Parents were scared of the polio epidemics that occurred each summer; they kept their children away from swimming pools, sent them to stay with relatives in the country, and clamored for an understanding of the spread of polio. They waited for a vaccine, closely following vaccine trials and sending dimes to the White House to help the cause. When the polio vaccine was licensed in , the country celebrated, and Jonas Salk, its inventor, became an overnight hero.
In , the measles vaccine was developed, and by the late s, vaccines were also available to protect against mumps and rubella These three vaccines were combined into the MMR vaccine by Dr. Maurice Hilleman in During the s, one vaccine was eliminated. Because of successful eradication efforts, the smallpox vaccine was no longer recommended for use after While vaccine research continued, new vaccines were not introduced during the s.
The vaccine for Haemophilus influenzae type b was licensed in and placed on the recommended schedule in When the schedule was published again in , the hepatitis B vaccine had been added. The hepatitis B vaccine was not new, as it had been licensed in and recommended for high-risk groups such as infants whose mothers were hepatitis B surface antigen positive, healthcare workers, intravenous drug users, homosexual men and people with multiple sexual partners.
However, immunization of these groups didn't effectively stop transmission of hepatitis B virus. The change of recommendation to immunize all infants in was the result of these failed attempts to control hepatitis B by only immunizing high-risk groups. Following this recommendation, hepatitis B disease was virtually eliminated in children less than 18 years of age in the United States. As more vaccines became available, an annual update to the schedule was important because of changes that providers needed to know, such as detailed information about who should receive each vaccine, age s of receipt, number of doses, time between doses, or use of combination vaccines.
Learn more about measles vaccine. Although this goal was not met, widespread use of measles vaccine drastically reduced the disease rates. Following widespread implementation of this recommendation and improvements in first-dose MMR vaccine coverage, reported measles cases declined even more.
Measles was declared eliminated absence of continuous disease transmission for greater than 12 months from the United States in This was thanks to a highly effective vaccination program in the United States, as well as better measles control in the Americas region. To read more about the history of vaccines, see History of Vaccines: Measles Timeline external icon.
Skip directly to site content Skip directly to page options Skip directly to A-Z link. Measles Rubeola. Other things being equal, money could be saved. Though mumps-related mortality was minimal many general practitioners were offering mumps vaccination to parents and import of mumps vaccine was rising. Looking at the numbers admitted to hospital with mumps, and the lengths of stay, the Health Inspectorate had estimated that in these hospital costs had been twice what had been spent on measles vaccine Gezondheidsraad, inventory When the Minister formally requested the Health Council to advise on the desirability of mumps vaccination, it was agreed that the committee looking into rubella would consider mumps too.
When it met for the first time in April it appeared that one of the arguments for considering mumps vaccination had lost some of its force. The number of doses imported annually had fallen for two years in succession.
Nor was the seriousness of the condition a major concern, since prevailing medical opinion was still that serious complications were rare. The duration of protection provided and the consequent risk of enhanced virus circulation among older age groups remained a source of uncertainty. Available data were inadequate for mathematical modelling to be of much value. One referred to practice elsewhere. Dutch experts were impressed by data from the USA showing an enormous fall in the number of reported cases of mumps.
At the same time it was increasingly accepted that Dutch vaccination practice should be harmonised with those of other European countries. The second important argument related to costs and benefits. By September , the broad lines of the recommendations were becoming clear. All children should be vaccinated against mumps at the age of 14 months. A second shot should follow later. This would help deal with the risk of immunity declining over time, but it also reflected what by now was becoming the virtual certainty that the Netherlands would switch to a combined MMR vaccine.
Since vaccinating boys only was incompatible with use of the combined vaccine, that would have to be given to all children, arguments were needed for vaccinating girls too. A second was that vaccinating only half the children would insufficiently reduce virus circulation, so that passive protection of the non-immunised would be limited. Whilst these discussions were ongoing, the Ministry of Health requested RIV to consider what the options would be, were the Health Council to advise in favour of mumps vaccination.
Acknowledging that this was likely, and that it had no expertise in the mumps field, in the RIV had begun considering the options. The initial intention was to produce a mumps vaccine which could then be mixed with their existing measles and rubella vaccines. A mumps strain would have to be obtained from a commercial manufacturer. Given doubts that had been raised regarding the safety of Urabe, the preference was for the Jeryl Lynn strain.
Anticipating the forthcoming change in the immunisation programme, RIV that in was reorganised as RIVM , continued negotiations with this and two other manufacturers regarding production of MMR under licence. Financial considerations weighed heavily, both with the Health Council and with the Ministry of Health.
The new arrangements would take effect in January MMR vaccine would be given to all children at the ages of 14 months and 9 years. The first claim that we wished to substantiate was that in course of a decision-making process the significance attached to different forms of evidence may change, as a result of changes in the context in which decision-making takes place.
The decision-making process that resulted in the addition of MMR vaccine to the Dutch national immunisation programme in can be said to have started in Since immunisation of all children against measles, and 11 year old girls against rubella had already much reduced the incidence of these diseases, and since mumps was viewed as clinically unimportant, there were scant epidemiological grounds for changing the programme.
The RIV, an important participant in vaccine policy discussions, had devoted years of effort to developing and producing the vaccines against both measles and rubella then in use. Having seen mumps as unimportant it had not invested in development of a mumps vaccine, and had no institutional interest in pressing for mumps vaccination. A series of shifts in both the internal and the external contexts of decision-making then began to undermine this status quo. First, opinion internationally was converging on the view that the purpose of vaccination against rubella should no longer be protection of individual women before they reached childbearing age, but rather reduction of virus circulation in the population as a whole.
