Research Outline

INTRODUCTION:

In recent years, vaccinations have become one of the most controversial topics to discuss. The use of vaccinations has been shown to protect large amounts of people from diseases that are can be life threatening, especially in largely populated, developed countries. “Vaccines truly represent one of the miracles of modern science. Responsible for reducing morbidity and mortality from several formidable diseases, vaccines have made substantial contributions to global public health” (Grady). Vaccines provide safety by making the body believe that it is being attacked by the actual disease, so that it can build up a strong immunity to the agent so that if the person is ever exposed to the disease, they will have the ability to fight it off (Baker Institute). When large quantities of people get vaccinated in an area, it creates what is called herd immunity. Herd immunity helps protect those who are unable to be vaccinated for specific reasons such as medical conditions or allergic reactions to vaccines themselves. Herd immunity is only effective when it reaches a certain level, which for many diseases, there needs to be at least 90-95% of people vaccinated (PLOS Medicine). Since the recent anti-vaccination movement in the United States, some of the more controversial vaccinations such as the Measles, Mumps, Rubella (MMR) have fallen below the necessary percentage to keep the disease eradicated and to protect the general population that has not received vaccinations. “Eventually, the existing equilibrium reaches a stage where the population is no longer immune and the number of individuals who maintain a level of immunity are too few to provide any sort of herd immunity. At this stage, known as “The susceptibility Period”, the population becomes almost destined to another epidemic” (Paternoster).

Even though much research shows that vaccines can have positive effects on public health, it is important to understand why people are choosing not to vaccinate. Specifically, when it comes to the MMR controversy, there is a retracted study to blame. The doctor, Andrew Wakefield, published a false study to the world claiming that the MMR vaccine caused a direct correlation to Autism in the patients that got vaccinated. It has since been found to be fraudulent information, released by Wakefield for financial gain (NCBI). (To read the original retracted study, click here). Even though this article has been retracted for many years, people still believe that the information from the study is true, causing widespread fear when it comes to making the decision as to whether or not a child should receive this vaccine. Some parents are not willing to take the risk that the vaccine could actually cause a disorder in their child. Many studies have been done recently to see what other causes are fueling the anti-vaccination movement and to see what percentage of children are not getting vaccinated in the country.       

STUDIES:

Naturopaths promoting Anti-vaccination https://academic-oup-com.libproxy.plymouth.edu/jlb/article/4/2/229/3871793

  • “After reviewing just over 330 websites, we found 40 websites with vaccine hesitancy discourse, and 26 websites offering vaccine or flu shot alternatives. Thirteen websites had both. In total, 53 had either vaccine-hesitant language, suggested a vaccine alternative or had both.”
  • Continuum on how harsh the naturopaths are pushing for no treatment or alternative treatment
  • Only have the information that posted online to the public, they do not know what is being said to patients in person
  • People see that the website is displayed as a healthcare provider and may believe it is a real doctor putting this information out there
  • Social media sharing can greatly raise the number of people who see this information
  • Competition Act: this offense is punishable by fine or imprisonment, changes to the federal Natural Health Product Regulations in 2015 now require homeopathy vaccines to include on their labels the statement that “this product is neither a vaccine nor an alternative to vaccination. This product has not been proven to prevent infection.”
  •  “On November 15, 2016, the FTC, which is responsible for marketing regulation in the USA, released an ‘Enforcement Policy Statement on Marketing Claims for Over-the-Counter (OTC) Homeopathic Drugs’ that changes the national marketing landscape.71 Under this new policy, the FTC prohibits claims of efficacy and safety for OTC homeopathic drugs that are not supported by ‘competent and reliable’ scientific evidence, unless the promotion also clearly communicates that there is ‘no scientific evidence that the product works’”
  • There can be disciplinary action towards those who give their patients false info about vaccines or try to get them to use unproven or disproven alternatives.
  • Naturopaths becoming doctors can be found criminally negligent if they are having patients use remedies rather than proven treatments.

