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Health and Disease

State-Mandated Childhood Vaccinations

State-mandated childhood vaccinations have always been a controversial topic. Now with the rise of the internet, more individuals are concerned about the effects mandatory vaccinations will have on our safety and liberty, despite the overwhelming positive effects that will result if childhood vaccinations become state-mandated.

Introduction

Vaccines, a type of substance discovered in 1796, have been the center of conversations between frustrated politicians, overly-concerned mothers, and curious students themselves. This paramount medical discovery that regulates and regards the well-being and health of children all over the United States is now in the hands of our government. Their main point of discussion: the mandate of childhood vaccinations by state.

Background

 The concept of vaccinating resulted from a smallpox outbreak in England in 1796. British Dr. Edward Jenner realized he had the ability to protect a non-immunized child from the deadly smallpox virus by injecting the child with lymph from a cowpox blister. The live cowpox virus would act as a weaker, asymptomatic form of the smallpox virus, safely allowing the body’s immune system to be prepared for the fatal smallpox virus. However, Edward Jenner’s methods and theories of vaccination were constantly looked down upon. At the time, the local clergy in Jenner’s town believed that the smallpox vaccine went against common Christian morals as it involved the flesh of an animal being injected into a human body. In Great Britain, the Anti-Vaccination League formed soon after, publishing numerous anti-vaccination journals that promoted self-liberty and Christian values. When the concept of vaccines was starting to be implemented by doctors in the United States, it was met with opposition. Magazines, which were critical to the imposition of liberty that modern vaccinations brought, started to become popular. Following suit of European countries, the anti-vaccination movement in the U.S. began to grow in the mid to late 1900s. This mainly resulted from a pattern of newly developed vaccines, such as the Diphtheria, Pertussis, and Tetanus (DPT) vaccine; the Polio vaccine; and the Measles, Mumps, and Rubella (MMR) vaccine. About 15 years later, after the skeptical DPT: Vaccine Roulette documentary aired on television, Physician Andrew Wakefield published a paper in the reputable medical journal, The Lancet, claiming a correlation between the MMR vaccine and autism. The article was eventually retracted, however, and Wakefield’s medical license was revoked. Nevertheless, the article sparked many more doubts amongst parents on the safety of vaccines in general and muddled the assurance parents would receive from their pediatrician. It additionally sparked the national debate on the mandate of vaccinations that many are still engrossed in today.  

Eradication of Diseases

One of the primary effects of vaccines is that they assist in eradicating the most fatal and contagious diseases by promoting mass injection. In 1921, there was a presence of over “150,000-260,000 cases of pertussis” (Vidula). These cases dramatically dropped following the distribution of the Pertussis vaccine, as recent reports indicated there would be “97.56% fewer pertussis cases in the United States” than there would be without mass immunization (Vidula). The high percentage of vaccine coverage in children 19 – 35 months old resulted in a 95.4% decrease in the annual morbidity of children diagnosed with Pertussis when comparing figures from the 20th century to the 2000s. It is safe to assume that mandatory vaccinations will promote these trends to occur continuously, as more individuals will take the particular vaccine, reducing the number of cases annually. These statistics can also be explored with the Diphtheria vaccine. Before the diphtheria vaccine was developed in the 1930s, “the disease infected about 21,000 people in the United States each year” with a death toll of nearly “1800 people” (Welch). Less than 80 years after the introduction of the vaccine, “by 2006, both numbers [of cases and deaths] were zero” (Welch). In both statistics presented, the death toll and injury resulting from these vaccine-preventable diseases were extremely large before the introduction of a vaccine. However, it is evident that when accessible and clinically tested vaccinations were immunizing a colossal number of people safely, such as the numbers in 1921, the numbers were not repeatedly occurring. Suppose these trends of mass immunization were to continue in the future. In that case, such vaccine-preventable diseases could be completely eradicated in the United States, similar to the lifetime of the Poliovirus and the Smallpox virus in the nation. 

