Childhood Vaccinations & The Significance
Alexia L. Tate
L31737705
HLTH 630- B01
Abstract
Vaccinations are the reason we have eradicated many childhood diseases such as
rinderpest and smallpox.1 Children are the most vulnerable to these preventable
diseases therefore vaccinations are critical in children’s health. Communication,
income, geographic location, and social stigmas are all obstacles that contribute to the
negative connotation associated with vaccinations. Controversy on whether or not
children should be included in the most recent COVID-19 vaccines also contribute to the
negative association with vaccines. Overall physicians are unable to provide adequate
care to those in lower income geographic locations due to limited resources. Better
networking between physicians and patients is a potential solution to the risk factors
contributing to the lack of vaccinations in children. A proposal has been made to create
a universal database for physicians that includes sensitive patient information in order
to close the communication gap between physicians. Future interventions should
include case study methods and longitudinal studies in order to assess the effects
vaccinations and external risk factors have on children.
Introduction
Because of vaccinations, diseases like smallpox and rinderpest have been eradicated.1
Vaccinations are a safe and effective way to protect children against disease. Prior to
vaccinations, many children over the world have died from diseases such as polio,
measles, and whooping cough. Children are the most vulnerable to the diseases we
have eradicated through vacines. Study of the pattern of infectious diseases in
industrialized countries from the end of the nineteenth century onwards shows that
there was a large and progressive decline in child mortality, owing largely to a reduction
in mortality from infectious diseases, prior to the development and deployment of
vaccines.1
Poverty and factors associated with poverty are strong and persistent barriers to
childhood immunization.2 Substantive differences in coverage with basic vaccinations
have been consistently observed over time between children living in poverty and those
who are not.2 Children living in poverty are less likely to receive vaccines than children
living above the poverty line. Low vaccination coverage among children living in and
near poverty is a persistent problem in the United States.2 Our country needs to
prioritize and strategize additional efforts to improve immunization in children living
below the poverty line.
Children not receiving adequate vaccinations to make them immune to preventable
diseases is unacceptable. Children’s health should be our top priority as they are our
future. Making sure lower income neighborhoods receive access to these vaccines are
significant for future prevention and to keep the diseases eradicated. Prevention should
start at birth and continue throughout the child’s life. Reducing preventable diseases
and increasing immunization rates would ideally decrease the number of childhood
deaths and increase the number of healthy children in the world. Nonetheless, if we
grant access to vaccinations, we are contributing to raising people out of poverty.
Background
Infectious diseases are still prevalent across the United States. One of the
ultimate goals for Healthy People 2020 is to reduce preventable diseases and increase
immunization rates.The increase in life expectancy during the 20th century is largely
due to improvements in child survival; this increase is associated with reductions in
infectious disease mortality, due largely to immunization.3 Objectives new to Healthy
People 2020 focus on technological advancements and ensuring that States, local
public health departments, and nongovernmental organizations are strong partners in
the Nation’s attempt to control the spread of infectious diseases.4 Disease transmission
can be avoided through constant awareness, treatment and prevention techniques.
Vaccines in the long run are cost effective. Vaccines alone reduces direct health care
costs by $9.9 billion dollars.4 Not only are vaccines cost effective, but they prevent 14
million potential case of disease.4 Despite progress, approximately 42,000 adults and
300 children in the United States die each year from vaccine-preventable diseases.4
Communities with pockets of unvaccinated and undervaccinated populations are at
increased risk for outbreaks of vaccine-preventable diseases.4 Unfortunately, the longer
we allow for people to live in poverty, the longer they will suffer the consequences of
dying a preventable death.
Inappropriate use of antibiotics and environmental changes multiply the potential
for worldwide epidemics of all types of infectious diseases.5 A Healthy People 2020
data chart displayed that between 2006 and 2007 about 29% of children were
prescribed antibiotics during outpatient visits after being diagnosed with the common
cold.6 By 2011 the number of children prescribed antibiotics increased to about 30%
The campaign is continuing to grow partnership activities to increase public and
healthcare provider awareness for appropriate antibiotic use.7 Healthcare providers
should be more vigilant when prescribing medication, especially to children. Healthcare
providers should also seek alternative medications for children than those of adults.