Anti-vaccination Movement in the U.S.https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002578

  • “Since 2009, the number of “philosophical-belief” vaccine nonmedical exemptions (NMEs) has risen in 12 of the 18 states that currently allow this policy: Arkansas, Arizona, Idaho, Maine, Minnesota, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Texas, and Utah.”
  • Metropolitan areas are being targeted, but highly populated areas lead to high cases of outbreaks
  • “According to the 2015 National Immunization Survey, only 72.2% of children aged 19 to 35 months in the United States were fully vaccinated as per guidelines from the Advisory Committee on Immunization Practices”
  • Nonmedical exemptions include philosophical and religious beliefs
  • Having a lot of children that are not vaccinated due to nonmedical exemptions in the metro areas leave a large opportunity for disease that can normally be prevented by vaccines, can spread very quickly for those whom are unvaccinated for whatever reason. The majority of people that are unvaccinated live in cities, thus increasing the risk of disease spreading internationally.
  • NMEs weaken herd immunity that protects the population, especially those people whom are allergic, immunocompromised, or otherwise unable to be vaccinated
  •  Ideal herd immunity is 90-95%, depending on the disease 
  • “Overall, states with more NME students exhibited lower MMR vaccination rates. In contrast, states that have banned NMEs—MS, CA, and WV—exhibit the highest MMR vaccine uptake and lowest incidence of vaccine-preventable diseases.”

Vaccine exemption and state-level policy https://doi.org/10.1093/ofid/ofx244

  • “High rates of nonmedical exemptions have been associated with higher rates of vaccine-preventable diseases. Local clusters of vaccine exemptions geographically overlap with outbreaks of pertussis”
  •  “Moreover, there was an association between the administrative ease of obtaining nonmedical exemptions and rates on nonmedical exemptions and pertussis”
  • “In the United States, during the 2011–2012 through 2015–2016 school years, 48 states (excluding West Virginia and Mississippi) and the District of Colombia (DC) permitted nonmedical exemptions to vaccination requirements for school entry to kindergarten” 
  • States classified as easy if they required at least 1 standard for exemption
  • States were classified as medium if they required at least 2 standards
  • States were classified as difficult if they required at least 3 standards
  • “a total of 245 state-years were included in the analysis. From 2011–2012 through 2015–2016, 29 states and DC allowed for exemptions based on religious beliefs, and 19 states allowed for both exemptions based on religious beliefs and philosophical or personal belief reasons.”
  • “8 states were classified as having easy exemption policies, 18 states were classified as having medium exemption policies, and 23 states were classified as having difficult exemption policies”
  • “There was an increase in nonmedical exemption rates through the 2012–2013 school year; however, rates stabilized through the 2015–2016 school year”
  • The plateau can be caused by many things, such as doctors and media pushing the fact that vaccines are needed to prevent the deadly diseases that are reemerging, as well as that some states are making it more difficult for children to be enrolled in school without being vaccinated.
  • “We found that states allowing philosophical and easy-to-obtain exemptions continue to be associated with higher rates of exemptions”

CONCLUSION:

There is no simple explanation as to why the United States is seeing such a decrease in vaccination rates in recent history as so many factors are going into the decision-making process. Currently, the standard for health care and preventing disease is through the use of frequent and multiple vaccinations. “The World Health Organization estimates that 2 million childhood deaths were prevented through vaccination in 2003” (World Health Organization). For now, the U.S. does allow parents to have the option on whether or not to vaccinate their children and many are choosing not to. The studies have shown that there are very complex components to this argument, such as patients may not be seeking traditional medical treatment as often and naturopaths are promoting alternatives to medications and vaccines. Also, many states allow parents to file paperwork with the school based solely on philosophical beliefs as to why their children are not vaccinated and they do have the freedom to do so if they choose. There will need to be some immense changes to vaccine safety for more people to be willing to get on board with vaccinating their children. Currently, the United States only has enough information on vaccinations to promote them as our best defense against disease. Although some homeopathic remedies or alternatives may be effective, there has not been enough research and studies on the products yet to determine their safety and effectiveness.

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Comments

Matt Cheney
March 22, 2019 at 3:22 pm

This is a great start! As you continue to research, you will continue to refine your conclusions and your focus. One thing that stood out to me in your conclusion was the statement that “there will need to be some immense changes to vaccine safety for more people to be willing to get on board with vaccinating their children” — I wonder if this is about vaccine safety or about the public perception of vaccine safety, which are very different things.

I keep thinking of your project as I encounter more and more news items like this one: https://slate.com/technology/2019/03/plague-inc-petition-anti-vaxxers.html
It’s a story about the popular video game “Plague, Inc.”, which is now trying to add anti-vaxxers to the gameplay and it’s proving difficult because if anti-vax ideas spread with any real speed, then the plague easily wipes out all humans.



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