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Delamater PL, Goel V, Strack CN, Yang YT. Provisional Entrants, Exemptions, and Kindergarteners Up-to-Date on Vaccination Before and After a Regulatory Change in Pennsylvania, 2015-2019. Public Health Rep 2024; 139:66-71. [PMID: 36927265 PMCID: PMC10905753 DOI: 10.1177/00333549231156569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES Before the 2017-2018 school year, Pennsylvania shortened the grace period for provisional entrants-kindergarteners who are not up-to-date on vaccination and do not have medical or nonmedical exemption-from 8 months to 5 days. We analyzed the impact of this change on school-entry vaccination status. METHODS Using data from the Pennsylvania Department of Health for school years 2015-2016 through 2018-2019, we examined state-level trends in Pennsylvania kindergarteners' vaccination status, including the percentage who were up-to-date on each required vaccine, provisionally enrolled, medically exempted from vaccination, and nonmedically exempted from vaccination. Using the Spearman correlation coefficient, we assessed associations at the school level among changes in kindergarteners' vaccination status after the grace period was shortened. RESULTS From 2016-2017 to 2017-2018, the provisional entrance rate of kindergarteners in Pennsylvania decreased substantially after the change in the grace period (from 8.1% to 2.2%), the medical exemption rate remained stable, and the nonmedical exemption rate increased slightly (from 1.8% to 2.5%). The percentage of kindergarteners up-to-date on required vaccines increased or remained stable across the study period except for polio, which decreased from 97.9% in 2015-2016 to 96.2% in 2018-2019. The change in provisional entrance rate was negatively associated with change in kindergarteners up-to-date on required vaccines (ρ range, -0.30 to -0.70) but not with change in medical or nonmedical exemptions (ρ range, -0.01 to -0.08). CONCLUSIONS Efforts to reduce provisional entrants may increase the percentage of kindergarteners up-to-date on vaccinations at school entry without a corresponding increase in exemptions.
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Affiliation(s)
- Paul L. Delamater
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Varun Goel
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claire N. Strack
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Y. Tony Yang
- Center for Health Policy and Media Engagement, School of Nursing, George Washington University, Washington, DC, USA
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Dixson HGW, Komugabe-Dixson AF, Medvecky F, Balanovic J, Thygesen H, MacDonald EA. Trust in science and scientists: Effects of social attitudes and motivations on views regarding climate change, vaccines and gene drive technology. JOURNAL OF TRUST RESEARCH 2023. [DOI: 10.1080/21515581.2022.2155658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Henry G. W. Dixson
- Department of Conservation, Auckland, New Zealand
- CSIRO Land and Water, Dutton Park, Australia
| | | | - Fabien Medvecky
- Centre for Science Communication, The University of Otago, Dunedin, New Zealand
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Hair NL, Gruber A, Urban C. Personal belief exemptions for school-entry vaccinations, vaccination rates, and academic achievement. JOURNAL OF HEALTH ECONOMICS 2021; 78:102464. [PMID: 33964652 DOI: 10.1016/j.jhealeco.2021.102464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Nonmedical exemptions from school-entry vaccine mandates are receiving increased policy and public health scrutiny. This paper examines how expanding the availability of exemptions influences vaccination rates in early childhood and academic achievement in middle school. We leverage 2003 legislation that granted personal belief exemptions (PBE) in Texas and Arkansas, two states that previously allowed exemptions only for medical or religious regions. We find that PBE decreased vaccination coverage among Black and low-income preschoolers by 16.1% and 8.3%, respectively. Furthermore, we find that those cohorts affected by the policy change in early childhood performed less well on standardized tests of academic achievement in middle school. Estimated effects on test scores were largest for Black students and economically disadvantaged students.
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Affiliation(s)
- Nicole L Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, United States.
| | - Anja Gruber
- University of Colorado at Boulder, United States
| | - Carly Urban
- Montana State University, United States; Institute for Labor Studies (IZA), Germany.
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Abstract
In an era when the success of the US vaccination policies to date is threatened by vaccine hesitancy, it is important for clinicians to have a working understanding of how vaccines are developed and recommended for use in the United States and how federal and state governments are coordinated to ensure a safe and effective vaccine supply. This article discusses the federal agencies involved in vaccine development and recommendation, other organizations involved in vaccine policy, and the role of vaccine-related public health law in promoting universal vaccination.
