Vaccination policy
Encyclopedia
Vaccination policy refers to the health policy a government adopts in relation to vaccination
. Vaccinations are voluntary in some countries and mandatory in some countries as part of the public health
system. Some governments pay all or part of the costs of vaccinations for vaccines in a national vaccination schedule.
s. Besides individual protection from getting ill, with some vaccines policies aim also to provide herd immunity
which is based on the idea that the pathogen will have trouble spreading when a significant part of the population has immunity against it.
coordinated the global effort to eradicate smallpox
globally. Victory is also claimed for getting rid of endemic measles
, mumps
and rubella
in Finland. The last naturally occurring case of smallpox occurred in Somalia in 1977. In 1988, the governing body of WHO targeted polio for eradication by the year 2000, but didn't succeed. The next eradication target would most likely be measles, which has declined since the introduction of measles vaccination in 1963.
will attempt to minimize the risk of illness, and will seek vaccination for themselves or their children if they perceive a high threat of disease and a low risk to vaccination. However, if a vaccination program successfully reduces the disease threat, it may reduce the perceived risk of disease enough so that an individual's optimal strategy is to encourage everyone but their family to be vaccinated, or (more generally) to refuse vaccination at coverage levels below those optimal for the community. For example, a 2003 study found that a bioterrorist attack using smallpox
would result in conditions where voluntary vaccination would be unlikely to reach the optimum level for the U.S. as a whole, and a 2007 study found that severe influenza epidemics cannot be prevented by voluntary vaccination without offering certain incentives. Governments often allow exemptions to mandatory vaccination for religious or philosophical reasons, but if too many of these exemptions are granted, the resulting free rider problem
may cause loss of herd immunity
, substantially increasing risks even to vaccinated individuals.
and Wales
, with fines levied on people who did not comply. In the United States, the Supreme Court
ruled in the 1905 case Jacobson v. Massachusetts
that the state could require individuals to be vaccinated for the common good. Common contemporary U.S. vaccination policies require that children receive common vaccinations before entering school. A few other countries also have some compulsory vaccinations. Compulsory vaccination is believed to have greatly reduced the rates of some infectious diseases.
Beginning with early vaccination in the nineteenth century, these policies led to resistance from a variety of groups, collectively called anti-vaccinationists, who objected on ethical, political, medical safety, religious
, and other grounds. Common objections are that compulsory vaccination represents excessive government intervention in personal matters, or that the proposed vaccinations are not sufficiently safe. Many modern vaccination policies allow exemptions for people who have compromised immune systems, allergies to the components used in vaccinations or strongly held objections.
In 1904 in the city of Rio de Janeiro
, Brazil
, following an urban renewal program that displaced many poor, a government program of mandatory smallpox vaccination triggered the so-called Vaccine Revolt
, several days of rioting with considerable property damage and a number of deaths.
Having compulsory vaccinations is connected with difficult policy issues where health authorities try to balance health of society and individual liberty:
Reviews of scientific evidence for different types of vaccination policies have found strong evidence for the effectiveness of standing orders, which allow healthcare workers without prescription authority (such as nurses) to administer vaccines in defined circumstances; sufficient evidence for the effectiveness of requiring vaccinations before attending child care and school; and insufficient evidence to assess the effectiveness of requiring vaccinations as a condition for hospital and other healthcare jobs.
, a massive increase in vaccination rates was observed when the federal government made certain benefits (such as the universal 'Family Allowance' welfare payments for parents of children) dependent upon vaccination compliance. As well, children were not allowed into school unless they were either vaccinated or their parents completed a statutory declaration refusing to immunize them, after discussion with a doctor, and other bureaucracy. (Similar school-entry vaccination regulations have been in place in some parts of Canada
for several years.) It became easier and cheaper to vaccinate one's children than not to. When faced with the annoyance, many more casual objectors simply gave in.
or a team of other medical staff from outside the school. All the children in a given school year are vaccinated as a cohort
. For example, children may receive the oral polio vaccine in Year One of primary school (about six or seven years of age), the BCG in Year Six, and the MMR
in Form Three of secondary school
. Therefore, most people have received their core vaccines by the time they finish secondary school.
against measles, mumps and rubella, sparked by media coverage of controversial research linking it to autism, caused a significant drop in vaccinations and a rise in the incidence of these diseases. Prime Minister Tony Blair
refused to confirm whether his children had received the vaccine.
makes scientific recommendations which are generally followed by the federal government, state governments, and private health insurance companies.
