Introduction

Infectious diseases have profoundly influenced human history and reshaped societies, economies, and healthcare systems across centuries [1]. From ancient beliefs rooted in humoral imbalances to scientific breakthroughs in modern microbiology, the perception and management of infectious diseases have evolved dramatically with the advancement of medical science [1]. The development of germ theory, antibiotics, and virology in the 19th and 20th centuries transformed the ability to identify, treat, and prevent infectious diseases. In recent decades, the focus has shifted towards precision medicine and a holistic “One Health” approach, which recognizes the critical interconnectedness of human, animal, and environmental health as many emerging pathogens are zoonotic in origin [1-3]. This interconnected understanding of disease ecology naturally positions vaccination as a cornerstone intervention bridging human, animal, and environmental health issues.

Among the most significant innovations in public health is vaccination, which has revolutionized disease prevention and control [4]. Vaccines not only reduce mortality and morbidity from infectious diseases but also contribute to broader health, economic, and societal stability. This is especially true in low-income settings, where vaccination can prevent catastrophic healthcare expenditures that push families into poverty [4,5]. With the emergence of novel pathogens and rising threats such as antimicrobial resistance and climate change-driven zoonoses, the role of vaccination is expanding beyond infectious diseases to potential applications in noncommunicable diseases (NCDs) [2,3,6-8].

Technological advances are accelerating the development of next-generation vaccines, offering hope for rapid responses to future pandemics and personalized prevention strategies. Platforms, such as messenger RNA (mRNA) and DNA, along with innovative methodologies, such as reverse vaccinology and immunoinformatics, are at the forefront of this transformation [9-11]. This review aims to provide a comprehensive overview of the historical context, current significance, and future directions of vaccination. It highlights the recent trends in vaccine development, explores the growing applications in NCDs, and discusses the challenges and socioeconomic implications of vaccine deployment in a rapidly changing global health landscape. This narrative review was based on a non-systematic search of PubMed and Scopus databases using the terms ‘vaccination,’ ‘vaccine technology,’ and ‘One Health’ for articles published between 1990 and 2025.

History and trends of infectious diseases

Perceptions of infectious diseases have evolved significantly from ancient times to the modern era, mirroring scientific development [1]. Before the 15th century, diseases were often explained by supernatural forces or imbalances in bodily fluids (humoral theory) without a clear concept of infection [1]. The 16th to 18th centuries, marked by the advent of printing and advances in anatomy, fostered medicine based on observations and documentation, leading to a basic understanding of contagion [1]. The 19th century was a revolutionary period that saw the establishment of pathology and bacteriology, leading to the scientific identification of infectious pathogens. The 20th century further built on this foundation with the discovery of antibiotics, characterization of viruses, and invention of the electron microscope, which collectively transformed diagnosis and treatment [1].

Since the 1990s, precision medicine has become a cornerstone of healthcare, emphasizing advanced imaging, evidence-based treatment, patient-centered decisions, and interdisciplinary collaboration [1]. A critical modern paradigm is the “One Health” approach. Recognizing that approximately 75% of recently emerging infectious diseases in humans are of animal origin (zoonotic), this framework integrates human, animal, and environmental health to create a unified strategy for disease surveillance and control [1]. The frequency and impact of infectious diseases are increasing owing to complex factors, such as climate change, ecosystem disruption, and the rise of antibiotic resistance. In response, global health organizations such as the World Health Organization (WHO) and developed countries now prioritize research and development targeting high-risk pathogens and are building flexible, science-driven response systems to prepare for unknown future threats, often termed “Disease X” [12,13].

Significance of vaccination in infectious disease control

Vaccination plays a vital role that extends beyond simple disease prevention and provides broad health, economic, and social benefits. Vaccines save millions of lives annually and significantly reduce morbidity and mortality, particularly by preventing the catastrophic healthcare expenses that can devastate families in low-income countries [14]. Furthermore, some vaccines confer benefits beyond those of their primary targets. For instance, routine childhood vaccinations have been associated with improved cognitive development, academic performance, and physical growth, partly by preventing the debilitating effects of infectious diseases and maintaining a well-functioning immune system [6].

A key societal benefit of high vaccination coverage is herd immunity, which indirectly protects the most vulnerable members of a population that cannot be vaccinated, such as infants, older individuals, and those who are immunocompromised [4,15-17]. By reducing the overall incidence of bacterial infections and their complications, vaccination also plays a crucial role in combating antimicrobial resistance by decreasing the need for antibiotic use [18,19]. Modern vaccine research is developing next-generation vaccines to elicit more robust and durable immune responses. These are specifically designed for populations with weaker immune systems, including older individuals and those who are immunocompromised. Such developments align with the “One Health” concept, a holistic framework recognizing the interconnectedness of human, animal, and environmental health (Fig. 1).