Economic Effects

Furthermore, the occurrence of cases from vaccine-preventable diseases is reported to spur financial issues for both parents and medical institutions. For instance, in a 2005 measles outbreak in Indiana, “thirty-four individuals in total contracted measles” with an additional 500 cases discovered as contacts of the original thirty-four (Andrada). This outbreak ultimately cost “health establishments an estimated $167,685 ($4,932 per confirmed case)” as ninety-nine hospital personnel were assigned to deal with the cases. Additionally, more than 3,500 person-hours were spent on “telephone calls, MMR vaccines, immunoglobulin, specimen collection kits and laboratory tests, and transportation” (Andrada). The data gathered from this small Indiana measles outbreak conveys the general amount of funds utilized to manage cases of diseases where protection is readily available. Instead of hospital funds being directed towards clinical trials involving novel illnesses and developing new research, funds were being spent on managing preventable diseases, ultimately lengthening the time needed by institutions to obtain new research about diseases that aren’t vaccine-preventable yet. Parents and sick individuals face a financial burden as well when confronted by a fatal, yet preventable disease. To identify this economic burden, the National Center for Biotechnology Information conducted a study in which “107 individuals of 216 subjects with identified cases of Pertussis completed questionnaires” and had medical records reviewed to determine the total costs of the illness, “including physician office visit … hospitalization…  additional child care, and lost days from school or from work” (Pichichero and Treanor). The results of this study indicated that the total “cost” of the disease was $381,052. Moreover, the impact of the disease primarily affected the parents who took care of their ill children. “Child care costs ranged from $12 to $2688,” and for every 50 families, one adult lost workdays to “provide child care for an average of 8.3 days,” which is a loss in income for almost two working weeks (Pichichero and Treanor). In one particular case, “2 adults lost an average of 44 days from work,” resulting in over a month of reduced income (Pichichero and Treanor). It is evident that once epidemics advance, unemployment will occur, and most parents who prioritize their child’s well-being before their living will automatically prohibit themselves from contributing to the state’s economy. 

Psychological Effects of Quarantine

Additionally, once a community has been inflicted by a vaccine-preventable disease, one of the only methods present to prevent the disease’s continuation would be to quarantine, a method proven to be connected to mental disorders. The University of Toronto surveyed 129 individuals who had been quarantined during the SARS outbreak. The survey utilized psychometric tests designed to identify the signs of depression and PTSD. It was noted that the 129 individuals exhibited “a high prevalence of psychological distress” and that “symptoms of posttraumatic stress disorder and depression were observed in 28.9% and 31.2% of respondents” (Galea and Hawryluck). These results indicate the high likeliness of receiving mental distress after being quarantined, a method that could easily be prevented by mandatory vaccinations. Mandatory vaccinations would dramatically reduce the probability of an epidemic occurring within a community needing a quarantine. Another study was conducted by the National Center for Biotechnology. It analyzed the psychological effects of quarantine on a sample population in Sierra Leone, an area that had recently experienced an Ebola quarantine. The results of this study convey that the “prevalence of any anxiety-depression symptom was 48%” of the sampled and “[prevalence] of any PTSD symptom 76%” (Jalloh et al.). Additionally, “6% met the clinical cut-off for anxiety-depression” and “ 27% met levels of clinical concern for PTSD” (Jalloh et al.). It was concluded that the longer one spends quarantined, the higher the chance that they have a resulting mental disorder. Whether vaccine access is restricted unwillingly, meaning it hasn’t been developed yet, such as an Ebola vaccine, or willingly, such as a Polio vaccine, an individual has a higher chance of contracting the virus and therefore being quarantined in their state. Advocates of the mandate on routine vaccinations, therefore, argue that laws have abilities to prevent masses of people from being quarantined and receiving the subsequent mental health effects that could impact them throughout their lives. 

