Running head: VACCINATIONS & IMMUNIZATIONS 1

Mandatory Vaccinations and Immunizations

Anne M. Waskiewicz

Frostburg State University

VACCINATIONS & IMMUNIZATIONS 2

Mandatory Vaccinations and Immunizations

The question is simple: Will you agree to vaccinate your child, or will you refuse to

vaccinate your child? The answer, however, continues to cause ethical debate and conflict to

present day. The 14th amendment to the Constitution of the United States recognizes the respect

for autonomy. The law upholds an individuals right to make his or her own decisions about

health care. (Pozgar, 2013) In an effort to protect the greatest number of people, public health

vaccine regulations may infringe upon individual autonomy and liberty. Tension results when

individuals want to exercise their right to protect themselves and/or their children by refusing

vaccination, if they do not accept existing medical or safety evidence, or if their ideological

beliefs do not support vaccinations. (Vaccines & Immunizations, 2014) This paper will examine

the history of vaccinations and immunizations both from legal and ethical perspectives as well as

my professional position as a nurse.

Scientific Method. The discovery of any vaccine involves The Scientific Method, which

is a disciplined, systematic way of asking and answering questions about the physical world.

(Philadelphia, 2014) Generally, the steps involved in the scientific method are: observing,

forming a hypothesis (question), performing a test and drawing a conclusion. Edward Jenner, a

medical physician born in England in 1749, was a pioneer in his field with the discovery of the

smallpox vaccine. Jenner tested the hypothesis that infection with cowpox could protect a

person from smallpox infection. All vaccines developed since Jenners time stem from his

work. (Philadelphia, 2014). Robert Koch and Friedrich Loeffler (1884, developed a method to

identify a disease-causing agent), Louis Pasteur (1877, Anthrax), Pearl Kendrick (1939,
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Whooping Cough) and Jonas Salk (1954, Inactivated Poliovirus Vaccine) were other well-known

individuals who contributed to the history of scientific methods in vaccine research.

Lets define several basic terms:

Immunity: protection from an infectious disease. If you are immune to a disease, you

can be exposed to it without becoming infected.

Vaccine: A product that stimulates a persons immune system to produce immunity to a

specific disease, protecting the person from that disease. Vaccines are usually administered

through needle injections, but can also be administered by mouth or sprayed into the nose.

Vaccination: The act of introducing a vaccine into the body to produce immunity to

specific diseases.

Immunization: A process by which a person becomes protected against a disease through

vaccination. This term is often used interchangeably with vaccination or inoculation.

(Vaccinations & Immunizations, 2014)

Edward Jenner and the early scientists established a method for scientific research and

development which is the cornerstone for todays scientist. The stringent methods set forth in

1749 continues to help scientists today in their research to eradicate deadly diseases with

preventable vaccines.

Vaccines through the Ages.

The first vaccine was discovered in England. The Vaccination Act of 1853 ordered

mandatory vaccination for infants up to 3 months old, and the Act of 1867 extended the age

requirement to 14 years, adding penalties for vaccine refusal. (Philadelphia, 2014) The

Vaccination Act of 1898 removed the penalties and included a conscientious objector clause.

The Anti-Vaccination Society of America was founded in 1879 supporting the individuals right
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to choose whether to be vaccinated or not. In 1902, a smallpox outbreak in Cambridge,

Massachusetts prompted a mandatory smallpox vaccination for all city residents. In 1905 the

case was presented before the Supreme Court, The U.S. Supreme Court found in the states

favor, ruling that the state could enact compulsory laws to protect the public in the event of a

communicable disease. The ruling was the first U.S. Supreme Court case concerning the power

of states in public health law. (Philadelphia, 2014). The controversies are not limited to the past.

In the 1970s, opposition arose regarding Diphtheria, Tetanus, and Pertussis (DTP), which again

surfaced in 1982 and 1991. In 1998, controversies surfaced regarding Measles, Mumps and

Rubella vaccine (MMR) and the possible link between this vaccine and autism. A study was

performed:

In 1999, thimerosal, a mercury containing compound used as preservative in vaccines,

has also been the center of a vaccination and autism controversy.