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Affiliation(s)
- John W Epling
- Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, 1 Riverside Circle, Suite 102, Roanoke, VA 24016, USA.
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5
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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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Abstract
PURPOSE OF REVIEW This review summarizes the current state of school-entry vaccination requirements and related exemption policies in the United States and examines recent changes to these policies. RECENT FINDINGS With recent infectious disease outbreaks in the United States, there has been heightened awareness on unvaccinated individuals, and the state-level policies that allow individuals to be exempted from school-entry vaccination requirements. Between 2015 and 2017, there have been eleven states that have altered their policies regarding school-entry vaccination requirements and related reporting for which no formal evaluations have been published. One policy change during that period, California SB 277, which became law in 2016, reduced the nonmedical exemption and increased the childhood vaccination coverage rate in that state, though with some evidence of exemption replacement through the use of medical exemptions. Through September 2019, five additional state law changes have been enacted. SUMMARY The large number of heterogeneous changes to state-level policies for school-entry vaccination requirements in recent years need rigorous evaluation to identify best practices for balancing public health authority and parental autonomy while seeking to achieve the highest level of infectious disease prevention for children.
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Díaz Crescitelli ME, Ghirotto L, Sisson H, Sarli L, Artioli G, Bassi MC, Appicciutoli G, Hayter M. A meta-synthesis study of the key elements involved in childhood vaccine hesitancy. Public Health 2019; 180:38-45. [PMID: 31838344 DOI: 10.1016/j.puhe.2019.10.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/26/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Immunization is one of the most successful and cost-effective interventions to improve health outcomes. However, internationally, the phenomenon of parental vaccine hesitancy is increasing and presents a growing challenge for health professionals. This article summarizes the evidence surrounding childhood vaccine hesitancy from the perspective of parents. STUDY DESIGN We conducted a systematic review and meta-synthesis of qualitative studies. METHODS We searched for qualitative research articles in electronic databases from inception to March 2018. In addition, a manual search of the retrieved articles and their references was conducted to identify other potential articles. We used the Critical Appraisal Skills Programme to examine study validity, adequacy and potential applicability of the results. No articles were excluded for reasons of quality. By performing a meta-synthesis, we identified descriptive themes and, subsequently, the conceptual elements of vaccine hesitancy. RESULTS The review included 27 studies involving a total of 1557 parents who were hesitant about vaccinating their child. Five overarching categories were identified: (1) risk conceptualization; (2) mistrust towards vaccine-related institutions, pharmaceutical companies, researchers, health professionals and the information from media; (3) parental alternative health beliefs about childhood immunity, vaccine scheduling and the perceived toxicity of vaccinations; (4) philosophical views on parental responsibility; and (5) parents' information levels about vaccination. CONCLUSIONS Healthcare providers need to approach this difficult situation considering that parents desire to do what they feel right for the child. Understanding the core elements of hesitancy will allow health professionals to adopt effective communication and behavioural strategies.
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Affiliation(s)
| | - L Ghirotto
- Azienda USL - IRCCS di Reggio Emilia, Italy
| | - H Sisson
- Faculty of Health Sciences, University of Hull, UK
| | - L Sarli
- Department of Medicine and Surgery, University of Parma, Italy
| | - G Artioli
- Azienda USL - IRCCS di Reggio Emilia, Italy
| | - M C Bassi
- Azienda USL - IRCCS di Reggio Emilia, Italy
| | | | - M Hayter
- Faculty of Health Sciences, University of Hull, UK
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Delamater PL, Omer SB. Legislative and administrative actions to increase vaccination coverage in Washington schools. Hum Vaccin Immunother 2019; 16:1171-1177. [PMID: 31634042 PMCID: PMC7227713 DOI: 10.1080/21645515.2019.1678358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Current outbreaks of vaccine-preventable diseases in the U.S. highlight the consequences of declining levels of vaccination coverage. Attempts to increase coverage by banning or restricting nonmedical exemptions from school-entry vaccination requirements disregard children not up to date on vaccination who already attend school and those who are not up to date for reasons other than vaccine hesitancy. We analyze the potential effects of legislative and administrative options to increase vaccination coverage in Washington schools. We constructed a grade-specific model of the detailed vaccination status for all required vaccines and the MMR vaccine specifically for all children in the state's school system. We used scenario modeling to evaluate the effects of potential legislative and administrative actions on the percent of students up to date on all required vaccines and the MMR vaccine from 2018 to 2030. Our analysis shows that eliminating nonmedical exemptions may not be the optimal solution for reducing disease outbreak risk. Instead, focusing on children not up to date for reasons other than nonmedical exemption could have a larger impact and does not carry the controversy that accompanies attempts to ban or restrict nonmedical exemptions. Further, implementing a one-time catch-up period for all children not up to date would increase coverage promptly. Evidence-based policymaking is an essential component of efforts to reduce the risk of disease outbreaks in U.S. schools, and analysis of potential legislative and administrative actions complement these efforts.