Immunity in Future Generations

Most importantly, many argue that mandatory vaccinations have the ability to benefit the United States for years to come, as they directly protect future generations. Before 1963, when the Measles vaccine was commercialized and distributed, there was an annual amount of 500,000 measles cases reported, where the highest incidence of measles “was among 5–9-year-olds” who accounted for “more than 50% of reported cases” (“Measles”). However, after the introduction of the vaccine in 1963, a “median of only 29%” of the cases amongst children of all ages from 1980 to 1988 reported were “among children younger than 5 years of age” (“Measles”). According to the national vaccination schedule that many pediatric offices use, most children only receive their complete dosage of the measles vaccine at age 6, some even later. Therefore, the statistics that resulted in the 1980s convey that most children who couldn’t yet receive the measles vaccination due to their age still didn’t contract it, opposite to the trend in previous decades. This is due to the fact that every single child utilizes their parents’ immunization and depends on it for the health of their neonatal immune system. The young children in the 1980s had parents who grew up in the 60s, a time when the Measles vaccine was being produced and administered in heavy amounts; therefore, it is safe to assume that their parents’ generation received the vaccine, automatically improving the immunity of the generation immediately after them. This improvement in immunity was shown in the statistics from 1980 and can be further demonstrated in statistics of the 21st century. Furthermore, the National Center for Biotechnological Information states that a breast-fed infant is provided with “0.25-0.5 grams per day of secretory IgA antibodies via the milk” (Hanson and Soderstrom). The number of grams of the secretory antibodies, crucial proteins for the functions of the immune system, can be altered due to the immunization of the mother, as “recent studies suggest that it may be possible by vaccination” of the mom to “increase the immunity [of]… the breast-fed infant via the milk secretory IgA antibodies” (Hanson and Soderstrom). This further emphasizes the amount of protection vaccination provides for the future children of the individual taking the vaccine, which advocates say can be promoted and regulated through mandatory state vaccination laws.

The View of Most Opponents

Many opponents of mandatory vaccinations believe that the MMR vaccine and other common vaccines that provide three doses of different substances within one shot can cause permanent brain damage and autism. Consequently, they believe that the state shouldn’t mandate it because of the varying effects it has on a variety of people. Concerns were rising amongst the residents of Japan, as they too feared that the MMR vaccine would cause an adverse reaction relating to aseptic meningitis since three doses of different vaccines were administered simultaneously. As a result, in Japan, “in 1993, the combination MMR vaccine was discontinued,” and the vaccination was instead “replaced with separate measles, mumps, and rubella vaccines” (Ching and Kuwabara). However, after the change, there were no resulting differences in the number of brain disorders developed in children after the new vaccination schedule had been administered. Nevertheless, there was still heightened fear amongst the public about the MMR vaccine’s effects on the brain. It can be concluded that many of these fears originated from a research paper published in a reputable medical journal, The Lancet. This paper, published in 1998, describes a correlation between the administration of the MMR vaccine and autism. However, the piece was completely retracted from the journal in February 2010, with a statement from the medical community involved with the paper, admitting “that several elements in the paper were incorrect” and “contrary to the findings of the earlier investigation[s]” on the MMR, prior to the analysis done by Wakefield (Andrade and Sathyanarayanana Rao). Additionally, Dr. Andrew Wakefield “[was] held guilty of ethical violations” as there was strong evidence that his team had conducted “invasive” investigations on the test subjects without obtaining “ethical clearances” or formal consent (Andrade and Sathyanarayanana Rao). Therefore, this conveys that, despite the investigations providing evidence that the MMR vaccine had the potential to cause brain damage, the tests done to support such a claim were faulty and weren’t credible, ultimately meaning that the claim itself wasn’t accurate. Moreover, it concludes that the reason behind the objection of state-mandated childhood vaccination is not and can never be well supported.

Conclusion

Due to the points mentioned above, it is reasonable to conclude that state-mandated childhood vaccinations will provide a more stable state health-wise and financially. Therefore, the vaccinations should be enforced by law because of their ability in protecting future generations, eradicating dangerous and lethal diseases that have had a historical impact, providing a more stable budget for both health institutions and individuals who are in charge of caring for the ill, and directly preventing the damaging emotional effects of quarantines. The varying information on both sides of the debate surrounding a state mandate is extremely important as it has created a large amount of panic amongst parents who are hearing a variety of contradicting opinions, yet are focused on providing the best health for their child. The effect of this particular debate is common with almost all controversial issues, as both sides will usually have the same ultimate goal, yet argue about the most ideal way to approach it. Therefore, the different opinions can be a source of panic, as people who are merely trying to get more insight into the topic will be flabbergasted by the amount of contradicting ideas. However, once more insight is gained on state-mandated vaccinations, including the economic and social benefits, and the assurance it provides individuals and parents, there will be a more apparent consensus on the vaccine issue. 

