Abstract
We live in remarkable times, when wondrous biotechnological advances yield unprecedented opportunities for public health efforts; yet there is palpable tension. Visions for new tools to prevent deadly diseases pull against challenges for turning vision into reality. For preventing diseases such as tuberculosis, AIDS, malaria, schistosomiasis, and leishmaniasis, the question is not whether a vaccine is desperately needed or whether there are vaccine candidates but who will take on the considerable risk of bringing a vaccine through the intensive and costly steps of production, testing, and licensing. If a safe and effective vaccine makes it all the way to market, who will pay to ensure that it is actually used to effect the public health miracle it has the scientific basis to accomplish?

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