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Shah S, Brumberg HL. Advocate to vaccinate: moving away from the "politics" of vaccination. Pediatr Res 2024; 95:1168-1171. [PMID: 38337042 DOI: 10.1038/s41390-024-03043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Shetal Shah
- Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA.
| | - Heather L Brumberg
- Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA
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Novilla MLB, Goates MC, Redelfs AH, Quenzer M, Novilla LKB, Leffler T, Holt CA, Doria RB, Dang MT, Hewitt M, Lind E, Prickett E, Aldridge K. Why Parents Say No to Having Their Children Vaccinated against Measles: A Systematic Review of the Social Determinants of Parental Perceptions on MMR Vaccine Hesitancy. Vaccines (Basel) 2023; 11:vaccines11050926. [PMID: 37243030 DOI: 10.3390/vaccines11050926] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Ongoing outbreaks of measles threaten its elimination status in the United States. Its resurgence points to lower parental vaccine confidence and local pockets of unvaccinated and undervaccinated individuals. The geographic clustering of hesitancy to MMR indicates the presence of social drivers that shape parental perceptions and decisions on immunization. Through a qualitative systematic review of published literature (n = 115 articles; 7 databases), we determined major themes regarding parental reasons for MMR vaccine hesitancy, social context of MMR vaccine hesitancy, and trustworthy vaccine information sources. Fear of autism was the most cited reason for MMR hesitancy. The social drivers of vaccine hesitancy included primary care/healthcare, education, economy, and government/policy factors. Social factors, such as income and education, exerted a bidirectional influence, which facilitated or hindered vaccine compliance depending on how the social determinant was experienced. Fear of autism was the most cited reason for MMR hesitancy. Vaccine hesitancy to MMR and other childhood vaccines clustered in middle- to high-income areas among mothers with a college-level education or higher who preferred internet/social media narratives over physician-based vaccine information. They had low parental trust, low perceived disease susceptibility, and were skeptical of vaccine safety and benefits. Combating MMR vaccine misinformation and hesitancy requires intersectoral and multifaceted approaches at various socioecological levels to address the social drivers of vaccine behavior.
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Affiliation(s)
| | - Michael C Goates
- Harold B. Lee Library, Brigham Young University, Provo, UT 84602, USA
| | - Alisha H Redelfs
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA
| | - Mallory Quenzer
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA
| | | | - Tyler Leffler
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA
| | - Christian A Holt
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA
| | - Russell B Doria
- School of Osteopathic Medicine, Campbell University, Lillington, NC 27546, USA
| | - Michael T Dang
- School of Osteopathic Medicine, Campbell University, Lillington, NC 27546, USA
| | - Melissa Hewitt
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA
| | - Emma Lind
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA
| | - Elizabeth Prickett
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA
| | - Katelyn Aldridge
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA
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Marye S, Spencer G. A population study of the NYS measles epidemic: Lessons learned. Public Health Nurs 2022; 39:958-964. [PMID: 35452554 DOI: 10.1111/phn.13084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/01/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In 2019 the United States experienced the largest outbreak of measles in 27 years, 19 years after the United States declared measles eliminated. The purpose of this paper was to present a population study of a measles outbreak within Orthodox Jewish communities in New York that led to the elimination of religious exemption for school mandated vaccines. METHODS Peer reviewed articles, news media, health department, and government resources were used to investigate environmental factors that led to this outbreak. State, county, and city immunization records were accessed to explore measles compliance rates before and after policy change. RESULTS Rockland County had low compliance rates compared to the rest of the state, and the elimination of religious exemptions raised compliance rate almost to state level. In all but one affected New York City zip codes, compliance following policy change rose to 97.95%-99.15%. CONCLUSIONS Overall, changes in measles compliance rates reflect policy goals, but localized differences imply a need for more customized interventions for each unique community. Public health planning to promote vaccination should be sensitive to the concerns and perceptions of each community in order for health interventions to have a positive effect.
