Vaccination, Thesis Paper Example

A vaccine is a preparation that renders active immunity against a certain disease. A vaccine attempts to reduce or prevent infection of a specific pathogen. Several vaccines require several doses in order to achieve maximum effectiveness and the United States has developed vaccination schedules that combat fourteen types of diseases as of 2009. This means that by the age of two, a child in the United States can become the recipient of at least 24 types of vaccines, and might receive 5 shots of vaccines during a single visit to the a doctor. As a whole, the World Health Organization is responsible in monitoring vaccination schedules globally and implementation of auditing measures in relation to compliance and efficacy.

Although Vaccination is a measure mandated by the local government in order to prevent vaccine-preventable diseases, there is also the need to address the rights of individuals regarding their freedom of choice especially in a country such as the United States that emphasizes individual freedom. It is on account of this that exemptions are provided by each state that is classified into the following: medical exemptions, religious exemptions and philosophical exemptions. Medical exemptions are granted to individuals who have conditions that contraindicate vaccination, which includes (1) an immunocompromised state (2) allergic reaction any component of a vaccine, and (3) moderate or severe state of an illness. Religious exemptions, meanwhile, are granted to individuals who have a deep religious belief against vaccination. Philosophical exemptions may also be claimed by individuals who refuse vaccination based on their personal belief and in exercise of their right to determine their own or their child’s medical care. Currently, forty-eight states allow religious exemptions while only 19 states allow philosophical exemptions (Omer et al., 2006)

Vaccines have proven success in terms of reducing the morbidity and mortality rate as well as the costs in healthcare in the United States. Although each individual has the freedom to make their own choices, there must be certain measures and provisions that must be taken in consideration when honoring exemptions to vaccination. It must be ensured that individuals who refuse vaccination and claim exemptions should have undergone a thorough discussion with a medical professional or health care worker regarding its pros and cons. The completion and non-completion of vaccination is influenced by several factors that may be interrelated. The most predominant of these factors is familial in nature as it is the family that has direct responsibility over the well-being of its members. The characteristics of the family, particularly the socio-economic status and educational level of parents are important factors that could determine their child’s successful completion of vaccination (Smith et. al., 2004). Similarly, parental satisfaction with their children’s health is associated with compliance to later immunization (Schempf et. al., 2007). Second to the family is the role of health care providers as they are responsible for communicating the importance of vaccination. Inter-related to this theme is the role of culture especially in these times when the country is characterized by increasing diversity (Omer et. al., 2009). As such, health care workers must establish clear lines of communication, particularly with those of other race and culture as they may have different health beliefs. According to Salmon et al. (2005), claims to exemptions are oftentimes mere paths of least resistance and that these exemptions may have a wrong connotation that vaccination is not important. The amount of risk involved should be carefully considered especially during epidemic outbreaks or in instances when herd immunity is lost. In this case, any form of refusal to vaccination may be constituted as a form of medical neglect.

Annotated Bibliography

Omer, S.B. et al. (2009, May) Special Article: Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. The New England Journal of Medicine, Vol. 360, pp. 1981-8.

This special article proves that clinicians play a crucial role on promoting immunization of children and likewise in securing community health. The authors cite evidences that vaccine refusal is now increasing in the United States, and so is the incidence of vaccine-preventable diseases, stating that “There has been an increase in state-level rates of nonmedical exemptions from immunization requirements.” The clustering of those parents delaying or refusing vaccination for their children, owing to state differences in legal provisions for immunization exemptions, increases the threat of outbreak. The authors put pressure on clinicians and other health care providers to understand the benefits and risks of vaccines and anticipate questions that parents may have about safety, as they are the most common source of information about vaccination and hence influential factors in parents’ decision-making.

Salmon, D.A et al. (2005, May) Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study. Archives of Pediatrics and Adolescent Medicine, Vol. 159, pp. 470-476.

The study was primarily influenced by the assumption of the increasing numbers of children exempted from school immunization and that this has led to outbreaks of vaccine-preventable diseases. The authors designed a case control study by surveying parents of 815 exempt children and the parents of 1630 randomly selected, fully vaccinated children. This study was aimed at identifying the reasons for non-medical exemptions for vaccination and to explore the differences in perception between parents of fully vaccinated children and parents of exempt children. The study yielded surprising results as it showed that 22% of exempt children have achieved full vaccination, thereby suggesting that a factor in the application for non-medical exemption is the completion of vaccines before the required aged. The authors also discovered that non-religious reasons are often behind religious exemption. Other factors are perceptions that vaccines might cause harm, they might overload the immune system, the child is not at risk for the disease, the disease was not dangerous, the vaccines might not work, and differences in ethical or moral and religious beliefs. Authors conclude that “continued efforts must be made to educate parents about the utility and safety of vaccines.”

Schempf, A.H. et al. (2007) Parental satisfaction with early pediatric care and immunization of young children, the mediating role of age-appropriate well-child care utilization. Archive of Pediatrics and Adolescent Medicine, Vol. 161, pp.50-56

The researchers use data from National Evaluation of Healthy Steps for Young Children to investigate whether satisfaction with early pediatric care is connected to timely and adequate immunization during the first two years of life, and if so, whether this relationship leads to greater utilization of age-appropriate well-child care. The findings, after applying bivaraite associations and multivariate regression analyses, confirm that there is a relationship between parents’ satisfaction with their children’s health care at an early age to the children’s later immunization, such that negative satisfaction leads to reduced utilization of health services. Authors emphasize that “quality assurance activities that assess parental satisfaction with care may have added value in identifying children who are less likely to receive timely preventive services.”

Smith, P.J. et al. (2004 July) Children who have received no vaccines: who are they and where do they live? Pediatrics Vol. 114 No. 1, 187-195

Researchers collected a nationally representative probability sample of under-vaccinated and non-vaccinated children between the years 1995 to 2001. The purpose of the study was to assess whether the characteristics of children with no vaccination differ from those of under-vaccinated children. The study’s findings reveal that ethnic, geographical, economic, and other demographic characteristics are distinctly different between the under-vaccinated and unvaccinated, and between under-vaccinated and unvaccinated and fully vaccinated children. This supports that ethnic, geographical, and economic causes could become barriers against childhood immunizations. Researchers also state that “unvaccinated children are clustered geographically, increasing the risk of transmitting vaccine-preventable diseases to both unvaccinated and undervaccinated children.”

References:

Omer, S.B. et al. (2006) Nonmedical Exemptions to School Immunization Requirements: Secular Trends and Association of State Policies with Pertussis Incidence. JAMA; 296:1757-1763

.Omer, S.B. et al. (2009, May) Special Article: Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. The New England Journal of Medicine, Vol. 360, pp. 1981-8.

Salmon, D.A et al. (2005, May) Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study. Archives of Pediatrics and Adolescent Medicine, Vol. 159, pp. 470-476.

Schempf, A.H. et al. (2007) Parental satisfaction with early pediatric care and immunization of young children, the mediating role of age-appropriate well-child care utilization. Archive of Pediatrics and Adolescent Medicine, Vol. 161, pp.50-56

Smith, P.J. et al. (2004 July) Children who have received no vaccines: who are they and where do they live? Pediatrics Vol. 114 No. 1, 187-195