ensure a comprehensive, integrated vaccine strategy that will address the following critical elements:

The U.S. Secretary of Health and Human Services should ensure the formulation and implementation of a national vaccine strategy for protecting the U.S. population from endemic and emerging microbial threats. Only by focusing leadership, authority, and accountability at the cabinet level can the federal government meet its national responsibility for ensuring an innovative and adequately funded research base for existing and emerging infectious diseases and the development of an ample supply of routinely recommended vaccines. The U.S. Secretary of Health and Human Services should work closely with other relevant federal agencies (e.g., DOD, the Department of Homeland Security, VA), Congress, industry, academia, and the public health community to carry out this responsibility.

The U.S. Secretary of Defense, the U.S. Secretary of Health and Human Services, and the U.S. Secretary of Homeland Security should work closely with industry and academia to ensure the rapid development and deployment of vaccines for naturally occurring or intentionally introduced microbial threats to national security. The federal government should explore innovative mechanisms, such as cooperative agreements between government and industry or consortia of government, industry, and academia, to accelerate these efforts.

The Administrator of USAID, the U.S. Secretary of Health and Human Services, and the U.S. Secretary of State should work in cooperation with public and private partners (e.g., leaders of foundations and other donor agencies, industry, WHO, UNICEF, the Global Alliance for Vaccines and Immunization) to ensure the development and distribution of vaccines for diseases that affect populations in developing countries disproportionately.

Need for New Antimicrobial Drugs

Drug options for treatment of infections are becoming increasingly limited, largely as a result of growing antimicrobial resistance. Many generic but essential antibiotics are in short supply, and the development of new antibiotics has been severely curtailed. In the past three decades, only two new classes of antibiotics have been developed, and resistance to one class emerged even before the drugs entered the commercial market. Only four large pharmaceutical companies with antibiotic research programs

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