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Affiliation(s)
- Stacey Marye
- Decker College of Nursing and Health Sciences, Binghamton University, Binghamton, New York
| | - Gale Spencer
- Decker College of Nursing and Health Sciences, Binghamton University, Binghamton, New York
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4
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Attwell K, Drislane S. Australia's 'No Jab No Play' policies: history, design and rationales. Aust N Z J Public Health 2022; 46:640-646. [PMID: 35980171 DOI: 10.1111/1753-6405.13289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/01/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Since 2014, five Australian states have enacted 'No Jab, No Play' policies requiring children to be fully vaccinated to attend childcare and early education services. We review the five policies and their implications for implementers - including healthcare and childcare service providers - and analyse factors that shaped the design of state policies. METHODS We employed documentary analysis and analysed key informant interviews in NVivo 12. RESULTS Our findings reveal similarities and differences between state provisions regarding exemptions, grace periods, responsibilities of service providers and sanctions for non-compliance. We elaborate on five factors of influence that have shaped No Jab, No Play policies: i) impetus for change; ii) policy normalisation, growing concurrence and stringency; iii) increased co-optation of childcare providers into vaccination governance; iv) policy influence and lessons; and v) partisan politics and the development of party ideologies over time. CONCLUSION A range of factors contribute to how and why Australia's NJNPlay policies have taken their current forms. IMPLICATIONS FOR PUBLIC HEALTH NJNPlay policies impact families and healthcare providers as part of the broader policy ecosystem concerned with maintaining high immunisation rates in Australia. Increased coercion of parents over time has been tempered by partisan positions on exemptions for disadvantage.
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Affiliation(s)
- Katie Attwell
- School of Social Sciences, University of Western Australia
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Southall E, Brett TS, Tildesley MJ, Dyson L. Early warning signals of infectious disease transitions: a review. J R Soc Interface 2021; 18:20210555. [PMID: 34583561 PMCID: PMC8479360 DOI: 10.1098/rsif.2021.0555] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/06/2021] [Indexed: 01/07/2023] Open
Abstract
Early warning signals (EWSs) are a group of statistical time-series signals which could be used to anticipate a critical transition before it is reached. EWSs are model-independent methods that have grown in popularity to support evidence of disease emergence and disease elimination. Theoretical work has demonstrated their capability of detecting disease transitions in simple epidemic models, where elimination is reached through vaccination, to more complex vector transmission, age-structured and metapopulation models. However, the exact time evolution of EWSs depends on the transition; here we review the literature to provide guidance on what trends to expect and when. Recent advances include methods which detect when an EWS becomes significant; the earlier an upcoming disease transition is detected, the more valuable an EWS will be in practice. We suggest that future work should firstly validate detection methods with synthetic and historical datasets, before addressing their performance with real-time data which is accruing. A major challenge to overcome for the use of EWSs with disease transitions is to maintain the accuracy of EWSs in data-poor settings. We demonstrate how EWSs behave on reported cases for pertussis in the USA, to highlight some limitations when detecting disease transitions with real-world data.
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Affiliation(s)
- Emma Southall
- The Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry CV4 7AL, UK
- Mathematics for Real World Systems Centre for Doctoral Training, Mathematics Institute, University of Warwick, Coventry CV4 7AL, UK
| | - Tobias S. Brett
- Odum School of Ecology, University of Georgia, Athens, GA, USA
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Michael J. Tildesley
- The Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry CV4 7AL, UK
| | - Louise Dyson
- The Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry CV4 7AL, UK
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Reiss DR. Vaccines Mandates and Religion: Where are We Headed with the Current Supreme Court? THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:552-563. [PMID: 35006054 DOI: 10.1017/jme.2021.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article argues that the Supreme Court should not require a religious exemption from vaccine mandates. For children, who cannot yet make autonomous religious decision, religious exemptions would allow parents to make a choice that puts the child at risk and makes the shared environment of the school unsafe - risking other people's children. For adults, there are still good reasons not to require a religious exemption, since vaccines mandates are adopted for public health reasons, not to target religion, are an area where free riding is a real risk, no religion actually prohibits vaccinating under a mandate, and policing religious exemptions is very difficult.
