Introduction:
The introduction and widespread use of vaccines have
profoundly affected the occurrence of several infectious diseases, small pox
was eradicated from the world, and polio is on the verge of eradication. Recently, there has been an increase of
parents in the industrialized world participating in the anti-vaccination, or
“anti-vax”, movement. The main
theoretical structures of anti-vaccination ideology in the 19th and 20th
centuries are: vaccines cause idiopathic illness; opponents against vaccines
accused vaccine partisans to be afraid of the “search after truth,” they fear
unveiling errors; the vaccination law not only insults every subject of the
realm, but also it insults every human being; vaccine immunity is temporary; an
alternative healthy lifestyle, personal hygiene and diet stop diseases.1
Vaccination is one of the most effective public
health intervention methods to prevent the spread of communicable disease, so
why are parents refusing to immunize their children? Over the past decade there have been false
claims that certain vaccinations, specifically the MMR (measles, mumps, and
rubella) vaccine caused autism. Though
many studies have discounted these claims, many parents still believe that
vaccinations will cause more harm than good, herd immunity can protect their
child if they refuse vaccination, and change in lifestyle is better at
preventing the onset of disease than vaccination.2
Websites opposing vaccination are prevalent on the
Internet. Furthermore, a new postmodern
paradigm of healthcare has emerged, where power has shifted from doctors to
patients, the legitimacy of science is questioned, and expertise is redefined. Together this has created an environment
where anti-vaccine activists are able to effectively spread their messages.3
An intervention program is necessary to education parents of the
importance of immunization in conjunction with other positive health behaviors. I propose establishing an informative
discussion based website that fact check anti-vaccination, commonly known as anti-vaxing,
rhetoric and provide answers to questions about immunization. Heard immunity and community vaccination efforts
are imperative to prevention and control of preventable disease.
Evaluation of past and current literature on
immunization trends, the increased use of the Internet by patients, and any relevant
intervention programs was conducted.
The articles that selected for review were peer-reviewed and collected
using PubMed search engine. Articles
published prior to 2011 were removed from the sample. All articles containing data collected and or
assessing immunization or anti-immunization practices outside of the United
States were excluded. Twenty articles
were assessed however only ten were used for the nature of this literature
review.
Body
of Evidence:
Various article styles were used for data collection
and analysis to include reviews, policy papers, and theoretical articles to
understand anti-vaxing and recent influx of its practice. Articles assessed review the recent surge in
anti-vaxing, trends in contagious diseases in the United States from 1888-2013,
economic factors of immunization, herd immunity, and the correlation between
positive health behaviors and disease acquisition. Furthermore, assessment of vaccination
mandates in the United States, immunization trends in the United States, health
provider recommended immunization schedules, and the success of national
immunization efforts.
Why is there a growth in the number of parents
choosing not to have their children vaccinated? Kata A. attributes decreasing
vaccination practices to an increase in anti-vaxing rhetoric on social media,
noting the increase of parents researching information about immunization and
the anti-vaxing movement.3 Tafuri S et al. argue that doctors and
HCWs constantly have to face parents and patients who search information about
vaccination. A lot of these people have previously found data about
vaccinations from a lot of sources, such as opinion papers, social media or on anti-waxing
websites. It is important now more than
ever for public health officials to increase education efforts and utilize
modern methods of education to include social media and the internet. Moreover,
doctors and HWCs need to have updated knowledge about the vaccinations and are
responsible for educating general public on immunizations and their benefits.1
As with any medication, there are risks associated
with immunization. The US government established
the National Vaccine Injury Compensation Program (VICP) to implement controls
over immunization and the consequences thereof.
It acknowledges that vaccines, as with any medication, are not without
risk to the patient, that vaccines, unlike other medications, are a medical
intervention generally given to healthy individuals, and that vaccination has
benefits beyond the individual by significantly benefitting the public health
through creation of herd immunity, the VICP was established to shift the
monetary costs of vaccine injuries away from vaccine recipients and
manufacturers.4
The fear of negative side effects is especially
significant among parents of children with autism spectrum disorder (ASD). As a result, parents are becoming more
inquisitive about vaccination processes and are extremely concerned about their
outcomes. Comparably, parents of teens
are hesitant and refusing to have their teens vaccinated. According to Darden PM et al., the most
frequent reasons for not vaccinating were the same for Tdap/Td and MCV4,
including “Not recommended” and “Not needed or not necessary.” For HPV, the
most frequent reasons included those for the other vaccines as well as 4
others, including “Not sexually active” and “Safety concerns/Side effects.”5,6
There are recommendations and regulations in place
to ensure that infants and young children are vaccinated in the United States,
these rules have significantly improved the overall health and decrease
childhood morbidity rates. Ventola et al. notes that the incidence, prevalence,
morbidity, and mortality of many communicable diseases have significantly
decreased in Western countries largely because of national immunization
strategies aimed at infants and children.
