To understand the significance of vaccines, a world before them must be recognized. The flu, for example, was a death sentence, whereas now that is one the most common ailments from which patients recover. The overall improved health of the world exemplifies the success of vaccinations. Some believe vaccines have hardly made a lasting effect in the world, and there is only a lesser prominence of diseases because of better living conditions. Though that is absolutely a factor, significantly improved living conditions cannot be so credited that we forget that the cleanest locations still get infected with disease. A debate has started on whether or not vaccinations should be mandatory in order to preserve the health of the nation. The debate on mandatory vaccines stems from the original purpose of vaccines, vaccination benefits, the downfalls of the vaccination, and misunderstandings about the vaccine.

To understand the significance of vaccines, a concept called herd immunity must be defined. Herd immunity is the notion that when enough people are protected from a certain disease, the likelihood of a community contracting that disease is reduced overall. Herd immunity is an important component of immunizations because it displays the positive effects of vaccinations. The US Department of Health and Human Services reported that “since the pneumococcal vaccine was approved for use in children, the number of older adults hospitalized for pneumococcal disease has gone way down” (2006). The effect on adults not getting sick because of children being vaccinated tells the correlation is not coincidental. With an increase in children immunized against pneumococcal, there was a decrease in adults contracting the disease. The main argument against herd immunity is that this concept is not realistic, and does not make an effect in practice. However, in some cases it is evident that the spreading of a disease is more of a threat than contracting the disease independently. Dealing with smallpox in Nigeria, a particular vaccinating strategy aimed to cover only those infected and those in direct contact with the infected, which resulted in an extremely high success rate. This surveillance-containment strategy displayed the effectiveness of immunizing those at risk of infection.

A prime example of vaccination success is the smallpox virus. The smallpox vaccine has consistently been a threat to the human race, with a 30% mortality rate (Belongia, 2003). The smallpox virus marks the first popular emergence of inoculations. In the late 18^th century, Edward Jenner noticed milkmaids exposed to cows with cowpox were immune to the smallpox virus. He took a sample of the cowpox pus and injected it into a boy and then exposed him to smallpox. The boy did not contract the smallpox virus, so inoculation proved to be a success. From then on, Jenner referred to his discovery as a vaccination. In 1950, the World Health Organization launched efforts to eradicate the disease in America. With a sufficient supply of vaccines and various medical resources, the United States was no longer threatened by most smallpox viruses by 1949. Less developed nations, however, needed assistance to eradicate the disease. During efforts to eradicate this virus in poorer countries, the US and the Soviet Union donated more than 150 million doses of the vaccine. The fact that less developed nations needed more vaccines to eradicate the disease implicates smallpox eradication could not be done simply by cleaning up the streets and through personal hygiene. The global eradication strategy began with mass vaccination campaigns, which were effective in well-developed countries, but proved inefficient in under-developed countries. A new strategy was developed to aim at aggressive cases and all known contacts to that case to seal off the spread of the virus. This strategy, known as surveillance-containment led to the elimination of smallpox in Nigeria, with only 50% coverage of the population. It was declared by the World Health Organization (WHO) in 1980 that smallpox had been eradicated from the earth. Ultimately, the eradication acts as a prime example of herd immunity taking over and making a long-lasting effect on the community.

 

The debate of government mandated vaccinations is further complicated as there has been immense success in the military with required vaccinations. In 1945, it was declared that “As a result of the development and use of toxoids and vaccines there have been no deaths in the Army to date from tetanus, yellow fever or epidemic typhus” (1945). This report directly attributes the good health of the Army to the implementation of vaccines. To support the effectiveness of vaccines, it was reported that nine cases of tetanus in the Army occurred, but without proper immunization. Lastly, although troops in the Army and Navy were directly exposed to typhus in North Africa and Italy, the Army-Navy Typhus Commission has no records of typhus related deaths since vaccinations for the disease were mandated in the military. This example demonstrates the positive aspects of mandatory health care by the government. The government made extensive efforts to ensure the health of the soldiers because there are strict standards for those who can serve. The role of the federal government in vaccine policy is described as “development of guidelines for when to administer specific vaccines (and when not to) and to what populations” (2015). An Advisory Board at the Center for Disease Control recommends vaccines yearly to protect against diseases. One of the most relevant diseases from which the population needs to be protected is Hepatitis B. Hepatitis B vaccine is an example of a vaccine with success, yet the disease still needs to be treated regularly with booster shots. The CDC reported that “the rate of acute Hepatitis B Virus Infections declined 88.5% since recommendations for HepB vaccination were first issued, from 9.6 cases per 100,000 population in 1982 to 1.1 cases per 100,000 population in 2015” (Schillie, 2018). Though there was a relatively stable rate of infection during 2010-2015, this does not indicate a peak and decline in vaccination effectiveness. Rather, 2010-2015 is a period in which Hepatitis B vaccinations have already been used regularly, so the statistic reads that there is a causal relationship between the vaccination and the reduced the prominence of Hepatitis B. Generally, the Hepatitis B vaccination is recommended by the CDC for “all unvaccinated children and adolescents aged <19 years” (Schillie, 2018) due to its distinct frequency in children. Nevertheless, there are situations in which the Hepatitis B vaccine is not recommended. In 2011, the Institute of Medicine found evidence supporting a “causal relationship between HepB vaccine and anaphylaxis in yeast-sensitive persons” (Schillie, 2018). Although this may appear as a reason to discourage the CDC’s recommendation, it is taken out of context as the CDC qualifies who should not receive certain vaccinations based on allergic reactions. Therefore, the recommendation approved by the CDC has a purpose to better the health of the nation. The Center for Disease Control’s specified support of vaccinations to those who would not be harmed by them has contributed to the controversy of required vaccinations as it gives reason to implement them as well as risks that come with requirements.

