PH Communications & Advocacy

Vaccination Policy for Infectious Disease Prevention and Control

Scope of the Problem

Vaccines have done an excellent job at preventing many diseases, some of which can be deadly if not prevented. When bacteria or viruses enter the body, they immediately begin to attack and multiply, which then causes an infection. The immune system will then fight off the infection and establish antibodies, which will help recognize and fight off the same disease in the future. For this very reason, it has been important for children to be vaccinated at an early age so that they may establish those antibodies their bodies need. Vaccines act as the disease so that the body may produce antibodies, but the good thing is that it won’t cause an infection (CDC, 2017).

There are current policies that mandate vaccinations in the U.S., for example, all children are required to be up to date on their vaccines before beginning school. The problem is that there are many loopholes and exceptions to the rule, whether it’s due to religious reasons or other medical issues. Because of this, there are still many children and adults who have yet to be fully compliant with vaccine requirements

Some important statistics to note (Johns Hopkins Medicine):

· CDC estimated 2,700 new cases of hepatitis A in the U.S.

· It is estimated that in 2011, 19,000 new cases of hepatitis B and 17,000 cases of hepatitis C occurred.

· In 2012, nearly 10,000 new cases of tuberculosis were reported.

· Approximately 36,000 people per year die from influenza and pneumonia.

· 50,000 new cases of HIV infection occur annually.

· In 2012, new cases of STD’s were reported, including HPV, Chlamydia, Gonorrhea, HIV, and Syphilis.

Who is affected by this problem? Identify.

Children are mainly affected by this problem due to parents’ hesitancy for vaccinations. Although law mandates for children to be vaccinated for school enrollment, parents have the option to use exemptions to avoid having their children vaccinated. Currently, medical exemptions are allowed for medical reasons in all states, and it is estimated that one to three percent of children are excused from vaccinations because of these exemptions. Parents have continued to use reasons to avoid vaccinations, for example, the belief that the decline in vaccine-preventable diseases is due to improved health care, hygiene, and sanitation (Ventola, C. L., 2016).

Health disparities among Blacks, Hispanics, and Whites have played a huge role in terms of vaccination coverage. Studies have shown that health insurance has a direct impact on the vaccination coverage in adults, therefore, low-income families who can’t afford health insurance will most likely not get the vaccines they need. With that being said, uninsured prevalence was higher among non-Hispanic blacks (19.5%) and Hispanics (30.1%) compared with non-Hispanic whites (11.1%) (Lu, P., et al, 2015).

What has been written on the issue and policy options?

There has been much has been written in the media about vaccination policy in the United States. In 2016, an article in the American Journal of Public Health described the ethics of vaccination policy and the thin line between parent autonomy to decide whether their children are administered vaccines and the importance of herd immunity. Many parents incorrectly believe that vaccines can cause side effects such as autism or ADHD and refuse to get their children vaccinated, this decreases herd immunity and put the health of the public at risk. In light on this dilemma there are approaches that can be implemented to begin to solve the problem. From a policy perspective, it may mean reevaluating the ease with which non-medical exemptions are handled, with increased attention toward ensuring that parents are making informed decisions, especially when they opt out of vaccination (Hendrix, Sturm, Zimet & Meslin, 2016).

An article in the Los Angeles Times also examined the issue of vaccine exemptions. They stated that when California passed SB 277 which did away with personal-belief exemptions the number of medical exemptions increased three-fold (Khan, 2017). This indicates that parents who could no longer claim personal exemptions went doctor shopping for doctors who would loosely interpret the requirements for medical exemptions.

The Harvard Health Blog highlights the physical, economic, and social cost of not vaccinating both infants and adults. Preventable diseases are not always a case of getting sick, going to the hospital, and then getting sent home with some medication. They can cause life long disabilities that require costly ongoing treatments and potentially round the clock care. Dr. Claire McCarthy supports vaccinating as many people as possible with as few exemptions, both personal and medical, as possible.

What is the economic impact of the problem?

The economic impact of not vaccinating infants and adults can add up quickly. According to data from the Centers for Disease Control and Prevention (CDC), the cost of all of these vaccines is approximately $1,200 if obtained through CDC contracts, and about $1,600 if obtained through private insurance. In comparison, the average cost of a hospitalization to care for a baby with dehydration from rotavirus is $3,000-$5,000. More serious diseases can have even great economic implications. For example, he inpatient care unit costs abstracted from median values of the NIS ranged from $5,770 for a hospitalized case of influenza to $15,600 for a hospitalized case of invasive meningococcal disease (Ozawa et al., 2016).

A study published in JAMA Pediatrics estimated that if the vaccination rate of children between ages 2 and 11 for measles, mumps, and rubella dropped by 5% it would lead to 150 more cases of measles. This could cost over $2 million from local and state public health institutions (Lo & Hotez, 2017). The number would be even higher if those outside of that age range were taken into account. According to the Bureau of Labor Statistics, the average hourly wage in the US is about $26 an hour. That means that every day off to care for a sick child is a lost $208 in wages, not to mention lost productivity (McCarthy, 2017). The total current economic burden was estimated at approximately $9 billion in 2015 from vaccine-preventable diseases relevant to ten vaccines recommended for U.S adults. 95% of that burden was for directs costs associated with either inpatient or outpatient treatments. The remaining 5% was due to productivity losses as a result of wages lost during the course of treatment.