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Garnier R, Nedell ER, Omer SB, Bansal S. Getting Personal: How Childhood Vaccination Policies Shape the Landscape of Vaccine Exemptions. Open Forum Infect Dis 2020; 7:ofaa088. [PMID: 32258205 PMCID: PMC7111605 DOI: 10.1093/ofid/ofaa088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/12/2020] [Indexed: 02/02/2023] Open
Abstract
Background State-mandated school entry immunization requirements in the United States play an important role in achieving high vaccine coverage, but variations in vaccine exemption policies result in a patchwork of vaccine coverage across the country. Methods In this study, we evaluate epidemiological effects and spatial variations in nonmedical exemption (NME) rates in the context of vaccine policies. We first analyze the correlation between NME rates and vaccine coverage for 3 significant childhood vaccinations. Furthermore, we assess the effects of policy changes in a subset of states, using a correlative approach at the state level and performing a clustering analysis at the county level. Results We find that higher rates of exemptions are associated with lower vaccination rates of school-aged children in all cases. In a subset of states where exemption policy has recently changed, we show that the effects on statewide NME rates vary widely and that decreases in NMEs can lead to an increase in other types of exemptions. Finally, our clustering analysis in California, Illinois, and Connecticut shows that policy changes affect the spatial distribution of NMEs. Conclusions Our work suggests that vaccination policies have significant impacts on patterns of herd immunity. Our findings can be used to develop evidence-based vaccine legislation.
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Affiliation(s)
- Romain Garnier
- Department of Biology, Georgetown University, Washington, District of Columbia, USA
| | - Emma R Nedell
- Department of Biology, Georgetown University, Washington, District of Columbia, USA
| | - Saad B Omer
- Yale Institute for Global Health, Yale University, New Haven, Conneticut, USA.,Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Shweta Bansal
- Department of Biology, Georgetown University, Washington, District of Columbia, USA
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Zier ER, Bradford WD. To attend or not to attend? The effect of school-immunization exemption policies on enrollment rates for prekindergarten, kindergarten and elementary aged youth. Vaccine 2020; 38:2578-2584. [DOI: 10.1016/j.vaccine.2020.01.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/30/2019] [Accepted: 01/26/2020] [Indexed: 10/25/2022]
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Marshall GS. Vaccine Hesitancy, History, and Human Nature: The 2018 Stanley A. Plotkin Lecture. J Pediatric Infect Dis Soc 2019; 8:1-8. [PMID: 33513237 DOI: 10.1093/jpids/piy082] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 12/11/2022]
Abstract
Navigating the waters of vaccine hesitancy requires a view towards history and a deep understanding of how humans think. Getting children vaccinated is as much, or more, about connecting with people as it is about communicating scientific information.
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Affiliation(s)
- Gary S Marshall
- Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Kentucky
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Goldstein ND, Suder JS, Purtle J. Trends and Characteristics of Proposed and Enacted State Legislation on Childhood Vaccination Exemption, 2011-2017. Am J Public Health 2018; 109:102-107. [PMID: 30496007 DOI: 10.2105/ajph.2018.304765] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine trends and characteristics of proposed and enacted state legislation that would directly affect states' immunization exemption laws.Methods. We performed content analysis of proposed bills in state legislatures from 2011 to 2017. We classified bills as provaccination or antivaccination.Results. State legislators proposed 175 bills, with the volume increasing over time: 92 (53%) bills expanded access to exemptions, and 83 (47%) limited the ability to exempt. Of the 13 bills signed into law, 12 (92%) limited the ability to exempt. Bills that expanded access to exemptions were more likely to come from Republican legislators and Northeastern and Southern states.Conclusions. Although most proposed legislation would have expanded access to exemptions, bills that limited exemptions were more likely to be enacted into law. Legal barriers to exempt one's children from vaccination persist despite vaccine hesitancy, which is encouraging for public health.Public Health Implications. Most vaccine exemption laws introduced in state legislatures would pose threats to the public's health. There is a need for constituents to engage their elected legislators and advocate provaccination policies.
