement of 100% vaccination. This also indicated the vaccination inequalities among migrants. Female, the middle-aged, married or having a relationship, the highly educated and the healthy population had higher awareness of this project than others. Both univariate and multivariate logistic regressions showed greatly significant association between vaccination status and some vaccines. Specifically, after adding convariates, the results showed that there were significant associations between the vaccination rates of eight recommended vaccines in the childhood and their awareness of BPHSs project (all p values < 0.001), including HepB vaccine (OR: 1.28; 95%CI: 1.19, 1.37), HepA vaccine (OR: 1.27; 95%CI: 1.15, 1.41), FIn vaccine (OR: 1.28; 95%CI: 1.16, 1.45), JE vaccine (OR: 1.14; 95%CI: 1.04, 1.27), TIG vaccine (OR: 1.27; 95%CI: 1.05, 1.47), DTaP vaccine (OR: 1.30; 95%CI: 1.11-1.53), MPSV vaccine (OR: 1.26; 95%CI: 1.07-1.49), HF vaccine (OR: 1.32; 95%CI: 1.11, 1.53), except for RaB vaccine (OR: 1.07; 95%CI: 0.89, 1.53). CONCLUSIONS The vaccination inequalities exist among migrants. There is a strong relationship between the vaccination status in the childhood and the awareness rate of BPHSs project among migrants. From our findings we could know that the promotion of vaccination rates of the disadvantaged population such as the internal migrants or other minority population can help them increase the awareness of free public health services, which was proved to be beneficial for health equity and effectiveness and could promote public health in the future.
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Affiliation(s)
- Jun Wang
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872, China
| | - Yang Bai
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872, China
- School of Public Administration and Policy, Renmin University of China, Beijing, 100872, China
| | - Jingmin Zhu
- Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK.
| | - Xueyao Wang
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872, China
- School of Public Administration and Policy, Renmin University of China, Beijing, 100872, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, 100191, China.
- Institute for Global Health and Development, Peking University, Beijing, 100871, China.
- Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, 100083, China.
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Panda S, Singh PK, Mishra S, Mitra S, Pattnaik P, Adhikary SD, Mohapatra RK. Indian Biosimilars and Vaccines at Crossroads-Replicating the Success of Pharmagenerics. Vaccines (Basel) 2023; 11:110. [PMID: 36679955 PMCID: PMC9865573 DOI: 10.3390/vaccines11010110] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The global pharma sector is fast shifting from generics to biologics and biosimilars with the first approval in Europe in 2006 followed by US approval in 2015. In the form of Hepatitis B vaccine, India saw its first recombinant biologics approval in 2000. Around 20% of generic medications and 62% of vaccines are now supplied by the Indian pharmaceutical industry. It is this good position in biologics and biosimilars production that could potentially improve healthcare via decreased treatment cost. India has witnessed large investments in biosimilars over the years. Numerous India-bred new players, e.g., Enzene Biosciences Ltd., are keen on biosimilars and have joined the race alongside the emerging giants, e.g., Biocon and Dr. Reddy's. A very positive sign was the remarkable disposition during the COVID-19 pandemic by Bharat Biotech and the Serum Institute of India. India's biopharmaceutical industry has been instrumental in producing and supplying preventives and therapeutics to fight COVID-19. Despite a weak supply chain and workforce pressure, the production was augmented to provide reasonably priced high-quality medications to more than 133 nations. Biosimilars could cost-effectively treat chronic diseases involving expensive conventional therapies, including diabetes, respiratory ailments, cancer, and connective tissue diseases. Biologics and biosimilars have been and are being tested to treat and manage COVID-19 symptoms characterized by inflammation and respiratory distress. PURPOSE OF REVIEW Although India boasts many universities, research centers, and a relatively skilled workforce, its global University-Industry collaboration ranking is 24, IPR ranking remains 47 and innovation ranking 39. This reveals a wide industry-academia gap to bridge. There are gaps in effective translational research in India that must be promptly and appropriately addressed. Innovation demands strong and effective collaborations among universities, techno-incubators, and industries. METHODOLOGY Many successful research findings in academia do not get translation opportunities supposedly due to low industrial collaboration, low IP knowledge, and publication pressure with stringent timelines. In light of this, a detailed review of literature, including policy papers, government initiatives, and corporate reviews, was carried out, and the compilation and synthesis of the secondary data were meticulously summarized for the easy comprehension of the facts and roadmap ahead. For easy comprehension, charts, figures, and compiled tables are presented. RESULTS This review assesses India's situation in the biosimilar space, the gaps and areas to improve for Indian investment strategies, development, and innovation, addressing need for a more skilled workforce, industrial collaboration, and business models. CONCLUSIONS This review also proposes forward an approach to empowering technopreneurs to develop MSMEs for large-scale operations to support India in taking innovative thoughts to the global level to ultimately realize a self-reliant India. The limitations of the compilation are also highlighted towards the end.