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Affiliation(s)
- Paul L Delamater
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, CT, USA
| | - Saad B Omer
- Yale Institute for Global Health, Department of Medicine (Section of Infectious Diseases), Yale School of Medicine, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
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Bednarczyk RA, King AR, Lahijani A, Omer SB. Current landscape of nonmedical vaccination exemptions in the United States: impact of policy changes. Expert Rev Vaccines 2019; 18:175-190. [PMID: 30572729 DOI: 10.1080/14760584.2019.1562344] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION In the United States, high childhood vaccination coverage has reduced the morbidity and mortality due to vaccine-preventable diseases. The success of vaccination programs in achieving this high coverage is due, in part, to vaccination mandates for school entry. All states have such mandates, but there is heterogeneity across the states in the allowance of non-medical exemptions (e.g. religious or personal belief exemptions) to these mandates. AREAS COVERED We examine historical trends in non-medical exemption prevalence in the US, discuss recent state-level policy changes that may impact non-medical exemption prevalence, and review recent studies on the association between non-medical exemptions and infectious disease outbreaks. EXPERT COMMENTARY State-level implementation of mandates, and related allowances for medical and non-medical exemptions, varies greatly across the United States. Non-medical exemption rates have increased over the last two decades, with an increased risk of disease outbreaks in clusters of children with non-medical exemptions due to differences in state laws. Recent efforts to address non-medical exemption rates range from incorporating additional administrative requirements for exemptions and disallowance of any non-medical exemptions. Continued monitoring is needed to evaluate the impact of these changes on exemption rates, to develop optimal childhood vaccination policy across the United States.
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Affiliation(s)
- Robert A Bednarczyk
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,b Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,c Emory Vaccine Center , Emory University , Atlanta , GA , USA
| | - Adrian R King
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Ariana Lahijani
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Saad B Omer
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,b Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,c Emory Vaccine Center , Emory University , Atlanta , GA , USA.,d Department of Pediatrics , School of Medicine, Emory University , Atlanta , GA , USA
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Okeibunor J, Mihigo R, Anya B, Zawaira F. Five-year experience of African Vaccination Week implemented by the WHO Regional Office. JOURNAL OF IMMUNOLOGICAL SCIENCES 2018; Suppl:10-16. [PMID: 30687850 PMCID: PMC6345372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The 5th edition of the African Vaccination Week (AVW) kicked off in Lusaka, Zambia, on 23 April 2016, the same day as did the 4th World Immunization Week (WIW), and vaccination week in other WHO regions. The theme was "Save lives, prevent disabilities, vaccinate!". The aim was to draw attention to the need to attain universal immunization coverage in the African Region by closing the immunization gap, while also celebrating the important polio eradication milestone reached in the African Region. Twenty-eight (59.6%) of the 47 countries in the African Region celebrated the AVW within the regionally set dates of 24th to 30th April 2015. However, given its flexibility, the celebration continued until September in 15 other countries in the Region. Three countries, namely Comoros, Gabon, and Cape Verde did not join the celebration for the 2015 edition of the AVW. Countries used the opportunity to introduce new vaccines into their routine immunization. Populations, hitherto unreached with basic health services were reached with needed services, such as vitamin A supplementation, deworming, and catch up immunization services. The programmes promoted awareness of the benefits of vaccines and the rights of communities to demand vaccines and immunization services to save lives and prevent disabilities. The number of participating countries rose steadily from 40 in 2011 to 43 and 46 countries in 2013 and 2014 respectively. The number ranged from one intervention integrated with AVW in 17 countries to 5 interventions integrated with the AVW in three countries. In 2015, 67.4% of the participating countries integrated other interventions with AVW activities.
