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Older people are also reluctant to take vaccine shots for pneumonia, which kills 50,000 Americans a year. There is a pneumonia vaccine containing pieces of 23 different forms of killed pneumococcal bacteria. Dr. Maurice Hilleman of Merck & Co., Inc., the largest manufacturer of vaccines, says the injections could protect against 90 percent of pneumococcal pneumonia.

Pioneers in vaccine research are developing inoculations to fight some of society’s most virulent diseases.

In 1982, Dr. Hilleman received FDA approval for his vaccine against hepatitis B, also known as serum hepatitis. He constructed a vaccine out of partial rather than the whole hepatitis В virus. This virus infection inflames the livers of 200,000 Americans a year. At risk are blood transfusion patients, medical personnel who handle blood, and homosexuals. Hepatitis В kills a substantial number of victims with cirrhosis (or hardening) of the liver. One thousand Americans a year contract cancer of the liver. In the world today, 170 million people are infected with hepatitis B. Most of them were infected with the virus during their birth from an infected mother. Hepatitis В is largely a venereal disease: you get it from having sexual intercourse with an infected person.

“With this vaccine,” says Dr. Hilleman, “we could eradicate hepatitis in a few generations, just as we did smallpox. The technology is there.”

Also on the way is a vaccine against hepatitis A, known as infectious hepatitis, which you get from eating contaminated food.

Scientists are also struggling with vaccines for gonorrhea and genital herpes. The herpes virus is a particular scourge because it stays in the body for life and intermittently flares up. Dr. Bernard Roizman of Chicago has altered the herpes virus so that it does not linger in the body to infect again and again. His vaccine, now under tests, could prevent the disease but not cure it once you have been infected.

Biologists from the laboratories of the New York State Department of Health have altered the ancient cowpox virus so that it could defend against both genital and oral herpes without causing herpes.

“We’ve been working on it for a number of years,” reported a senior research scientist, Enzo Paoletti. “We’re pretty excited.”

Dr. Paoletti isolated a part of the herpes virus gene and inserted it into the cowpox virus. That changed the cowpox virus so that to your body it looks like an oral herpes virus and fools the body into making antibodies against both types of herpes. The cowpox virus becomes a sheep in wolf’s clothing.

Dr. Paoletti and his colleague, Dr. Dennis Panicali, also have produced hybrid vaccines for influenza and hepatitis B. But it could be several more years before a hybrid vaccine passes tests for human use.

Scientists also have begun a vaccine campaign against gonorrhea, which infects almost a million people a year and can lead to sterility in women. Scientists at the National Institute of Allergy and Infectious Diseases have isolated a protein from the outer membrane of the gonorrhea bacterium. Once injected, this protein leads to the formation of antibodies. It has yet to be tested to see whether it can prevent the disease in humans.

Vaccine makers are even more excited by entirely new chemical methods of creating vaccines in the test tube, without using either live or killed viruses or bacteria. Instead, they synthesize small pieces of protein that trigger immunity. They have only to make sure that the piece is identical to a protein found on the surface of a virus or bacterium. In this way, Dr. Richard A. Lerner, of the Scripps Clinic in La Jolla, California, has synthesized experimental vaccines against influenza, hepatitis B, and foot-and-mouth disease, an infection of animals.

“In the future, we won’t have to rely on killed or weakened viruses,” says Dr. Lerner. “We can design a piece of the virus, make it, and then give it without worrying about side effects or the weakened virus turning deadly again.”

Down the line lie vaccines against malaria, infant diarrhea, croup, and meningitis, and even a rare disease called megalovirus, or CMV, which attacks 1 to 2 percent of all newborns. The disease causes mental retardation in 2,500 infants a year.

Finally, although most cancers are not caused by germs, scientists are working on revolutionary new vaccines that will stimulate the body’s defenses against newly formed cancer cells and, perhaps, one day even wipe out advanced forms of cancer.

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