With any story of medical success, there will be stories of failure. Take the polio vaccine, for example. In 1955, studies “showed the vaccine to be 60 to 90 per cent effective against paralytic poliomyelitis caused by all three types of polio virus. Against Type 1 virus, which accounts for most of the epidemics in the United States, the vaccine was 60 to 70 per cent effective” (Shaffer, 1955).While this rate appears to be high, it can also be interpreted as lower than necessary. The polio vaccine has demonstrated that certain vaccines are more effective to certain people, particularly dependent on age range. A National Foundation survey showed that acute polio had “only dropped 17% in the population as a whole” (Shaffer, 1955) but “52% among eight-year-olds” (Shaffer, 1955) indicating more success in younger patients. The correlation between vaccinated children and reduction of polio in children is causative, as exhibited by Canada’s health minister report in 1955 that “only five cases occurred among 600,000 children who had received two or more doses [of vaccine], while there were 51 cases among 885,000 unvaccinated children” (Shaffer, 1955). Though there is success in the polio vaccine, there is also some credibility to parents who do not have faith in the polio vaccine. The US Public Health Service was accosted for lack of surveillance over vaccine production when a once approved vaccination was recalled after a number of children contracted polio after inoculation. This incident, however, was not due to the failure of the inoculation process, but, rather, the nature of the vaccine. This case has led many to be skeptical of government-approved medicines and plays a large part in why there is much debate in whether or not the US population should trust the government to make recommendations on vaccinations. This should not discourage parents from ever restoring faith in science based medicine. In a study of a polio outbreak, it was discovered that the virus was not properly killed. The reason for failure of the vaccine lay in “inadequacy of the inactivation process, which failed to kill all of the virus, and in inadequacy of the testing procedure, which failed to show presence of live virus” (Shaffer, 1955). The fault lying in inadequate measures taken to ensure the virus could not infect the subject shows there should not be concern of vaccine failure when the procedure is done properly. In other words, it is not the vaccination that was dangerous, but the improper use of the virus. This controversy also led to the debate on health care and the expenses of vaccines. In the case that vaccinations are consistently effective, the resources are at stake, and must be rationed.

The last thing I will mention is misunderstandings of vaccinations, specifically the Measles-Mumps-Rubella vaccine. This is important because it has made a large contribution to parents not getting their children vaccinated, thereby decreasing herd immunity. In 1998, a report came out that eight children developed symptoms of autism subsequent to receiving a MMR shot, particularly due to the use of thimerosal in vaccinations. This report has been discredited, but it already made a large impact worldwide. This false report caused British vaccination rates to fall to a historic low in 2003, which raised concerns of compromised herd immunity, and decreased protection from a possible outbreak of disease. This misbelief caught political wind when Representative Dan Burton declared an “epidemic” (Glazer, 2014) and held multiple autism hearings promoting the link between vaccines and autism. This is essential because this rumor about autism and vaccinations jeopardized the community’s health because “many parents blamed childhood vaccines” (Glazer, 2014) for the cause in the increase in autism, which turned them away from vaccinating their children. Believers of this myth are not credible as they ignore scientific findings that “the widely discussed theory that autism was linked to childhood vaccines has been discredited by scientific research” (Glazer, 2014). It may appear that this rumor had truth to it because in 1999, the federal government requested vaccine manufacturers to reduce the use of thimerosal. However, with the exception of some flu vaccinations, it has not been used in childhood vaccines since 2001. Therefore, this already discredited myth, has made a lasting impact on parents not wanting their children vaccinated. This controversy has also brought politics in the question of vaccination requirements.

There are circumstances when children must be vaccinated, such in the case of entering daycare or school. State laws have vaccination requirements, but also offer exemptions from these requirements on the basis that they intervene with religious/philosophical practices or are medically harmful for the particular person. Exemptions are an essential part of vaccine requirements because, even in health emergency periods, exemptions remain intact.

Exemptions defend the laws for vaccinations as they ensure mandating vaccines does not violate rights. Exemptions are essential to the ethical debate over mandatory vaccinations because many see mandatory vaccines as an invasive procedure. Even laws do not take away an individual’s choice on vaccinations, so these requirements cannot be viewed as a method for the federal government to diminish the rights of citizens. Regardless of the success, failure, or myths on record about vaccines, the question of mandatory vaccinations remains a debate in federal policy, medical practice, and civilian opinion.