States in the U.S. mandate immunization, or obtaining exemption, before children enroll in public school. Exemptions are typically for people who have compromised immune systems, allergies to the components used in vaccinations, or strongly held objections. All states but West Virginia and Mississippi allow religious exemptions, and twenty states allow parents to cite personal or philosophical objections. A widespread and growing number of parents falsely claim religious and philosophical beliefs to get vaccination exemptions, and an increasing number of disease outbreaks have come from communities where herd immunity was lost due to insufficient vaccination.
The American Academy of Pediatrics
(AAP) notes the dilemma faced by many parents in that vaccines are a very safe and important health intervention, but are neither risk-free nor 100% effective. It advises physicians to respect the refusal of parents to vaccinate their child after adequate discussion, unless the child is put at significant risk of harm (e.g., during an epidemic, or after a deep and contaminated puncture wound); under such circumstances, the AAP states that parental refusal of immunization constitutes a form of medical neglect and should be reported to state child protective services
agencies.
See Vaccination schedule
for the vaccination schedule used in the United States.
Immunizations are often compulsory for military enlistment in the U.S.
All vaccines recommended by the U.S. government for its citizens are required for green card applicants. This requirement has stirred controversy when it applied to HPV vaccine
because of the cost of the vaccine, and because the other thirteen required vaccines prevent diseases which are spread by a respiratory route and are considered highly contagious.
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
. Vaccinations are voluntary in some countries and mandatory in some countries as part of the public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
system. Some governments pay all or part of the costs of vaccinations for vaccines in a national vaccination schedule.
Immunity and herd immunity
Vaccination policies aim to produce immunity to preventable diseaseDisease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
s. Besides individual protection from getting ill, with some vaccines policies aim also to provide herd immunity
Herd immunity
Herd immunity describes a form of immunity that occurs when the vaccination of a significant portion of a population provides a measure of protection for individuals who have not developed immunity...
which is based on the idea that the pathogen will have trouble spreading when a significant part of the population has immunity against it.
Eradication of disease
With some vaccines, a goal of vaccination policies is to eradicate the disease - make it disappear from Earth altogether. The World Health OrganizationWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
coordinated the global effort to eradicate smallpox
Smallpox
Smallpox was an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning "spotted", or varus, meaning "pimple"...
globally. Victory is also claimed for getting rid of endemic measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
, mumps
Mumps
Mumps is a viral disease of the human species, caused by the mumps virus. Before the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide...
and rubella
Rubella
Rubella, commonly known as German measles, is a disease caused by the rubella virus. The name "rubella" is derived from the Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is...
in Finland. The last naturally occurring case of smallpox occurred in Somalia in 1977. In 1988, the governing body of WHO targeted polio for eradication by the year 2000, but didn't succeed. The next eradication target would most likely be measles, which has declined since the introduction of measles vaccination in 1963.
Individual versus group goals
Rational individualsRational choice theory
Rational choice theory, also known as choice theory or rational action theory, is a framework for understanding and often formally modeling social and economic behavior. It is the main theoretical paradigm in the currently-dominant school of microeconomics...
will attempt to minimize the risk of illness, and will seek vaccination for themselves or their children if they perceive a high threat of disease and a low risk to vaccination. However, if a vaccination program successfully reduces the disease threat, it may reduce the perceived risk of disease enough so that an individual's optimal strategy is to encourage everyone but their family to be vaccinated, or (more generally) to refuse vaccination at coverage levels below those optimal for the community. For example, a 2003 study found that a bioterrorist attack using smallpox
Smallpox
Smallpox was an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning "spotted", or varus, meaning "pimple"...
would result in conditions where voluntary vaccination would be unlikely to reach the optimum level for the U.S. as a whole, and a 2007 study found that severe influenza epidemics cannot be prevented by voluntary vaccination without offering certain incentives. Governments often allow exemptions to mandatory vaccination for religious or philosophical reasons, but if too many of these exemptions are granted, the resulting free rider problem
Free rider problem
In economics, collective bargaining, psychology, and political science, a free rider is someone who consumes a resource without paying for it, or pays less than the full cost. The free rider problem is the question of how to limit free riding...
may cause loss of herd immunity
Herd immunity
Herd immunity describes a form of immunity that occurs when the vaccination of a significant portion of a population provides a measure of protection for individuals who have not developed immunity...