In 2001, The Institute of Medicines Immunization Safety Review Committee issued a

report concluding that there wasnt enough evidence to prove or disprove claims that thimerosal

in childhood vaccines causes autism, attention deficit hypersensitivity disorder, or speech or

language delay. (Philadelphia, 2014).

Concerns continue to emerge despite the lack of conclusive scientific evidence regarding

the effects of thimerosal. In 2007, celebrity Jenny McCarthy and her advocacy group, Generation

Rescue, in conjunction with the organization Talk with Curing Autism (TACA) have spearheaded

efforts to remove perceived toxins from vaccines.

Today the U.S. Supreme court ruling hasnt changed. Jacobson remains a public health

legal cornerstone, but acknowledged that vaccination mandates must be strongly supported by

public health necessity. The U.S. Supreme Court has not considered mandatory vaccinations on
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the merits since Jacobson (1905), though it has denied certiorari in some notable challenges,

including Workman v Mingo County Board of Education, which upheld West Virginias school

mandate in 2011.(Public health law conference, 2014) By the 1990s, all 50 states required

students to receive certain immunizations, and most states required coverage for older

schoolchildren as well as those in daycare centers and Head Start programs. According to the

article in Legal and Respiratory Issues, all 50 states have legislation requiring specified vaccines

for students. It further states, Although exemptions vary from state to state, all school

immunization laws grant exemptions to children for medical reasons. Almost all states, except

Mississippi and West Virginia, grant religious exemptions for people who have religious beliefs

against immunizations. Nineteen states allow philosophical exemptions for those who object to

immunizations because of personal, moral, or other beliefs. (Skehan & Muller, 2014).

We have a group of parents who refuse because vaccinations because of religious beliefs.

Individuals within the Christian Science religion and a minority of Amish believe God will keep

them from illness or He will provide the healing should they become sick

(www.immunizeca.nd). Others decide it is not in their best interest and believe the vaccines will

result in more harm to their child than the good it is intended. Another group may distrust the

government, or organized pharmaceutical industry and just dont believe the state has the right to

mandate vaccines.

The ethical conflict regarding vaccinations is multifaceted. We have the patient

exercising his or her right to choose what is best regarding their health. We have the nurse whose

primary commitment is to the patient. (ANA, 2010) The nurse is faced with the ethical

responsibility to do no harm (nonmaleficence), to do good (beneficence) which may conflict with

the patients autonomy. (Pozgar, 2013) Another person included in the ethical conflict is the
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physician. The physician has a medical code of ethics regarding the patients care. How does he

provide for the greater good if his patients beliefs conflict with the doctors best medical

advice? The community where they live can be affected by the decision, if they opt not to

vaccinate. According to Vincent Iannelli, measles outbreak got off to a very strong start in 2015

with at least 188 cases in 24 states. Most concerning, more and more, is that cases don't seem to

have any source that is easy to find, which could mean that the endemic spread of measles has

returned in the United States. So instead of having to travel out of the country or be exposed to

someone who got measles with a link to international travel, you could get measles just by going

to a ball game, a movie theater, or to Disneyland.(Iannelli, 2015)

We find varying opinions expressed on both sides regarding decisions throughout the

Healthcare community. We know that healthcare is constantly changing, and patients, family,

community and healthcare providers continue to look for what is best for all involved. Today we

currently face a new dilemma: Is it ethical for a physician to discharge a child from a pediatric

practice if the parent refuses immunization? Kathleen Tenrreiro expressed why she would

discharge a patient from her practice. She states, One of the cornerstones of the Healthcare

Provider/parent/patient relationship is trust; pediatric HCPs may feel if parents do not trust their

advice regarding vaccinations, then what other advice wont they trust. (Tenrreiro & Del

Vecchio-Gilbert, 2014) Does the Healthcare Provider risk exposing other patients in his office

waiting area to a vaccine preventable disease when unvaccinated patients are in the same room?