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Affiliation(s)
| | | | - Blanche Anya
- WHO Regional Office for Africa, Brazzaville, Congo
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11
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Abstract
The major impediment to increased human papillomavirus (HPV) vaccination coverage in young males and females is lack of health care provider recommendation. Despite its efficacy in preventing cervical cancer, HPV vaccination in females (49.5%) and males (37.5%) ages 13 through 17 falls well below the Centers for Disease Control and Prevention's (CDC) Healthy People 2020 target of 80% coverage. Parents' willingness to vaccinate their child has been shown to be much higher when physicians share personal vaccination decisions for their own children as well as what other parents have done at that particular clinic. Furthermore, the vaccine must be presented presumptively as a "bundle" along with the rest of the standard adolescent vaccine panel. Multiple exemplars presented including in several European countries, low-income countries and Rwanda, demonstrate that school-based health care systems dramatically increase vaccination coverage. Finally, acceptability for vaccination of males must improve by increasing provider recommendation and by presenting the HPV vaccine as a penile, anal and oropharyngeal cancer prevention therapy in males and not merely a vaccine to prevent cervical cancers in females. Paediatricians, obstetrician/gynaecologists and primary care physicians should consider these data as a call-to-action. Key messages • Despite recent efforts in the US, only 49.5% of females and only 37.5% of males ages 13 through 17 have received all recommended HPV vaccine doses. These numbers fall well below the 80% target set forth by the Healthy People 2020 initiative. • According to the CDC, if health care providers increase HPV vaccination rates in eligible recipients to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years. Furthermore, for every year that the vaccination rate does not increase, an additional 4400 women will develop cervical cancer. • First and foremost, healthcare providers (HCPs) must make a strong recommendation to vaccinate patients and these recommendations must become routine, including for males. • It is clear that HPV vaccination rates improve significantly when vaccine administration occurs at designated, well-organized sites such as school-based vaccination programmes. Furthermore, HPV vaccination should be a high school requirement and offered in the standard adolescent vaccine panel as a bundle with Tdap and MenACWY vaccines in order to promote maximum adherence. • Finally, research on immunogenicity and antibody titre longevity needs to be done in newborns. The HPV vaccine may be recommended in the newborn panel of vaccines to avoid any issues of sexualization and misplaced fears of sexual disinhibition, akin to the success of the Hepatitis B vaccine in the 1980s. • The HPV vaccine is a vaccine against cancer and should be aggressively marketed as such. As healthcare providers, we need to make every effort to overcome barriers, real or perceived, to protecting our population from potential morbidity and mortality associated with this virus.
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Affiliation(s)
- Aria C Attia
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Judith Wolf
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Ana E Núñez
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
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12
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Delamater PL, Leslie TF, Yang YT. Examining the spatiotemporal evolution of vaccine refusal: nonmedical exemptions from vaccination in California, 2000-2013. BMC Public Health 2018; 18:458. [PMID: 29688861 PMCID: PMC5913803 DOI: 10.1186/s12889-018-5368-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 03/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccine hesitancy continues to be an issue throughout the United States, as numerous vaccine hesitant parents are choosing to exempt their children from school-entry vaccination requirements for nonmedical reasons, despite the safety and effectiveness of vaccines. We conduct an analysis of how vaccine refusal, measured by the use of nonmedical exemptions (based on personal or religious beliefs) from vaccination (NMEs), evolved across space and over time in California. METHODS Using school-entry data from the California Department of Public Health, we examined NMEs for students entering kindergarten in California from 2000 to 2013. We conduct global and local spatial autocorrelation analysis to determine whether NME use became more geographically clustered over the study period and whether the location of local clusters of high use were temporally stable. We conducted a grouping analysis that identified the general temporal trends in NME use over the time period. RESULTS The use of NMEs increased from 0.73% of all kindergarteners in 2000 to 3.09% in 2013 and became more geographically clustered over the study period. Local geographic clusters of high use were relatively isolated early in the study period, but expanded in size over time. The grouping analysis showed that regions with high NME use early in the study period were generally few (15% of all US Census tracts) and relatively isolated. Regions that had low initial NME use and moderate to large increases over the study period were located in close proximity to the initial high use regions. The grouping analysis also showed that roughly half of all tracts had 0% or very low NME use throughout the study period. CONCLUSIONS We found an observable spatial structure to vaccine refusal and NME use over time, which appeared to be a self-reinforcing process, as well as a spatially diffusive process. Importantly, we found evidence that use of NMEs in the initially isolated regions appeared to stimulate vaccine refusal in geographically proximal regions. Thus, our results suggest that efforts aimed at decreasing future NME use may be most effective if they target regions where NME use is already high, as well as the nearby regions.
