This updated and enlarged Second Edition of a major resource furnishes authoritative and exhaustive coverage of vaccine development from state-of-the-art technologies for creating new and improved vaccines to commercial and regulatory aspects of vaccine production and distribution.
The past 10 years have seen an expanded scientific and commercial interest in the potential of new vaccines. Scientific advances have created new tools for developing vaccines for diseases for which no vaccines exist. The complete genomic sequence of a pathogen provides a catalogue of potential vaccine components. Improved techniques of protein purification and peptide synthesis facilitate the identification, isolation, and engineering of candidate vaccines. Novel adjuvants, formulations, and delivery systems to induce an optimal immune response have been developed. Recombinant-DNA techniques facilitate the construction of live vaccines, live vectors, or nucleic acid vaccines into which a gene coding for the vaccine antigen can be cloned. The vaccine market is also growing rapidly, and by the year 2000 it is estimated that it will reach a sales volume twice or even three times that of the early 1990s. Average annual growth rates of the vaccine business could, in the next few years, be above 10 percent, which will obviously stimulate research and development in academic institutions and commercial pharmaceutical companies.
Infections that are potentially preventable by vaccine remain major causes of morbidity and mortality worldwide. Infections caused 17 million deaths in 1996. Childhood immunizations prevent 3 million deaths every year, but an additional 8 million children could potentially be saved with new and improved vaccines. The spectrum of infectious diseases is expanding, and we have been challenged by many newly identified pathogens and syndromes. Also, the role of microbes as cofactors in chronic disease and disability emphasizes the importance of prevention. Good new vaccines would make a difference in all our lives.
The second edition of New Generation Vaccines introduces applications of molecular immunology and new ways of making vaccines (immunopotentiation, novel adjuvants, live and nonliving antigen delivery systems, and nucleic acid vaccines) in 20 chapters and describes new or improved vaccines in 40 chapters. It presents the various phases of vaccine development, ranging from the computer prediction of T-cell epitopes to the public health effect after implementation. Most of the chapters are balanced and up to date, but since there are 164 contributors, the presentation necessarily varies. The book covers both prevention and therapy as well as vaccines to prevent pregnancy or tumors. There are, however, surprising gaps -- e.g., vaccines against cytomegalovirus, measles, chlamydia, and group B streptococcal infections are not included.
The editors have looked for a compromise between detailed descriptions of individual vaccines and a general overview of the vaccine-development process. This has resulted in relatively short reviews on various topics. Although at first I liked the idea of having an introduction to economic analyses of vaccines or clinical evaluations of candidate vaccines, the chapters describing these seemed tangential to the main subject of the book and tended to be superficial. The same applies to the overviews of the vaccination programs and the commercial and regulatory aspects of vaccine production and distribution. Knowing the long and expensive developmental process of a new vaccine, I would have found interesting a description of the selection process of new candidates for development, including the political, commercial, and ethical implications. I realize, however, that 1215 pages are too few for both a thorough description of new vaccines and an introduction to other aspects of vaccine development. The publisher could expand these chapters and use them as a seed for another book: The Development and Evaluation of New Vaccines.
New Generation Vaccines is a valuable book for those who would like an overview of vaccines in the pipeline. Those who wish to learn about traditional vaccines and those who want detailed information about experiments with candidate vaccines need in most cases to look for other books and original articles. Vaccine researchers will find this book useful as an introduction to areas outside their own field. In general, it contains a lot of up-to-date information for those interested in future trends of infectious-disease prevention.
Progress in vaccinology is rapid. Therefore, future revised editions of this book will certainly be needed. If they are as readable and contain as much new information as the second edition, they will be most welcome. However, I hope that the weight of the book is kept within reasonable limits; future editions should not be expanded.
Reviewed by Juhani Eskola, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
