Trevor Collins
April 10, 2015
The Role of Vaccinations in Current and
Future Disease Outbreaks
In 2013, measles was responsible for an estimated 145,700 deaths
throughout the world - nearly 400 deaths per day.i However, out of these
numerous deaths, none of the m occurred in the United Statesii, which had
fewer than 200 cases of measles occur that year and fewer than 100 cases
the previous [Link] Thanks to vaccines, measles was a disease that had been
nearly eradicated within the United States; that is, until recently. In 2014, the
number of cases in the U.S. nearly tripled, with over 600 cases [Link] In
2015, the U.S. is currently experiencing outbreaks in several states as a
result of one major outbreak that occurred in Disneyland, CA.v While 600
cases may not sound like much, it is still very much a cause for concern.
According to Anne Schuchat, the director of the Center for Disease Control, it
is possible that this highly contagious, potentially fatal disease may gain a
foothold in the United States once [Link]
The reason that these outbreaks are occurring is that there is an
insufficient number of vaccinations being given to children. vii Over the past
several years, an anti-vaccination movement has started and gained
popularity among parents who are, for various reasons, choosing to not have
their children receive [Link] These concerns include the fear of
having their
children suffer
from very rare
but very
serious side
effects from
vaccinations,
the belief that
children
already
receive too
many shots, the unfounded but popular belief that vaccinations lead to
autism, or simply religious [Link] Although all states in the U.S.
require that children entering schools receive vaccinations, these parents are
receiving philosophical or religious exemptions for their children.x Among the
areas where measles outbreaks are occurring in California, Arizona, and
Illinois, it is estimated that the vaccination rates are somewhere between
50% and 86%, which is much lower than the 96% necessary to create a
herd immunity effectxi; the number of non-medical exemptions being made
for children is increasing as more and more parents choose to not vaccinate
their children, and as a result, the immunization rates have fallen low enough
that diseases that these children are not being immunized for, such as
measles in this case, can once again begin to spread.
This anti vaccination movement all started as a result of a paper
published in 1998 in a U.K. medical journal that claimed there was a
connection between the MMR vaccine and [Link] However, since this
paper has been published, over a dozen studies have been conducted, all of
which have failed to find any plausible evidence that vaccinations, or that
the MMR vaccine specifically, causes [Link] Another popular concern is
over the small chance of their child suffering from rare but serious side
effects that may sometimes [Link] For example, all vaccines have roughly a
one in one million chance of causing anaphylaxis in children, which can be
life threatening. Another example is that the rotavirus vaccine has about a 1
in 20,000 chance of causing intussusception, which often requires
[Link] While it is irrefutable that vaccines do have an incredibly
small chance of causing these side effects, this should not deter parents
from having their children vaccinated. It is important to realize that vaccines
prevent significantly more deaths than they [Link] It can then be
concluded that it is considerably more likely that your child dies from
contracting a disease that could have been prevented with a vaccine, than
from the vaccine itself.
The potential impacts of this anti vaccination movement and of these
measles outbreaks are dire. According to the Center for Disease Control, it is
estimated that as of 2014, vaccines have prevented 322 million illnesses and
732,000 deaths in people born in the last 20 [Link] Specifically in the case
of measles, it was estimated by the World Health Organization that the MMR
vaccine prevented 15.6 million measles deaths between the years 2000 and
[Link] Despite the low number of measles cases in the U.S. over the past
several years, these numbers are rising, and will continue to do so as more
and more parents either choose to not have their children vaccinated, or
continue to refuse to have their children [Link] Not only will this
increase the number of cases of measles, as well as the number deaths
caused by it, but also the chance for outbreaks of other diseases to occur
within the U.S, as the measles vaccine isnt the only vaccine that parents are
refusing to have their children receive. This creates an opportunity for polio,
rubella, whooping cough, diphtheria, as well as several other diseases to
begin [Link] Specifically regarding polio, according to Robert Daum, a
doctor at the University of Chicago, [The United States has] a perfect storm
for polio to make a reappearance in the American [Link]
A common misconception among parents is that vaccines are
unnecessary because several of the diseases that are being vaccinated for
are nearly gone in the U.S. The reason that these diseases are nearly gone,
though, is due to the fact that parents are continuously having their children
vaccinated; the agents that cause these diseases are still very much present,
and will emerge if vaccinations [Link] When too many parents decide not
to have their children vaccinated, this ultimately enables outbreaks to occur,
like the U.S. is currently facing with measles. History has also demonstrated
that it is entirely possible for diseases that had been nearly nonexistent in a
region to become prevalent again if immunization rates become low enough.