, substantially increasing risks even to vaccinated individuals.
Compulsory vaccination
In an attempt to eliminate the risk of outbreaks of some diseases, at various times several governments and other institutions have instituted policies requiring vaccination for all people. For example, an 1853 law required universal vaccination against smallpox in EnglandEngland
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
and Wales
Wales
Wales is a country that is part of the United Kingdom and the island of Great Britain, bordered by England to its east and the Atlantic Ocean and Irish Sea to its west. It has a population of three million, and a total area of 20,779 km²...
, with fines levied on people who did not comply. In the United States, the Supreme Court
Supreme Court of the United States
The Supreme Court of the United States is the highest court in the United States. It has ultimate appellate jurisdiction over all state and federal courts, and original jurisdiction over a small range of cases...
ruled in the 1905 case Jacobson v. Massachusetts
Jacobson v. Massachusetts
In the case of Jacobson v. Massachusetts, , the Supreme Court of the United States on February 20, 1905, upheld the authority of states to enforce compulsory vaccination laws...
that the state could require individuals to be vaccinated for the common good. Common contemporary U.S. vaccination policies require that children receive common vaccinations before entering school. A few other countries also have some compulsory vaccinations. Compulsory vaccination is believed to have greatly reduced the rates of some infectious diseases.
Beginning with early vaccination in the nineteenth century, these policies led to resistance from a variety of groups, collectively called anti-vaccinationists, who objected on ethical, political, medical safety, religious
Vaccination and religion
Vaccination and religion have interrelations of varying kinds.-Historical:Catholic and Anglican missionaries vaccinated Northwest Coast Indians during an 1862 smallpox epidemic....
, and other grounds. Common objections are that compulsory vaccination represents excessive government intervention in personal matters, or that the proposed vaccinations are not sufficiently safe. Many modern vaccination policies allow exemptions for people who have compromised immune systems, allergies to the components used in vaccinations or strongly held objections.
Rio de Janeiro
Rio de Janeiro , commonly referred to simply as Rio, is the capital city of the State of Rio de Janeiro, the second largest city of Brazil, and the third largest metropolitan area and agglomeration in South America, boasting approximately 6.3 million people within the city proper, making it the 6th...
, Brazil
Brazil
Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...
, following an urban renewal program that displaced many poor, a government program of mandatory smallpox vaccination triggered the so-called Vaccine Revolt
Vaccine Revolt
The Vaccine Revolt, or Vaccine Rebellion, was a period of civil disorder which occurred in the city of Rio de Janeiro, Brazil, November 10 through 16, 1904.-Antecedents:...
, several days of rioting with considerable property damage and a number of deaths.
Having compulsory vaccinations is connected with difficult policy issues where health authorities try to balance health of society and individual liberty:
"Vaccination is unique among de facto mandatory requirements in the modern era, requiring individuals to accept the injection of a medicine or medicinal agent into their bodies, and it has provoked a spirited opposition. This opposition began with the first vaccinations, has not ceased, and probably never will. From this realisation arises a difficult issue: how should the mainstream medical authorities approach the anti-vaccination movement? A passive reaction could be construed as endangering the health of society, whereas a heavy handed approach can threaten the values of individual liberty and freedom of expression that we cherish."
Reviews of scientific evidence for different types of vaccination policies have found strong evidence for the effectiveness of standing orders, which allow healthcare workers without prescription authority (such as nurses) to administer vaccines in defined circumstances; sufficient evidence for the effectiveness of requiring vaccinations before attending child care and school; and insufficient evidence to assess the effectiveness of requiring vaccinations as a condition for hospital and other healthcare jobs.
Australia
In AustraliaAustralia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
, a massive increase in vaccination rates was observed when the federal government made certain benefits (such as the universal 'Family Allowance' welfare payments for parents of children) dependent upon vaccination compliance. As well, children were not allowed into school unless they were either vaccinated or their parents completed a statutory declaration refusing to immunize them, after discussion with a doctor, and other bureaucracy. (Similar school-entry vaccination regulations have been in place in some parts of Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
for several years.) It became easier and cheaper to vaccinate one's children than not to. When faced with the annoyance, many more casual objectors simply gave in.
