No Shots, No Service Policy: Immunization Woes - Research Paper Example

?Running Head: “No Shots, No Service Policy”-Immunization Woes. “No Shots, No Service Policy”-Immunization Woes       Instructor’s Name:       Institution:       Date: Abstract Families which choose not to immunize their children are on the rise. This number has almost doubled in the last two decades. In response compulsory immunization programs have been recommended for school attendance. These have worked phenomenally well, but they have not been without limitations. For example, home-schooling has reduced the ability of these programs to reach all children. Correlation studies on the school-house element shows that removing it from the equation leads to very little protection of the involved children from exposure to disease. This happens because these children still continue to get into contact with diseases through other daily engagements such as socialization and sports. Once these children get the diseases they become vectors of transmission of the diseases they harbor. The compilation of data from past outbreaks in the last decade shows that voluntarily unimmunized children are not the only negative result of their parent’s choices, but they are often the cause (index patient) in bringing illness to other children, that are unable to undergo immunization for valid health reasons. This poses health challenges to the entire population. As such, the expansion of compulsory immunization to other venues apart from school set ups becomes essential so as to extend the positive results already witnessed in the initial school-based immunization programs. This may go a long way in reducing voluntary rejections of immunization. Thesis statement: With current studies determining that autism is not linked to vaccinations, in any way, there is no further reasoning behind the practice of not vaccinating one’s children, thus it is time for our society to take a tougher stance against this practice not only through government but also through private industry by adapting a “no shots, no service” policy. Introduction Vaccinations or immunizations work through a similar mechanism in which the body’s natural defense system is activated in a manner that makes it able to recognize disease causing agents and produce antibodies that disable or destroy the invading disease causing agents such as viruses or bacteria. In essence these processes prepare the immune system to fight against particular disease causing agents. Viral immunizations use the weakened or dead form of the virus that is introduced into the body. Bacterial immunizations may be carried out through the introduction of a very small portion of the dead bacteria to activate antibody production. The effectiveness of the approach may be enhanced through occasional repeat immunizations known as ‘boosters.’ Vaccination is one among the most effective preventive measures against communicable diseases (Davey & Maurice, 2009). Vaccines have been an important tool for clinicians in the fight against some diseases, which have virtually been eliminated. The benefits of vaccines are massive and they have undoubtedly saved millions of people’s lives since their initiation in clinical processes. Firstly, immunization is cost effective in preventing disabilities and diseases because it prevents the incidences from occurring. It also helps to avoid the costs and time involved in the treatment of the diseases after infection. Childhood immunization programs initiated locally in most states and nations have greatly helped in reducing the occurrence of vaccine-preventable conditions. Immunization has helped in the eradication of conditions such as small pox and poliomyelitis in America (Satcher, 1999). The effectiveness of vaccines can be exemplified by the improvements obtained through polio vaccines. Polio’s vaccine got licensure in 1955 in the United Stated. In the 1951 to 1954 period an estimated 16316 paralytic cases and 1879 death cases from polio were reported in each year. By1991wild virus polio had been eliminated from the whole of the Western hemisphere, and the cases of polio had in general declined greatly (Satcher, 1999). In the current decade cases of polio have been very limited even within the underdeveloped regions of the globe due to successful immunization programs. Hopefully, if the trend continues polio may become a disease of the past just as small pox. Effective control has also been obtained in the control of other conditions such as tetanus, haemophilus influenzae, rubella and diphtheria. In fact, in the current practice it is very rare for a practicing clinician to encounter a case of meningitis because of the introduction of a vaccine against the condition (Satcher, 1999). Prior to the introduction of Haemophilus influenzae type b (Hib) in 1988, an estimated one in every 200 children aged below five were infected with Hib which was the major cause of bacteria-caused meningitis. This condition persisted despite the use of antibiotics and Hib accounted for over 60% of meningitis cases. However, pre-school vaccination in the US cut down the rates of the disease by almost 99% (Satcher, 1999). Rubella also offers a perfect example of vaccines’ effectiveness. Prior to and in the sixties terrible effects of rubella were witnessed. The rubella epidemic that occurred between 1964 and 1965, led to infection of an estimated 20000 children that ended up blind, deaf, retarded or with congenital heart diseases because of the virus, which infected their mothers before birth. Contrastingly, the current use of vaccines against rubella has ensured that the condition poses no health threat to unborn children and their mothers. The effectiveness of this approach to combating infectious diseases has not only been endorsed, but also encouraged by various professional organizations such as the World Health Organization (WHO), Center for Disease Control (CDC) and the American Medical Association. Undoubtedly, immunization has great advantages in maintaining the health state of the society by preventing and reducing the occurrence of conditions that can be vaccinated against. However, the success in the use of immunization heavily relies on high acceptance of the administration of the immunization process (Halsey, 2009). Higher rates of coverage in immunization translate to better reduction of the conditions targeted, but lower rates lead to deleterious effects when outbreaks recur and those not immunized act as vectors to transmit the disease. Therefore, in