The Vaccine Crossroads

Hundreds of college students each year catch meningococcal disease, an illness that preys particularly on young people in close living conditions. Meningococcal disease is rare, but for those infected, it can be highly dangerous, turning from flu-like symptoms to impaired circulation, failing organs, loss of extremities, and death within 24 hours. About 1 in 10 people with the disease die, and those who survive it may suffer severe complications, such as limb loss and brain damage. Often, however, meningococcal disease never has to happen: A $75, single-shot vaccine protects against four of the five serotypes of meningococcal bacteria. Why then, with such a simple intervention available, are so few students getting immunized?

It's a question that could easily be asked about many vaccines that protect adults from diseases. American adults are 100 times more likely than their children to die of vaccine-preventable illnesses, which, in adults, include influenza, pneumococcal pneumonia, and hepatitis B. Relatively inexpensive, effective vaccines are available for all of these diseases.

“There are a lot of missed opportunities. Doctors don't think to ask, and patients don't know they need vaccination, or they fear the side effects,” said Richard K. Zimmerman, MD, MPH, a family practitioner at the University of Pittsburgh and chair of the adult working group of the Advisory Committee on Immunization Practices, which publishes an annual list of recommended adult immunizations.

But the situation may be changing. A range of factors is bringing vaccines to the forefront of public health and politics for the first time in decades. In particular, fear of bioterrorism has caused people to consider the possibility of vaccination against smallpox and anthrax. During the past few years, the nation has faced unprecedented vaccine shortages—including routine pediatric vaccines such as measles–mumps–rubella (MMR) and diphtheria–tetanus–pertussis (DTaP) vaccines, varicella and pneumococcal conjugate vaccines, and …