As a microbiologist who managed a federal programme on Lyme disease in the 1990s, I consider that any new clinical trials of a vaccine candidate based on the protein OspA, as mentioned in your News Feature "Uphill struggle" (Nature 439, 524–525; 2006), should be confined to Europe, for three reasons.
First, Lyme disease is non-communicable, readily treatable with common antibiotics and geographically localized in the United States. Neurological cases — where treatment can be problematic — are more common in Europe and a new vaccine may reduce the costs and consequences of infection.
Second, European experience with the widely used tick-borne encephalitis virus (TBEV) vaccine may facilitate vaccine-trial recruitment and greater public acceptance of a new Lyme vaccine.
Third, Europe is a less litigious environment and is largely free of organized Lyme-patient advocacy groups. In the United States, activists have turned Lyme disease into everyone's backyard bogeyman. They have demonized experts for their views on treatment and prevention, and hired lawyers to successfully argue the dangers of vaccine-induced autoimmunity (Philadelphia Inquirer B03, July 9 2003).
The activists are already using Internet discussion groups to warn against a new vaccine. One of them recently wrote "I would encourage all Lyme patients to consider writing letters, emphasizing the lack of demand for the last vaccine, and also the fact that any future vaccines can expect a lack of cooperation, protests, legal quagmires, etc."
A careful, hysteria-free trial of the new OspA vaccine in Europe may help to undermine the opposition to it in the United States.