In the past, the time between the development of a new public health tool and its widespread use was often extremely long. For example, the tetanus toxoid vaccine, developed in 1926 and used to protect soldiers during World War II, was not widely administered to children in industrialized countries until the 1940s and 1950s, and did not reach high levels of coverage in developing countries until the mid-1980s, a 60-year interval.

Today, this gap is narrowing. After the hepatitis B vaccine was licensed in 1981, universal infant hepatitis B vaccination projects were initiated in many countries, including five U.S.-affiliated Pacific islands where HBV infection is highly endemic and HBV-induced chronic liver disease is a leading cause of death. After a decade of successful demonstration projects, routine childhood hepatitis B vaccination was recommended by the World Health Assembly for all countries. During the 1990s, more than 100 countries (including the United States) implemented hepatitis B immunization programs, although lack of financing hindered vaccine use in the poorest countries. In 2000, financial assistance for the purchase of hepatitis B vaccine became available through The Vaccine Fund, and the Global Alliance for Vaccines and Immunization (GAVI) targeted hepatitis B vaccine for universal introduction into developing countries by 2007.

The history of the hepatitis B vaccine provides a good example of how the gap in time between introduction and widespread use of a new public health tool can be shortened through strategic planning, a rapid sequence of efficacy studies and demonstration projects, active advocacy and funding. As future vaccines and other public health innovations are developed, it should be possible to narrow the gap further. CDC can play an important role in this area.

 

A man being immunized against hepatitis B virus. Expanded use of the hepatitis B vaccine will decrease mortality from cirrhosis, liver failure, and hepatocellular carcinoma, which is the 4th leading cause of cancer death worldwide. Adapted from: Centers for Disease Control and Prevention. Preventing emerging infectious diseases: Addressing the issue of vaccine development and use. Atlanta, GA: U.S. Department of Health and Human Services, 2001.