New Decade of Vaccines 4 The future of immunisation policy, implementation, and fi nancing

Vaccines have already saved many lives and they have the potential to save many more as increasingly elaborate technologies deliver new and eff ective vaccines against both infectious diseases—for which there are currently no eff ective licensed vaccines—such as malaria, tuberculosis, and HIV and non-infectious diseases such as hypertension and diabetes. However, these new vaccines are likely to be more complex and expensive than those that have been used so eff ectively in the past, and they could have a multifaceted eff ect on the disease that they are designed to prevent, as has already been seen with pneumococcal conjugate vaccines. Deciding which new vaccines a country should invest in requires not only sound advice from international organisations such as WHO but also a well informed national immunisation advisory committee with access to appropriate data for local disease burden. Introduction of vaccines might need modifi cation of immunisation schedules and delivery procedures. Novel methods are needed to fi nance the increasing number of new vaccines that have the potential to save lives in countries that are too poor to aff ord them. Here, we discuss some options.