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Critical Thinking Paper: Requiring Vaccinations

Abbigail Willis
CAP 9
Red Group
April 1, 2015

Critical Thinking Paper: Requiring Vaccinations

In recent years, an increasing number of parents have declined to vaccinate their children
due to personal beliefs, which are often rooted in common misconceptions about harmful side
effects of vaccines. This practice threatens herd immunity, the idea that when a certain
percentage of a population is immune to something it drastically decreases the likelihood a
susceptible person will be exposed to it, therefore putting others who cannot receive vaccinations
for reasons beyond their control at risk. Because vaccinations prevent deadly diseases, are safe
and effective and help eradicate disease from the population as a whole, the United States
government must require vaccinations for chickenpox, diptheria, haemophilus influenzae,
hepatitis A and B, influenza, measles, mumps, pertussis, polio, pneumococcus, rotavirus, rubella
and tetanus.
Vaccinations have become a commonplace practice since 1796, when Edward Jenner
invented and introduced the smallpox vaccine. Vaccines for rabies, tetanus and the bubonic
plague, polio, and measles followed, along with several others. By 1979, smallpox had been
eradicated from the world and fifteen years later, polio was declared eradicated from the
Americas. Measles and rubella were no longer endemic in the United States in 2003 and 2004,
respectively. By 2006, childhood vaccination rates remained at peak levels and the amount of
diseases contracted by children worldwide was dropping steadily (ProQuest Staff).
In 1998, Andrew Wakefield, along with a group of researchers, published a study in the
British medical journal The Lancet proving a connection between the MMR (measles, mumps,
and rubella) vaccine and autism. Despite the fact that the study was disproven and retracted
multiple times, the damage had been done. In 2008, only two years after childhood immunization
rates had reached record levels, measles outbreaks began occurring in the United States as a
result of parents neglecting to vaccinate their children for fear of their safety. By 2011, one in ten

parents admitted to not following the recommended childhood vaccination schedule due to safety
concerns, and an increasing number of parents were opting out of required vaccinations for
public school (ProQuest Staff).
A recent outbreak of measles traced to Disneyland, California has once again sparked
national interest in the public benefit of vaccinations. During the national debate about whether
or not vaccines need to be made required, a Supreme Court case has been cited multiple times. In
Jacobson v. Massachusetts (1905), the Supreme Court ruled that states had the right to require
smallpox vaccinations during an epidemic in favor of public health (Mariner, Annas and
Glantzf). This raises the question of whether immunization can be required federally, despite the
lack of a serious epidemic. Currently, twenty U.S. states allow medical, religious, and
philosophical or personal belief exemptions from vaccinations, twenty-eight offer medical and
religious exemptions, and two states allow exemptions only based on medical reasons (States
with Religious and Philosophical Exemptions from School Immunization Requirements). Many
parents without serious religious or philosophical aversion to vaccinations apply for exemptions
nonetheless, putting the immunity of others at stake.
Vaccinations prevent deadly diseases. In 2010, California suffered its largest outbreak of
whooping cough since 1947, killing ten children. In the first six months of 2012, Washington
state had 2,520 cases of whooping cough, an increase of 1,300% from the previous year and the
largest outbreak since 1942. In the first nine months of 2014 alone, the United States suffered
600 cases of measles, in a country that was measles-free at the turn of the century (Offit). The
evidence is irrefutable - when children are vaccinated, diseases are eradicated. When parents stop
vaccinating their children, deadly diseases break out and everyone is threatened.
Not only do vaccinations prevent against a single instance of the disease they are meant

to protect against, but contracting a preventable disease can have serious repercussions. Five
percent of children who contract measles will later come down with pneumonia due to a
weakened immune system. Ten percent will get an ear infection. Another .01-.02% of measles
victims will suffer from serious brain inflammation and damage, and that same percentage will
die. Even children who do end up contracting a disease that they have been vaccinated against
tend to suffer much milder symptoms than those who were not vaccinated (Daley and Glanz).
Vaccinations protect individuals against disease, even in communities where most people
are vaccinated and feel that they can get by as free riders - not receiving the vaccines but
relying on the immunity of others for their own protection. Unvaccinated children are 23 times
more likely to contract whooping cough and 6.5 times more likely to contract pneumonia and
pneumococcal disease than those who were immunized (Daley and Glanz). These diseases
spread quickly - measles is highly contagious, with an attack rate of 90%, meaning that 90% of
infected people will spread the disease to someone else (Siegel). Each child who is vaccinated
has a much higher chance of remaining healthy than if he or she had not received the
immunization.
Vaccines have been proven safe and effective. The measles vaccination provides 99%
immunity after two doses (Siegel). From the beginning of the administration of the HPV
vaccination in 2006 to 2011, cases of the disease dropped from 11% to 5% (Pellerin).
Vaccinating children against influenza reduced their risk of contracting any flu-related illnesses
by 74% (Vaccine Effectiveness - How Well Does the Flu Vaccine Work?). According to the
Centers for Disease Control and Prevention, for more than 50 years, seasonal flu vaccines have
had very good safety track records (Influenza Vaccine Safety). Side effects are rare, and if
appear at all, are usually mild (Influenza Vaccine Safety). This holds true for most preventable

