Mandatory Childhood

Immunizations:
No Shots - No School?
Presented by
Amy Lewis and Ronda Mott

Objectives
1. Review the science, history, goals and achievements of mass
childhood vaccinations.
2. Expose, through root cause analysis, the anti-vaccine counter
culture and impact on childhood health.
3. Dissect and respond to anti-vaccine myths and
misconceptions.
4. Identify specific actions to promote childhood vaccinations
and implications for nursing practice.

Background
A. Science
B. History and Philosophy of mass vaccination
C. Rise of and result of the vaccine counter culture

Science
1. What is a vaccine?
2. What is herd immunity?

What is a Vaccine?

a chemical compound that creates active immunity.

delivers an antigen to a host (person) to create an immune response.

Immunization is the process of creating immunity, to protect a person from disease.

Types of vaccines
Live vaccines are weakened (or attenuated) to a level to produce immunity but not the disease
Examples of live vaccines are: measles, mumps, rubella, nasal flu mist and varicella
Inactivated vaccines are made of infectious agents which are treated to make them incapable
of transmitting infection
Examples of inactivated vaccines are Hepatitis A, Hepatitis B and whole-virus influenza,
tetanus, pertussis and diptheria

Herd Immunity
Definition: When a high percentage of a communities members have
been immunized against a certain disease, the disease has less chance of
gaining a foothold in the community.
most efficient method of promoting herd immunity is mandatory
immunizations
protects those who have been vaccinated, and those with weakened
immune systems
most cost effective way of preventing illness and human suffering
far less costly to have mass immunizations than to treat people with
the disease after it has appeared in the community

History and Philosophy of Mass Vaccination

1. Resistance from the beginning.
2. Philosophy and rationale of mass vaccination.

Resistance from the beginning...

fear and mistrust have been present with each new
vaccine, dating to the 18th century
resistance to vaccines receded between 1940-1980s
but then.in the late 1970s there was an increase in antivaccine thinking!!
this resistance continues today.

Philosophy and Rationale

All states require children entering school to receive certain vaccines, yet all states
permit medical exemptions
48 states allow religious exemptions for vaccinations
19 states allow personal or philosophical exemptions for vaccinations
Unvaccinated children: at greater risk for contracting vaccine-preventable diseases
(VPDs) and for transmitting diseases to other unvaccinated people.

Rise and Results of the Anti-Vaccine Culture

1. Refusal of childhood vaccines.
2. Public health impact (video).

If You Dont Vaccinate Your Kid,

Dont Judge Me
www.businessinsider.com
https://www.youtube.com/watch?v=tCyvptNFzHQ

Refusal of childhood vaccines

most common reason was perceived vaccine safety
often associated with lower levels of confidence in medical
community
parents of these children more likely to have confidence in
complementary alternative medicine (CAM)
some parents oppose only certain vaccines
10% of physicians refuse to care for children of parents who have
refused vaccines
most common vaccine not received is varicella

Assessment of the Healthcare Environment

Root Cause Analysis Spawning
the Anti-Vaccine Culture
A. Lack of familiarity (generational) of the sequelae of disease
no historical underpinning to justify modern day
vaccinations. (devastation and death from polio, measles,
diphtheria, pertussis, tetanus)

Devastation of Childhood Diseases

Measles

Devastation of Childhood Diseases

Chicken Pox

Devastation of Childhood Diseases

Polio

Devastation of Childhood Diseases

Whooping Cough Pertussis

Devastation of Childhood Diseases

Assessment of the Healthcare Environment

Root Cause Analysis
B. Misinformation regarding vaccine safety, manufacturer and
components.
a. Conspiracy theory genocidal government agenda.
(Believing the negative or a lie is easier and more
welcomed than believing the truth.)
b. Selective demonization of vaccines to explain the
unknown. (autism scare)

Vaccine Myths and Misconceptions

More parents are questioning the
safety and effectiveness of vaccines.
-

Too many chemicals!

Why risk Autism?
Im going to wait and see!
Too many injections at a time
Too expensive

Vaccine Myths and Misconceptions

Really??
Im just a baby!!
2 pokes
4 pokes
6 pokes
Does it really matter?

Vaccine Myths and Misconceptions

MISCONCEPTION
Giving a child multiple vaccinations
for different diseases at the same time
increases the risk of harmful side
effects and can overload the immune
system.

Vaccine Myths and Misconceptions

MISCONCEPTION
Vaccines cause many harmful side
effects, illnesses, and even death,
not to mention possible long-term
effects we don't even know about.

Vaccine Myths and Misconceptions

MYTH
Ingredients in Vaccines Are Harmful?
Aluminum

Antibiotics

Egg protein

Formaldehyde

Monosodium glutamate (MSG)

Thimerosal

Assessment of the Healthcare Environment

Root Cause Analysis
C. Lack of organized, comprehensive health care
establishment rebuttals regarding vaccine myths and
misconceptions.
D. Lay public cognitive dissonance regarding modern
medicine. ( The Paradox: Public distrust of modern
medicine to prevent disease with vaccination vs. trust
and expectation to identify, treat and salvage society from
epidemics.)

Vaccine Myths and Misconceptions

MISCONCEPTION
The majority of people who get
disease have been vaccinated.

Vaccine Myths and Misconceptions

MISCONCEPTION
Vaccine-preventable diseases have
been virtually eliminated from the
United States, so there is no need
for my child to be vaccinated.

