The end of the beginning: Vaccines for the next 25 years

The first virus vaccines against smallpox and rabies proved their effectiveness even before the ultra microscopic viruses had been identified as a new world of infectious agents. To date most antibacterial and antiviral vaccines have not been designed but rather built step by step. Designer vaccines with T cell epitopes and adjuvants which stimulate innate or acquired immune responses to will are now under serious investigation but have yet to impact on the practical world of infection. The latter is not small, with millions of deaths annually in the world from not uncommon microbes such as enterforms, pneumococci, respiratory and hepatitis viruses and HIV. But can vaccines be used in more social directions to control birth or prevent addiction?Polio should join smallpox this year in the pantheon of eradicated viruses. The infectious disease community can then turn attention to hepatitis B. War has been declared on pandemic influenza but with this zoonotic virus containment is key, with vaccines used alongside antivirals and social distancing. Undoubtedly “we have the guns, and now we can finish the job”.