Linda Del Vecchio-Gilbert expressed why she would not discharge a patient from her

practice. From her perspective, would you ever discharge a patient with asthma whose parents

refuse to stop smokingwe need to nurture an open and honest relationship and treat each
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family with respect and compassion regardless of their beliefs. (Tenrreiro & Del Vecchio-

Gilbert, 2014)

As a nurse I see the importance of my core values of equality and sensibility and how

they interact with the vaccination debate. Personally, I prioritize the value of equality over

autonomy; my primary concern is the well-being of the whole community (Overview of the

Ethical Lens, 2014). I can still remember receiving my vaccination shot before I started

kindergarten. The shot wasnt pleasant, but my parents made the choice to have us vaccinated.

My brother had polio when he was under five years old and is still affected by the disease today.

Years ago, my husband and I made the decision to have our children vaccinated. I remember

reading the pamphlet the doctors office gave us regarding the vaccine and the possible side

effects. It was a little scary reading about the extreme side effects. I hoped my child would not

fall into that category.

I continue to stay up-to-date on my vaccines as I work in the hospital setting. Today my

physician encourages me to get the shingles and pneumonia vaccine because of my profession.

At work, I see and hear the complaints among my colleagues yearly when it is time for the flu

vaccine. It is a mandatory hospital requirement. My autonomy kicks in and says no! (Pozgar,

2013) Its like a voice ringing inside me saying, you cant tell me what to do! We realize it is

mandated as part of our job, with a couple of exceptions. Over the past several years, our

hospital has become more diligent to ensure that as many employees as possible are vaccinated.

Immunizations are a means to eliminate vaccine- preventable diseases. According to the

CDC, smallpox has been eradicated since the 1980s. If this one disease has been eradicated

because of an efficient vaccine, I suggest we continue finding more vaccines. I must

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acknowledge that the individual who is vehemently opposed to receiving any vaccines is

exercising their right (autonomy). I am obligated as a nurse to practice beneficence (helping

others) to any patient even if the patient and I do not agree on the plan of care. I must not

impose my opinion by coercion. We are in an excellent position to educate the patient why

vaccines are important to them and to the community. If the individual is hesitant but not

resistant to receiving the vaccine, we can provide more vaccine information and direct them to

reliable websites, give them handouts from the CDC and a little more time to come to an

informed decision.

The debate whether to accept or refuse the vaccines available today will most likely

continue to the end of times. We cannot mandate our opinion on the lives of the patients we

interact with daily. We can offer information, education and compassion. We can provide the

information to help individual make an educated, informed decision about various choices.

Hopefully with the advancement of science the individuals who adamantly oppose vaccinations

will be swayed to see the benefits. It is ultimately the patients decision.

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References

Diekema, D. S. (2015). Physician Dismissal of Families Who Refuse Vaccination. Law, Medicine

& Ethics, 654-660.

Iannelli, V. (2015, sept 2). Measles Outbreaks 2015. Retrieved from pediatric.about.com.

Orenstein, D. G., & Yang, Y. T. (2015). From Beginning to End: The Importance of Evidence-

Based Policymaking in Vaccination Mandates. Journal of Law, Medicine & Ethics, 99 -

102.

Philadelphia, C. o. (2014, July 31). History of Vaccines. Retrieved from Vaccine Science:

http://www.historyofvaccines.org/content/articles/scientific-method-vaccine-history

Skehan, J., & Muller, L. S. (2014). Legal and Regulatory Issues. Professional Case Management,

289 -293.

Tenrreiro, K., & Del Vecchio-Gilbert, L. (2014). Should a Child be Discharged from a Pediatric

Practice if the Parent Refuses Immunization. The American Journal of Maternal Child

Nursing, 78-79.

Vaccines & Immunizations . (2014, may 19). Retrieved from Center for Disease Control and

Prevention: http://www.cdc.gov/vaccines/vac-gen/imz-basics.htm

www.immunizeca.org/. (n.d.). Retrieved from Religious-Views-At-a-glance.pdf.