During the past century the life expectancy at birth of the average Englishman has risen from 40 to around 70 years. Whereas it is likely that in 1870 only 60 per cent or less of children born alive in this country survived their first five years 98 per cent did so in 1970.

A major factor in these dramatic changes in mortality has been the virtual eradication, in the economically ‘developed’ world, of infectious disease as a significant cause of death. This was accomplished primarily by environmental improvements and public health measures such as adequate sanitation, clean water supplies and better nutrition and housing. Through these the sources of many infections have been eliminated and the resistance of the population to communicable illness has been raised.

Pharmaceutical developments since the 1930s have also aided in the reduction of such ill health, as has the introduction of new vaccines and their use in national and international programmes of disease control. This paper is concerned with questions relating to the latter sphere, looking in particular at the significance of current immunising techniques in social and economic as well as in medical terms.

On a world-scale vaccination is still at a stage where its major contributions to the welfare of mankind are probably yet to be made, although the current WHO smallpox eradication programme based on vaccination already ranks as one of the major achievements of preventative medicine in modern times. Between 1967 and 1973 the estimated true incidence of the disease (as opposed to the notified incidence) fell to about one twentieth of its former level and it is thought possible that the target of the global elimination of smallpox may be achieved by the end of 1975, despite its continued endemic presence in the Indian subcontinent and Ethiopia.

There is also good reason to believe that there will shortly be new additions and improvements to the vaccines currently available for human use. Promising areas for further research include the control of infectious and serum hepatitis (jaundice) and the development of a vaccine against cytomegalovirus disease, which is the main viral cause of severe mental retardation.

Yet in countries like Britain where health standards in the area of communicable diseases are already high the scope for extending the application of existing immunising methods are to a degree limited. Indeed, some of the epidemiological changes which vaccination programmes have helped to promote have led to questioning of their continued value within communities such as our own. An important objective of this paper is therefore to examine to what degree and in what areas the future use of vaccines in this country is to be encouraged or restricted.