History of vaccination

The history of modern vaccines began with Edward Jenner’s pioneering work on the smallpox vaccine in the late 18th century, which demonstrated that inoculation with a less virulent virus could confer immunity [20]. This was followed by Louis Pasteur’s development of the concept of attenuation in the 19th century, which created weakened forms of pathogens to induce immunity without causing severe disease, leading to the development of vaccines for rabies and anthrax [21]. The mid-20th century witnessed a golden age of vaccine development, where advances in cell culture techniques enabled the mass production of vaccines for widespread diseases such as measles, mumps, rubella, and polio, drastically reducing their global burden [21].

In the 21st century, molecular biology and genomics have revolutionized vaccine design. Technologies such as genetic recombination, protein subunit engineering, and conjugate chemistry have led to the development of safer and more targeted vaccines. A paradigm-shifting approach known as “reverse vaccinology” allows scientists to screen an entire pathogen’s genome to identify potential antigens, dramatically accelerating the initial stages of vaccine development [9,10]. Currently, vaccines are increasingly personalized by age group, and ongoing research on adjuvants, substances that enhance the immune response, continues to improve the safety, efficacy, and long-term durability of vaccinations [4,13].

Types of vaccines

Over the course of vaccine history, several structural types of vaccines have been developed [10,22]. Among these, virus-like particle and nanoparticle vaccines show great promise, as they can present antigens in a highly organized manner that mimics natural viruses, leading to strong immune responses while maintaining a high safety profile [6]. DNA vaccines offer advantages in terms of stability and ease of production but often require advanced delivery systems to overcome their limited immunogenicity in humans [6]. In contrast, mRNA vaccines, which instruct the body’s own cells to produce a target antigen, demonstrated great efficacy during the coronavirus disease 2019 (COVID-19) pandemic owing to their capacity for rapid design, scalable manufacturing, and potent induction of immunity [23] (Table 1).

Alongside these platform technologies, computational and genomic approaches are transforming vaccine design. Reverse vaccinology and immunoinformatics allow for rapid, genome-based prediction of effective antigens, bypassing slower traditional methods [10]. These cutting-edge technologies not only accelerate the response to infectious diseases but also expand the scope of vaccination into new territories, including cancer immunotherapy, treatments for substance use disorder, and other chronic diseases, paving the way for truly personalized vaccines tailored to an individual’s specific needs [7,8].

Applications of vaccine-like technologies for noncommunicable diseases

The success of vaccination technologies against infectious diseases is now being leveraged to prevent and treat NCDs [15]. Established vaccines have indirectly reduced the risk of certain cancers. For example, human papillomavirus (HPV) vaccines are highly effective in preventing cervical cancer and other HPV-related malignancies [15], and hepatitis B vaccines have dramatically reduced the incidence of liver cancer (hepatocellular carcinoma) worldwide [24]. Furthermore, some studies have explored the nonspecific effects of preventive vaccines, suggesting that they may broadly modulate the immune system. For example, vaccines such as the diphtheria, tetanus, and pertussis vaccine have shown unexpected benefits on overall childhood mortality beyond their target diseases, prompting research into whether other vaccines may influence conditions such as asthma and allergies [25].

In addition, a new class of “therapeutic vaccines” is in active development to treat existing chronic conditions. These vaccines aim to retrain the immune system to target the molecules involved in disease pathology. Promising research is underway on conditions such as hypertension, dyslipidemia, and neurodegenerative disorders, including Alzheimer disease [7,8,26]. For Alzheimer disease, immunotherapy strategies are being developed to target the amyloid-β plaques that are a hallmark of the disease [8,26]. Compared with conventional drug therapies that often require frequent administration, these therapeutic vaccines offer the potential for long-lasting immunity with fewer side effects, representing a new frontier in the management of chronic diseases.

Limitations of vaccination

Despite considerable success, vaccines face significant challenges. Vaccine hesitancy (reluctance or refusal to vaccinate despite the availability of vaccines) is a major obstacle recognized by the WHO as a top global health threat. This phenomenon is fueled by a complex mix of factors, including mistrust of health authorities, the spread of misinformation, and personal or cultural beliefs [26,27]. Another critical issue is the disparity in vaccine distribution and access. Logistical hurdles such as cold chain requirements coupled with high costs hinder the delivery of life-saving vaccines to low-income regions, creating a gap in global health equity [13,28].