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Affiliation(s)
- Sunita Panda
- School of Biotechnology, KIIT Deemed University, Bhubaneswar 751024, India
| | - Puneet Kumar Singh
- School of Biotechnology, KIIT Deemed University, Bhubaneswar 751024, India
| | - Snehasish Mishra
- School of Biotechnology, KIIT Deemed University, Bhubaneswar 751024, India
| | - Sagnik Mitra
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology, Indore 453552, India
| | - Priyabrata Pattnaik
- Merck Pte Ltd., 2 Science Park Drive, Ascent Building, #05-01/12, Singapore 118222, Singapore
| | - Sanjib Das Adhikary
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Ranjan K. Mohapatra
- Department of Chemistry, Government College of Engineering, Keonjhar 758002, India
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Chakraborty C, Agoramoorthy G. India's cost-effective COVID-19 vaccine development initiatives. Vaccine 2020; 38:7883-7884. [PMID: 33129610 PMCID: PMC7574682 DOI: 10.1016/j.vaccine.2020.10.056] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/08/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Chiranjib Chakraborty
- Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Kolkata, West Bengal, India.
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Structural equation modeling to detect correlates of childhood vaccination: A moderated mediation analysis. PLoS One 2020; 15:e0240749. [PMID: 33057426 PMCID: PMC7561155 DOI: 10.1371/journal.pone.0240749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/01/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives This study used a health belief theory derived framework and structural equation model to examine moderators, mediators, and direct and indirect predictors of childhood vaccination. Methods A secondary analysis was conducted using data collected from a cross-sectional survey of a random sample of 1599 parents living in urban and rural areas of Mysore district, India. Applying two-stage probability proportionate-to-size sampling, adolescent girls attending 7th through 10th grades in 23 schools were selected to take home a questionnaire to be answered by their parents to primarily assess HPV vaccine intentions. Parents were also asked whether their children had received one dose of Bacillus Calmette–Guérin; three doses of Diphtheria, Pertussis, Tetanus; three doses of oral Polio vaccine; and one dose of Measles vaccine. In addition, parents were asked about their attitudes towards childhood vaccination. Results Out of the 1599 parents, 52.2% reported that their children had received all the routine vaccines (fully vaccinated); 42.7% reported their children had missed at least one routine vaccine, and 5.2% reported that their children had missed all routine vaccinations. Perceptions about the benefits/facilitators to childhood vaccination significantly predicted the full vaccination rate (standardized regression coefficient (β) = 0.29) directly and mediated the effect of parental education (β = 0.11) and employment (β = -0.06) on the rate of full vaccination. Parental education was significantly associated indirectly with higher rates of full vaccination (β = 0.11). Parental employment was significantly associated indirectly with decreasing rates of full vaccination (β = -0.05). Area of residence moderated the role of religion (β = 0.24) and the ‘number of children’ in a family (β = 0.33) on parental perceptions about barriers to childhood vaccination. The model to data fit was acceptable (Root Mean Square Error of Approximation = 0.02, 95% CI 0.018 to 0.023; Comparative Fit Index = 0.92; Tucker–Lewis Index = 0.91). Conclusions Full vaccination rate was relatively low among children in Mysore, especially among parents who were unsure about the benefits of routine vaccination and those with low educational levels. Interventions increasing awareness of the benefits of childhood vaccination that target rural parents with lower levels of education may help increase the rate of full childhood vaccination in India.
