Reflections on US Immunization Challenges: Lady Montague, Where Are You?

Abstract

Dickens' oft-quoted words describe well the opportunities and challenges of US immunization programs: “… the best of times… the worst of times … the age of wisdom … the age of foolishness … .”1 Vaccine-preventable disease rates are low, and immunization rates are high, but the broad societal consensus that supported the US immunization program has eroded.2 Our new understanding of immunology, along with new technologies, has launched a renaissance in vaccine research that holds real promise of preventing more infections and their sequelae, but not all US children are yet ensured timely access to all recommended vaccines. The transfer of most immunization from public clinics to physicians' offices has resulted in the cross-subsidy of public health by primary care, which, because of the economics of vaccine administration, is unsustainable. In the world of adult medicine, the gap between what we have and what we could achieve if we fully used the vaccines now in hand is even greater. As a nation, we talk of the value of prevention, of reining in health care costs, but we fail to walk the talk. We seem to have lost sight of the interface between public health and the individual health of all the members of our communities.3 Today there … Address correspondence to Edgar K. Marcuse, MD, MPH, Seattle Children's, 4800 Sand Point Way NE, T-0111, Seattle, WA 98105. E-mail: edgar.marcuse{at}seattlechildrens.org