One example of this occurred in Japan in the 1970s. In 1974, 80% of children
were being vaccinated for whooping cough, and there were only 393 cases
that year. Whooping cough had been nearly eradicated, much like several
diseases in the U.S. today. However, vaccination rates began to drop, and in
1979, only 10% of children were vaccinated. This resulted in 13,000 cases of
whooping cough, and 41 [Link] This goes to show that even though a
vaccine might seem unnecessary because a disease appears to be gone,
diseases can almost always re-emerge when not enough children are
vaccinated, and this is likely to happen in the U.S. if parents continue to opt
out of vaccinations for their [Link]
What is currently being done?
As of 2015, all states require that children entering not only public schools,
but also private schools and daycare facilities receive a series of specified
vaccinations prior to their [Link] While all states allow exemptions to
be made for children who cannot receive these vaccinations for medical
reasons, laws vary between states for other types of exemptions. For
example, 48 states and the District of Columbia allow religious exemptions to
be made, while only 20 states allow philosophical [Link] The laws
regarding the procedure for obtaining non-medical exemptions also varies
from state to [Link] While some efforts are being made to make it more
difficult to obtain non-medical exemptions, such as requiring a doctor's
signature, this doesnt necessarily prevent parents from still obtaining
[Link]
The biggest problem with this current exemption system is that the number
of exemptions being made for non-medical reasons is considerably higher
than those made for medical reasons, and these non-medical exemptions
also tend to be clustered in specific [Link] For example, in the state of
California for the 2013-2014 school year, roughly 1,000 medical exemptions
were made, but nearly 17,000 philosophical exemptions were made. In
Florida during the same school year, 4000 religious exemptions were made,
compared to only 800 medical [Link] Due to the fact that these non
medical exemptions tend to cluster geographically, not only are these
exemptions putting children at risk of contracting various diseases they
arent being vaccinated for, but they also put entire communities at risk of
having outbreaks occur. The increasing number of measles cases and
outbreaks exemplifies this. This also means that even though some states
may begin to disallow non-medical exemptions, communities that tend to
have higher rates of unvaccinated children in states that still allow nonmedical exemptions will likely still be at risk of outbreaks occurring.
How do we solve this?
It has been
established time
and time again that
vaccines work,
providing enough
people actually
receive [Link]
With the measles
outbreak
specifically,
according to the
The effectiveness of the measles vaccine
CDC director, This is not a problem with the measles vaccine not working
This is a problem of the measles vaccine being [Link] It is because of
vaccines that diseases like measles have been nearly nonexistent in the
United States for the past decade, and it is because of the absence of
vaccinations that they are coming back. For this reason, vaccine
requirements need to be stricter, and effectively make it so that more
parents end up having their children vaccinated, whether this is by their own
choice, through stronger regulations, or by providing more of an incentive to
vaccinate.
The most straightforward way to go about implementing this is for states to
simply remove the capability for parents to receive philosophical and
religious exemptions. Because these non medical exemptions make up the
vast majority of exemptions received, this would make increase the number
of children with immunity to a number high enough to prevent the spread of
various diseases, as well as prevent outbreaks from [Link] This would
also protect all of the people within the previously mentioned clustered
regions with high exemption rates. Although this approach is the most
effective, it would likely also be met with the most opposition.
Although removing philosophical and religious exemptions would leave
parents feeling as though they have no choice in the matter, one way to help
combat this would be to also provide these parents more easily accessible,
straightforward information on vaccinations and why they are necessarily not
only for their children but for their communities. It would also be effective if
this type of information were to be specifically targeted at regions that
currently have high rates of non-medical exemptions. This would hopefully
help many of these parents realize why it is necessary for their children to be
vaccinated and why it is the right thing to for their childrens health, and
eventually accept their inability to receive exemptions.
