https://orcid.org/0000-0002-7072-2995
Vaccines and Immunizations is a textbook that introduces medical theories while addressing practical vaccination needs. Published by People’s Medical Publishing House in September 2020 and listed among China’s “Reform and Innovation exemplary textbooks,” it is coauthored by 40 renowned scholars from 23 leading universities and organizations in China, with Professor Chuanxi Fu as the editor-in-chief. Professor Fu has contributed to the compilation of many instructions on vaccine technologies in China and worked extensively with leading international institutions such as the World Health Organization (WHO). The motive of the writers is to fill the absence of readily available textbooks on vaccination in China. “Currently, education on vaccines in China is fragmented, with only vaccination practitioners having access to related training, while Chinese universities do not offer systematic curriculums, and there is not even any standard instructional material on vaccinology, which underlines the importance of closing the gap with a textbook for college students in the country,” as explained by Professor Fu. Dr. Nanshan Zhong, a highly respected epidemiologist, academician of the Chinese Academy of Engineering, recipient of the Medal of the Republic and an honored Exemplary Educator in China, has written a preface for the book, giving his recognition for the value of this work.
Vaccines serve as a barrier between human bodies and infectious diseases. They interrupt the transmission of epidemics and help prevent against public health risks. Since the twentieth century, vaccines have helped eradicate smallpox from human history and put a variety of dreaded diseases under effective control, including poliomyelitis (Type 2 and Type 3 wild poliovirus have already been eliminated), Diphtheria, Hepatitis B, tetanus, pertussis, measles, mumps, rubella and rabies. Each year, about 2.5 million children lives around the world are saved by vaccines. Today, there are more than 70 types of vaccines available to help protect people against diseases. In view of the critical role of vaccines in saving lives, China has raised the standards on vaccination and inoculation under the “Healthy China 2030” initiative, and required medical practitioners to build up expertise in vaccinology and offer practical and targeted advice for people at high risk or with pressing needs; public health practitioners are also asked to understand basic vaccinology theories and acquire the necessary practical skills, in order to improve their vaccination practice and the management of related resources and processes. Answering the country’s call for improving education on vaccines, this textbook not only informs its readers on the wide range of vaccines already available but also updates them on the most recent progress in the development of new vaccines. Meanwhile, it systematically introduces how vaccination and inoculation are to be carried out and managed under China’s latest laws, regulations and standards. It is hoped that the book, plainly written and reader-friendly, will offer useful theoretical guidance to university students, vaccination practitioners and researchers alike.
In the first chapter, Professor Chuanxi Fu provides a brief introduction to the history of vaccines and some core concepts related to them. Of particular note, he reviews the development of vaccines in China and indicates that China is the first country in the world to try smallpox inoculation through artificial immunity, which can be proved by the ancient Chinese literatures he cites. The famous French thinker and philosopher Voltaire said in his Lettres Sur Les Anglais – On Inoculation (Letter XI): “I am informed that the Chinese have practised inoculation these hundred years, a circumstance that argues very much in its favour, since they are thought to be the wisest and best governed people in the world.” In addition, Professor Fu presents the status-quo of vaccine development and disease control and analyzes trends in the incidences of seven major infectious diseases in China, namely smallpox, measles, poliomyelitis, Diphtheria, pertussis, epidemic cerebrospinal meningitis and encephalitis B. Readers will learn that China has reduced the incidence rate of some of the most prevalent epidemics and the number of lives they claim to historically low levels, through intensified vaccination and inoculation endeavors, especially through its planned immunization drive and the WHO’s Expanded Programme on Immunization (EPI).
Starting with the concepts of antigens and antibodies, the second chapter systematically depicts the process of how vaccines induce an immune response in human bodies, including the functioning of pattern recognition receptors (PRR), the activation of innate immunities and the immune responses of T cells and B cells. In addition, Yanmin Wan, a coauthor of the book, has described the specificity and the broad-spectrum feature of vaccine-induced immune response. He further explains this with examples that research on vaccines for AIDS and influenza virus strains focuses more on how to make protective immune responses more broad-spectrum, while the BCG vaccine can trigger nonspecific immunity and lower all-cause mortality. The chapter also encompasses knowledge about the limitations of vaccines in activating immunity responses and possible response mechanisms at different stages of human life, as well as the influences of gender on the response process.
