Childhood Vaccinations: Why They're Important

Part I: Ethical and Cultural 

What Laws Govern or Should Pertain to the Issue? 

Today, many parents have been misled about the safety of vaccination. Ethical concerns about childhood vaccination have risen amongst policymakers, clinicians, and medical professionals. After the measles outbreak in December 2014 at a popular amusement park in California, there has been increased attention to childhood vaccination laws (Hendrix, Sturm, Zimet, & Meslin, 2016). According to the CDC, state laws were established for vaccination, and they determine requirements and guidelines that everybody must adhere to including healthcare workers, parents and guardians. These requirements affect vaccination of school children in both public and private schools as well as those in daycare facilities (Vaccination Requirements and Laws, n.d.). There is another vaccination law in California that eliminated the provisions that allow exceptions on personal beliefs regarding child vaccination in the state. This means that nonmedical reasons cannot be used to prevent a child from getting vaccinated. It also means that California is among the three states in the US that do not allow nonmedical vaccine exceptions (Devitt, 2018) While, states like Oregon and Washington allow vaccine exemptions for philosophical, religious and medical reasons. 

What Ethical Obstacles Affect How the Issue is Addressed by the Medical Community? 

Health care providers play a major role in assuring that children receive immunizations. However, there has been an increase in vaccine refusal due to nonmedical reasons such as cultural and religious beliefs. The perspective of patients and patients’ parents as immunization decision-makers is also critical. These individuals may or may not take into consideration that their choices can affect their health and the health of others. Primary care physicians should acknowledge parents’ concerns and correct any misinformation. Many parents are often misled by unreliable sources on the internet and anti-vaccine groups on social media. Medical Professionals hear patient or patient’s parent argue that vaccines will harm and not help or that vaccination is “unnatural” and “natural” immunity is preferable. Others will argue that exposing their child to the vaccines will harm their body, and some believe that they will enjoy herd immunity without subjecting their child to the risk of vaccination. Given the difficulty of communicating with anti-vaccination individual’s medical professional should find ways to better communicate with patients regarding vaccine safety (Hendrix, 2016) 

Which Cultural Values and Norms Influence the Issue? 

Opinions on vaccination include beliefs, individual rights, religion, and vaccine safety. As I mentioned earlier, there are state laws that dictate mandatory vaccines. There are some religions and cultural belief systems that have an alternative perspective on vaccination, and they promote them to their members. Religious objections to vaccines are based generally on the ethical dilemmas associated with using human tissue cells to create vaccines, and beliefs that the body is sacred and should not receive certain chemicals or blood or tissues from animals, and should be healed by God or natural means (Cultural Perspectives on Vaccination, n.d.). Cultural perspectives and opinions put the public at health risk. Also, it makes it challenging to provide immunity for those who are unable to obtain the vaccines due to age or health condition. 

Which Spiritual Traditions Affect the Treatment(s)? 

When an individual is infected with a vaccine-preventable disease, it might require additional resources to treat the disease. According to the New York School of Medicine, there are some individuals that refuse the vaccine due to religious beliefs and also interferes with medical treatment and prevention. One of the religions that would affect healthcare decisions is Jehovah's Witness. For example, religion does not believe that one should get a blood transfusion even when the induvial has a life-threatening condition (Wombwell et al., 2015, p. 601). 

Part II: Peer Reviewed Articles 

Ethical Inquiry Article 

The Ethical Issues 

A study done by Beeler et al. (2016) examines the issues of ethics in maternal immunization because of the importance of immunization during pregnancy in protecting both the mother and the child. There are few studies and clinical trials regarding vaccination that includes pregnant women. This is because of the ethical issues concerning pregnant women and children. They are considered as vulnerable groups who are excluded from many clinical trials. This makes many researchers avoid including pregnant women as subjects to avoid the associated risks. This research aims to analyze and inform researchers on the ethics of including vulnerable subjects in controlled studies. 

Reasons 

This study was done because it was shown that researchers are reluctant to conduct studies that will make them use pregnant women and infants as subjects. These two populations belong to the vulnerable population. A lot of care must be taken when conducting clinical trials on them. As a result, there are only a few studies and trials on vaccination among pregnant women. This review was done to improve on this issue by determining the scope of ethical issues involving vaccine trials on pregnant women Beeler et al. (2016). 

Three Key Points 

First, the majority of research articles on this issue focus on “pregnant women, neonates, and fetuses being classified as vulnerable subjects in human-subject research” (Beeler et al., 2016). Few studies have been directed to describing the ethical issues that need to be looked at when conducting the clinical trials involving pregnant mothers. The second key issue in this article is that studies need to provide clear and evident information on the risks and ethical issues regarding vaccine in pregnant women instead of relying on theoretical risks. Finally, the article suggests that more studies be done on cultural considerations regarding the vaccination of pregnant women Beeler et al. (2016). 