diseases.
The benefits of vaccinating a child seriously outweigh the risks of not doing so. From ten
million doses of the MMR (measles, mumps and rubella) vaccine given every year, only 6,000
have resulted in serious side effects and 288 in death since 1990. From actually contracting
measles, one to two out of a thousand will suffer serious brain inflammation, and another one to
two will die (Siegel). Miniscule percentages of the population who receive vaccinations will
show serious side effects compared to those who suffer the consequences of contracting the
actual disease.
Many parents are afraid to vaccinate their children due to safety concerns, particularly
regarding the MMR vaccine, that are founded upon false beliefs. Andrew Wakefields study,
which proved the link between the MMR vaccine and autism, had been rejected multiple times.
The Institute of Medicine disproved Wakefields claim in 2001 and rejected his study again in
2004. In that same year, The Lancet, the British medical journal in which the study had been
published, partially retracted Wakefields paper. A study published in the Public Library of
Science One medical journal found no link between MMR and autism in 2008, and in 2010 the
U.S Vaccines Court - a branch off the Court of Federal Claims - drew the same conclusion.
The Lancet fully retracted Wakefields article that year. The next year, Wakefields research was
declared fraudulent by the British Medical Journal. In 2013, the Journal of Pediatrics again
disproved the link between the MMR vaccine and autism (ProQuest Staff). Despite all this,
studies continue to show that parents had become afraid of vaccines. Between 1991 and 2004,
vaccination rates dropped at 6% every year, bringing the herd immunity down to dangerously
low levels. Because of the neglect of parents to vaccinate their children, preventable epidemics
have broken out around the country (Offit).

Leaving children unvaccinated threatens the herd immunity and puts other children at risk
of contracting the same disease. Herd immunity works by having a small percentage of
susceptible people within a protected population, where the immunity of almost everyone
drastically decreases the chance that an unvaccinated person will contract a contagious disease.
Herd immunity reaches unsafe levels for measles and whooping cough when 8% of children
remain unvaccinated (Vaccine Doubt and Your Kids). In Beverly Hills, California, the rates of
unvaccinated children reach nearly 70% in some places (Offit). At this point, not only are parents
endangering the health of their own child, but the health of the 30% of students who are
vaccinated. Not every vaccine is perfect, and occasionally it will not take or immunity will
wear off.
Sometimes, vaccinating a child is simply not an option. Infants are often too young to
receive certain vaccinations (Offit). It is also common for elderly citizens vaccinations to have
worn off with time and their weakening bodies. Some children sick with cancer or other diseases
cannot receive vaccinations during treatment (Siegel). These groups often have weakened
immune systems, and therefore are more susceptible to diseases and will suffer worse that others
if they contract them. It is in the public interest to protect those who cannot take the steps to
protect themselves.
The government must require vaccinations for all currently recommended diseases, or at
least strictly limit exceptions, to protect the common good. Providing easily-accessible
information about the benefits of vaccines and statistics on vaccination rates in correlation with
outbreaks of preventable disease may help to raise vaccination rates and increase herd immunity.
If not, outbreaks that could be prevented will continue to occur, and more and more children will
get sick and suffer serious, sometimes permanent, side effects, including death. To protect

individual people, communities, and the country as a whole, information needs to be provided
about vaccinations and exemptions from mandatory vaccines must be harder to receive.

Works Cited
Daley, Matthew F., and Jason M. Glanz. Straight Talk about Vaccination. Scientific
American 16 Aug. 2011: n. pag. Scientific American. Web. 15 Mar. 2015.
Influenza Vaccine Safety. Centers for Disease Control and Prevention. Centers for
Disease Control and Prevention, 2 Oct. 2014. Web. 31 Mar. 2015.
Mariner, Wendy K., George J. Annas, and Leonard H. Glantz. Jacobson v
Massachusetts: Its Not Your Great-Great-Grandfathers Public Health Law. PMC.
National Center for Biotechnology Information, 2005. Web. 30 Mar. 2015.
Offit, Paul A. The Anti-Vaccination Epidemic. Wall Street Journal 25 Sept. 2014: A.21.
SIRS Issues Researcher. Web. 15 Mar. 2015.

Pellerin, Cheryl. Early HPV Vaccination Protects Those at Risk, Official Says. DoD
News 22 Oct. 2014: n. pag. SIRS Government Reporter. Web. 15 Mar. 2015.
ProQuest Staff. Vaccination of Children Timeline. SIRS Issues Researcher. N.p., 2014.
Web. 15 Mar. 2015.
Siegel, Marc. Fear Measles, Not Vaccines. Wall Street Journal 27 Jan. 2105: A.11.
SIRS Issues Researcher. Web. 15 Mar. 2015.
States with Religious and Philosophical Exemptions from School Immunization
Requirements. National Conference of State Legislatures. National Conference of State
Legislatures, 3 Mar. 2015. Web. 30 Mar. 2015.
Vaccine Doubt and Your Kids. Los Angeles Times 10 Sept. 2014: A.14. SIRS Issues
Researcher. Web. 15 Mar. 2015.
Vaccine Effectiveness - How Well Does the Flu Vaccine Work? Centers for Disease
Control and Prevention. Centers for Disease Control and Prevention, 14 Jan. 2015. Web.
31 Mar. 2015.