Malaysia
In Malaysia, mass vaccination is practised in public schools. The vaccines may be administered by a school nurseSchool nurse
A school nurse is a nurse assigned to work in a school.Schools have nurses to promote good health in students, and in preparation for illnesses and emergencies in students.Some places have laws requiring schools to have nurses.-Duties:...
or a team of other medical staff from outside the school. All the children in a given school year are vaccinated as a cohort
Cohort (statistics)
In statistics and demography, a cohort is a group of subjects who have shared a particular time together during a particular time span . Cohorts may be tracked over extended periods in a cohort study. The cohort can be modified by censoring, i.e...
. For example, children may receive the oral polio vaccine in Year One of primary school (about six or seven years of age), the BCG in Year Six, and the MMR
MMR vaccine
The MMR vaccine is an immunization shot against measles, mumps, and rubella . It was first developed by Maurice Hilleman while at Merck in the late 1960s....
in Form Three of secondary school
Secondary school
Secondary school is a term used to describe an educational institution where the final stage of schooling, known as secondary education and usually compulsory up to a specified age, takes place...
. Therefore, most people have received their core vaccines by the time they finish secondary school.
United Kingdom
In the 2000s, public concern about the combined MMR vaccineMMR vaccine
The MMR vaccine is an immunization shot against measles, mumps, and rubella . It was first developed by Maurice Hilleman while at Merck in the late 1960s....
against measles, mumps and rubella, sparked by media coverage of controversial research linking it to autism, caused a significant drop in vaccinations and a rise in the incidence of these diseases. Prime Minister Tony Blair
Tony Blair
Anthony Charles Lynton Blair is a former British Labour Party politician who served as the Prime Minister of the United Kingdom from 2 May 1997 to 27 June 2007. He was the Member of Parliament for Sedgefield from 1983 to 2007 and Leader of the Labour Party from 1994 to 2007...
refused to confirm whether his children had received the vaccine.
United States
The Advisory Committee on Immunization PracticesAdvisory Committee on Immunization Practices
The Advisory Committee on Immunization Practices provides advice and guidance on effective control of vaccine-preventable diseases in the U.S. civilian population. The ACIP develops written recommendations for routine administration of vaccines to the pediatric and adult populations, along with...
makes scientific recommendations which are generally followed by the federal government, state governments, and private health insurance companies.
States in the U.S. mandate immunization, or obtaining exemption, before children enroll in public school. Exemptions are typically for people who have compromised immune systems, allergies to the components used in vaccinations, or strongly held objections. All states but West Virginia and Mississippi allow religious exemptions, and twenty states allow parents to cite personal or philosophical objections. A widespread and growing number of parents falsely claim religious and philosophical beliefs to get vaccination exemptions, and an increasing number of disease outbreaks have come from communities where herd immunity was lost due to insufficient vaccination.
The American Academy of Pediatrics
American Academy of Pediatrics
The American Academy of Pediatrics is the major professional association of pediatricians in the United States. The AAP was founded in 1930 by 35 pediatricians to address pediatric healthcare standards. It currently has 60,000 members in primary care and sub-specialist areas...
(AAP) notes the dilemma faced by many parents in that vaccines are a very safe and important health intervention, but are neither risk-free nor 100% effective. It advises physicians to respect the refusal of parents to vaccinate their child after adequate discussion, unless the child is put at significant risk of harm (e.g., during an epidemic, or after a deep and contaminated puncture wound); under such circumstances, the AAP states that parental refusal of immunization constitutes a form of medical neglect and should be reported to state child protective services
Child Protective Services
Child Protective Services is the name of a governmental agency in many states of the United States that responds to reports of child abuse or neglect. Some states use other names, often attempting to reflect more family-centered practices, such as "Department of Children & Family Services"...
agencies.
See Vaccination schedule
Vaccination schedule
A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence....
for the vaccination schedule used in the United States.
Immunizations are often compulsory for military enlistment in the U.S.
All vaccines recommended by the U.S. government for its citizens are required for green card applicants. This requirement has stirred controversy when it applied to HPV vaccine
HPV vaccine
The human papilloma virus vaccine prevents infection with certain species of human papillomavirus associated with the development of cervical cancer, genital warts, and some less common cancers...
because of the cost of the vaccine, and because the other thirteen required vaccines prevent diseases which are spread by a respiratory route and are considered highly contagious.