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Son S, Thamlikitkul V, Chokephaibulkit K, Perera J, Jayatilleke K, Hsueh PR, Lu CY, Balaji V, Moriuchi H, Nakashima Y, Lu M, Yang Y, Yao K, Kim SH, Song JH, Kim S, Kim MJ, Heininger U, Chiu CH, Kim YJ. Prospective multinational serosurveillance study of Bordetella pertussis infection among 10- to 18-year-old Asian children and adolescents. Clin Microbiol Infect 2018; 25:250.e1-250.e7. [PMID: 29689428 DOI: 10.1016/j.cmi.2018.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/11/2018] [Accepted: 04/16/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Bordetella pertussis continues to cause outbreaks worldwide. To assess the role of children and adolescent in transmission of pertussis in Asia, we performed a multinational serosurveillance study. METHODS From July 2013 to June 2016, individuals aged 10 to 18 years who had not received any pertussis-containing vaccine within the prior year were recruited in 10 centres in Asia. Serum anti-pertussis toxin (PT) IgG was measured by ELISA. Demographic data and medical histories were obtained. In the absence of pertussis immunization, anti-PT IgG ≥62.5 IU/mL was interpreted as B. pertussis infection within 12 months prior, among them levels ≥125 IU/mL were further identified as infection within 6 months. RESULTS A total of 1802 individuals were enrolled. Anti-PT IgG geometric mean concentration was 4.5, and 87 (4.8%) individuals had levels ≥62.5 IU/mL; among them, 73 (83.9%) had received three or more doses of pertussis vaccine before age 6 years. Of 30 participants with persistent cough during the past 6 months, one (3.3%) had level ≥125 IU/mL. There was no significant difference in proportions with anti-PT IgG ≥62.5 IU/mL among age groups (13-15 vs. 10-12 years, 16-18 vs. 10-12 years), between types of diphtheria, pertussis and tetanus (DTP; whole cell vs. acellular), number of doses before age 6 years within the DTP whole-cell pertussis vaccine (five vs. four doses) or acellular pertussis vaccine (five vs. four doses) and history of persistent cough during the past 6 months (yes vs. no). CONCLUSIONS There is significant circulation of B. pertussis amongst Asian children and adolescents, with one in 20 having serologic evidence of recent infection regardless of vaccination background.
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Affiliation(s)
- S Son
- Samsung Medical Center, Sungkyunkwan University, Department of Pediatrics, Seoul, South Korea
| | - V Thamlikitkul
- Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Medicine, Bangkok, Thailand
| | - K Chokephaibulkit
- Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Medicine, Bangkok, Thailand
| | - J Perera
- University of Colombo, Department of Microbiology, Colombo, Sri Lanka
| | - K Jayatilleke
- Sri Jayewardenepura General Hospital, Department of Microbiology, Nugegoda, Sri Lanka
| | - P-R Hsueh
- National Taiwan University Hospital, Departments of Laboratory Medicine and Internal Medicine, Taipei, Taiwan
| | - C-Y Lu
- National Taiwan University Hospital, Department of Pediatrics, Taipei, Taiwan
| | - V Balaji
- Christian Medical College & Hospital, Department of Clinical Microbiology, Vellore, India
| | - H Moriuchi
- Graduate School of Biomedical Sciences, Nagasaki University, Department of Molecular Microbiology and Immunology, Nagasaki, Japan
| | - Y Nakashima
- Graduate School of Biomedical Sciences, Nagasaki University, Department of Molecular Microbiology and Immunology, Nagasaki, Japan
| | - M Lu
- Shanghai Children's Hospital, Department of Pulmonary Medicine, Shanghai, China
| | - Y Yang
- Beijing Children's Hospital, Capital Medical University, Department of Microbiology and Immunology, Beijing, China
| | - K Yao
- Beijing Children's Hospital, Capital Medical University, Department of Microbiology and Immunology, Beijing, China
| | - S H Kim
- Asia Pacific Foundation for Infectious Diseases (APFID), Division of Infectious Disease, Seoul, South Korea
| | - J H Song
- Asia Pacific Foundation for Infectious Diseases (APFID), Division of Infectious Disease, Seoul, South Korea
| | - S Kim
- Samsung Medical Center, Statistics and Data Center, Seoul, South Korea
| | - M-J Kim
- Samsung Medical Center, Statistics and Data Center, Seoul, South Korea
| | - U Heininger
- University of Basel Children's Hospital, Pediatric Infectious Diseases and Vaccinology, Basel, Switzerland
| | - C-H Chiu
- Chang Gung Children's Hospital, Chang Gung University, Department of Pediatrics, Taoyuan, Taiwan.
| | - Y-J Kim
- Samsung Medical Center, Sungkyunkwan University, Department of Pediatrics, Seoul, South Korea.
