Organised efforts to prevent the spread of infectious diseases through mass vaccination began slowly. By World War I, although successes in saving soldiers’ lives offered encouragement, vaccination practices differed from country to country. In 1945, amid the rapid post-war spread of tuberculosis, preventive vaccination was deemed a necessary ‘technological fix’. During the Cold War period, technical cooperation coexisted with ideological rivalry. Although the Soviet Union and the United States supported vaccination for different reasons, they successfully cooperated on the WHO smallpox eradication programme beginning in 1965. Out of this grew the EPI, and disputes between supporters of ‘vertical’ and ‘horizontal’ approaches emerged. In recent decades new vaccine production has become a major driver of market growth for the pharmaceutical industry. New forms of collaboration between public and private sectors (such as public-private partnerships) have been crafted, whilst the global introduction of new vaccines is supported by the GAVI Alliance. However, at a time of shrinking health care budgets the wisdom of disease eradication targets is contested, and parents everywhere are becoming more critical.