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Affiliation(s)
- Paul L Delamater
- Department of Geography, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Timothy F Leslie
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, VA, USA
| | - Y Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
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Silverman RD, Hensel WF. Squaring State Child Vaccine Policy With Individual Rights Under the Individuals With Disabilities Education Act: Questions Raised in California. Public Health Rep 2017; 132:593-596. [PMID: 28792852 DOI: 10.1177/0033354917720939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ross D Silverman
- 1 Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.,2 Robert H. McKinney School of Law, Indiana University, Indianapolis, IN, USA
| | - Wendy F Hensel
- 3 Georgia State University College of Law, Atlanta, GA, USA
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Halsey NA. Reflections of a Vaccinologist: Lessons Learned About What We Can Do to Improve Trust in Vaccines and Vaccine Programsa. J Pediatric Infect Dis Soc 2017; 6:3-8. [PMID: 26611984 DOI: 10.1093/jpids/piv077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/13/2015] [Indexed: 11/14/2022]
Abstract
Public trust can be improved by learning from past mistakes, by establishing a standing forum for review of new concerns as they arise, and by maintaining a robust vaccine safety system. Developing standard guidelines for reporting causality assessment in case reports would help educate physicians and prevent future unnecessary concerns based on false assumptions of causal relationships.
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Affiliation(s)
- Neal A Halsey
- Institute for Vaccine Safety, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Colgrove J, Lowin A. A Tale Of Two States: Mississippi, West Virginia, And Exemptions To Compulsory School Vaccination Laws. Health Aff (Millwood) 2017; 35:348-55. [PMID: 26858391 DOI: 10.1377/hlthaff.2015.1172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
School-based compulsory vaccination laws have provoked debates over the legitimacy of government coercion versus the scope of parental rights. A key point of contention in these school vaccination laws are provisions known as exemption clauses that allow some parents to enroll their children in school unimmunized for reasons other than medical conditions. For more than three decades Mississippi and West Virginia stood apart as the only two US states that did not offer nonmedical exemptions to school vaccination laws. But other states seem to be moving in this direction, such as California, which in 2015 eliminated nonmedical exemptions following the Disneyland measles outbreak. The apparent shift creates an opportune moment to look at the experiences of Mississippi and West Virginia. Through a review of legislative histories, legal rulings, media accounts, and interviews with health officials in the two states, we consider the reasons for and consequences of their allowing only medical exemptions and the prospects their approach holds out for other states that may wish to emulate it. The experiences of these two states suggest that contrary to conventional wisdom, it may be politically tenable to limit exemptions to only medical reasons without damaging either the stature of public health or the immunization system.
