THE CONCEPT OF IMMUNIZATION

immunization is a global health and development success story, saving millions of

lives every year. Vaccines reduce risks of getting a disease by working with your
body’s natural defences to build protection. When you get a vaccine, your immune
system responds.

We now have vaccines to prevent more than 20 life-threatening diseases, helping

people of all ages live longer, healthier lives. Immunization currently prevents 2-3
million deaths every year from diseases like diphtheria, tetanus, pertussis, influenza
and measles.

Immunization is a key component of primary health care and an indisputable human

right. It’s also one of the best health investments money can buy. Vaccines are also
critical to the prevention and control of infectious-disease outbreaks. They underpin
global health security and will be a vital tool in the battle against antimicrobial
resistance.

Yet despite tremendous progress, far too many people around the world – including
nearly 20 million infants each year – have insufficient access to vaccines. In some
countries, progress has stalled or even reversed, and there is a real risk that
complacency will undermine past achievements.

Global vaccination coverage – the proportion of the world’s children who receive
recommended vaccines – has remained the same over the past few years.

History of immunization
The story of vaccines did not begin with the first vaccine–Edward Jenner’s use
of material from cowpox pustules to provide protection against smallpox.
Rather, it begins with the long history of infectious disease in humans, and in
particular, with early uses of smallpox material to provide immunity to that
disease.
Evidence exists that the Chinese employed smallpox inoculation (or variolation,
as such use of smallpox material was called) as early as 1000 CE. It was
practiced in Africa and Turkey as well, before it spread to Europe and the
Americas.
Edward Jenner’s innovations, begun with his successful 1796 use of cowpox
material to create immunity to smallpox, quickly made the practice
widespread. His method underwent medical and technological changes over
the next 200 years, and eventually resulted in the eradication of smallpox.
Louis Pasteur’s 1885 rabies vaccine was the next to make an impact on human
disease. And then, at the dawn of bacteriology, developments rapidly followed.
Antitoxins and vaccines against diphtheria, tetanus, anthrax, cholera, plague,
typhoid, tuberculosis, and more were developed through the 1930s.
The middle of the 20th century was an active time for vaccine research and
development. Methods for growing viruses in the laboratory led to rapid
discoveries and innovations, including the creation of vaccines for polio.
Researchers targeted other common childhood diseases such as measles,
mumps, and rubella, and vaccines for these diseases reduced the disease
burden greatly.
Innovative techniques now drive vaccine research, with recombinant DNA
technology and new delivery techniques leading scientists in new directions.
Disease targets have expanded, and some vaccine research is beginning to
focus on non-infectious conditions such as addiction and allergies.
More than the science behind vaccines, these timelines cover cultural aspects
of vaccination as well, from the early harassment of smallpox variolators (see
the intimidation of a prominent minister described in the 1721 Boston
Smallpox Epidemic entry) to the establishment of vaccination mandates, to the
effect of war and social unrest on vaccine-preventable diseases. Edward
Jenner, Louis Pasteur, and Maurice Hilleman, pioneers in vaccine development
receive particular attention as well.

This timeline category holds nearly all of the entries for the subject-specific
timelines. A few of the entries have been left out in order to provide a broad
overview.
Types of vaccines
There are many approaches to vaccine development, but vaccines can be
broadly classified by how the antigen(s), the active component(s) that generate a
specific immune response against the disease-causing organism, are prepared.
Vaccines may be viral (live or inactivated), viral vector, subunit (protein or
polysaccharide) or nucleic acid (DNA or RNA). Combination vaccines may
include inactivated, protein-based and/or protein-conjugated polysaccharide
vaccine components. Other ingredients in vaccines vary depending on the
manufacturing process and the nature of the antigen(s).
There has been an increased focus on vaccine development using the viral-
vector and nucleic-acid based platforms since the appearance of the SARS-
CoV-2 virus and COVID-19 disease in late 2019.