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Affiliation(s)
- Neal D Goldstein
- Neal D. Goldstein is with the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA. Joanna S. Suder is with the Civil Division, Delaware Department of Justice, Wilmington. Jonathan Purtle is with the Department of Health Management and Policy, Drexel University Dornsife School of Public Health
| | - Joanna S Suder
- Neal D. Goldstein is with the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA. Joanna S. Suder is with the Civil Division, Delaware Department of Justice, Wilmington. Jonathan Purtle is with the Department of Health Management and Policy, Drexel University Dornsife School of Public Health
| | - Jonathan Purtle
- Neal D. Goldstein is with the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA. Joanna S. Suder is with the Civil Division, Delaware Department of Justice, Wilmington. Jonathan Purtle is with the Department of Health Management and Policy, Drexel University Dornsife School of Public Health
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Mohanty S, Buttenheim AM, Joyce CM, Howa AC, Salmon D, Omer SB. California's Senate Bill 277: Local Health Jurisdictions' Experiences With the Elimination of Nonmedical Vaccine Exemptions. Am J Public Health 2018; 109:96-101. [PMID: 30495995 DOI: 10.2105/ajph.2018.304768] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To understand the experiences of local health jurisdictions with Senate Bill 277 (SB277), the California law that eliminated nonmedical vaccine exemptions for public- and private-school entry.Methods. We conducted semistructured telephone interviews with health officers and local health department (LHD) staff in California between August and September 2017.Results. Two overall themes emerged: (1) vague legislative and regulatory language led to variation in the interpretation and implementation of SB277, and (2) lack of centralized review of medical exemptions allowed medical exemptions that are not consistent with valid contraindications for immunizations to be accepted. Variation in the interpretation and implementation was commonly reported with provisions related to individualized education programs and special education, and independent study programs and homeschooling. Without a centralized review of medical exemption requests, respondents reported variation in the interpretation of which specialties of physicians can write medical exemptions, which conditions constitute a valid contraindication for immunization, and the process for reporting a questionable or suspicious medical exemption.Conclusions. The regulatory language within SB277 led to variation in how the law was interpreted and implemented within and across LHD jurisdictions and school districts.
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Affiliation(s)
- Salini Mohanty
- Salini Mohanty, Alison M. Buttenheim, and Caroline M. Joyce are with the University of Pennsylvania, School of Nursing, Philadelphia. Alison M. Buttenheim is also with the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine of the University of Pennsylvania. Amanda C. Howa and Saad B. Omer are with Emory University, Rollins School of Public Health, Atlanta, GA. Daniel Salmon is with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | - Alison M Buttenheim
- Salini Mohanty, Alison M. Buttenheim, and Caroline M. Joyce are with the University of Pennsylvania, School of Nursing, Philadelphia. Alison M. Buttenheim is also with the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine of the University of Pennsylvania. Amanda C. Howa and Saad B. Omer are with Emory University, Rollins School of Public Health, Atlanta, GA. Daniel Salmon is with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | - Caroline M Joyce
- Salini Mohanty, Alison M. Buttenheim, and Caroline M. Joyce are with the University of Pennsylvania, School of Nursing, Philadelphia. Alison M. Buttenheim is also with the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine of the University of Pennsylvania. Amanda C. Howa and Saad B. Omer are with Emory University, Rollins School of Public Health, Atlanta, GA. Daniel Salmon is with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | - Amanda C Howa
- Salini Mohanty, Alison M. Buttenheim, and Caroline M. Joyce are with the University of Pennsylvania, School of Nursing, Philadelphia. Alison M. Buttenheim is also with the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine of the University of Pennsylvania. Amanda C. Howa and Saad B. Omer are with Emory University, Rollins School of Public Health, Atlanta, GA. Daniel Salmon is with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | - Daniel Salmon
- Salini Mohanty, Alison M. Buttenheim, and Caroline M. Joyce are with the University of Pennsylvania, School of Nursing, Philadelphia. Alison M. Buttenheim is also with the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine of the University of Pennsylvania. Amanda C. Howa and Saad B. Omer are with Emory University, Rollins School of Public Health, Atlanta, GA. Daniel Salmon is with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | - Saad B Omer
- Salini Mohanty, Alison M. Buttenheim, and Caroline M. Joyce are with the University of Pennsylvania, School of Nursing, Philadelphia. Alison M. Buttenheim is also with the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine of the University of Pennsylvania. Amanda C. Howa and Saad B. Omer are with Emory University, Rollins School of Public Health, Atlanta, GA. Daniel Salmon is with Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
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Affiliation(s)
- Ann M Bowling
- Wright State University-Miami Valley, College of Nursing and Health, Dayton, OH, USA.