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Chickenpox and measles clusters among college students in Pune, Maharashtra. Virusdisease 2017; 28:337-340. [PMID: 29291222 DOI: 10.1007/s13337-017-0395-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022] Open
Abstract
Chickenpox and measles, both vaccine preventable febrile rash illnesses, present in a comparatively severe form among young adults/adults than among children. Immunity levels against chickenpox are not known in India and those against measles have been found variable across the country. Places where students or adults/young adults from various parts of the country come together pose a peculiar challenge in preventive policy making regarding these diseases. In this article, we present findings from parallel outbreaks of the two diseases in a graduate/postgraduate institute in the city of Pune. A team from National Institute of Virology [Pune] investigated outbreak of febrile rash illness in a premier graduate institute and found that it was a case of two parallel outbreaks of chickenpox and measles. In this outbreak chickenpox cases did not present with greater severity but measles cases were severe. The concerned institute hosts more than 800 students and 300 staff including faculty. These outbreaks were contained because of the alert physician in the institute; but it also highlights a need for uniform policies across such educational institutions in the country.
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Huzair F, Sturdy S. Biotechnology and the transformation of vaccine innovation: The case of the hepatitis B vaccines 1968-2000. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2017; 64:11-21. [PMID: 28511068 PMCID: PMC5541201 DOI: 10.1016/j.shpsc.2017.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 05/22/2023]
Abstract
The approval, from 1986, of a series of recombinant hepatitis B vaccines was a landmark both in the growth of biotechnology and in the development of the vaccine innovation system. In this paper, we show how the early development of the hepatitis B vaccines was shaped by a political and economic context that newly favoured commercialisation of academic research, including the appropriation and management of intellectual property; we elucidate the contingent interests and motivations that led new biotechnology companies and established pharmaceutical businesses to invest in developing recombinant vaccines specifically against hepatitis B; and we show how these and other factors combined to make those vaccines an unexpected commercial success. Broadening the scope of our analysis to include not just North America and Europe but also low- and middle-income countries, we show how the development of the hepatitis B vaccines facilitated the emergence of a two-tier innovation system structured by tensions between the demands for commercial profitability on the one hand, and the expectation of public health benefit for low- and middle-income countries on the other.
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Affiliation(s)
- Farah Huzair
- Science, Technology and Innovation Studies, University of Edinburgh, Old Surgeons' Hall, High School Yards, Edinburgh EH1 1LZ, Scotland, UK
| | - Steve Sturdy
- Science, Technology and Innovation Studies, University of Edinburgh, Old Surgeons' Hall, High School Yards, Edinburgh EH1 1LZ, Scotland, UK.