Inappropriate use of antibiotics promotes resistance. Resistance can affect the efficacy
of antibiotics. Misdirected treatment can then promote antibiotic-resistant properties in
harmless bacteria that can be shared with other bacteria, or create an opportunity for
potentially harmful bacteria to replace the harmless ones.8 Prescribing physicians need
to be more aware of what medication is being prescribed to children. Needless to say
this minor adjustment can help contribute to the decline in child mortality rates.
In previous objectives, the focus was more on producing as many vaccines as
possible. The conflict occured when there was no survellience of whether or not the
diseases were completely eradicated or emerging into a new potent disease. This
current objective also focuses on disease survellience to improve the response rate
when new diseases emerge. New methods allow for people who have been exposed to
the disease to receive immediate treatment and to produce vaccines faster. In the
coming decade, the United States will continue to face new and emerging issues in the
area of immunization and infectious diseases. 4 This objective should equip public
health officals with the approproate resources to respond to emerging threats.
As international trade and travel increases the need to increase vaccination and
immunization increases. New infectious diseases and agents emerge from all over and
not all populations are prepared to battle such diseases. In 2008, imported measles
resulted in 140 reported cases—nearly a 3-fold increase over the previous year.4 The
emergence of new or replacement strains of vaccine-preventable disease can result in a
significant increase in serious illnesses and death.4 This further suggests that more
protocols need to be implemented when traveling abroad or even from region to region
in the US. Disease transmission is the most receptible when the infected individual is
oblivious to infection. As we can learn from the recent COVID-19 pandemic that basic
interventions such as washing hands or covering your mouth when coughing or
sneezing can help reduce the transmission of germs.
Current Research
A 2010 study in the Maternal and Child Health Journal
revealed that children in
Washington State who received care from complementary health practitioners were
substantially less likely to get recommended immunizations and were more likely to be
diagnosed with a vaccine-preventable disease.9 The risk determinants here are
geographic area and income. The two determinants are intertwined with one another as
a person's annual salary determines the area they can afford to reside therefore
determining the quality of care they receive from local hospitals and or clinics.As time
progressed between 2010 and 2020 child vaccination coverage stablized, according to
the CDC.10 Insurance coverage plays a substantial part in reconciling children of low
income families health and is ultimately the determinig factor of healthcare quality.
Vaccination coverage among children enrolled in Medicaid or with no health insurance
was lower than that among children who were privately insured.10
There has been an enormous debate regarding the possibility of a link between
childhood vaccinations and the subsequent development of autism.11 Many parents
lived in fear of vaccinating their children due to this stigma that vaccines caused the
onset development of autism. The risk factors presented here are quality of care and
social conspiracies. Based on social trends and debates, the majority of parents will not
put their child at increased risk for the development of autism therefore vaccination
trends can potentially become stagnant. A study in 2014 investigated the association of
vaccines and the development of autism. Five cohort studies involving 1,256,407
children, and five case-control studies involving 9,920 children were included in this
analysis.11 The cohort data revealed no relationship between vaccination and autism
(OR: 0.99; 95% CI: 0.92 to 1.06) or ASD (OR: 0.91; 95% CI: 0.68 to 1.20), nor was
there a relationship between autism and MMR (OR: 0.84; 95% CI: 0.70 to 1.01), or
thimerosal (OR: 1.00; 95% CI: 0.77 to 1.31), or mercury (Hg) (OR: 1.00; 95% CI: 0.93 to
1.07).11 Additionally, the case control studies also showed no evidence of increased risk
in devlopming autism when recieveing vaccines. Moreover, the components of a
vaccine or MMR are also not associated with the development of autism.
There was a cross-sectional survey done in Israel to measure better communication
and collaboration among physicians and alternative and complementary practitioners.
Questionnaires were mailed electronically or through the mail to 2532 primary care
physicians and 450 complementary and alternative medicine practitioners employed by
Clalit Health Services, the largest health maintenance organization in Israel.12 The
majority of both groups expressed an interest in clinical practice collaboration (69% of
physicians and 77% of practitioners,); preferred using a medical letter to communicate
with each other; and expected to consult with each other about mutual patients to
formulate treatment plans. Future interventions should include medical letters for
practitioners and physicians to communicate as represented in the questionnaire. A
common ground network or database should be established to help health care
providers have an uniform method of storing patient data accessible to the appriopriate
users. Nonetheless an uniform network created for participating hospitals and clinics
could be a step in the positive direction for patient safety and communication.