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Affiliation(s)
- James Colgrove
- James Colgrove is a professor in the Department of Sociomedical Sciences at the Mailman School of Public Health, Columbia University, in New York City
| | - Abigail Lowin
- Abigail Lowin is a student at the Columbia University School of Law, in New York City
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16
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Thompson KM, Logan GE. Characterization of Heterogeneity in Childhood Immunization Coverage in Central Florida Using Immunization Registry Data. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1418-1426. [PMID: 26033542 DOI: 10.1111/risa.12424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/17/2015] [Accepted: 04/19/2015] [Indexed: 06/04/2023]
Abstract
Despite high vaccine coverage in the United States in general, and in the State of Florida specifically, some children miss scheduled vaccines due to health system failures or vaccine refusal by their parents. Recent experiences with outbreaks in the United States suggest that geographic clustering of un(der)vaccinated populations represent a threat to the elimination status of some vaccine-preventable diseases. Immunization registries continue to expand and play an important role in efforts to track vaccine coverage and use. Using nearly 700,000 de-identified immunization records from the Florida Department of Health immunization information system (Florida SHOTS™) for children born during 2003-2014, we explored heterogeneity and potential clustering of un(der)vaccinated children in six counties in central Florida-Brevard, Lake, Orange, Oseola, Polk, and Seminole-that represent a high-risk area for importation due to family tourist attractions in the area. By zip code, we mapped the population density, the percent of children with religious exemptions, the percent of children on track or overdue for each vaccine series without and with exemptions, and the numbers of children with no recorded dose of each vaccine. Overall, we found some heterogeneity in coverage among the counties and zip codes, but relatively consistent and high coverage. We found that some children with an exemption in the system received the vaccines we analyzed, but exemption represents a clear risk factor for un(der)immunization. We identified many challenges associated with using immunization registry data for spatial analysis and potential opportunities to improve registries to better support future analyses.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | - Grace E Logan
- University of Central Florida, College of Medicine, Orlando, FL, USA
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Lee C, Whetten K, Omer S, Pan W, Salmon D. Hurdles to herd immunity: Distrust of government and vaccine refusal in the US, 2002-2003. Vaccine 2016; 34:3972-8. [PMID: 27344291 DOI: 10.1016/j.vaccine.2016.06.048] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/10/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
High rates of nonmedical exemptions (NMEs) from required childhood vaccinations have contributed to outbreaks of vaccine-preventable diseases, such as measles and pertussis. Understanding the parental decision to obtain an NME could help health professionals and public health programs improve vaccination rates in areas with high vaccine refusal. Using a 2002-2003 multi-state survey of parents of school age children (n=2445), this study found that parental distrust of the government and of healthcare providers is a significant factor related to a number of vaccine-related beliefs and behaviors. The odds that parents who distrust the government have seen a complementary/alternative medicine (CAM) provider were 2.11 times greater than those of parents who trust the government (70.1% vs 52.6%; OR, 2.11; 95% CI, 1.59-2.84; P<0.01). Parents who distrust the government had increased odds of trusting vaccine information from CAM providers compared to trusting parents (57.9% vs 46.3%; OR, 1.53; 95% CI, 1.16-2.01; P<0.01). Parents who distrust the government also had increased odds of distrusting vaccine information acquired at their healthcare providers' offices (12.6% vs 4.7%; OR, 2.64; 95% CI, 1.64-4.24; P<0.01). Distrustful parents had increased odds of thinking government sources of information about vaccines were unreliable, categorizing the CDC, the Food and Drug Administration (FDA), or local and state health departments as poor or very poor sources (distrust government vs trust government: 25.2% vs 11.7%; OR, 2.39; 95% CI, 1.70-3.36; P<0.01; distrust healthcare providers vs trust healthcare providers: 24.4% vs 11.4%; OR, 2.44; 95% CI, 1.75-3.38; P<0.01). These findings indicate that distrustful parent populations may need to be reached through modalities outside of traditional government and healthcare provider communications. Research into new and more effective techniques for delivering pro-vaccine messages is warranted.
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Affiliation(s)
- Charlotte Lee
- Sanford School of Public Policy & Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Kathryn Whetten
- Sanford School of Public Policy & Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Saad Omer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - William Pan
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Daniel Salmon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Delamater PL, Leslie TF, Yang YT, Jacobsen KH. An approach for estimating vaccination coverage for communities using school-level data and population mobility information. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2016; 71:123-132. [PMID: 31327881 PMCID: PMC6641576 DOI: 10.1016/j.apgeog.2016.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Childhood vaccination data are made available at a school level in some U.S. states. These data can be geocoded and may be considered as having a high spatial resolution. However, a school only represents the destination location for the set of students that actually reside and interact within some larger areal region, creating a spatial mismatch. Public school districts are often used to represent these regions, but fail to account for private schools and school of choice programs. We offer a new approach to estimate childhood vaccination coverage rates at a community level by integrating school level data with population commuting information. The resulting mobility-adjusted vaccine coverage estimates resolve the spatial mismatch problem and are more aligned with the geographic scale at which public health policies are implemented. We illustrate the utility of our approach using a case study on diphtheria, tetanus, and pertussis (DTP) vaccination coverage for kindergarten students in California. The modeled community-level DTP coverage estimates yield a statewide coverage of 92.37%, which is highly similar to the 92.44% coverage rate calculated from the original school-level data.