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Kapoor AN, Tharyan P, Kant L, Balraj V, Shemilt I. Combined DTP-HBV vaccine versus separately administered DTP and HBV vaccines for primary prevention of diphtheria, tetanus, pertussis, and hepatitis B. Hippokratia 2017. [DOI: 10.1002/14651858.cd008658.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ambujam N Kapoor
- Public Health Foundation of India; Immunization Technical Support Unit; B-28, Qutab Institutional Area New Delhi New Delhi India 110016
| | - Prathap Tharyan
- Christian Medical College; Cochrane South Asia, Prof. BV Moses Center for Evidence-Informed Health Care and Health Policy; Carman Block II Floor CMC Campus, Bagayam Vellore Tamil Nadu India 632002
| | - Lalit Kant
- Indian Council of Medical Research; Ansari Nagar New Delhi India 110029
| | - Vinohar Balraj
- Christian Medical College; Community Health Department; Vellore Tamil Nadu India 632002
| | - Ian Shemilt
- University College London; EPPI-Centre; 10 Woburn Square London UK WC1H 0NR
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Shrivastwa N, Gillespie BW, Kolenic GE, Lepkowski JM, Boulton ML. Predictors of vaccination in India for children aged 12-36 months. Vaccine 2016; 33 Suppl 4:D99-105. [PMID: 26615176 DOI: 10.1016/j.vaccine.2015.09.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION India has one of the lowest immunization rates worldwide despite a longstanding Universal Immunization Program (UIP) that provides free childhood vaccines. This study characterizes the predictors for under- and non-vaccination among Indian children aged 12-36 months. METHODS This study utilized District Level Household and Facility Survey Data, 2008 (DLHS3), from India. DLHS3 is a nationally representative sample collected from December 2007 through December 2008; this analysis was conducted during 2014. Children's vaccination status was categorized as fully, under-, and non-vaccinated based on whether children received all, some, or none of the UIP-recommended vaccines (one dose each of bacillus Calmette-Guérin and measles, and three doses of diphtheria-pertussis-tetanus). A multinomial logistic regression model estimated the odds of undervaccination compared with full vaccination, and odds of non-vaccination compared with full vaccination. Analytic predictors included socioeconomic, cultural, household, maternal, and childhood characteristics. RESULTS The analysis included 108,057 children; the estimated proportions of fully, under-, and non-vaccinated children were 57%, 31%, and 12%, respectively. After adjusting for state of residence, age, gender, household wealth, and maternal education, additional significant predictors of children's vaccination status were religion, caste, place of delivery, number of antenatal care visits, and maternal tetanus vaccination, all of which demonstrated large effect sizes. CONCLUSIONS India's immunization coverage remained low in 2008, with just slightly more than half of all children aged 12-36 months fully vaccinated with UIP-recommended vaccines. A better understanding of the predictors for vaccination can help shape interventions to reduce disparities in full vaccination among children of differing demographic/cultural groups.
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Affiliation(s)
- Nijika Shrivastwa
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States.
| | - Brenda W Gillespie
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, United States
| | - Giselle E Kolenic
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, United States
| | - James M Lepkowski
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States; Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, United States
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Shrivastwa N, Gillespie BW, Kolenic GE, Lepkowski JM, Boulton ML. Predictors of Vaccination in India for Children Aged 12-36 Months. Am J Prev Med 2015; 49:S435-44. [PMID: 26297449 DOI: 10.1016/j.amepre.2015.05.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/01/2015] [Accepted: 05/12/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION India has one of the lowest immunization rates worldwide despite a longstanding Universal Immunization Program (UIP) that provides free childhood vaccines. This study characterizes the predictors for under- and non-vaccination among Indian children aged 12-36 months. METHODS This study utilized District Level Household and Facility Survey Data, 2008 (DLHS3), from India. DLHS3 is a nationally representative sample collected from December 2007 through December 2008; this analysis was conducted during 2014. Children's vaccination status was categorized as fully, under-, and non-vaccinated based on whether children received all, some, or none of the UIP-recommended vaccines (one dose each of bacillus Calmette-Guérin and measles, and three doses of diphtheria-pertussis-tetanus). A multinomial logistic regression model estimated the odds of under-vaccination compared with full vaccination, and odds of non-vaccination compared with full vaccination. Analytic predictors included socioeconomic, cultural, household, maternal, and childhood characteristics. RESULTS The analysis included 108,057 children; the estimated proportions of fully, under-, and non-vaccinated children were 57%, 31%, and 12%, respectively. After adjusting for state of residence, age, gender, household wealth, and maternal education, additional significant predictors of children's vaccination status were religion, caste, place of delivery, number of antenatal care visits, and maternal tetanus vaccination, all of which demonstrated large effect sizes. CONCLUSIONS India's immunization coverage remained low in 2008, with just slightly more than half of all children aged 12-36 months fully vaccinated with UIP-recommended vaccines. A better understanding of the predictors for vaccination can help shape interventions to reduce disparities in full vaccination among children of differing demographic/cultural groups.
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Affiliation(s)
- Nijika Shrivastwa
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Brenda W Gillespie
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - Giselle E Kolenic
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - James M Lepkowski
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan
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Francis DP, Du YP, Precioso AR. Global vaccine supply. The increasing role of manufacturers from middle income countries. Vaccine 2014; 32:5259-65. [PMID: 25110294 DOI: 10.1016/j.vaccine.2014.07.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/27/2014] [Accepted: 07/18/2014] [Indexed: 10/24/2022]
Abstract
Hallmarks in the remarkable evolution of vaccines and their application include the eradication of smallpox, the development and delivery of the early childhood vaccines and the emergence of recombinant vaccines initiated by the hepatitis B vaccine. Now we enter a most exciting era as vaccines are increasingly produced and delivered in less developed countries. The results are dramatic decreases in childhood morbidity and mortality around the world.