order to enhance effectiveness of immunization programs wider coverage and high rates of acceptance have to be targeted and achieved. However, this is becoming a challenge in the United States because an increasing number of parents are choosing not to immunize their children. The geographic clustering of vaccine refusal in the nation results in occasional localized outbreaks, which lead to infections among even those that cannot acquire immunization due to various health challenges or are too young to undergo any immunization (Halsey, 2009). Children exempted from school-based immunization are at a greater vulnerability to pertussis, measles and other conditions. These children can infect other children who may not have reached the vaccination age or have medical conditions that do not allow them to undergo vaccination. Additionally, it is also possible for them to infect children that may have been vaccinated but had a very low and weak immunologic response. The refusal of immunization results from fear created by information which has greatly been disseminated in the media, about the ability of vaccine shots to cause adverse effects such as autism. The claim may be traced back to a research by Wakefield et al. (1998). This research was later retracted from “The Lancet Journal” after “The British Medical Journal” found its work to be fraudulent. The research had linked immunization to adverse effects that led to behavioral changes after administration of rubella, mumps and measles vaccines. The association has not been proven as true by any other research and in fact, most research studies have shown that there is no such kind of association (Leask & McIntyre, 2003). An example of these numerous reports include one by the US Institute of Medicine (IOM) which cleared the air by stating that their research findings had established no association between immunization and autism. Similarly, the same report delinked any form of association between immunization and diabetes. The fact that immunization displays some temporal side-effects is undisputable, but the use of today’s social media and more so the internet has blown the all issue out of proportion to an extent of causing great fear that increases refusal of immunization (Calandrillo, 2004). According to WHO (2009), vaccines are not a perfect protection for all that receive them, and they are also not entirely safe for all. The organization also notes that vaccines may be responsible for some side-effects, but these are mostly mild and can clear up quick. In addition, a large number of adverse events associated with immunization are in actual sense not as a result of the immunization itself, but rather coincidental events which may result from program or human error (WHO 2009). The error factor is usually high in the developing and less developed world, and as such this factor should be removed from the blame laid on the vaccine itself. The fact that most vaccine administrations are a one-time event means that it is almost impossible to determine which patient may have an adverse or mild reaction. However, there are a number of contraindications and if well observed adverse effects may be greatly reduced (WHO 2009). There is an ability to minimize the adverse effects and since these are not as many as the merits that immunization delivers there is no reason whatsoever to refuse immunization. Additionally, there are no significant statistical findings that have shown high rates of significant adverse effects among populations (Kimmel, 2002). In a bid to increase immunization coverage most states have taken measures such as imposing compulsory immunization programs in some instances. The mandating of immunization requirements before school entry has been one of the most effective methods of achieving wider coverage. State legislation requiring immunization before school entry dates back to 1800s, when the state of Massachusetts made smallpox vaccination a mandatory requirement for all residents. Modern era licensure began when the states made efforts to eliminate measles in the 1970’s and 1960’s (Satcher, 1999). Historically, the maintenance of public health has been a state mandate and all immunization legislations are state-based. There are no Federal legislations that govern immunization in the nation and as such the coverage of immunization programs may differ depending on the state of residence. School-based immunization legislations create a safety net and they have played a great role in reducing diseases. For example, in the initial 31 weeks of legislation in 1978 the states which made school-based immunization compulsory were able to reduce the incidence of measles by more than 90% when compared to the nation in general (Satcher, 1999). The Supreme Court in the US has confirmed the rights of all states to legislate laws on immunization and confirmed its constitutionality. Presently, all states have legislated school-based immunization programs. However, these programs differ depending on the specific vaccines, schedules and doses acceptable within states. All states have made exemptions based on health conditions. Additionally, different states allow a number of exemptions to vaccination based on philosophical (15 states) and religious grounds (48 states) (Satcher, 1999). The map and graph below shows how rates of refusal are increasing due to religious based reasons across Oregon. The implication of the statistical trend is that the refusals are ever rising. Picture one & two-An example or rising exemption cases in Oregon, which may be replicated across other states through time The school-based immunization programs have proven to be effective as per the obtained statistics in most cases. However, the effectiveness is under threat because of the varied legislative frameworks which create windows for widespread exemptions. The variations in legislations based on types of vaccines coupled with exemptions such as those based on religious and philosophical grounds greatly reduces the effectiveness of the immunization programs that are school-based. Additionally, the increase of home-based learning creates another window for refusal of immunization. As the rates of refusal increase due to these windows, so does the increase of risks associated with lack of immunization. The high and rising number of refusals is not only a threat for the non-immunized children, but also for other children who may not have undergone immunization due to health related conditions or undue age. This even becomes riskier when the