Different Source Supporting the Argument 

Verweij, Lambach, Ortiz, & Reis (2016) argues that maternal immunization should be a priority and “offered in response to concrete, severe, risks of disease for mother and child.” This article supports the argument that pregnant women should be vaccinated to protect both the fetus and the mother from various preventable infections. The author adds that the seriousness of the risks needs to be assessed and used to inform decision making on this matter. 

Ethical Issues Neglected 

This paper covers all the ethical issues on maternal immunization. However, they are generalized rather than discussing specific ethical considerations. 

Article Two: Cultural Inquiry 

Cultural Issues 

A study by Browne, Thomson, Rockloff, & Pennycook (2015) examines the issue of cultural beliefs on immunization because of the current trend in which parents delay or refuse immunization on their children. This article examines a culture in the United States in which parents tend to delay or refuse vaccination on their children. The article is based on a current pattern seen in the modern culture which consists of literate and semi-literate individuals. A national survey revealed that about 40% of the United States’ parents are involved in this habit of refusing immunization. 

Reasons 

This study was done because it was shown that refusing or delaying immunization is a result of miscommunication or misinterpretation of various information. Various cultural beliefs insist on using complementary and alternative medicine (CAM). This is one of the most common justifications that vaccination opponents use to support their decisions and beliefs. However, most of these CAM practices are not based on scientific evidence and can also lead to further health problems (Browne et al., 2015). 

Three Key Points 

The author states that the use of CAM is popular despite its lack of empirical evidence to support the medications’ safety and efficacy. Therefore, the appealing properties of the CAMs should be examined to find how they can be related to vaccination. Secondly, the distrust of authority is another contributor to vaccination refusal. Many parents who resist vaccination do so because they have little trust in government processes and policies. The final key point is the role of cognitive factors in refusing vaccination. There are some religions and culture which have comprehensive teachings about health and medication. Many believers interpret the teachings differently, and this leads to many of them refusing vaccination (Browne et al., 2015). 

Different Scientific Source 

Ventola (2016) supports the findings by arguing that a good number of parents refuse vaccination to their children because of various reasons. Some of the reasons include interpretation of cultural beliefs and teachings and distrust of government programs. The author also explains that parents have a misconception about the side effects associated with the vaccines. 

Other Issues Neglected 

This article only focused on the recent patterns associated with modern cultures. However, some of this pattern was established by traditional beliefs where most treatments were done using herbal medicines and traditional healers. Many religions also taught that only God could heal and there was no need of going to hospitals (Browne et al., 2015). 

Solution 

The problem of refusal to immunization was shown to be serious because about 40% of parents tend to delay or refuse to immunize their children. The studies examined showed that this problem is associated with cultural beliefs and considerations. The weaknesses of this study included the limited number of items to measure because this was a cross-sectional study. The key strength of this study was the availability of data from the Electronic White Pages (Browne et al., 2015). 

Of the areas examined, cultural was the strongest for my paper because it showed that in modern society, parents still make healthcare decisions based on cultural beliefs and assumptions instead of available scientific evidence. 

A study in 2015 have been performed in the United States by Browne et al., and it has shown promise in solving this problem. Healthcare providers and authorities will need to educate parents on the need for vaccination and its importance on children’s health. Reasons for continues trust in CAMs need to be examined and used to build the same trust in vaccines. Ventola (2016) also find a solution to this problem by proposing that health care providers need to be targeted to assist by developing interventions and recommendations. They need to use automated EMR-based reminder machines and counselling mechanisms . 

References 

Beeler, J. A., Lambach, P., Fulton, T. R., Narayanan, D., Ortiz, J. R., & Omer, S. B. (2016). A systematic review of ethical issues in vaccine studies involving pregnant women. Human vaccines & immunotherapeutics , 12 (8), 1952-1959. 

Browne, M., Thomson, P., Rockloff, M. J., & Pennycook, G. (2015). Going against the herd: psychological and cultural factors underlying the ‘vaccination confidence gap’. PLoS One , 10 (9), e0132562. 

Devitt, M. (2018, November 27). Study Examines Fallout of California Vaccine Exemption Law. Retrieved from https://www.aafp.org/news/health-of-the-public/20181127califvaccstudy.html 

Hendrix, K. S., Sturm, L. A., Zimet, G. D., & Meslin, E. M. (2016). Ethics and Childhood Vaccination Policy in the United States.  American Journal of Public Health,106 (2), 273-278. doi:10.2105/ajph.2015.302952 

Vaccination Requirements and Laws | CDC. (n.d.). Retrieved from https://www.cdc.gov/vaccines/imz-managers/laws/index.html 

Ventola, C. L. (2016). Immunization in the United States: Recommendations, barriers, and measures to improve compliance: Part 1: Childhood vaccinations. Pharmacy and Therapeutics , 41 (7), 426. 

Verweij, M., Lambach, P., Ortiz, J. R., & Reis, A. (2016). Maternal immunisation: ethical issues. The Lancet Infectious Diseases , 16 (12), e310-e314.