In the past thirty years we have seen dramatic advances in vaccine technology and development that have yielded vaccines to protect against the pneumococcus, Hib, rotavirus, HPV, and meningococcal disease amongst others.1,2,3,4 We have also seen a paradigm shift in the availability of these vaccines in the developing world through the efforts of the Gavi alliance and WHO.5 In addition, new vaccines are being developed to target diseases whose primary impact is in developing countries such as the malaria6 and meningococcal A vaccines7. These changes in technology and the distribution of vaccines have saved many lives and have the potential to save millions more if widespread vaccine use is sustained. Unfortunately, vaccines safety scares and loss of public and political confidence in vaccines and vaccination programs have the potential to negate these public health gains. As we have seen with the polio eradication program in Africa and Asia, bogus vaccine safety concerns and loss of public confidence in the polio vaccination program, whatever the scientific reality, can derail successful programs.8 Similarly, unfounded vaccine safety concerns regarding the hepatitis B vaccine in France have led to low hepatitis B vaccination rates and persistent disease there.9

Thus, for vaccines to reach their full public health potential, it is critical not only that the vaccine be effective and that an appropriate delivery system exist, but there must also be public confidence in the vaccination program and the safety of the vaccines so that the vaccines are accepted by the public and actually utilized.