Classification of vaccines
Live attenuated vaccines
The virus or bacteria is functional/alive but has been weakened so it can
replicate in the body several times and generate an immune response without
causing the disease, e.g. chickenpox, measles, mumps and rubella, rotavirus,
and shingles vaccine viruses. The BCG vaccine contains live weakened
tuberculosis bacteria.
After immunisation, the weakened vaccine viruses or bacteria replicate (grow)
in the vaccinated person. This means a relatively small dose of virus or bacteria
can be given in order to stimulate an immune response.
Live attenuated vaccines do not usually cause disease in vaccine recipients who
have a healthy immune system. If a live attenuated vaccine does cause disease,
e.g. chickenpox disease from the vaccine virus, it is usually more mild than
disease caught from another person in the community.
If administered to a person who has an impaired immune system response, e.g.
they have leukaemia or HIV infection, or are taking immunosuppressing
medications, administration of a live attenuated vaccine may cause severe
disease as a result of uncontrolled replication (growth) of the vaccine virus.

Inactivated or dead vaccines

Inactivated vaccines do not contain live viruses or bacteria. Viruses in these
vaccines are inactivated or split, e.g. polio or influenza vaccines in New
Zealand, and bacteria killed. New Zealand does not have a killed bacteria
vaccine on the Immunisation Schedule, but a travel-related vaccine is available
for purchase. They cannot cause the disease but the inclusion of adjuvants
(immune enhancers) in the vaccine help generate an immune response.
These types of vaccine can be safely given to a person with an impaired
immune system response. However, a person with an impaired immune system
response may not develop the same amount of protection after immunisation as
a healthy person receiving the vaccine.
Inactivated vaccines usually require multiple doses. Some inactivated vaccines
may also require periodic supplemental doses to increase, or ‘boost’ protection
against disease.
Hepatitis A, influenza and polio vaccines are inactivated virus vaccines on the
New Zealand Immunisation Schedule.

Subunit vaccines
These vaccines present proteins or sugars derived from the disease-causing
organism.

Protein vaccines
Protein vaccines may include fragments extracted from a virus or bacteria such
as inactivated bacterial toxoid proteins, e.g. tetanus and diphtheria vaccines, or
be engineered without the disease-causing organism, e.g. virus-like particles in
hepatitis B and human papillomavirus (HPV) vaccines.
Protein vaccines may also include bacterial sugar/carbohydrate (polysaccharide)
molecules that are joined (conjugated) to proteins, e.g. Haemophilus
influenzae type b (Hib), meningococcal and pneumococcal conjugate vaccines.
The immune system of infants and young children is not able to generate a
useful immune response to the sugar molecules on these bacteria, which is one
reason why their risk of disease and complications is so high. Joining
(conjugating) each sugar molecule to a protein helps their immune system can
generate a protective immune response. These vaccines also generate an
excellent immune response in adults. Protein vaccines cannot cause the disease
and the inclusion of adjuvants in some vaccines help generate an immune
response.

Pure polysaccharide vaccines

Some vaccines only include sugar/carbohydrate (polysaccharide) molecules
found on the outside of some bacteria, e.g. some vaccines to protect against
pneumococcal or typhoid disease. This type of vaccine can generate a
protective immune response in older children and adults and cannot cause the
disease.

Nucleic acid-based vaccines

At present, different types of nucleic-acid vaccines are in developmental, pre-
clinical and clinical evaluation phases, e.g. for prevention of human
immunodeficiency virus (HIV), influenza and malaria diseases and treat some
cancers. This vaccine platform is also being used to develop vaccines to prevent
COVID-19 disease.
Nucleic acid-based vaccines use the hosts own cell machinery to make the
antigen, which is then presented to the immune system. While RNA is
encapsulated into lipid nanoparticle and injected, DNA is fired directly in the
host cells using a brief electrical pulse.

Targeted disease and vaccine application

Vaccines train your immune system to create antibodies, just as it does
when it’s exposed to a disease. However, because vaccines contain
only killed or weakened forms of germs like viruses or bacteria, they do
not cause the disease or put you at risk of its complications.