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Affiliation(s)
- Donald P Francis
- Global Solutions for Infectious Diseases, South San Francisco, CA, USA.
| | - Yu-Ping Du
- Vaccine Consultant, Beijing, PR China; Former WHO Medical Officer, EPI, Democratic People's Republic of Korea
| | - Alexander R Precioso
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, Sao Paulo, Brazil
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14
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Synthesizing evidences for policy translation: A public health discourse on rotavirus vaccine in India. Vaccine 2014; 32 Suppl 1:A162-70. [DOI: 10.1016/j.vaccine.2014.03.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Singh PK, Parasuraman S. 'Looking beyond the male-female dichotomy' - sibling composition and child immunization in India, 1992-2006. Soc Sci Med 2014; 107:145-53. [PMID: 24607676 DOI: 10.1016/j.socscimed.2014.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 02/05/2014] [Accepted: 02/07/2014] [Indexed: 11/30/2022]
Abstract
This study examines trends in gender differentials in child immunization beyond the conventional male-female dichotomy, by considering older surviving sibling composition between 1992 and 2006 in India. The present study adopts the World Health Organization (WHO) guidelines for appraising full immunization among children utilising three rounds of the National Family Health Survey. Twelve combinations of sex composition of surviving older siblings were constructed. Bivariate differentials and pooled multilevel logistic regression analysis were conducted to assess the trends and patterns of child immunization with respect to various categories of older surviving sibling composition. Although child immunization increased between 1992 and 2006, majority of all eligible children did not receive the recommended immunization. Further, full immunization significantly varies by twelve categories of siblings composition during 1992-2006. The probability of full immunization among male children who did not have any older surviving sibling was 60% in 2005-06, while it was just 26% among female children who had 1+ older surviving sister and brother. This study emphasizes the need to integrate sibling issues in child immunization as a prioritized component in the ongoing Universal Immunization Programme, which could be an effective step towards ensuring full immunization coverage among Indian children.
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Affiliation(s)
- Prashant Kumar Singh
- Population, Health & Nutrition Research Programme (PHN-RP), Institute for Human Development, NIDM Building, IIPA Campus, IP Estate, Mahatama Gandhi Marg, New Delhi 110 002, India; International Institute for Population Sciences Govandi Station Road, Deonar, Mumbai 400 088, India.
| | - Sulabha Parasuraman
- International Institute for Population Sciences Govandi Station Road, Deonar, Mumbai 400 088, India.
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Singh PK. Trends in child immunization across geographical regions in India: focus on urban-rural and gender differentials. PLoS One 2013. [PMID: 24023816 DOI: 10.1371/journal.pone.0073102.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although child immunization is regarded as a highly cost-effective lifesaver, about fifty percent of the eligible children aged 12-23 months in India are without essential immunization coverage. Despite several programmatic initiatives, urban-rural and gender difference in child immunization pose an intimidating challenge to India's public health agenda. This study assesses the urban-rural and gender difference in child immunization coverage during 1992-2006 across six major geographical regions in India. DATA AND METHODS Three rounds of the National Family Health Survey (NFHS) conducted during 1992-93, 1998-99 and 2005-06 were analyzed. Bivariate analyses, urban-rural and gender inequality ratios, and the multivariate-pooled logistic regression model were applied to examine the trends and patterns of inequalities over time. KEY FINDINGS The analysis of change over one and half decades (1992-2006) shows considerable variations in child immunization coverage across six geographical regions in India. Despite a decline in urban-rural and gender differences over time, children residing in rural areas and girls remained disadvantaged. Moreover, northeast, west and south regions, which had the lowest gender inequality in 1992 observed an increase in gender difference over time. Similarly, urban-rural inequality increased in the west region during 1992-2006. CONCLUSION This study suggests periodic evaluation of the health care system is vital to assess the between and within group difference beyond average improvement. It is essential to integrate strong immunization systems with broad health systems and coordinate with other primary health care delivery programs to augment immunization coverage.
