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The creator of several vaccines given to children around the world everyday, Maurice Hilleman, advised that at the same time that new vaccines would emerge in the 21st century due to technological advances, unfounded criticisms of vaccines would extended beyond spurious belief systems to actual anti-vaccine movements. He pointed out that these movements are aimed at disruption of vaccine programmes through use of public media including the press, television and the Internet in his response to the spurious association between autism and Crohn's disease with one of his main creations, MMR vaccine (1). Andrew Wakefield, author of an unsound scientific paper in 1998 proposing such association, was motivated by an undue agreement to support a lawsuit (2). Nevertheless, Wakefield remains as an outstanding voice in the anti-vaccine movement (3).

Why the once feared diseases disappeared from collective memory? On the other hand, adverse events following immunization that we used to bear as a fair risk for the expected benefit are not accepted anymore? Why we have forgotten the benefits, but not forgiven the risks? How could we define new strategies to face the challenges of immunization programmes?

The 1976 swine flu immunization programme in United States was a landmark on the questioning of risk-benefit ratio for vaccines. The concern on a new pandemic flu after triggered a large mass vaccination campaign. Pandemic flu cases did not appear, but serious adverse events did raise questions on public opinion (4). This contrasted with most of the vaccines where decreasing incidence of a preventable diseases compared with safety concerns seems to be acceptable for the society. On the other hand, efficacious vaccines, like whole-cell pertussis vaccine (wP), have been also on the spot due to relevant adverse events after immunization...

Ricardo Palacios, Instituto Butantan, São Paulo, Brazil

Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, SP, Brazil.
School of Philosophy, Literature and Human Sciences, Universidade de São Paulo, São Paulo, SP, Brazil.


Palacios, R. (2018). Forgotten, but not forgiven: facing immunization challenges in the 21st century. Colombia Medica, 49(3), 189–192.

Hilleman MR. Current overview of the pathogenesis and prophylaxis of measles with focus on practical implications. Vaccine. 2001;20(5-6):651-665.

Deer B. How the case against the MMR vaccine was fixed. BMJ. 2011;342:c5347-c5347.

Bennato D. The shift from public science communication to public relations The Vaxxed case. JCOM. 2017;16(02):C02_en-C02_en.

Sencer DJ, Millar JD. Reflections on the 1976 swine flu vaccination program. Emerg Infect Dis. 2006;12(1):29-33. [PMC free article]

Gangarosa EJ, Galazka AM, Wolfe CR, Phillips LM, Gangarosa RE, Miller E. Impact of anti-vaccine movements on pertussis control the untold story. Lancet. 1998;351(9099):356-361.

Chen RT, Rastogi SC, Mullen JR, Hayes SW, Cochi SL, Donlon JA. The vaccine adverse event reporting system (VAERS) Vaccine. 1994;12(6):542-550.

World Health Organization . Vaccine safety basics - E-course learning manual. WHO; Geneva: 2013. [ 09 September 2018]. Available at

Guerra FM, Bolotin S, Lim G, Heffernan J, Deeks SL, Li Y, Crowcroft NS. The basic reproduction number (R0) of measles a systematic review. Lancet Infect Dis. 2017;17(12):e420-e428. doi: 10.1016/S1473-3099(17)30307-9.

Zipprich J, Winter K, Hacker J, Xia D, Watt J, Harriman K. Measles Outbreak - California, December 2014-February 2015. MMWR Morb Mortal Wkly Rep. 2015;64(6):153-154.

Phadke VK, Bednarczyk RA, Salmon DA, Omer SB. Association between vaccine refusal and vaccine-preventable diseases in the United States: a review of measles and pertussis. JAMA. 2016;315(11):1149-1158.

Meissner HC, Farizo K, Pratt D, Pickering LK, Cohn AC. Understanding FDA-Approved Labeling and CDC Recommendations for Use of Vaccines. Pediatrics. 2018;142(3):e20180780.

Greenfield PM. Social change, cultural evolution, and human development. Curr Opin Psychol. 2016;8:84-92.

Larson HJ, Smith DM, Paterson P, Cumming M, Eckersberger E, Freifeld CC. Measuring vaccine confidence analysis of data obtained by a media surveillance system used to analyse public concerns about vaccines. Lancet Infect Dis. 2013;13(7):606-613.

Schulz PJ, Nakamoto K. Health literacy and patient empowerment in health communication the importance of separating conjoined twins. Patient Educ Couns. 2013;90(1):4-11.

Philip RK, Shapiro M, Paterson P, Glismann S, Van Damme P. Is it time for vaccination to "go viral" Pediatr Infect Dis J. 2016;35(12):1343-1349.

World Health Organization. Health and Welfare Canada. Canadian Public Health Association . The Ottawa charter for health promotion. Ottawa, Canada: WHO; 1986.


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