It has been estimated that for each U.S. birth cohort receiving
recommended childhood immunizations, around 20 million illnesses and more than
40,000 deaths are prevented, resulting in $70 billion in savings.2 Analyses
conducted by Zhou et al. showed that routine childhood immunization among
members of the 2009 US birth cohort will prevent ∼42 000 early deaths and 20 million cases
of disease, with net savings of $13.5 billion in direct costs and $68.8 billion
in total societal costs, respectively. The direct and societal benefit-cost
ratios for routine childhood vaccination with these 9 vaccines were 3.0 and
10.17
From both direct cost and societal perspectives,
vaccinating children as recommended with vaccines results in substantial cost
savings and has reduced the transmission of certain communicable diseases. Van
Panhuis et al. evaluates changes in contagious trends in the United States as a
result of immunization practices. It is
concluded that state public health programs — especially vaccination — have led
to dramatic declines in the incidence of contagious diseases in the United
States over the past century.8Though vaccinations of many
preventable diseases are available and being utilized, there is still a rise in
some preventable, contagious diseases specifically pertussis. Van Panhuis et al. accredit this to the lack
of follow-up and booster vaccine practices.
It is important to note that in addition to individuals failing to
continue receipt of immunization after childhood, increases in the overall
incidence of contagious diseases is a result of the perception that the risk of
acquiring a communicable disease is low—low perceived risk of disease at the
individual level can lead to lower participation in control programs, with
negative consequences for the entire community.8
General immunity to a pathogen in a population
through vaccines that protect against transmission and/or protect against
disease has benefits and consequences as described by Domenech do Celles M et
al. They determine that the precise
nature of vaccine-induced protection is both controversial and consequential.
Vaccines that protect against transmissible infection protect those vaccinated
directly, but also protect the unvaccinated who benefit from decreased infection
risk: so-called herd immunity. In contrast, vaccines that protect against
disease but not transmission benefit only the vaccinated. Although experimental
evidence on the transmission impacts of pertussis vaccination is lacking,
available incidence data provide evidence for vaccine-induced herd immunity.9
There is no denying the benefits of vaccination, however it is important to
note that herd immunity perpetuates false indications of disease and the risk
of acquiring certain disease. Herd
immunity has and will continue to influence parents decision to vaccinate their
children causing vaccination rates to drop, substantially causing herd immunity
to dip below healthy “safety thresholds.”.10
Despite the benefits of herd immunization, many
parents chose to refrain or are hesitant about vaccinating their children. There are concerns about side effects, fears
of autism, moral and religious reasons but more often than not, the reason is
lack of accurate information regarding immunization. To improve compliance, the CDC’s Task Force
on Community Prevention Services has identified three categories for
interventions to overcome vaccine noncompliance: increasing community demand
for vaccination, enhancing access to vaccination services, and provider-based
interventions.2 These in addition to education will repair herd
immunity safety thresholds, and prevent disease.
Summary
and Conclusions
In conclusion, it is clear that immunization is an
effective way to reduce/eradicate disease.
However, despite the effectiveness of vaccines and the importance of
herd immunity, there has been a growing trend of parents choosing the forgo or
delay vaccinations for their children. A
large percentage of parents deciding not to vaccinate are making their choices
based on false information most of which read on the internet. The proposed forum style website will be run
by public health officials. It will
offer accurate and honest answers to questions about immunization. It will have health provider information,
national immunization trends reporting, epidemics/outbreaks of diseases, and
clinics where free or low cost immunizations can be received.
More research is required to assess the benefits of
increasing parental education. It is
unclear if parents will choose to vaccinate their children if they are
explained the benefits of the public health practice.
References:
See reference page.
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