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Singh PK. Trends in child immunization across geographical regions in India: focus on urban-rural and gender differentials. PLoS One 2013; 8:e73102. [PMID: 24023816 PMCID: PMC3762848 DOI: 10.1371/journal.pone.0073102] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 07/17/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although child immunization is regarded as a highly cost-effective lifesaver, about fifty percent of the eligible children aged 12-23 months in India are without essential immunization coverage. Despite several programmatic initiatives, urban-rural and gender difference in child immunization pose an intimidating challenge to India's public health agenda. This study assesses the urban-rural and gender difference in child immunization coverage during 1992-2006 across six major geographical regions in India. DATA AND METHODS Three rounds of the National Family Health Survey (NFHS) conducted during 1992-93, 1998-99 and 2005-06 were analyzed. Bivariate analyses, urban-rural and gender inequality ratios, and the multivariate-pooled logistic regression model were applied to examine the trends and patterns of inequalities over time. KEY FINDINGS The analysis of change over one and half decades (1992-2006) shows considerable variations in child immunization coverage across six geographical regions in India. Despite a decline in urban-rural and gender differences over time, children residing in rural areas and girls remained disadvantaged. Moreover, northeast, west and south regions, which had the lowest gender inequality in 1992 observed an increase in gender difference over time. Similarly, urban-rural inequality increased in the west region during 1992-2006. CONCLUSION This study suggests periodic evaluation of the health care system is vital to assess the between and within group difference beyond average improvement. It is essential to integrate strong immunization systems with broad health systems and coordinate with other primary health care delivery programs to augment immunization coverage.
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Bottomley MJ, Serruto D, Sáfadi MAP, Klugman KP. Future challenges in the elimination of bacterial meningitis. Vaccine 2012; 30 Suppl 2:B78-86. [PMID: 22607903 DOI: 10.1016/j.vaccine.2011.12.099] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 12/19/2011] [Accepted: 12/20/2011] [Indexed: 01/13/2023]
Abstract
Despite the widespread implementation of several effective vaccines over the past few decades, bacterial meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis and Group B Streptococcus (GBS) still results in unacceptably high levels of human mortality and morbidity. A residual disease burden due to bacterial meningitis is also apparent due to a number of persistent or emerging pathogens, including Mycobacterium tuberculosis, Escherichia coli, Staphylococcus aureus, Salmonella spp. and Streptococcus suis. Here, we review the current status of bacterial meningitis caused by these pathogens, highlighting how past and present vaccination programs have attempted to counter these pathogens. We discuss how improved pathogen surveillance, implementation of current vaccines, and development of novel vaccines may be expected to further reduce bacterial meningitis and related diseases in the future.
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Bharati K, Vrati S. Viral Vaccines in India: An Overview. PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES, INDIA. SECTION B 2012; 82:181-198. [PMID: 32226202 PMCID: PMC7100346 DOI: 10.1007/s40011-011-0014-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 11/14/2011] [Indexed: 01/27/2023]
Abstract
Viruses cause a large number of diseases in humans, some of which are fatal, while others are highly debilitating. A majority of viral diseases attack infants and young children, while others strike people in their prime. Development of preventive measures against viral diseases is, therefore, of paramount importance. Vaccination is the most cost-effective medical intervention for preventing mortality and morbidity against infectious diseases. A number of effective and safe vaccines are currently available against several viral diseases of significant medical importance. Many of these manufactured in India, are at par with international standards and are affordable. For many other viral diseases, for which vaccines are currently not available, research is underway at various national laboratories, as well as in the private sector companies in India. The present overview highlights the various vaccine preventable viral diseases that are of special importance to India and aims to provide a glimpse of the various vaccines that are currently available, or are under development in India.