From a biological perspective, the effectiveness of vaccines can be limited by the natural evolution of pathogens. Viruses such as influenza and severe acute respiratory syndrome coronavirus 2 can mutate over time, leading to new variants that may escape immunity induced by existing vaccines, necessitating ongoing surveillance and vaccine updates [12,28]. Furthermore, vaccine-induced immunity can wane over time, requiring booster doses to maintain protection. Finally, although the application of vaccines to NCDs is promising, it remains a nascent field. The complex etiology of most chronic diseases makes the development of effective therapeutic vaccines a significant scientific challenge.

Vaccination and socioeconomic security in emerging infectious diseases

Although scientific and logistical limitations persist, the societal importance of vaccines remains undeniable, as demonstrated during recent global crises. Vaccination is a critical tool for maintaining socioeconomic stability during large-scale outbreaks and pandemics. By mitigating the spread of disease, vaccination prevents the collapse of healthcare systems and preserves the functioning of essential public services, reducing the societal chaos that can arise from resource shortages and widespread illnesses [5,29]. Data from the COVID-19 pandemic clearly show that high vaccination rates correlate with a reduced healthcare burden, allowing the loosening of economically damaging lockdowns and other public health restrictions [30]. In the geopolitical arena, countries with domestic vaccine production and development capacity can gain significant advantages through “vaccine diplomacy,” using their resources to strengthen international alliances [14].

The economic impact of vaccination is profound. Vaccination protects the labor force, restores consumer confidence, and helps stabilize fragile supply chains disrupted during health crises [5]. Vaccination offers an exceptionally high return on investment. By reducing costs related to hospitalization and long-term care, vaccines are among the most cost-effective health interventions available [5,24,31,32].

Future of vaccination

The future of vaccination lies at the intersection of technological breakthroughs and personalized healthcare [9]. mRNA platforms continue to transform the speed and flexibility of vaccine development, with significant applications extending to personalized cancer immunotherapy, where vaccines can be tailored to specific tumor mutations [23]. The field of “vaccinomics” is advancing our ability to create tailored vaccine strategies based on an individual’s genetic and immune profile, promising a future of more effective and safer personalized immunization [33-35].

To prepare for future pandemics, global initiatives, such as the “100 Days Mission” of the Coalition for Epidemic Preparedness Innovations, aim to compress the vaccine development timeline to a mere 100 days from the identification of a new pathogen [12]. However, technological innovations alone are insufficient. Addressing social acceptance and ensuring equitable global access remain critical challenges that must be addressed in parallel [21,29]. To improve the efficacy in vulnerable populations, new adjuvants and high-dose vaccine formulations are under development to enhance immune responses in older individuals [10]. Ultimately, the long-term outlook of global health security demands a seamless integration of scientific innovation and equitable accessibility to ensure a rapid and effective response to known diseases and unknown threats such as “Disease X.”

Conclusion

The understanding and management of infectious diseases have evolved dramatically over the centuries, transitioning from ancient humoral theories to the modern era of precision medicine and genomics. Vaccination has played a pivotal role in this evolution, not only in preventing diseases but also in improving societal stability, reducing healthcare costs, and promoting global health equity. From Edward Jenner’s smallpox vaccine to the rapid development of mRNA vaccines, immunization strategies have continuously advanced through scientific innovations. Currently, vaccines contribute to herd immunity, help reduce antibiotic resistance, and are expanding into personalized approaches such as vaccinomics and reverse vaccinology.

Additionally, novel platforms such as DNA-, mRNA-, and nanoparticle-based vaccines are accelerating development and enabling broader disease coverage, including promising applications for NCDs. However, vaccination continues to face several limitations, including the persistent threat of vaccine hesitancy, profound inequities in global access, and the biological challenges of pathogen mutations and waning immunity. Misinformation, logistical hurdles, and the complexity of chronic diseases continue to hinder global immunization efforts. Despite these challenges, vaccination remains an indispensable cornerstone of pandemic preparedness, economic resilience, and national security. Ultimately, future strategies must holistically integrate technological innovation with a steady commitment to equity and public trust. This integrated approach is essential not only for addressing the unpredictable threats of tomorrow, such as “Disease X,” but also for ensuring sustainable global health.

Article information

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

Acknowledgments

The author thanks Skywork.ai, Dr. Yong-Geun Jung, and Mr. Justin Cho for their contributions in structuring, organizing references, and proofreading the language of this work. And the author appreciates the Yeungnam University College of Medicine research support team for providing the illustrations used in this study.

Funding

None.

Fig. 1.

An image symbolizing the “One Health” concept. A protective shield, representing vaccination, guards an interconnected ecosystem of humans, animals, and the environment from external threats such as pathogenic microbes. Illustrated by Yeungnam University College of Medicine research support team.

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