Prioritisation of routine vaccines: a mistake for the USA

Frequency of disease is at a record low1 and vaccination coverage at record highs.2 During the past 2 years, an unprecedented number of new, and more expensive, vaccines were recommended for universal use, including: meningococcal conjugate vaccine; tetanus, diphtheria, and acellular pertussis vaccine for adolescents; hepatitis A vaccine; rotavirus vaccine; and human papillomavirus vaccine. The USA fosters the development of new vaccines through: consistent support from paediatricians, family physicians, public-health officials, and parents for the use of vaccines to prevent infectious diseases; private insurance that generally supports higher prices for new vaccines; the Vaccines for Children programme, which guarantees purchase of almost half the vaccines in the USA; and school immunisation requirements that help to weave vaccination into the fabric of society.5 A favourable forum for vaccine development is only part of the story.