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13
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Pierik R. On religious and secular exemptions: A case study of childhood vaccination waivers. ETHNICITIES 2017; 17:220-241. [PMID: 28546785 PMCID: PMC5428064 DOI: 10.1177/1468796817692629] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This paper analyses exemptions to general law through the prism of vaccine waivers in the United States. All US states legally require the vaccination of children prior to school or daycare entry; however, this obligation is accompanied with a system of medical, religious, and/or philosophical exemptions. Nonmedical exemptions became subject of discussion after the 2015 Disneyland measles outbreak in California, which unequivocally brought to light what had been brewing below the surface for a while: a slow but steady decline in vaccination rates in Western societies, resulting in the reoccurrence of measles outbreaks. This can be traced back to an increasing public questioning of vaccines by a growing anti-vaccination movement. In reaction to the outbreak and the public outrage it generated, several states proposed-and some already passed-bills to eliminate nonmedical exemptions. I analyze two questions. First, can legal exemptions from mandatory childhood vaccination schemes for parents who are opposed to vaccination (still) be justified? Second, should legal exemptions be limited to religious objections to vaccination, or should they also be granted to secular objections? Although the argument in the paper starts from the example of the US, it seeks to provide a more general philosophical reflection on the question of exemptions from mandatory childhood vaccination.
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Affiliation(s)
- Roland Pierik
- Roland Pierik, Faculty of Law, Paul Scholten Centre for Jurisprudence, University of Amsterdam, P.O. box 1030, 1000BA Amsterdam, The Netherlands.
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14
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Navin MC, Largent MA. Improving Nonmedical Vaccine Exemption Policies: Three Case Studies. Public Health Ethics 2017. [DOI: 10.1093/phe/phw047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moss JL, Reiter PL, Truong YK, Rimer BK, Brewer NT. School Entry Requirements and Coverage of Nontargeted Adolescent Vaccines. Pediatrics 2016; 138:peds.2016-1414. [PMID: 27940689 PMCID: PMC5127065 DOI: 10.1542/peds.2016-1414] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Low human papillomavirus (HPV) vaccination coverage is an urgent public health problem requiring action. To identify policy remedies to suboptimal HPV vaccination, we assessed the relationship between states' school entry requirements and adolescent vaccination. METHODS We gathered data on states' school entry requirements for adolescent vaccination (tetanus, diphtheria, and pertussis [Tdap] booster; meningococcal; and HPV) from 2007 to 2012 from Immunization Action Coalition. The National Immunization Survey-Teen provided medical record-verified vaccination data for 99 921 adolescents. We calculated coverage (among 13- to 17-year-olds) for individual vaccinations and concomitant vaccination. HPV vaccination outcomes were among female adolescents. Analyses used weighted longitudinal multivariable models. RESULTS States with requirements for Tdap booster and meningococcal vaccination had 22 and 24 percentage point increases in coverage for these vaccines, respectively, compared with other states (both P < .05). States with HPV vaccination requirements had <1 percentage point increase in coverage for this vaccine (P < .05). Tdap booster and meningococcal vaccination requirements, respectively, were associated with 8 and 4 percentage point spillover increases for HPV vaccination coverage (both P < .05) and with increases for concomitant vaccination (all P < .05). CONCLUSIONS Ensuring all states have meningococcal vaccination requirements could improve the nation's HPV vaccination coverage, given that many states already require Tdap booster but not meningococcal vaccination for school entry. Vaccination programs and clinicians should capitalize on changes in adolescent vaccination, including concomitant vaccination, that may arise after states adopt vaccination requirements. Additional studies are needed on the effects of HPV vaccination requirements and opt-out provisions.
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Affiliation(s)
| | - Paul L. Reiter
- College of Medicine, The Ohio State University, Columbus, Ohio
| | | | - Barbara K. Rimer
- Departments of Health Behavior and,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; and
| | - Noel T. Brewer
- Departments of Health Behavior and,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; and
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Abstract
In the absence of a single national policy, some states have begun taking action to strengthen vaccination requirements.
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Affiliation(s)
- Jessica Bylander
- Jessica Bylander is a senior editor at Health Affairs, in Bethesda, Maryland
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