Vaccines protect against many different diseases, including:

 Cervical cancer  Pneumonia

 Cholera  Polio
 Diphtheria  Rabies
 Hepatitis B  Rotavirus
 Influenza  Rubella
 Japanese encephalitis  Tetanus
 Measles  Typhoid
 Meningitis  Varicella
 Mumps  Yellow
 Pertussis fever
Some other vaccines are currently under development or being piloted,
including those that protect against Ebola or malaria, but are not yet
widely available globally.

Benefits of immunization
An overwhelming majority of health professionals, medical researchers,
and professional medical organizations (such as the American Academy
of Pediatrics and the American Academy of Family Practice Physicians)
recommend immunization. Getting immunized is important for at least
two reasons: to protect yourself and to protect those around you.
Vaccines are the best way we have to prevent infectious disease. A
successful immunization program depends on the cooperation of every
person.
 Vaccinations prevent you or your child from getting diseases for
which there are often no medical treatments. These illnesses can
result in serious complications and even death.
 A small number of people may be susceptible to diseases, such as
those with impaired immune systems. These people may not be able
to get vaccinations or may not develop immunity even after having
been vaccinated. Their only protection against certain diseases is for
others to get vaccinated so the illnesses are less common.
 Getting immunized costs less than getting treated for the diseases
that the shots protect you from.
 If exposure to a disease occurs in a community, there is little to no
risk of an epidemic if people have been immunized.
Improved sanitation, hygiene, and other living conditions have created a
generally healthier environment and reduced the risks for disease
exposure and infection in the United States. But the dramatic and long-
term decrease of diseases is primarily a result of widespread
immunizations throughout the U.S. population.
 Even though some diseases, such as polio, rarely affect people in the
U.S., all of the recommended childhood immunizations and booster
vaccines are still needed. These diseases still exist in other countries.
Travelers can unknowingly bring these diseases into the U.S. and infect
people who have not been immunized. Without the protection from
immunizations, these diseases could be imported and could quickly
spread through the population, causing epidemics. Nonimmunized
people living in healthy conditions are not protected from disease. Your
body's immune system can fight a disease better and faster if you have
had the infection before or if you get immunized.

Vaccine Side Effects

Most people don’t have any serious side effects from vaccines. The most
common side effects—like soreness where the shot was given—are usually mild
and go away quickly on their own.

What are common side effects of vaccines?

The most common side effects after vaccination are mild. They include:

 Pain, swelling, or redness where the shot was given

 Mild fever

 Chills

 Feeling tired

 Headache

 Muscle and joint aches

Fainting can also happen after any medical procedure, including vaccinations.

Keep in mind that most common side effects are a sign that your body is
starting to build immunity (protection) against a disease.
 serious side effects?
Serious side effects from vaccines are extremely rare. For example, if 1 million
doses of a vaccine are given, 1 to 2 people may have a severe allergic reaction.

Signs of a severe allergic reaction can include:

 Difficulty breathing

 Swelling of your face and throat

 A fast heartbeat

 A bad rash all over your body

 Dizziness and weakness

References
1. World Health Organization. “Vaccines and Immunization.” Www.who.int, 2020,

www.who.int/health-topics/vaccines-and-immunization#tab=tab_1.

2. The Immunisation Advisory Centre. “Types of Vaccines.” Immunisation Advisory

Centre, 27 Mar. 2017, www.immune.org.nz/vaccines/vaccine-development/types-

vaccines.

3. “Importance of Immunizations | Michigan Medicine.” Www.uofmhealth.org, 31 Aug.

2020, www.uofmhealth.org/health-library/hw255342.

4. The College of Physicians of Philadelphia. “Timeline | History of Vaccines.”

Historyofvaccines.org, 2019, www.historyofvaccines.org/timeline/all.

5. Policy (OIDP), Office of Infectious Disease and HIV/AIDS. “Vaccine Side Effects.”

HHS.gov, 26 Apr. 2021, www.hhs.gov/immunization/basics/safety/side-

effects/index.html.