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Affiliation(s)
- Paul L. Delamater
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, VA, US
| | - Timothy F. Leslie
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, VA, US
| | - Y. Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, US
| | - Kathryn H. Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, VA, US
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Mihigo R, Anya B, Okeibunor J, Ajibola S, Boakye-Agyemang C, Muzenda L, Issembe F, Nshimirimana D. African vaccination week as a vehicle for integrated health service delivery. BMC Health Serv Res 2015; 15:358. [PMID: 26328630 PMCID: PMC4557633 DOI: 10.1186/s12913-015-0989-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/05/2015] [Indexed: 12/03/2022] Open
Abstract
Background African Vaccination Week (AVW) is an initiative of the Member States of the African Region aimed at promoting vaccination and ensuring equity and access to its benefits. The initiative has proven to be particularly effective in reaching populations with limited access to regular health services as well as providing an opportunity to integrate other interventions with immunization services. Methods Using data available from the countries within the African Region, the effectiveness of AVW in creating awareness on vaccination as well as providing platform for integrated delivery of other interventions with immunization in the African Region were explored during the 2013 and 2014 campaigns of the AVW. Results Countries that participated in the two campaigns of AVW have integrated other interventions with immunization during the AVW. The most common integrated intervention is vitamin A supplementation, followed by deworming. However, other interventions integrated, include public health educational activities, supplementation with vitamins and minerals, provision of other health services as well as introduction of new interventions. In 2013, more than 7,500,000 doses of different vaccine antigens were delivered in17 countries. Vitamin A administered to children under 5 years and women in post-partum in 13 countries with 31,500,000 tablets distributed. Polio eradication campaigns reaching young children in ten countries with 36,711,984 doses of oral polio vaccines (OPV) was the third most common intervention added onto the AVW activities. Over 21,190,000 deworming tablets were distributed to children <5 years and pregnant women in 9 countries. With respect to nutritional interventions, 6,377,222 children were screened for malnutrition in 3 countries while 3,814,680 water, sanitation and hygiene kits were distributed in 3 countries. In 2014, these results were even higher as many more countries integrated multiple interventions in the AVW. Conclusion Integration of other interventions with immunization during AVW, in the African Region is common and has shown potentials for improving immunization coverage, as this dedicated period is used both for catch-up campaigns and periodic intensified routine immunization. While its impact may call for further examination, it is a potential platform for integrated delivery of health interventions to people with limited access to regular health service.
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Affiliation(s)
- Richard Mihigo
- Immunization, Vaccines & Emergencies, World Health Organization Regional Office for Africa, Cité du Djoué, Brazzaville, Republic of Congo.
| | - Blanche Anya
- Immunization, Vaccines & Emergencies, World Health Organization Regional Office for Africa, Cité du Djoué, Brazzaville, Republic of Congo.
| | - Joseph Okeibunor
- Immunization, Vaccines & Emergencies, World Health Organization Regional Office for Africa, Cité du Djoué, Brazzaville, Republic of Congo.
| | - Samuel Ajibola
- Communication, Advocacy & Media, World Health Organization Regional Office for Africa, Cité du Djoué, Brazzaville, Republic of Congo.
| | - Collins Boakye-Agyemang
- Communication, Advocacy & Media, World Health Organization Regional Office for Africa, Cité du Djoué, Brazzaville, Republic of Congo.
| | - Linda Muzenda
- Communication, Advocacy & Media, World Health Organization Regional Office for Africa, Cité du Djoué, Brazzaville, Republic of Congo.
| | - Flavienne Issembe
- Communication, Advocacy & Media, World Health Organization Regional Office for Africa, Cité du Djoué, Brazzaville, Republic of Congo.
| | - Deo Nshimirimana
- Immunization, Vaccines & Emergencies, World Health Organization Regional Office for Africa, Cité du Djoué, Brazzaville, Republic of Congo.
