1. Immunizations and Parental Choice Andrea West Eastern University

2. Vaccinations in Childhood The discovery of vaccines in the 20 th century has had a substantial impact on preventing or eliminating many debilitating contagious diseases including (Song, 2014): –Pertussis - Polio –Smallpox - Diptheria –Measles - Rubella The Centers for Disease Control (2015) recommends a child in the United States receive 28 immunizations (injections) by the age of six

3. Issue at Hand Parents have expressed concern regarding possible adverse effects of vaccines to their children –Some parents feel children receive too many vaccines thus weakening their immune systems (Bronfin, 2008) –Religious or moral objections (Harmsen et al, 2013) –Adjuvants, preservatives, or chemicals present in trace amounts in vaccines (i.e. thimerosal and mercury) are toxic to children and cause harmful side effects such as autism and neurodevelopmental deficits (Carrillo-Marquez & White, 2013) Some children are undervaccinated –Due to barriers to access, such as poverty or cost, children do not receive all recommended vaccines (Lee, Rosenthal & Scheffler, 2013)

4. Current Immunization Policy All states require a variety of immunizations prior to a child being able to enroll in school (both public and private) (CDC, 2015) Almost every state allows exemption from immunization for religious beliefs –Mississippi and West Virginia DO NOT allow religious exemption Twenty states currently allow exemptions for philosophical or moral beliefs (National Council of State Legislatures, 2015) Free or reduced cost immunizations provided at local Health Departments across the country (CDC, 2015)

5. National Council of State Legislatures, 2015 State Non-Medical Exemptions from School Immunization Requirements

6. Issues with Current Policy The ability to decline vaccination has resulted in the resurgence of the diseases the vaccines are made to prevent (Council on Foreign Relations, 2015) Those unvaccinated individuals have the ability to spread disease to society at large –Children who have not yet been fully vaccinated because of their age –Immunocompromised individuals (Chatterjee & O’Keefe, 2010) No consensus in policy among the states in policy enforcement (Lee, Rosenthal & Scheffler, 2013)

7. Vaccine Preventable Outbreaks 2008-2015 Council on Foreign Relations, 2015

8. Recommended Policy Changes Tighten the exemption for philosophical or moral reasons –Parents must complete paperwork to qualify for exemption through the local Health Department –This allows for tracking of individuals when potential outbreaks of vaccine preventable illnesses occur (Lee, Rosenthal & Scheffler, 2013) The exemption for religious reasons will continue –However, parents would be required to submit documentation of exemption status with the local Health Department for tracking purposes (Lee, Rosenthal & Scheffler, 2013) Removal of thimerosal and mercury as ingredients from all vaccines per the American Academy of Pediatrics recommendations (1999)

9. Potential Impact of Proposed Policy Changes More education regarding vaccine safety Would not deter those with truly held philosophical beliefs Better control and containment of potential outbreaks of vaccine preventable illnesses (Lee, Rosenthal, Scheffler, 2013) Allow for better data collection

10. References American Academy of Pediatrics. (1999). Joint statement of the American Academy of Pediatrics (AAP) and the United States Public Health Service (USPHS). Pediatrics, 104(3), 568-569. Bronfin, D. (2008). Childhood immunization controversies: What are parents asking? The Ochsner Journal, 8, 151-156. Carrillo-Marquez, M., & White, L. (2013). Current controversies in childhood vaccination. South Dakota Medicine: The Journal Of The South Dakota State Medical Association, Spec no46-51. Centers for Disease Control. (2015). 2015 recommended immunizations for children from birth through 6 years old. Retrieved from http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0- http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0- 6yrs.pdf Chatterjee, A., O’Keefe, C. (2010). Current controversies in the USA regarding vaccine safety. Expert Reviews Vaccines, 9(5), 497- 502. Council on Foreign Relations. (2015). Vaccine-preventable outbreaks. Retrieved from http://www.cfr.org/interactives/GH_Vaccine_Map/#map

11. References Harmsen, I. A., Mollema, L., Ruiter, R. C., Paulussen, T. W., de Melker, H. E., & Kok, G. (2013). Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC Public Health, 131183. Lee, E., Rosenthal, L. & Scheffler, G. (2013, November 14). The effect of childhood vaccine exemptions on disease outbreaks. Health Care. Retrieved from https://www.americanprogress.org/issues/healthcare/report/2013/1 1/14/76471/the-effect-of-childhood-vaccine-exemptions-on- disease-outbreaks/ https://www.americanprogress.org/issues/healthcare/report/2013/1 National Council of State Legislatures. (2015). Immunizations policy issues overview. Health Research. Retrieved from http://www.ncsl.org/research/health/immunizations-policy-issues- overview.aspx http://www.ncsl.org/research/health/immunizations-policy-issues- Song, G. (2014). Understanding Public perceptions of benefits and risks of childhood vaccinations in the United States. Risk Analysis: An International Journal,34(3), 541-555.