Should you opt-out of vaccines?

Author: Deborah Carnahan
HLTH 640: Health Communication, Summer 2020

Vaccines did not become a matter of interest until my son was born, and he started receiving vaccinations. After each trip to the pediatrician, my son developed a fever and cried for days, which was scary for a new mom. The pediatrician identified the probable cause of the reaction, removed pertussis from his vaccines, and he was able to tolerate future vaccinations. From that point, I was skeptical about the process of vaccinations, and my concern recycled when my dogs started getting shots, and a dog died after a rabies vaccination. Even though situations occurred that caused a bit of hesitancy, there is a case for vaccinations in preventing the spread of disease, and for the pharmaceutical and biotech industries to continue the ongoing research and development of vaccines to prevent and combat the spread of infectious diseases.

Background of vaccines

The theory of immunization dates back thousands of years and originated in the ancient Indian peninsula (Northern and Eastern India) as a practice of variolation/inoculation, with the immunization of individuals from a product taken from an infected person (Vijay, 2019). The first major breakthrough in immunizations later occurred on May 14, 1796, by Edward Jenner, who was prompted by Lady Montagu’s “variolation” concept and inoculated eight-year-old James Phipps with cowpox pus to prove that the less virulent cowpox would protect against smallpox. It was the first time it was possible to prevent infection in a healthy person medically, but then it took 180 years after that breakthrough to make the six essential vaccines available around the world (Naran et al., 2018).

Interestingly, vaccines are recommended to everyone at some point in their life. Vaccines are products, comprised of sub-components, killed or inactivated organisms, or live-attenuated (reduced) viruses, that work by stimulating the immune system to fight an infection or disease. Together, the immune system and vaccines can help fight disease and infection (See Piot et al., 2019 and Naran et al., 2018).

Also, immunizations are an enormous part of the reason for the decrease in the rates of vaccine-preventable diseases, and advancement in the health of children. Vaccination against infectious diseases changed history by preventing millions of deaths each year from disease (Edwards, & Hackell, 2016). Though, there are some parents and individuals that feel there is reason for concern over the safety of vaccines, referred to as vaccine hesitancy.

Vaccine hesitancy is a term used to explain the varying degrees to which people feel about vaccines, and to remove the pro- and anti-vaccination labels (Edwards, & Hackell, 2016). Vaccine hesitancy has been around from the beginning since the first smallpox vaccine. Most often, people who are vaccine-hesitant are not part of any organized group but are individuals who lack of trust in the safety or efficacy of vaccines or believe the risk of vaccination is higher than the risk of the infectious disease. There is also some that believe that because certain infectious diseases are no longer a threat, they do not need vaccines (Picard, 2017).

Because most individuals have been vaccinated, the vaccine-preventable disease levels are at a low. However in 2014, America had over 600 cases of measles, the highest number in 20 years, linked to a trip to Disneyland. Another reason for the spike in measles during 2014 is that more people are opting not to vaccinate their children, and cited one reason is a discredited study linking vaccination to autism (Wang et al., 2016). There are also theories that doctors and pharmaceutical companies profit from vaccinations, and for that reason, push vaccinations onto the public. That is not the case, and pediatricians and doctors do not profit but lose money on vaccine administration (Lam, 2015).

Health care professionals and the public health system make efforts to reverse vaccine hesitancy, including The World Health Organization (WHO) which works at addressing vaccine hesitancy by looking at the factors, motivations, or barriers causing vaccine hesitancy. Some of the barriers that have been identified that have prevented individuals from getting vaccines include perceptions about vaccines, social norms, availability, affordability, and access, and the WHO is continuing the work of developing an approach to increase participation in vaccinations (“Improving vaccination demand and addressing hesitancy,” n.d.).