Annotated Bibliography
Daley, Matthew F., and Jason M. Glanz. Straight Talk about Vaccination. Scientific
American 16 Aug. 2011: n. pag. Scientific American. Web. 15 Mar. 2015. This article is
well-researched and presents good data, statistics and studies on the lowering numbers of
vaccinations. It also highlights possible causes of the issue as well as possible solutions.
Figure Depicting Coverage with Individual Vaccines from the Inception of NIS, 1994
Through 2013. Centers for Disease Control and Prevention. Centers for Disease Control
and Prevention, 2 Sept. 2014. Web. 31 Mar. 2015. Statistics in both graph and chart form
of percentages of people receiving vaccinations from 1994-2013, over an almost 20-year
span.
Immunization and Infectious Diseases. HealthyPeople.gov. Office of Disease
Prevention and Health Promotion, n.d. Web. 31 Mar. 2015. This source discusses the
importance of vaccinations and why everyone should be vaccinated. Provides up-to-date
information on the topic and new research.

Influenza Vaccine Safety. Centers for Disease Control and Prevention. Centers for
Disease Control and Prevention, 2 Oct. 2014. Web. 31 Mar. 2015. Discusses safety rates
of the flu vaccine, links to several other possible sources regarding vaccination safety.
Mariner, Wendy K., George J. Annas, and Leonard H. Glantz. Jacobson v
Massachusetts: Its Not Your Great-Great-Grandfathers Public Health Law. PMC.
National Center for Biotechnology Information, 2005. Web. 30 Mar. 2015. Gives
historical background on the Jacobson v. Massachusetts case and what it means in
application to todays issues with vaccines.
National, State, and Local Area Vaccination Coverage Among Children Aged 1935
Months United States, 2012. Centers for Disease Control and Prevention. Centers for
Disease Control and Prevention, 13 Sept. 2013. Web. 31 Mar. 2015. Interesting statistics
about infant and toddler vaccinations, including demographics. Includes by-state charts of
percentages for each vaccination.
Offit, Paul A. The Anti-Vaccination Epidemic. Wall Street Journal 25 Sept. 2014: A.21.
SIRS Issues Researcher. Web. 15 Mar. 2015. Provides background on vaccinations, what
causes parents to not want to vaccinate their children. Highlights the fact that most people
not vaccinating their children are the wealthiest people in America. Suggests that parents
do not see sufficient risk to vaccinate their children because they did not live in an era
when they were exposed to now-treatable diseases.
Pellerin, Cheryl. Early HPV Vaccination Protects Those at Risk, Official Says. DoD
News 22 Oct. 2014: n. pag. SIRS Government Reporter. Web. 15 Mar. 2015.
Communicates the effectiveness and low risk of vaccinations, particularly the HPV
vaccine.

ProQuest Staff. Vaccination of Children Timeline. SIRS Issues Researcher. N.p., 2014.
Web. 15 Mar. 2015. This source provides a timeline of vaccination statistics and
milestones since Jenners smallpox vaccine in 1796.
Siegel, Marc. Fear Measles, Not Vaccines. Wall Street Journal 27 Jan. 2105: A.11.
SIRS Issues Researcher. Web. 15 Mar. 2015. The article provides statistics and causes of
the measles outbreak out of Disneyland in December. Discusses the risks to individual
children and the public as a whole if parents continue to not vaccinate their kids.
States with Religious and Philosophical Exemptions from School Immunization
Requirements. National Conference of State Legislatures. National Conference of State
Legislatures, 3 Mar. 2015. Web. 30 Mar. 2015. Provides a list of excepted vaccine
exemptions in all 50 United States.
U.S. Multi-state Measles Outbreak 20142015. Centers for Disease Control and
Prevention. Centers for Disease Control and Prevention, 30 Mar. 2015. Web. 31 Mar.
2015. Provides a brief overview of the Disneyland cases with the most recent information
and maps to show where the outbreak was concentrated.
Vaccination Coverage Among Children in Kindergarten United States, 201314
School Year. Centers for Disease Control and Prevention. Centers for Disease Control
and Prevention, 17 Oct. 2014. Web. 31 Mar. 2015. Good background information about
specific laws, requirements, exemptions, etc. for public schools. Provides demographics,
charts, maps and other data that I will not specifically use but is good to know.
Vaccine Doubt and Your Kids. Los Angeles Times 10 Sept. 2014: A.14. SIRS Issues
Researcher. Web. 15 Mar. 2015. The article presents the risks to both individual children

and communities if parents continue to forgo vaccines. Discusses flaws created by herd
immunity.
Vaccine Effectiveness - How Well Does the Flu Vaccine Work? Centers for Disease
Control and Prevention. Centers for Disease Control and Prevention, 14 Jan. 2015. Web.
31 Mar. 2015. Provides good facts and statistics regarding effectiveness of the influenza
vaccination, both more general and very specific. .Discusses how vaccination
effectiveness is tested.