A Nation With Vaccination Hesitation

The health of an individual is important for a variety reasons such as well-being and longer lifespans but will all the aliments in the world there some that are worse than others such as measles. The recent measles resurgence has involved the past decade, but the year of 2019 has shown outbreaks increasing at a significant rate including six that have happened just in 2019 alone (Bortz, 2019b, p.9). The importance of mandatory vaccinations for healthy medically able children is a major step not only in protecting them but also the people who are unable to get vaccinations. Mandatory vaccinations increase the collective health of our communities by preventing outbreaks of diseases that used to be catastrophic.

The outbreaks have not always been the way they are now such as in the year 2000, the usage of vaccinations had made the disease considered eliminated in the United States (Bortz, 2019b, p.1). Due to below recommended vaccine coverage rates outside of the U.S., Europe has also experienced a spread of measles throughout the continent with over 14,000 cases from 2016 to June of 2017 (Astrup, 2018, p.14). Before the invention of the measles vaccination the outbreaks were not so different in scale according to Russell (2019) who states, “…epidemics in large population centers occurred every 2 to 3 years, and 95% of children were immune by age 15 years” (p.1835). The number of outbreaks today that were caused by a proposed “eliminated” disease is frustrating as there is a tool available to people that can help prevent the disasters from happening in the first place.

The origin of the first measles vaccine came from a boy named David Edmonston in 1954. The original vaccine while causing measle-like symptoms to the recipients for a short period of time was a crucial step towards developing the modern measle vaccine used today (Russell, 2019, p.1836). Another example of a vaccine with similar life saving capabilities is the smallpox vaccine as with the removal of smallpox with aggressive vaccination programs, lives were saved and overall health of populations increased(Astrup, 2018, p,14). All good things must come to end as Stulpin (2019) remarks “Measles cases have surged worldwide amid a growth in anti-vaccine sentiment and gaps in vaccination coverage” (p.20). Ensuring the education and stance changing for the members of anti-vaccine groups is crucial to changing the disease spreading throughout the civilized world.

With all the lives saved by vaccination programs, the purpose seems to be simple, to increase the overall health of a population and ultimately save lives. The amount of lives saved by vaccination programs is upwards of two to three million every year according to the World Health Organization (Mallory, 2018, p.64). However, the lives saved could easily be overshadowed by the concerning fragility of overall vaccine coverage according to research by JAMA pediatrics in Bortz (2019b) which states, “Even slight reductions in measles, mumps and rubella (MMR) vaccine coverage caused by vaccine hesitancy could result in a threefold increase in measles case...” (p.1,8). Another point made by JAMA pediatrics was the lower the MMR vaccine use, as the lower use and coverage is a greater risk to measles for children ages 2 to 11 (Bortz, 2019a, p.12). All the information points toward the conclusion that vaccine use is highly important, but the people in charge of children receiving the vaccines are not always looking for incite on vaccine use towards are accurate or credible places such as social media.

While social media itself is not a source for all things evil, there does exist a potential for the widely used platform to be a place for spreading information that anyone can produce with little to no effort or credibility required. The concern to the use of social media to learn about vaccines is best described in Larson (2018) which states, “The deluge of conflicting information, misinformation and manipulated information on social media should be recognized as a global public-health threat” (p.309). If the information on social media is such an issue then possibly just giving hard facts on social media would solve the problem, however, when Ethan Lindenberger, a child of an anti-vaccination household spoke to the Senate about how his parents don’t rely on statistical information is because they believe heavily in anecdotal evidence because the information comes from real people they may know in the community (Bortz, 2019a, p.12). So while social media use and overreliance on anecdotal evidence are a major problem, a point was made by Saad Omer, experienced member of vaccine research in the U.S. at the same Senate meeting calling out that physicians allow an opportunity for people regardless of their positions of vaccines to learn and are commonly seen as the most trusted source for medical information (Bortz, 2019a, p.12). The knowledge and experience physicians have is important to providing an informative experience but, high ranking members of the medical scientific community have also caused many issues for vaccine acceptance.

One issue has stood among others as a prime example of why parents have such strong hesitancy toward vaccines. The link between Autism spectrum disorder to MMR vaccination use has plagued the vaccination movement for years. When looking at what causes the most fear when people get involved in understanding science, Larson (2018) states, “Among the most damaging is bad science: people with medical credentials stoking overblown or unfounded fears” (p.309). One of those people who at one point had medical credentials was Andrew Wakefield, a scientist who published a study that linked autism to use of the MMR vaccine. The study was supported by prominent figures in the U.S. government such as Robert F. Kennedy Jr. who was a possible candidate assigned by Donald trump to chair a commission on vaccine safety (Bortz, 2019b, p.10). From 2004 to 2014, the Somalian American population around the city of Minneapolis, Minnesota had a decrease of 50% of MMR vaccinations. The decrease was due to concerns of higher than expected autism levels in their community, but according to as study by the University of Minnesota in Dyer (2017) which stated, “… Somali children were statistically similar to those in white children although lower than in Hispanic and other black children” (p.1). After the decrease in MMR vaccines had been going on for some time the rates of autism did not change. Even after the measles outbreaks in the Somalian American community, Andrew Wakefield, a speaker at several anti-vaccine meetings in the community stated to the Washington Post in Dyer (2019), “I don’t feel responsible at all” (p.1).