A proposal was proposed by Maryland pediatricians that children and adolescents
should be included in COVID-19 vaccine clinical trials.13 The pediatricians’ main concern
was that children may not be able to receive the vaccine until the vast majority of adults
are vaccinated in the United States. The debate arises that children are more
susceptible to the side effects of the vaccination. One could argue that disease
transmission is more likely in children due to close contact at school, daycare, or family
members house etc. Similar to the association of the development of autism to
vaccines, parents are not going to deliberately allow their children to be test subjects for
the COVID-19 clinical trials. Past vaccination histories have included children as young
as 2 years old, particularly in HPV vaccine clinical trials. Including children in COVID-19
clinical trials could provide more insight on how often the virus is being spread.
Additionally, it would target a specific population and assist in determining the risk of
exposure in children. Without further investigation into this matter, children face the
risk of beginning next school year without a FDA approved vaccine.13 Moreover, if
vaccinating children means turning the country back to normalcy then it is a case worth
investigating. Furthermore vaccinating more teachers could potentially allow for more
schools to open and bring children back together for active learning. Personally, I would
argue that children under the age of 5 are too young to be a part of an experiment and
the focus should be more on adolescents, where you can gain informed or written
consent.
Discussion
Based on the information presented in the previous section, each one of the studies or
proposals have the common idea that vaccinations are recommended to keep our
children safe. The studies and proposal all have underlying factors that affect patient
safety. In the first study, where children who received health care from a
complementary physician were less likely to receive recommended vaccinations, the
risk factors are income and geographic location. These factors will determine the
quality of care a patient receives. The question arises, why do healthcare providers not
provide the same quality of care across the board? I think it is unrealistic to think that
physicians and other health care providers are able to provide the same level of care
due to limited resources in those low income areas. Furthermore insurance rates are
relatively lower in lower income neighborhoods than those of their counterparts.10 More
investigations should be conducted to determine if better resources can be made
readily available to physicians so that the quality of care can increase.
From the study conducted in 2014, we now know that vaccinations have no direct link to
children developing autism. This gives peace of mind to parents cautious about
vaccinating their child. In this decade social media has taken over the majority of our
lives. From personal experience, I know that a lot of misleading information can be on
the internet especially on social media. When evaluating articles on the internet, we
should verify the source and do more research into the issue before creating an opinion
on the topic at hand. Personally, I believe this is how the stigma of vaccines caused the
development of autism began. As stated in previous sections, parents are not going to
deliebrtately cause harm to their child therefore if they hear bad reviews about
vaccinations then they are more likely to be hesitant in vaccinating their children.
Physicians should be more encouraging and understanding of parents' concerns. This
study on autism and vaccination association provides support for physicians to
promote child vaccines to parents.
Communication is key for physicians to adequatly provide exceptional care to their
patients. Having a network of physicians that are in communication and have the
access to the appropriate resources and medical charts are critical in health care
facilities. Personally, I believe that a patient should be able to visit multiple physicians in
a region and be able to receive the same quality of care. For instance, if you were on the
organ transplant list you are able to list yourself at multiple organ transplant centers.
The organ procurement organizations use a database designed to store all recipient
and donor information to help the transplant centers access the medical information
needed for their recipient. Having a central database helps the physicians stay in the
know about patient information and history and can spend more quality time with the
patient rather than trying to figure out why they are visiting the physician in the first
place.
The Maryland pediatricians had a point when they pointed out that children are more
prone to the transmission of illness due to the close proximity of daycares, schools, etc.
From a medical standpoint, I could agree that the addition of children in COVID-19
clinical trials could be a strategy to get the United States back to a state of normalcy.
Likewise, from a parent’s perspective, it would be too risky to place their children in that
predicament. Personally, I think the most logical method to include children in COVID-19
clinical trials would be to include adolescents. Adolescents are old enough to make the
decision on whether or not they are willing to participate. Hence, the choice in allowing
teens to return to in-person learning at school versus virtual learning. Also, adolescents
are more socially active, independent and are more isolated from their parents,
therefore they are more exposed to external factors that may cause illness, another
reason to include adolescents in COVID-19 clinical trials to help determine exposure and
transmission risk. Despite this, adolescents are still children and it would ultimately be
up to the parents to allow for participation in the clinical trials.
