Pharmacy and Therapeutics - January 2008 - (Page 41) Advances in Vaccine Technology continued from page 38 as the health care dollar is stretched, proven results, both clinical and financial, will be required. In health care, there is an increasing awareness of the need to look at the “bigger picture” and to have less “siloing” between pharmacy and medical divisions. Most organizations that practice evidence-based medicine acknowledge that both pharmacy and medical dollars often need to be spent in order to realize improved overall outcomes and reduced long-term expenses. One obstacle that affects this “investment” is the phenomenon of continuous enrollment in areas of the community with high competition for plan enrollees. If one plan invests liberally in vaccine benefits but a competitor does not, is the plan making the investment placed at a disadvantage in terms of premiums? Community-wide standards, agreed upon by health plans, employers, and physicians, would need to address this matter and ensure that all parties act in concert through their investments in the short-term and long-term health of the community. Rapid advances in our understanding of the immune system and our desire to engineer both preventive and therapeutic vaccines for a wide spectrum of diseases are fueling changes in medicine and in the managed care industry. There will be a growing emphasis on providing evidence-based medicine demonstrating tangible, long-term clinical benefits and cost effectiveness. There will always be a need to balance cost, efficacy, and choice, and our advancements in science will force all parties to alter their approaches to treatment. REFERENCES 1. Centers for Disease Control and Prevention. Achievements in Public Health, 1900–1999. Impact of Vaccines Universally Recommended for Children: United States, 1990–1998. 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