Joshua Hughes, Class of 2021
The development and implementation of vaccination has been one of the biggest advancements in infectious disease prevention of the past century, with vaccines drastically reducing incidence rates and eliminating several infection diseases in the United states, such as the complete global eradication of smallpox in 1977 (Nabet et al. 2020). Through widespread vaccination coverage we are able to ensure and create herd immunity to greatly limit or stop the spread of some diseases, even in the select small percent of the population that would remain unvaccinated. Vaccine hesitancy is a rising threat to this herd immunity, in which people refuse or are reluctant to have them or their families receive vaccinations. It is this hesitancy that leads to lower vaccination rates and coverage, which in turn compromises the population’s herd immunity and safety, leading to thousands of preventable deaths each year in the U.S. Increasing vaccination efforts and overall coverage would save thousands of lives, save billions in healthcare and societal costs (i.e. economic consequences, impact on available workforce, etc), and prevent millions of cases of disease each year (Nabet et al. 2020). Among the 50 states, the most commonly required immunizations for K-12 schooling are Hep B, DTaP (Diphtheria, tetanus, and pertussis), IPV (polio), MMR (measles, mumps, rubella), and Varicella (chickenpox) vaccines, while Hep A, Flu, Hip and PCV vaccines are advised but still not mandated in the majority of states. Vaccine K-12 requirements vary at the state-level, but hesitancy for many of these state-mandated vaccinations is a huge threat to the herd immunity that ensures diseases like chickenpox, measles, and polio do not resurface (ProCon.org. 2018). This problem is especially alarming in 2020 with the persistence of the COVID-19 pandemic, affecting millions of people across the globe. Vaccine hesitancy could have dire consequences on public health officials' efforts to bring an end to this disease through a potential future COVID-19 vaccine, which is currently being fast tracked for development. It is imperative that we find effective methods to deter this hesitancy, correct misinformation, and promote vaccinations to ensure the general population’s health and safety. One proposed solution is through state legislation to increase the legal barriers for opting out of mandatory vaccinations and subsequently promoting proper pediatric immunization through enforced Parental Counseling Intervention.
A study conducted in 2017 titled “Exemptions From Mandatory Immunization After Legally Mandated Parental Counseling” by Omer et al. presented findings on how vaccination exemptions decreased after the introduction of the Washington State Senate Bill 5005 (SB5005) in 2011, which required approval and parent counseling from licensed healthcare providers for all vaccination exemptions. The study used exemption data and rates collected by the state from 1998 to 2014 in order to analyze the effects of SB5005. After the implementation, there was a relative reduction of 40% and an absolute reduction of 2.9% for exemption rates, along with increases in vaccine coverage for all school entrance vaccinations except the Hepatitis B vaccine. Furthermore, the chances of exempted kindergarteners encountering non-exempted and other exempted students also significantly decreased (Omer et al. 2017). This is a good sign for improvements in coverage, but also in the protection of herd immunity, as less contact between exempted students would theoretically be beneficial for the prevention of transmission. The authors concluded that parental counseling, as was required by legislation in Washington state, was an effective tool in increasing compliance and decreasing exemptions. The authors also clearly made the claim and call to action that the U.S. and other countries should consider adding parental counseling by physicians as a requirement for all vaccination exemptions, as a solution to the effects of vaccination hesitation (Omer et al. 2017). For the most part, I agree with the authors and the study’s findings that parental counseling is an effective method in promoting vaccination, but I believe there are further areas of exploration that should be conducted to ensure the long-term effectiveness of the parent-counseling legislation.
No study is ever perfect and a major flaw highlighted in this study is that it is difficult to tell if the new requirement for exemption just provided a higher barrier and hindrance to the exemption process (causing parents to give up on exemption) or if it actually caused the parent’s perspectives on medicine and vaccination to be changed. For future legislation to be deemed successful it should aim to get to the base of the problem causing resistance. Vaccine hesitancy is thought to be largely due to a general distrust of the medical community which brings about concerns of efficacy, safety, and necessity of vaccines (Nabet et al. 2020). Furthermore, studies have shown social networks, as found in geographical clusters, play a large role in parent’s vaccination decision making and perception of medicine (Brunson 2013). This calls into question whether parental counseling was truly effective in changing their views and are enough to ensure future adherence. Without changing these hesitant populations’ perceptions of medicine there is still likely to be vaccination hesitancy in the form of increased attempts at postponing or not following recommended vaccination schedules. By not solving the root cause, the spread of vaccine hesitant views and misinformation may still continue in the long-term, which in turn may increase the number of people seeking exemptions, given that 45 states, including Washington, still allow non-medical exemptions (Nabet et al. 2020).
In conclusion, parental-counseling is a promising method for decreasing vaccine hesitancy, but further studies should be done before additional legislation is enacted to assess whether required parental-counseling is effective in solving the foundation of the problem. This may include researching the effectiveness of these medical authority-led interventions in changing the parents’ perspectives on immunization and medicine as a whole. This may include surveying for improvements on factors such as trust/confidence in medical science and the scientific community, greater understanding of vaccines and their proven risks, contextualization of the targeted diseases, and the importance of herd immunity. By changing these factors and improving, it is possible that the general trust and outlook on medical science may be shared within the geographical cultural clustering, and allow for vaccine hesitancy to be broken down on a cultural and population level within communities. Furthermore, states could enable strict legislation and interventions in districts with concentrated geographical populations of vaccine hesitancy and anti-vaxx sentiments, like in Los Angeles California. They could monitor the vaccination rates and survey for change in populations perspectives, and determine if parental interventions as previously developed may potentially have long-term worthwhile effects. Securing wide vaccination coverage through such experimental legislation and interventions is vital in preventing future epidemics and will pave the way in ensuring the eradication of numerous diseases.