Overall, from these studies and proposals I have gathered that communication is the
greatest obstacle that physicians and patients are faced with. In my opinion, physicians
in the United States need to collaborate more often for better patient care. Moreover,
the controversy of children in healthcare also contributes to the lack of communication
in health care settings. Parents and physcians need to be more transparent when
discussing and determining if vaccinations are the most suitable for them. More
networking between physician to parent and physician to physician is critical in the
increase of childhood vaccination rates.
Recommendations
Future investigations need to be conducted to further analyse the effects vaccines have
on children. There have been studies in the past about the diseases we have eradicated
with vaccines but we need to dive deeper into current diseases that put our youth at
risk. If parents were willing to allow their children to take the current COVID-19 vaccine,
a longitudinal study could be done to examine the long term effects the vaccine has on
the children. I think six months is a long enough time for the side effects to surface if
any. The study design should involve children of high and low class families. This factor
could help determine if socioeconomic status and geographic location play a role in the
surfacing of germs. In total there should be two hundred children. Half of the children
should be from lower income families while the other have are from higher income
families. Next there will be a randomized method that determines who gets the vaccine
and who does not, this should reduce bias in the study design. The children who do not
receive a vaccine will be given a placebo treatment. Once the treatment and control
groups are established then we can proceed in the study. The participants should
record weekly whether any symptoms occured or if none at all. After all data is collected
from the weekly assessments the researchers can determine if the vaccine is effective
in children.
Another study design that could work in the vaccination world effectively could be a
case study trial. This study can be completed using the essential workers who are
qualified at this time to receive the COVID -19 vaccine. This investigation would include
three essential workers who recieved the vaccine and reported symptoms and three
essential workers who recieved the vaccine and reported no symptoms. By studying
specific cases, it can represent the variability of the virus. This would be a small scale
project but it can paint a larger picture. It also could provide a comparative ratio for
those who develop symptoms after recieving the vaccine to those who report no
symptoms.
As far as trying to close the communication gap physicians are faced with daily, I think
the best intervention would be to divide all primary care facilities into regions. Next
within those regions, create a software that allows for storage of patient medical
information. Furthermore, I believe this would create a better atmosphere for not only
communication but collaboration of medical findings. The software could be set up
similar to how LinkedIn works and how networks are built in the careerfield. Medical
technology is constantly advancing, therefore making these small changes will better
the health and wellbeing of patients.
Future interventions could include more vaccine information sessions in schools and
the jobplace. I think if employers and school personnel took the time to educate their
associates on the pros and cons of getting vaccinated then the patient could have a
better understanding of vaccines and formulate their own opinion. Social media and the
Google search engine determines a lot of people’s destiny in terms of getting
vaccinated. For example, there is “rumor weblink” circling social media platforms that is
misinforming people saying that the CDC recommends zombie apoclalypse preparation
from COVID-19 vaccine. A lot of social media users will read this link and immediately
decline the thought of receiving a COVID-19 vaccine. Propaganda has a major influence
on those who lack the educational background to know otherwise. This web link was
created to incite fear and panic into those who received the vaccine and even those who
did not receive the vaccine because they may be exposed to a person who did receive
the vaccine. To take it a step further, instead of only having educational sessions about
vaccinations, there should be an advertisement ban on propaganda that instills fear into
the target audience. I think in order to control the advertisements of vaccines, only
qualified sources should be allowed to even produce advertisements. Another option
could be to have a board that specifically votes on certain advertisements that are
made to the public surrounding vaccines; really any drug for that matter. If there is a
board that is auditing the potential advertisements, I think it could improve the negative
stigma surrounding vaccinations.
In conlusion, we as public health advocates need to do more to help reduce preventable
diseases from resurfacing, espercially in children. Having children go on with life
without being vaccinated is dangerous not only to themselves but they are putting
others at risk as well. Further studies in the matter should open the eyes of the
appropriate officials and optimistically we can increase the preventable disease
vaccination rate. Annual salary and geographic location should not determine the
quality of a child’s health.
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