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Summary
The era when most vaccines provided efficacy well beyond 90% is over. Many of the more recently developed vaccines only provide partial efficacy. Although vaccines are typically licensed on the basis of demonstrated efficacy, the ultimate goal of vaccination goes far beyond efficacy. In addition to averting disease and death at an individual level, vaccination programs should decrease the public health burden of diseases at the population level. What counts is the impact on the reduction of vaccine-preventable disease incidence through direct and indirect protection, which is particularly pertinent for diseases that are of high public health importance.