AHS22

Evolution rewards "fitness" as a holistic calculation of many inputs into differential reproductive success. Not all of these inputs are related to health and some concerns we may have about health such as longevity are not given preeminence in the calculation. Nevertheless, we can use the example evolution gives us as a mental model for appreciating the state of health we pursue as a holistic composite. Modern medicine in general struggles to define health in a holistic way. Vaccine research in particular has been increasingly characterized since 1980 by narrow focus on the pathogen of interest at the expense of such holistic measures. This "mismatch" with holistic measures of health as exemplified in the concept of evolutionary fitness will be examined by highlighting central characteristics of vaccine efficacy study designs that put pathogen-centric definitions of disease and holistic definitions of health at odds with one another.