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Parents are the people with the most responsibility in whether their child get vaccinated, but with the use of vaccine exemptions, a parent can evade a major hurdle for their child’s ability to participate in the public-school system. States allowing exemptions including several in the Northwest, Southwest, and sections of the Midwest for philosophical and personal reasons are becoming hot spots for high exemption rates. States can have two and a half times the amount of exemptions than states with only religious and medical exemptions only (Bortz, 2019b, p.1,8). Anti-vaccine groups such as the Canary Party abused the use of exemptions when they proposed to members of the Somalian American community to obtain philosophical objects to evade requirements of public services in the state of Minnesota (Dyer, 2017, p.1). The importance of the use of exemptions should be used for medical reasons such as the CDC states in Bortz (2019b), “…people who have had a life-threatening allergic reaction to a component of the vaccine; people living with HIV/AIDS or another disease that affects the immune system; people who are treated with drugs that affect the immune system; and people who have any kind of cancer, who are being treated for cancer with radiation or drugs or who have a blood disorder” (p.8). Medical exemptions have a purpose for protecting those from complications, but since they cannot get vaccinated, the people who are able to get vaccinated can protect them by means of herd immunity.

Herd immunity is crucial in protection of the people who are not able to get vaccinated due to medical reasons. The concept of herd immunity is best described in Mallory (2018) which states, “…immunization of large portions of the population to protect the unvaccinated, immunocompromised, and immunologically naive by reducing the number of susceptible hosts to a level less than the threshold needed for transmission” (p.64). However, to ensure herd immunity to be minimally effective, a population’s vaccination status must be at least 95% (Astrup, 2018, p.14). With the importance of high levels of vaccination coverage to maintain herd immunity, Offit in Bortz (2019b) compares the recent resurgence of measles to “the canary in the coal mine” (p.8). The canary is used to ensure the safety of miners by seeing if a canary will return after being released into a mine shaft. For measles the connection is that as herd immunity declines, unvaccinated people entering areas of outbreaks may become infected due to lower vaccine coverage levels.

The places where the outbreaks are located are generally groups of people of similar stance on vaccinations and exemptions. The places where outbreaks are occurring according to the CDC in Bortz (2019b) who states, “…have consistently tracked with communities of lower immunization rates” (p.8). A reason why the areas are susceptible is mentioned in a study done by Hotez in Bortz (2019b) which states, “In areas with high rates of nonmedical vaccine exemptions, the researchers observed low rates of MMR vaccine coverage, leaving unvaccinated residents susceptible to disease if an outbreak were to occur” (p.8). The CDC also mentioned in the same article that the origin of where measles come from are travelers from outside countries who are linked to transmission of measles (Bortz, 2019b, p.9). The connections to communities of outbreaks and communities of unvaccinated people is certainly a cause for concern as being apart of a group is important to many people.

A study showing if there is a link between autism and MMR vaccine was done in a study on the comparison of Autism Spectrum Disorders with MMR vaccine use of children with siblings who do or do not have Autism Spectrum Disorder by Jain, Marshall, Buikema, Bancroft, Kelly, and Newschaffer (2015) Data was used from Children from the US with commercial insurance or Medicare from the period of 2001 to the end of 2007. Information from status of the child and their older siblings with or without 2 claims of Autism Spectrum Disorder was also used. Their finding showed there was no substantial difference between individuals with children who have MMR vaccine with older siblings with Autism Spectrum Disorder and those without MMR vaccine with older siblings with ASD (p.1535). A limitation for the study was only children with commercial insurance or Medicare were considered with no information on children without insurance is examined.

A study done to see the effect of current vaccination requirements compared to those of strict compulsory polices on measles susceptibility in high-wealth countries using simulations from 2018-2050 by Trentini, Poletti, Melegaro, and Merler (2019) Data from birth rates and mortality rates by country and transmission rates of measles for a population were used (p.2-3). Their findings showed vaccination policies in the U.S., U.K., Ireland, and Australia do not meet the required coverage to meet the 95% herd immunity standard (p.5). They also found compulsory vaccination polies would allow for countries to increase overall coverage to the herd immunity threshold and therefore lead to measle elimination. The major limitation for the study was the scope of when, where, and how large a measles epidemic can occur is challenging as well.