Types of vaccines

Currently, there are 18 vaccines available to fight serious diseases. These vaccines have helped save millions of lives of infants, children, adolescents, teens, and adults, and given based on age, physical location, health condition, and sometimes as a necessity for travel. Some of those vaccines are for chickenpox, diphtheria, flu, mumps, polio, and measles. There are also vaccines available to prevent diseases that are no longer present in the United States, such as cholera, smallpox, and tuberculosis, but continue to exist in other parts of the world (Centers for Disease Control and Prevention, 2020).

Mom holding newborn baby

Who needs vaccines?

The states have vaccination laws, which include vaccination requirements for children in public and private schools, daycare settings, college/university students, healthcare workers, and patients in certain facilities. Children need to be vaccinated against certain contagious diseases as a condition for school and childcare attendance. Most laws apply to public and private schools with similar immunization and exemption provisions. Each state has immunization information and exemptions specifically for that state in the State School Immunization Requirements and Vaccine Exemption Laws (Centers for Disease Control and Prevention, 2020). There is a comprehensive schedule of recommended immunizations for children and adolescents under 18 years of age on the CDC website (Centers for Disease Control and Prevention, 2020).

Why are vaccines important?

Vaccines not only protect the individual against disease, but they can also protect the unvaccinated individuals by reducing transmission from person to person and limiting the risk of infection throughout a population. This type of protection is called herd protection or immunity, yet requires a large percentage of the people to be vaccinated, around 75-95%, to be effective (Iftikhar, n.d.).

Herd immunity is essential in the prevention and spread of diseases like measles. An individual’s natural immunity, which happens after a person gets a disease and their body creates the antibodies to fight that disease, works along with herd immunity to interrupt the spread of disease. For natural immunity to be effective against diseases, everyone would have had to contract the disease. Since that is not the case, vaccines help stop the spread of infectious diseases (Iftikhar, n.d.).

3 teens standing

What exemptions exist for vaccines?

When parents have concerns about vaccines, they may refuse a dose of a vaccine, or a specific series of vaccines, or possibly all vaccines, and have some level of vaccine hesitancy. However, the odds of a parent refusing all vaccines, based on the information from the Centers for Disease Control and Prevention (CDC), is rare. There are cases that exist where children, or adults, should avoid vaccines because of age, allergies, pregnancy, or other health issues, and guidelines per vaccine regarding who or who should not get a particular vaccine (Centers for Disease Control and Prevention, 2020).

For school children, some states allow exemptions from the requirements for vaccines for schools in certain cases. A medical exemption is one case that is permitted and occurs when a child has a medical reason not to get a vaccine. Also, some states allow non-medical reasons, such as for religious or philosophical reasons. There are requirements regarding the application process and requirements if an outbreak of disease happens, which in case a student’s exemption may not be allowed, or the child may be excluded from school. Also, recertification for a medical exemption may be classified as temporary or permanent and may need to be recertified by a doctor (Centers for Disease Control and Prevention, 2020).

Could a policy about vaccines change?

It has been over one hundred years since the first recorded influenza pandemic, the 1918 Spanish flu, caused by an A(H1N1) virus. Before this recent coronavirus, there were three other pandemics that occurred since the Spanish flu, Asian flu in 1957, the Hong Kong flu in 1968, and the 2009 swine-origin flu. (Yamayoshi & Kawaoka, 2019).

Each year, seasonal cases of the flu cause 3 – 5 million deaths, and a significant number of deaths. Symptoms of flu may include can a cough, fever, sore throat, runny nose, body or headaches, and some vomiting or diarrhea. There are vaccines that have been developed to combat seasonal influenza, which differ from new viruses, or pandemics (“Seasonal flu vs. pandemic flu infographic,” 2019).

There is a push in the scientific community to speed up the process of vaccines, especially because of the urgent need to address epidemics like the H1N1 influenza, Ebola, Zika, and SARS-CoV-2. There is new vaccine technology that allows a quicker response as in the H1N1 influenza vaccine, and some vaccines are in the experimental phase, like Ebola vaccines, or a malaria vaccine, and this research should continue (Lurie et al., 2020). Yet, vaccine development requires financial resources, a development and testing phase, manufacturing capabilities, and some type of fair allocation to needed areas, even though a pandemic crisis may subside, before a vaccine is available (Lurie et al., 2020).

older couple on the beach

What is the future of vaccines?