Vaccine Myth and Misconceptions

Misconception
Vaccines are too expensive!
- Public clinic or health department
- Vaccines for Children (VFC)

Recommendations/Actions to Promote
Childhood Vaccinations
1. What we should do: educate, educate!
2. Legislative response.
3. How organized medicine should respond.

What should we do about it??

1. Enhance public education using a multimedia,
multi-institutional approach similar to
education regarding smoking, drunk driving
and drug use
2. Teach health care providers, parents and
patients how to counter false claims regarding
vaccines

Recommended Childhood Vaccination Schedule

Root Cause Analysis

Lack of Understanding
Healthcare Worker Educ.
Parental Education

Cost
Private Insurance
Public Health Programs

Refusal of
Vaccinations
Myths
Misconceptions

Disbelief/Safety

Medical
Religious/Personal Beliefs

Exemptions

Legislative Response
A. Continue to legally mandate childhood vaccinations?
B. Legal penalties to parents for the deleterious impact
unvaccinated children have on society?
C. Make vaccinations available without parental consent?

Legislative Response
A. State Law
State law governs mandatory vaccinations. Loopholes and
exemptions should be closed just like veterinary medicine: zerotolerance (livestock, pets, performance animals require
vaccination)

B. Penalties to Parents
Legal precedents already exists in civil, criminal and property
law which make parents responsible for the injury their minor
children cause to other persons or society. Expand to
unvaccinated children?

Should We Do This?
No Shots - No School
Home School May Be Your Option?

Legislative Response
C. Vaccination availability without parental consent
HPV

HPV Vaccine
1. Only mandatory in Virginia and Washington, D.C.
2. Prevention of this does not pose a potential harm to others
in the unvaccinated school population (unless sexual contact)
3. In California, state law passed allowing minors (ages 12
and up) to be allowed to consent to obtain HPV vaccine
without parents consent

Organized Medicine Response

1. Fund and publish high quality studies to investigate vaccine
safety concerns.
2. Maintain and improve monitoring programs
3. Medical school, nursing school and mid-level provider
graduate education should include formal course work
on the science, safety and implementation of best
immunization practices.

Implications for Nursing Practice

Nurses as primary patient education advocates
- Information and guidance
- Clarify questions or concerns
- Safety of vaccinations
- Knowledge of basic principles of immunity
- Vaccination recommendations

Conclusions
1. Vaccination against childhood infectious disease
is an undisputed, safe, prudent and proactive
step toward the health and wellbeing of children.
2. Mass childhood vaccination programs are cost
effective, save lives and reduce morbidity.

Conclusions
3. Confusion, fear and misinformation resulting in
vaccination avoidance are whittling away at the
effectiveness of immunization programs.
4. Due to an anti-vaccine counter culture,
diseases
thought to be eradicated only three decades ago
are posed to make a come back and spawn a new
public health crisis. (Measles)

Conclusions
5. A coordinated effort including public education,
legislative action, research and scientific
indoctrination is necessary to combat the
anti-vaccine culture.

References
Blendall, R. L., & Fehr, J. L. (2012). Discussing vaccination with concerned patients: An evidence based
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Brown, K. F., Long, S. J., Ramsay, M., Hudson, M. J., Green, J., Vincent, C. A.,...Et Al. (2012). U.K. parents
decision-making about measles-mumps-rubella (MMR) vaccine 10 years after the MMR-autism controversy: A
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Centers for Disease Control. (2011, February). Ingredients of vaccines fact sheet. Retrieved from
http://www.cdc.gov/vaccines/vac-gen/additives.html
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References
Centers for Disease Control. (2014). Parents: Guide to childhood immunizations part 4: Frequently asked
questions. Retrieved from http://www.cdc.gov/vaccines/pubs/parents-guide/parents-guide-part4.html
Centers for Disease Control. (2014, September). Vaccines and immunizations. Retrieved from
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http://www.cdc.gov/vaccines/vac-gen/whatifstop.html
Ciolli, A. (2008.). Mandatory school vaccinations: The role of tort law. Yale Journal of Biology and Medicine,
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References
Cullen, J. (2005, January). Why parents choose to not vaccinate their children against childhood diseases.
Retrieved from http://www.nursingtimes.net/nursing-practice/specialisms/immunology/why-parents-choose
-to-not-vaccinate-their-children-against-childhood-diseases/199780.article
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36(3), 39-45.
Mrozek-Budzyn, D., Kieltyka, A., & Majewska, R. (2010). Lack of association between measles-mumps-rubella
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References
National Report. (2015). Anti-Pet vaccination trend spurns rabies outbreak in orange county. Retrieved from
http://http://nationalreport.net/anti-pet-vaccination-trend-spurns-rabies-outbreak-orange-county/
Pediatric Home Service. (2010, September). Childhood immunizations - Nursing implications. Retrieved from
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Salmon, D. A., Moulton, L. H., Omer, S. B., Dehart, M. P., Stokley, S., & Halsey, N. A. (2005). Factors
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References
Wexler, D. L. (2014, August). Common immunization myths and misconceptions: Talking points and resources
for busy healthcare professionals. Retrieved from http://www.immunize.org
Wood Television. (n.d.). Wood TV 8. Retrieved January 23, 2015, from http://www.woodtv.com/measles