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Affiliation(s)
| | - Sudhanshu Vrati
- Vaccine and Infectious Disease Research Centre, Translational Health Science and Technology Institute, 496, Udyog Vihar Phase III, Gurgaon, 122016 India
- National Institute of Immunology, New Delhi, 110067 India
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21
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Einsiedel EF. Publics and vaccinomics: beyond public understanding of science. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2011; 15:607-14. [PMID: 21732820 DOI: 10.1089/omi.2010.0139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Vaccines have been among the most effective tools for addressing global public health challenges. With the advent of genomics, novel approaches for vaccine discovery are opening up new opportunities for vaccine development and applications, particularly with the expectation of personalized vaccines and the possibility of addressing a broader range of infectious diseases. In this context, it is useful to reflect on the social contexts of vaccine development as these have been influenced by social, ethical, political challenges. This article discusses the historical context of vaccine controversies and factors that help explain public acceptance and resistance, illustrating that these challenges go well beyond simple public misunderstandings. The broader vaccine challenges evident along the innovation trajectory, from development to commercialization and implementation include problems in research and development, organizational issues, and legal and regulatory challenges that may collectively contribute to public resistance or confidence. The recent history of genomics provides further lessons that the developing field of vaccinomics can learn from.
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Affiliation(s)
- Edna F Einsiedel
- Department of Communication and Culture, University of Calgary, Calgary, Alberta, Canada.
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22
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Corsi DJ, Bassani DG, Kumar R, Awasthi S, Jotkar R, Kaur N, Jha P. Gender inequity and age-appropriate immunization coverage in India from 1992 to 2006. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2009; 9 Suppl 1:S3. [PMID: 19828061 PMCID: PMC3226235 DOI: 10.1186/1472-698x-9-s1-s3] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A variety of studies have considered the affects of India's son preference on gender differences in child mortality, sex ratio at birth, and access to health services. Less research has focused on the affects of son preference on gender inequities in immunization coverage and how this may have varied with time, and across regions and with sibling compositions. We present a systematic examination of trends in immunization coverage in India, with a focus on inequities in coverage by gender, birth order, year of birth, and state. METHODS We analyzed data from three consecutive rounds of the Indian National Family Health Survey undertaken between 1992 and 2006. All children below five years of age with complete immunization histories were included in the analysis. Age-appropriate immunization coverage was determined for the following antigens: bacille Calmette-Guérin (BCG), oral polio (OPV), diphtheria, pertussis (whooping cough) and tetanus (DPT), and measles. RESULTS Immunization coverage in India has increased since the early 1990s, but complete, age-appropriate coverage is still under 50% nationally. Girls were found to have significantly lower immunization coverage (p<0.001) than boys for BCG, DPT, and measles across all three surveys. By contrast, improved coverage of OPV suggests a narrowing of the gender differences in recent years. Girls with a surviving older sister were less likely to be immunized compared to boys, and a large proportion of all children were found to be immunized considerably later than recommended. CONCLUSIONS Gender inequities in immunization coverage are prevalent in India. The low immunization coverage, the late immunization trends and the gender differences in coverage identified in our study suggest that risks of child mortality, especially for girls at higher birth orders, need to be addressed both socially and programmatically. ABSTRACT IN HINDI : See the full article online for a translation of this abstract in Hindi.
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Affiliation(s)
- Daniel J Corsi
- Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, ON, M5C 1N8, Canada
- Population Health Research Institute, McMaster University, Hamilton, ON, L8L 2X2, Canada
| | - Diego G Bassani
- Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, ON, M5C 1N8, Canada
| | - Rajesh Kumar
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shally Awasthi
- Department of Pediatrics, King Georges Medical University, Lucknow, Uttar Pradesh, India
| | - Raju Jotkar
- Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, ON, M5C 1N8, Canada
| | - Navkiran Kaur
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabhat Jha
- Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, ON, M5C 1N8, Canada
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Abstract
The vaccines are regarded as a major contribution to the retreat of the infectious diseases at the XX th century: they allowed a demographic rise without precedent in the world, even if there is still an important shift between the countries. A watershed is in the years 1950, with the beginning of the production of vaccines on cellular cultures and the first clinical trials concerning millions of people. It marks the beginning of the diversification of the vaccines and their production with an industrial scale, which makes it possible to consider new strategies and give precise contents to the dreams of eradication which had been expressed as of the Pasteurian time.
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Affiliation(s)
- Anne-Marie Moulin
- CNRS-CEDEJ (Centre d'études et de documentation économiques, juridiques et sociales), 2, Sikkat al-Fadl Qasr al-Nil 11777, BP 392, Muhammad Farid, Le Caire, Egypte.
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