Another approach is for states to create stricter regulations on who can
and cannot receive non-medical exemptions. Requiring doctors signatures
for these exemptions is an example of such a policy. Another option could be
to disallow philosophical exemptions, while still allowing religious exemptions
so that those who have very deeply held beliefs rooted in their religious
views against vaccinations arent being forced to do something they are
firmly against, however, this would likely still leave certain communities at
risk. Regardless, keeping the availability of religious exemptions while
removing philosophical exemptions would increase the number of vaccinated
children substantially in states that previously allowed philosophical
exemptions, as these are significantly more common in those [Link]
An approach that Australia has taken is to better incentivize parents to get
their children vaccinated. The way they have done this is by giving family
allowances, which can help to cover the cost of daycare, kindergarten,
vacation care, etc., but requires that the child be vaccinated for parents to
be eligible to receive these allowances. A similar approach could be taken in
the U.S., which may encourage some parents who are on the [Link]
One last point that should be addressed is the notion that vaccination
is a personal matter; even when it has been established that the risk of
having a child vaccinated is nearly nonexistent, and that the consequences
for not doing so are much greater, many parents still feel that the
government should not interfere with what they consider to be a personal
medical decision; whether it be for religious or philosophical reasons, some
parents do not want their children to be vaccinated. While religious and
philosophical beliefs certainly do have a place in decisions regarding ones
children, vaccination simply isnt a personal decision. While the decision to
put a child at risk of contracting preventable diseases for religious or
philosophical beliefs may be a personal decision, choosing to not vaccinate a
child has more consequences than this. By not having a child vaccinated,
parents are putting those who cannot be vaccinated for medical reasons are
at a much greater risk, and also increasing the probability of outbreaks
occurring, helping to enable these diseases to regain prevalence in the
[Link] Vaccination isnt a personal decision, but rather a public health and
safety [Link] For the well being of the U.S. at large, more children
need to be vaccinated.
Regardless of which policy is implemented, the result needs to be a
higher vaccination rate in order to prevent outbreaks such as the one the
U.S. is currently facing, and to enable U.S. citizens to not have to worry about
these preventable diseases. The decision on how to reach such a goal needs
to take into account the feelings of individuals and their potential opposition
to vaccines, but also that vaccinations simply arent a personal health issue,
but rather a public one, and that personal opposition cannot necessarily be
the driving force behind whether or not a child is vaccinated. The policies
outlined here are all steps that should at the very least lead the U.S. in the
direction of having sufficiently high immunization rates, if not solve the
problem and end the current outbreaks all together.
End Notes
i World Health Organization, Measles,
[Link] (Feb. 2015)
ii Center for Disease Control and Prevention, Measles United States, January 1August
24, 2013, [Link] (Sep. 13, 2013)
iii Mariano Castillo, Measles outbreak: How bad is it? CNN, Feb. 2, 2015
iv Ibid.
v Center for Disease Control and Prevention, Measles Cases and Outbreaks,
[Link] (2015)
vi CNN, Feb. 2, 2015
vii Tom Ulrich, Behind the Measles Outbreak, Lab Manager,
[Link]
fw1pk=2#.VSep5VPF9CV (March 28, 2015)
viii PBS Newshour, Tracing the origins of the anti-vaccination movement, Feb. 2, 2015:
[Link]
ix Josh Levs, The unvaccinated, by the numbers CNN, Feb. 4, 2015
x Ibid.
xi [Link]
fw1pk=2#.VSep5VPF9CV
xii Tracing the origins of the anti-vaccination movement
xiii Center for Disease Control and Prevention, Parents Guide to Childhood
Immunizations, [Link]
(Oct. 10, 2014)
xiv CNN, Feb. 4, 2014
xv [Link], Should Any Vaccines Be Required for Children?,
[Link] (Feb. 6, 2015)
xvi Liz Szabo, CDC: Vaccines save hundreds of thousands of lives, USA Today, April 24,
2014
xvii Ibid.
xviii [Link]
xix CNN, Feb. 2, 2015
xx Center for Disease Control and Prevention, Why Are Childhood Vaccines So Important?
[Link] (May 19, 2014)
xxi Could Polio Make Comeback in US, Newsmax Health, Feb. 24, 2015
xxii World Health Organization, What are some of the myths and facts- about
vaccination? [Link] (April 2013)
xxiii Center for Disease Control and Prevention, What Would Happen If We Stopped
Vaccinations? [Link] (May 19, 2014)
xxiv Ibid.
xxv Center for Disease Control and Prevention, State Vaccination Requirements,
[Link] (April 7, 2015)
xxvi CNN, Feb. 4, 2014
xxvii NCSL, States with Religious and Philosophical Exemptions from School
Immunization Requirements, [Link] (March 3, 2015)
xxviii Ibid.
xxix CNN, Feb. 4, 2014
xxx Ibid.
xxxi [Link], Vaccines are Effective, [Link]
xxxii CNN, Feb. 2, 2014
xxxiii CNN, Feb. 4, 2014
xxxiv Steven P. Caladrillo, Vanishing Vaccinations: Why Are So Many Americans Option
Out Of Vaccinating Their Children? University of Michigan Journal of Law Reform 37
(2004): 432, [Link]
xxxv [Link], Family payments and allowances,
[Link]
xxxvi [Link]
xxxvii Ibid.