References

Andrada, Carolina. “Cost of Outbreak Response.” Outbreak ObservatoryI, Johns Hopkins Center for Health Security, 12 July 2018, https://www.outbreakobservatory.org/outbreakthursday-1/7/12/2018/cost-of-outbreak-response. Accessed 4 March 2020.

Andrade, Chittarajan, and T.S Sathyanarayanana Rao. “The MMR vaccine and autism: Sensation, Refutation, Retraction, and Fraud.” Indian Journal of Psychiatry, National Center for Biotechnology Information, 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136032/. Accessed 4 March 2020.

Ching, Micheal, and Norimitsu Kuwabara. “A Review of Factors Affecting Vaccine Preventable Disease in Japan.” Hawai’i Journal of Medicine & Public Health : A Journal of Asia Pacific Medicine & Public Health, National Center for Biotechnology Information, 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300546/. Accessed 5 March 2020.

Hanson, LA and T. Soderstrom. “Human Milk: Defense Against Infection.”  Progress in Clinical and Biological Research, National Center for Biotechnology Information, 1981, https://www.ncbi.nlm.nih.gov/pubmed/6798576. Accessed 9 March 2020.

Hawryluck, Laura, et al. “SARS Control and Psychological Effects of Quarantine, Toronto Canada.” Emerging Infectious Diseases, National Center for Biotechnology Information, 2004,  /www.ncbi.nlm.nih.gov/pmc/articles/PMC3323345/. Accessed 9 March 2020.

Jalloh, MF, et al. “Impact of Ebola experiences and risk perceptions on mental health in Sierra Leone.” BMJ Global Health, National Center for Biotechnology Information, 2018. https://www.ncbi.nlm.nih.gov/pubmed/29607096. Accessed 9 March 2020.

“Measles.” Epidemiology and Prevention of Vaccine-Preventable Diseases, Centers for Disease Control and Prevention, 2019, https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html. Accessed 5 March 2020.

Pichichero, ME and J Treanor. “Economic Impact of Pertussis.” Archives of Pediatrics & Adolescent Medicine, National Center for Biotechnology Information, 1997, https://www.ncbi.nlm.nih.gov/pubmed/9006526. Accessed 9 March 2020.

Schafly, Andrew. “The Chickenpox Vaccine Is Unnecessary and Its Safety Is Unproven.” Vaccines, edited by Sylvia Engdahl, Greenhaven Press, 2009. Current Controversies. Gale In Context: Opposing Viewpoints, Accessed 14 Feb. 2020.

Staver, Mathew D. “Mandatory Vaccinations Threaten Religious Freedom.” Should Vaccinations be Mandatory?, edited by Noël Merino, Greenhaven Press, 2010. At Issue. Gale In Context: Opposing Viewpoints. Accessed 14 Feb. 2020.

Vidula, Mahesh. “Individual Rights vs. Public Health: The Vaccination Debate.” Angles / Individual Rights vs. Public Health: The Vaccination Debate. Angles, 2010. http://web.mit.edu/angles/2010_Mahesh_Vidula.html Accessed 14 February 2020.

Welch, Matt. “Should Vaccines Be Mandatory?” Reason, 2014. Sirsissuesresearcher, Accessed 9 Mar. 2020.

Prish Ramnath, Youth Medical Journal 2020

By Prisha Ramnath

Prisha Ramnath is a Junior at Clarksburg High School in Maryland, U.S. She is an avid app developer who wants to assist those with medical issues through technology. She is passionate about medicine, but specifically wants to focus on biomedical engineering in college.

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