Scientific advancements may bring new vaccines, but the road from discovery to the marketplace can be lengthy because of financing, development, trials to determine efficacy, licensing, and public approval. Despite the hurdles, immunization should remain at the forefront of research and health for humans and society.

Vaccine hesitancy will most likely continue to be an issue though the development process for vaccines has, in the past, been long, with testing and regulation for safety and efficacy (Edwards & Hackell, 2016). With a push to develop vaccines faster in consideration of new infectious diseases, vaccine hesitancy may increase, but individuals should consider looking at the positives of vaccines, before opting out of vaccines.

When it came to administering the core vaccines for my dog, now six years old, I requested an alternative vaccination schedule. The veterinarian administered the vaccines one at a time and spread out the vaccinations over an extended period, and there were no side effects encountered. Individuals can also request alternative vaccination schedules or postpone vaccines, instead of declining them altogether (Edwards, & Hackell, 2016). Again, each individual must research vaccines, and choose the best course for themselves, their families, and their communities.

References:

Edwards, K. M., & Hackell, J. M. (2016). Countering vaccine hesitancy. PEDIATRICS, 138(3), e20162146-e20162146. https://doi.org/10.1542/peds.2016-2146

Iftikhar, N. (n.d.). Herd immunity: What it means for COVID-19. Healthline. https://www.healthline.com/health/herd-immunity

Improving vaccination demand and addressing hesitancy. (n.d.). World Health Organization. https://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/

Kaslow, D. C. (2020). Certainty of success: Three critical parameters in coronavirus vaccine development. npj Vaccines, 5(1). https://doi.org/10.1038/s41541-020-0193-6

Lam, B. (2015, February 10). Vaccines are profitable, so what? The Atlantic. https://www.theatlantic.com/business/archive/2015/02/vaccines-are-profitable-so-what/385214/

Lurie, N., Saville, M., Hatchett, R., & Halton, J. (2020). Developing COVID-19 vaccines at pandemic speed. New England Journal of Medicine, 382(21), 1969-1973. https://doi.org/10.1056/nejmp2005630

Naran, K., Nundalall, T., Chetty, S., & Barth, S. (2018). Principles of immunotherapy: Implications for treatment strategies in cancer and infectious diseases. Frontiers in Microbiology, 9. https://doi.org/10.3389/fmicb.2018.03158

Picard, A. (2017). 12. The roots of vaccine hesitancy. Public Health in the Age of Anxiety, 342-347. https://doi.org/10.3138/9781487510404-014

Piot, P., Larson, H. J., O’Brien, K. L., N’kengasong, J., Ng, E., Sow, S., &

Kampmann, B. (2019). Immunization: Vital progress, unfinished agenda. Nature, 575(7781), 119-129. https://doi.org/10.1038/s41586-019-1656-7

Seasonal flu vs. pandemic flu infographic. (2019, July 17). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/resource-center/freeresources/graphics/seasonal-vs-pandemic-flu-infographic.htm

Unsplash. (n.d.). Beautiful Free Images & Pictures | Unsplash. https://unsplash.com

Vetter, V., Denizer, G., Friedland, L. R., Krishnan, J., & Shapiro, M. (2017). Understanding modern-day vaccines: What you need to know. Annals of Medicine, 50(2), 110-120. https://doi.org/10.1080/07853890.2017.1407035

Vijay, K. (2019). Introductory chapter: The journey of vaccines – The past and the present. Vaccines – the History and Future. https://doi.org/10.5772/intechopen.86274

Vaccines and immunizations | Home | CDC. (2020, June 9). Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/

Yamayoshi, S., & Kawaoka, Y. (2019). Current and future influenza vaccines. Nature Medicine, 25(2), 212-220. https://doi.org/10.1038/s41591-018-0340-z

Leave a Reply

Your email address will not be published. Required fields are marked *