What work is being done by governmental and nongovernmental agencies?

The mission of getting as many people vaccinated as possible requires the cooperation of both governmental and nongovernmental agencies. A governmental agency that is working to prevent disease, disability and death through immunization is the National Center for Immunization and Respiratory Disease (NCIRD). The NCIRD is a center of the Centers for Disease Control and Prevention which is under the Department of Health and Human Services. Vaccines are provided through the NCIRD’s Vaccines for Children (VFC) Program. This program is a federally funded entitlement program that provides vaccines at no cost to eligible children. In order to be eligible the child must be younger than 19 years of age and is one of the following: medicaid eligible, uninsured, underinsured, or American Indiana or Alaska Native.

Nongovernmental agencies are also working to prevent the spread of infectious diseases that can be prevented with vaccines. The volunteer-based advocacy organization, Families Fighting Flu (FFF), is committed to preventing flu. They share stories from families whose children have died or who have had complications from influenza and provide programs for improving vaccination for flu. The FFF website has free educational materials such as posters and fact sheets for schools and doctors offices available with the hope that more people will understand the safety, effectiveness, and importance of receiving the flu vaccine every year.

Provide and describe a specific policy solution that can be addressed by an elected official

A policy solution that can be addressed by an elected official is the elimination of personal exemptions for vaccinations. In 2015, California passed SB 277 which provides a means for the eventual achievement of total immunization of appropriate age groups against the top 10 childhood diseases as well as any other disease deemed appropriate by the department, taking into consideration the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services, the American Academy of Pediatrics, and the American Academy of Family Physicians (SB. 277, 2015-2016). The bill also eliminates personal exemptions for vaccinations and makes medical exemptions the only exemptions allowed. Under this change no student shall be permitted to any public school, nursery school, or daycare without the proper vaccinations unless there is a medical necessity for not having the vaccinations at that time.

Coalition Membership Description

Our target in this description is to identify 3 stakeholders that work together to help the Immunization Action Coalition (IAC) with our mission. The Immunization Action Coalition works to increase immunization rates and prevent disease. With the help of our partners this has been made possible by creating and distributing educational materials for healthcare professionals and the public. Our efforts enhance the delivery of safe and effective immunization services.

The following 3 are stakeholders involved with our coalition:

· Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Diseases (NCIRD) NCIRD is the lead center of CDC for the prevention of disease, disability, and death through immunization. NCIRD's website includes a wealth of resources about vaccines and influenza for healthcare professionals, state and local health departments, and the general public (CDC,2018).

· National Association of County & City Health Officials (NACCHO) NACCHO is the national organization representing local health departments. NACCHO supports effective local public health practice and systems, including immunizations (NACCHO,2017).

· Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Disease (NCIRD)

Founded in 1993, the NCIRD is responsible for planning, coordination, and the conducting of immunization activity in the United States. The mission of the National Center for Immunization and Respiratory Diseases is the prevention of disease through immunization and by control of respiratory and related diseases.Our entity provides consultation, training, statistical, promotional, educational, epidemiological, and technical services to assist state and local health departments across the US in planning, developing, contracting and implementing immunization programs. The NCIRD is also tasked to support and supervise state and local agencies actively working on immunizations in their particular areas (CDC,2018).

The NCIRD can contribute to the Immunization Action Coalition through many different avenues one of which is funding. Backed by the CDC, the NCIRD has access to funds through grants and CDC budgeting. Secondly, being a well-established program that is well embedded into state and local agencies throughout the United States and has a great deal of experience in healthcare promotion campaigns will help the IAC with our overall goal to reach the public and educate on vaccination and why it is important.

· National Association of County & City Health Officials (NACCHO)

The National Association of County Health Officials was founded in 1965. In early 1984, the organization grew and opened its own office. In 1994, it was renamed to National Association of County and City Health Officials (NACCHO). Our mission is to support efforts that protect and improve the health of all people and all communities. We go about this by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems (NACCHO,2018). Today, NACCHO is made up of nearly 3,000 local health departments across the United States. Our main focuses on being a leader, partner, and voice for change for local health departments around the nation.

The National Association of County and City Health Officials can contribute greatly to the mission of the Immunization Action Coalition. The IAC having a partner that can help influence policy in local governments will translate to more support from elected officials and local agencies.

· National Foundation for Infectious Diseases (NFID)

The National Foundation for Infectious Disease was founded in 1972 and its mission is to educate the public and healthcare professionals about causes, prevention, and treatment of infectious diseases. The NFID has many publications including a quarterly newsletter named the The Double Helix which provides updated on NFID initiatives and promotes upcoming activities in the infectious disease community. Also, the NFID has call to action publications that educate and encourage readers to take the proper steps to dealing with different disease topics (NFID,2018).

The IAC can benefit from partnering with the NFID because of its strategies and tactics used to reach the public effectively and intuitively. Their programs in place that reach out to healthcare workers are also effective, with the use of webinars and providing continuing education so that healthcare workers are getting the latest news and research findings available.

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