number of children not immunized is higher because they create a large pool of potential agents of spreading the infectious diseases that may result from an outbreak. The rising refusal cases imply that there may be serious problems ahead if no drastic measures are undertaken, and since the sufficiency of the school-based programs is declining, there is a need to change government interventions and if possible incorporate the private sector. There is enough backing from research studies that have proven that there are no adverse associations to immunizations such as autism or diabetes. As such, there is no sound reason as to why anyone should deny their children a chance to get immunization if all due procedures are adhered to. Additionally, the getting or not getting a shot affects other people negatively by increasing chances of worse outbreaks, and as such, this becomes a concern not only for the families in question but also for the general public. In quoting John Stuart: “The only purpose for which power can rightfully be exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant (Anderson, 2009).” This is the principle known as the harm principle. The parents denying their children immunization or older people refusing some form of immunizations are risking the lives of others as well as their own lives, and it is prudent for the government and any other bodies with mandate to step in and enforce mandatory immunization or at least set up restrictions that would compel individuals to allow immunizations to continue. This principle would be interpreted to mean that mandates on immunization are justified when if they do not occur: (1) the decision of individuals would endanger the health of others and the nation’s economic state would be jeopardized through high care expenses and disability associated with vaccine-preventable conditions (Anderson, 2009). Therefore in order to realize full comprehensive coverage of the immunization programs there is a need to institute legislative measures that could make it compulsory to get immunized with exceptions only being possible when the medical constraints cannot allow. The private schooling for example, reduces effectiveness of earlier approaches because it undermines the institution of such mandates. Therefore, if the private sector would also be involved in instituting the “no shot, no service policy” more families would be compelled to adhere to the mandates on immunization. The same could for example be extended to the pediatric care, both in the private and public facilities. This would compel more parents to comply, because it is obvious that apart from immunization, they also require other services and if only these services were tied to the provision of immunization, only then would they be compelled to act. In addition to these measures it would also be wise to continue increasing sensitization to parents in order to curb the negative perceptions created by social and new media that is in most cases liberal and free enough to offer misleading information (Shan, 2011). In conclusion, the refusal of immunization of children by most parents poses a health challenge to the public and especially to those not immunized due to health conditions or age. Additionally, it poses a health risk to the not immunized children, and increases the probability of worse outbreaks because of the high number of potential vectors or spreading agents of the disease that may exist at one time. This also places the government at a higher risk of spending more in case of an outbreak. The semi-mandatory school-based programs may have been effective in increasing immunization, but the variations in legislation and differing exemptions weaken their effectiveness in intervention. Additionally, home-based schooling compromises the situation further. As such, it becomes necessary to have better interventions that can ensure wider coverage is obtained. This may be only realizable through both increase and bettering of government legislation as well as the inclusion of the private sector in instituting restrictions to service delivery till compliance to immunization is obtained. The institution of these stiffer measures is the only way to curb the possible problems ahead. Finally, education to parents should also be increased to help curb the negative perceptions created in their minds. References Anderson, J. (2009). Resolved: Public health concerns justify compulsory ?immunization, retrieved on April 18th, 2012 from http://decorabilia.blogspot.com/2009/06/resolved-public-health-concerns-justify.html Calandrillo, S. P. (2004). Vanishing vaccinations: why are so many Americans opting out of vaccinating their children? University of Michigan Journal of Law Reform, 37 (2), p. 353-440. Davey, S. & Maurice, M. J. (2009). State of the World's Vaccines and Immunization, 3rd edition, World Health Organization Halsey, N. DeHart, P. M. Orenstein, A. W. Salmon, A. D. Omer, B. S. (2009). Vaccine refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases: New England Journal of Medicine, 360 (1), p.1981-1988 Hayden, C. E. (2011). Childhood Vaccines Cleared of Autism, Diabetes Link in New Report U.S. Institute of Medicine finds "very little evidence" of serious harm, retrieved on April 18th 2012 from http://www.scientificamerican.com/article.cfm?id=childhood-vaccines-cleared-of-autism-diabetes-link-new-report Kimmel, S. R. 2002. Vaccine adverse events: separating myth from reality. American Family Physician, 66 (11), p. 2113-20 Leask, J. & McIntyre, C. R. (2003). Immunization myths and realities: Responding to arguments against immunization, 39 (7), p. 487-91. Satcher, D. (1999). Statement on Risk versus Benefit of Vaccinations: presented before the House Committee on Government Reform retrieved on April 18th 2012 from http://www.hhs.gov/asl/testify/t990803a.html Shan, Y, (2011). Strategies to improve vaccination uptake rates: Primary healthcare, 1 (2), p. 16-21 Wakefield, A. J. Murch, S. H. Anthony, A. Linnell, J. Casson, D. M. Malik, M. Berelowitz, M. Dhillon, A. P. Thomson, M. A. Harvey, P. Valentine, A. Davies, S. E. Walker-Smith, J. A. (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children: The Lancet, 351 (9103) W. H.O (2009). Adverse events following immunization (AEFI), retrieved on April 18th, 2012 from http://www.who.int/immunization_safety/aefi/en/ Appendix Picture one & two-An example or rising exemption cases in Oregon, which may be replicated across other states through time retrieved from http://oregonimminews.wordpress.com/ Read More