Reflecting this change of view other European countries, including the UK, were starting to vaccinate all children against rubella, and Dutch experts showed growing interest in their experiences. The increasingly international orientation led to the introduction of a new form of evidence in Dutch policy deliberation. Simulation modelling suggested that circulation of rubella virus could best be brought about by vaccinating all children.
Maintaining public trust was becoming an important consideration, and one committee member argued that this meant that the vaccine generally perceived as better had to be adopted, if data were ambiguous. When discussion of the desirability of immunising against mumps began, first in the CBI and then, responding to a formal request from the Minister, in the rubella and then also mumps sub-committee, various kinds of evidence were introduced.
They included the epidemiology of the disease its minimal fatality and limited serious sequelae , but also practice in other European countries, as well as economic considerations.
As discussion proceeded, and the implications of the various kinds of evidence debated, economic and international considerations became increasingly important. Rough calculations suggested that the costs of vaccinating against mumps would be more than outweighed by savings in medical care provided to affected children. The significance of practice elsewhere was changing: in Dobrow et al.
Whereas previously practice in other countries e. The formal structure within which expert advice to the Minister was prepared did not change between the late s and the late s. Nevertheless, the suggestion that European vaccination schedules were likely to be standardized can be seen as a pre-emptive shift both in the context and in the evidence deemed appropriate for decision-making in a member state of what would soon become the European Union.
Moreover, within the stable advisory structure subtle changes were taking place. It seems that the expertise in vaccine development and production RIVM representatives brought with them carried less and less weight in discussions.
Internationally, political commitment to domestic vaccine production, where it existed, was declining in the s. In a number of countries, including Australia and Sweden, it was decided that vaccine production should no longer be a task for the public sector.
Changes in the context of immunisation policymaking, and in the weighing of different forms of evidence, occurred in tandem. But in this particular area of health policy at least, there is a direction to the changes taking place.
Our second claim was that changes over time entailed a growing reliance on international rather than national data, and that this had important consequences for national scientific competences.
In the Dutch Minister of Health justified his decision to introduce MMR to the national vaccination programme by reference to studies conducted elsewhere, and despite the lack of cost-effectiveness studies carried out in the Netherlands itself. This statement points to more than the overriding importance that economic evidence had now acquired. It hints also at a shift in the relative weight coming to be attached to national as against international data. For the RIVM, with responsibilities for public health surveillance and so for the production of national epidemiological data and for vaccine production, the consequences were profound.
How was this to be accomplished? We could only do it by producing the threefold vaccine under license from one of the companies. I negotiated with the Belgians, and the French, and with Merck and we ultimately chose for Merck. Though moves toward European integration taking place in the s certainly influenced the course of decision-making in the Netherlands, more general forces were, and are, at play. A recent study found health policymakers in five very different countries agreeing that policy options based on national research were no match for policies based on international research and promoted internationally.
Policymakers in this study came from five countries in which the implementation of new programmes depended on financial support from international donors. Yet in the case of vaccine introduction, at least, something similar seems to be true for richer countries too. We also thank the Netherlands Vaccine Institute for permission to make use of their archives.
National Center for Biotechnology Information , U. Sponsored Document from. Soc Sci Med. Author information Copyright and License information Disclaimer. Stuart Blume: ln. This document may be redistributed and reused, subject to certain conditions.
This article has been cited by other articles in PMC. Abstract Based on a case-study of the introduction of measles-mumps-rubella MMR vaccine in the Netherlands two decades ago, using documentary and archival sources, this paper examines the way evidence is used in policymaking.
Introduction In the last few years the claim that health policy, like medical practice, should be evidence based has attracted widespread support e.
Method and analytical framework Most published studies of vaccine introduction, focusing on decisions recently taken or in course of being taken, rely principally on interviews with policymakers. Background: three diseases and three vaccines In the s scientists set about developing vaccines against measles, mumps and rubella.
Case study: vaccination against measles mumps and rubella in the Netherlands Ever since the establishment of the Dutch national immunisation programme RVP , in , the State Institute of Public Health Rijksinstituut voor Volksgezondheid or RIV — from RIVM had responsibilities not only for surveillance of public health but also for providing the vaccines the immunisation programme required.
Rubella and measles: commitments and controversies Vaccination against rubella and measles, which began in the Netherlands in and respectively, followed a decade of work by the RIV. Introduction of MMR In the Netherlands, as elsewhere, in the s and s mumps was seen as a minor disease of childhood. Discussion: evidence in context The first claim that we wished to substantiate was that in course of a decision-making process the significance attached to different forms of evidence may change, as a result of changes in the context in which decision-making takes place.
References Behague D. Evidence-based policy-making: the implications of globally-applicable research for context-specific problem-solving in developing countries. Blume S. Lock in, the state and vaccine development: lessons from the history of the polio vaccines. Research Policy. Varicella vaccine program for Year 7 secondary school students or age equivalent in the community ceased 31 December. The program started 22 January and ends 31 December April Influenza vaccine funded by the Victorian government for all infants and children aged from 6 months to less than five years.
One or two doses of vaccine available for all adults born during or since and aged from 20 years without evidence of two documented doses of valid MMR vaccine or without serological evidence of immunity. Ceased 31 December Extended to 30 June Extended to 31 October Ceased 30 June Ceased 31 October In this topic.
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