A study conducted in 2017 titled “Exemptions From Mandatory Immunization After Legally Mandated Parental Counseling” by Omer et al. presented findings on how vaccination exemptions decreased after the introduction of the Washington State Senate Bill 5005 (SB5005) in 2011, which required approval and parent counseling from licensed healthcare providers for all vaccination exemptions. The study used exemption data and rates collected by the state from 1998 to 2014 in order to analyze the effects of SB5005. After the implementation, there was a relative reduction of 40% and an absolute reduction of 2.9% for exemption rates, along with increases in vaccine coverage for all school entrance vaccinations except the Hepatitis B vaccine. Furthermore, the chances of exempted kindergarteners encountering non-exempted and other exempted students also significantly decreased (Omer et al. 2017). This is a good sign for improvements in coverage, but also in the protection of herd immunity, as less contact between exempted students would theoretically be beneficial for the prevention of transmission. The authors concluded that parental counseling, as was required by legislation in Washington state, was an effective tool in increasing compliance and decreasing exemptions. The authors also clearly made the claim and call to action that the U.S. and other countries should consider adding parental counseling by physicians as a requirement for all vaccination exemptions, as a solution to the effects of vaccination hesitation (Omer et al. 2017). For the most part, I agree with the authors and the study’s findings that parental counseling is an effective method in promoting vaccination, but I believe there are further areas of exploration that should be conducted to ensure the long-term effectiveness of the parent-counseling legislation.
No study is ever perfect and a major flaw highlighted in this study is that it is difficult to tell if the new requirement for exemption just provided a higher barrier and hindrance to the exemption process (causing parents to give up on exemption) or if it actually caused the parent’s perspectives on medicine and vaccination to be changed. For future legislation to be deemed successful it should aim to get to the base of the problem causing resistance. Vaccine hesitancy is thought to be largely due to a general distrust of the medical community which brings about concerns of efficacy, safety, and necessity of vaccines (Nabet et al. 2020). Furthermore, studies have shown social networks, as found in geographical clusters, play a large role in parent’s vaccination decision making and perception of medicine (Brunson 2013). This calls into question whether parental counseling was truly effective in changing their views and are enough to ensure future adherence. Without changing these hesitant populations’ perceptions of medicine there is still likely to be vaccination hesitancy in the form of increased attempts at postponing or not following recommended vaccination schedules. By not solving the root cause, the spread of vaccine hesitant views and misinformation may still continue in the long-term, which in turn may increase the number of people seeking exemptions, given that 45 states, including Washington, still allow non-medical exemptions (Nabet et al. 2020).
In conclusion, parental-counseling is a promising method for decreasing vaccine hesitancy, but further studies should be done before additional legislation is enacted to assess whether required parental-counseling is effective in solving the foundation of the problem. This may include researching the effectiveness of these medical authority-led interventions in changing the parents’ perspectives on immunization and medicine as a whole. This may include surveying for improvements on factors such as trust/confidence in medical science and the scientific community, greater understanding of vaccines and their proven risks, contextualization of the targeted diseases, and the importance of herd immunity. By changing these factors and improving, it is possible that the general trust and outlook on medical science may be shared within the geographical cultural clustering, and allow for vaccine hesitancy to be broken down on a cultural and population level within communities. Furthermore, states could enable strict legislation and interventions in districts with concentrated geographical populations of vaccine hesitancy and anti-vaxx sentiments, like in Los Angeles California. They could monitor the vaccination rates and survey for change in populations perspectives, and determine if parental interventions as previously developed may potentially have long-term worthwhile effects. Securing wide vaccination coverage through such experimental legislation and interventions is vital in preventing future epidemics and will pave the way in ensuring the eradication of numerous diseases.
References:
1. Brunson EK. 2013. The Impact of Social Networks on Parents' Vaccination Decisions. PEDIATRICS 131:e1397-e1404. [accessed 2020 Jun 2].
2. Nabet BB, Gable JL, Eder JP, Feemster KA. 2020. Addressing Vaccine Hesitancy to Protect Children and Communities Against Preventable Diseases. Policylab.chop.edu. [accessed 2020 Jun 2]. http://policylab.chop.edu/sites/default/files/pdf/publications/Addressing_Vaccine_Hesitancy.pdf
3. Omer S, Allen K, Chang D, Guterman L, Bednarczyk R, Jordan A, Buttenheim A, Jones M, Hannan C, deHart M et al. 2017. Exemptions From Mandatory Immunization After Legally Mandated Parental Counseling. Pediatrics 141:e20172364. [accessed 2020 Jun 2].
4. ProCon.org. 2018. State-by-State: Vaccinations Required for Public School Kindergarten - Vaccines - ProCon.org. Vaccines. [accessed 2020 Jun 7]. https://vaccines.procon.org/state-by-state-vaccinations-required-for-public-school-kindergarten/
5. Wikimedia Commons contributors. 2015. File:Smallpox vaccine.jpg - Wikimedia Commons. Commons.wikimedia.org. [accessed 2020 Jun 10]. https://commons.wikimedia.org/wiki/File:Smallpox_vaccine.jpg [Untitled illustration of Vaccine & Syringe].
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