The third chapter discusses vaccine development and production, and the fourth chapter evaluates the effectiveness of vaccines. As new technologies and disciplines emerge and mature, progress has been made in vaccine development and production. The creation of vaccines involves multiple procedures, including the development of techniques, clinical trials and quality tests; their production also covers several stages such as obtaining, isolating and purifying antigens, and preparing the vaccines; evaluation of the effectiveness of produced vaccines is a demanding task, which can range from rigorous pre-marketing clinical trials to post-marketing appraisals of the vaccines’ protective effects based on both epidemiologic theories and feedbacks on actual applications such as routine monitoring data. Of particular note, “effectiveness” and “efficacy” are two similar concepts that are both used to assess the ability of a vaccine in preventing against the disease it is designed to target, but they are different from each other. To help readers understand the differences, coauthor Zhang Li has distinguished between them from several perspectives. Moreover, she has introduced how phase IV clinical trials on vaccines are performed and the epidemiologic methodologies to test their effectiveness, such as randomized double-blind trials, disease surveillances and case-control studies.
The fifth chapter explores the development of vaccination and inoculation in China, including their history, the country’s National Immunization Programme, the types of vaccines it covers and their inoculation procedures and the implementation and monitoring of vaccination plans. The development of vaccination and inoculation in the People’s Republic of China since its founding in 1949 can be broken down into five stages: the early years of the People’s Republic (1949–1952), the period of national economic development (1953–1965), the “Cultural Revolution” (1966–1976), the period of planned immunization (1977–2000) and the period of the China National Immunization Programme (2001-today). Vaccines in China basically fall into two categories: those within the National Immunization Programme framework that the Chinese government requires the population to have and those beyond this framework that are taken on a voluntary basis. After the vaccination is finished, medical practitioners will keep monitoring the occurrence of adverse reactions, changes in the inoculation rate and the spread of epidemics that the inoculated vaccines are designed to prevent against. China has sustained improvement in its immunization planning over the past seven decades, which has reduced the number of incidences of vaccine-preventable diseases.
The concept of vaccine hesitancy is also incorporated into this chapter. Listed by the WTO among the ten threats to global health in 2019, vaccine hesitancy has come along with vaccines since they were introduced and evolved as vaccination developed. As anti-vaccine movements gain momentum worldwide, the vaccine coverage rate has started to reduce due to growing vaccine hesitancy. That’s why people need to understand the concept of vaccine hesitancy, the reasons behind it and the harm it can do. That health education and risk communication can help address the problem is also proposed in this book.
Vaccinology is not all about medicine, science and technology; it is also related to humanities and sociology. The next chapter, compiled by Ruishuang Liu from Peking University, features a concise introduction to the laws and regulations on vaccines with a special detailed mention of the Vaccine Administration Law of the People’s Republic of China. Taking effect on December 1, 2019, the Vaccine Administration Law aims to enhance vaccine management in China, securing the quality and adequate supply of vaccines, and regulating vaccination and inoculation processes in order to promote the sound development of the vaccine industry and protect people’s well-being and public health security. It’s a milestone in the development of vaccines in China, and the country is stepping up efforts to improve its R&D abilities and transform from a vaccine producer to a vaccine developer.
The seventh and eighth chapters are the main bodies of this book. They provide detailed knowledge about bacterial vaccines and viral vaccines, respectively, including the diseases that the two types of vaccines target, how they work, the target population they apply to and points for attention in their immunization. Besides the 15 vaccines covered by the National Immunization Programme, the book also encloses information on other types of vaccines that China is promoting among its people, such as HPV vaccine, herpes zoster vaccine and influenza vaccine. Medications that suppress passive immunity are also expounded in the ninth chapter.
American entrepreneur Lee Iacocca once famously said: “In my book, if you’re not No. 1, you’ve got to innovate.” To fundamentally reduce the incidence of epidemics, we have to deepen our understanding of their pathogeneses and work to develop effective vaccines based on vaccinology knowledge. The last chapter of the book updates readers with the latest development in vaccine R&D, including vaccines for COVID-19 that are currently attracting the most attention.
With the ten chapters set out above, this book serves as a comprehensive guide to vaccinology and gathers the most important and updated knowledge and information in this field. It’s hoped that it can be of help to students, researchers and practitioners dedicated to vaccine study and development, and contribute its due part to vaccinology education in China and beyond.