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| Ultimately, expansion and sustainment of access to the benefits of immunisation requires ownership of the programme by developing-country governments and the communities that they serve. Finally - more effort should be made to explain the benefits of vaccines, not just to relevant health professionals, but also to the general public and decision-makers. They write: The challenge is that between development of a vaccine and its public consummation there is a so-called black box within which a multiplicity and heterogeneity of human factors must be negotiated to realise the public health gains of immunisation. If trust and confidence in vaccines is not secure, our efforts to advocate increased resources to make possible the necessary research, development, and supporting clinical investigation will be a bridge too far. Clearly we do not have answers to many basic questions. What is needed? What motivates people to be immunised? What deters them? (conclusion We have the knowledge base, expertise, and methodology with which to investigate what needs to be done to increase public trust and confidence in immunisation. 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