A study on the effect of the political party preference of an individual can increase their use of Personal Belief Exemptions for avoiding mandatory vaccine requirements in public schools from 2000 to 2015 was done by Estep (2018, p.4298). Information from Personal Belief Exemptions [PBE] for kindergarten in California public schools which included 6348 schools. Also, data from California Republican and Democratic registrations and statistics from voting data and their approximate location was used (p.4299). According to the findings, the more a community aligned with the Republican party, the amount of Personal Belief Exemptions increased over the period from 2000 to 2015. Along with the information it was found after the introduction of AB 2109 requiring parents to request a Personal Belief Exemption after visiting a health care professional, all groups regardless of political alinement lowered their use of exemptions (p.4300). The limitations of the study included the issue with the use of political party preference does not specifically allow for understand which belief play a role in vaccine hesitancy. Another limitation was the use of only California public elementary school measurements instead of all school levels including private schools (p. 4302-4303).

The recent resurgence of the measles disease is certainly difficult to combat due to how widespread the disease is and where outbreaks may occur, however, understanding the concepts of the research done to help support the use of vaccines is crucial to informing people about what they can do to help prevent outbreaks. Healthy people who can get vaccinated should be required to do as the choice to not get vaccinated is one that not only is dangerous to themselves, but to those who are not medically able to be vaccinated. Some people will feel the requirements are hurting their right to personal freedom, but spreading measles by transmission of their unvaccinated bodies, they take away the rights of those who may not survive a measles outbreak.

References

1. Astrup, J. (2018). Mandatory vaccinations? The journal of the health visitors' association. Community Practitioner, 91(2), 14-16. Retrieved from https://login.glacier. sou.edu/login?url=https://search.proquest.com/docview/2023683759?accountid=26242
2. Bortz, K. (2019a). Senate committee warned about harms of vaccine hesitancy. Infectious Diseases in Children, 32(4), 12. Retrieved from https://login.glacier.sou.edu/login ?url=https://search.proquest.com/docview/2215508581?accountid=26242
3. Bortz, K. (2019b). Nonmedical vaccine exemptions 'violate' a 'fundamental right' of children. Infectious Diseases in Children, 32(4), 1-10. Retrieved from https://login. glacier.sou.edu/login?url=https://search.proquest.com/docview/2215508736?accountid=26242
4. Dyer, O. (2017). Measles outbreak in Somali American community follows anti-vaccine talks. BMJ : British Medical Journal (Online), 357 doi: http://dx.doi.org/10. 1136/bmj.j2378
5. Estep, K. A. (2018). Neighborhood political composition and personal belief exemptions from immunization requirements in California kindergartens, 2000–2015. Vaccine, 36(29), 4298-4303. doi:http://dx.doi.org/10.1016/j.vaccine.2018.05.108
6. Jain, A., Marshall, J., Buikema, A., Bancroft, T., Kelly, J. P., & Newschaffer, C. J. (2015). Autism occurrence by MMR vaccine status among US children with older siblings with and without autism. Jama, 313(15), 1534. doi: 10.1001/jama.2015.3077
7. Larson, H. (2018). The biggest pandemic risk? Viral misinformation. Nature, 562(7727), 309. doi:http://dx.doi.org/10.1038/d41586-018-07034-4
8. Mallory, M. L., Lindesmith, L. C., & Baric, R. S. (2018). Vaccination-induced herd immunity: Successes and challenges. Journal of Allergy and Clinical Immunology, 142(1), 64-66. doi:http://dx.doi.org/10.1016/j.jaci.2018.05.007
9. Russell, Stephen J,M.D., PhD., Babovic-Vuksanovic, D., Bexon, A., M.D., Cattaneo, R., PhD., Dingli, David,M.D., PhD., Dispenzieri, A., M.D., . . . Peng, K., PhD. (2019). Oncolytic measles virotherapy and opposition to measles vaccination. Mayo Clinic Proceedings, 94(9), 1834-1839. doi:http://dx.doi.org/10.1016/j.mayocp.2019.05.006
10. Stulpin, C., & Hotez, Peter J, M.D., PhD. (2019). Mandatory school vaccination could keep measles at bay, study suggests. Infectious Diseases in Children, 32(7), 20. Retrieved from https://login.glacier.sou.edu/login?url=https://search.proquest.com/docview/2258090705?accountid=26242
11. Trentini, F., Poletti, P., Melegaro, A., & Merler, S. (2019). The introduction of ‘No jab, no school’ policy and the refinement of measles immunisation strategies in high-income countries. BMC Medicine, 17 doi:http://dx.doi.org/10.1186/s12916-019-1318-5