Since the March 1995 Food and Drug Administration approval of the varicella vaccine for the prevention of varicella and the early 1996 American Academy of Pediatrics recommendation for universal vaccination for all susceptible children age 12 months and older, controversy over the need for a universal vacination has existed. This article reviews the pathogenesis and epidemiology of the varicella zoster virus, the historic development of the vaccine, and the benefits and barriers to adoption of a universal varicella vaccination schedule. It concludes with the public health perspective on this controversial vaccine and future research recommendations.