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Crouch E, Dickes LA. A prediction model of childhood immunization rates. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:243-251. [PMID: 25672824 DOI: 10.1007/s40258-015-0157-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND This research begins by providing background on the status and literature of childhood immunization in the USA. Vaccine-preventable diseases have been on the rise in Europe and the USA in the last few years. Cases of measles and pertussis have all been increasing at alarming rates. The article begins with a discussion of the use of immunization exemptions across the states and a brief history of US immunization policy. A review of the literature confirms that socioeconomic status and other demographic characteristics can be important predictors of childhood vaccine uptake. AIM Given the seriousness of this public health issue, the primary objective of this research is to analyze the determinants of a child in the USA being fully vaccinated. METHODS A range of socioeconomic and demographic characteristics, along with data from the National Immunization Survey, are used to develop an immunization prediction model. Logistic regression is the chosen method in determining whether a preschool-age child in the USA today is likely to be vaccinated based on various demographic and socioeconomic characteristics. RESULTS Model results reveal a number of significant socioeconomic and demographic characteristics that contribute to the likelihood of a child being immunized. The overall logistic regression model was highly significant at the 5 % level and model parameters are significant. Significant variables in the model include categories of educational attainment, first born child, race and ethnicity, age of mother, and census region. This model does not definitively reveal that later born children are less likely to get fully vaccinated than first born children but does confirm the significance of geography in immunization outcomes. All levels of education were found to be significant along with all census regions. CONCLUSIONS Overall, these models reveal that demographic and socioeconomic characteristics are predictors of childhood immunization and if leveraged appropriately can assist policy makers and public health officials to understand immunization rates and craft policy to improve them.
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Affiliation(s)
- Elizabeth Crouch
- The Division of Policy and Research on Medicaid and Medicare (PRMM), Institute for Families in Society, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, SC, 29208, USA,
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Wang E, Clymer J, Davis-Hayes C, Buttenheim A. Nonmedical exemptions from school immunization requirements: a systematic review. Am J Public Health 2014; 104:e62-84. [PMID: 25211732 DOI: 10.2105/ajph.2014.302190] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We summarized studies describing the prevalence of, trends in, and correlates of nonmedical exemptions from school vaccination mandates and the association of these policies with the incidence of vaccine-preventable disease. We searched 4 electronic databases for empirical studies published from 1997 to 2013 to capture exemption dynamics and qualitatively abstracted and synthesized the results. Findings from 42 studies suggest that exemption rates are increasing and occur in clusters; most exemptors questioned vaccine safety, although some exempted out of convenience. Easier state-level exemption procedures increase exemption rates and both individual and community disease risk. State laws influence exemption rates, but policy implementation, exemptors' vaccination status, and underlying mechanisms of geographical clustering need to be examined further to tailor specific interventions.
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Affiliation(s)
- Eileen Wang
- Eileen Wang is with the Department of the History and Sociology of Science, University of Pennsylvania, Philadelphia. Jessica Clymer is with the School of Nursing, University of Pennsylvania. Cecilia Davis-Hayes is with the Columbia University College of Physicians and Surgeons, New York, NY. Alison Buttenheim is with the School of Nursing, the Leonard Davis Institute, and the Center for Public Health Initiatives, University of Pennsylvania
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Lawrence HY, Hausman BL, Dannenberg CJ. Reframing medicine's publics: the local as a public of vaccine refusal. THE JOURNAL OF MEDICAL HUMANITIES 2014; 35:111-129. [PMID: 24682632 DOI: 10.1007/s10912-014-9278-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although medical and public health practitioners aim for high rates of vaccination, parent vaccination concerns confound doctors and complicate doctor-patient interactions. Medical and public health researchers have studied and attempted to counter antivaccination sentiments, but recommended approaches to dispel vaccination concerns have failed to produce long-lasting effects. We use observations made during a small study in a rural area in a southeastern state to demonstrate how a shift away from analyzing vaccination skepticism as a national issue with a global remedy reveals the nuances in vaccination sentiments based on locality. Instead of seeing antivaccinationists as a distinct public based on statistical commonalities, we argue that examining vaccination beliefs and practices at the local level offers a fuller picture of the contextualized nature of vaccination decisions within the psychosocial spaces of families. A view of vaccination that emphasizes the local public, rather than a globally conceived antivaccination public, enables medical humanists and rhetoricians to offer important considerations for improving communications about vaccinations in clinical settings.
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Wheeler M, Buttenheim AM. Ready or not? School preparedness for California's new personal beliefs exemption law. Vaccine 2014; 32:2563-9. [PMID: 24681274 PMCID: PMC4500935 DOI: 10.1016/j.vaccine.2014.03.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/06/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This paper describes elementary school officials' awareness of and preparedness for the implementation of California's new exemption law that went into effect on January 1, 2014. The new law prescribes stricter requirements for claiming a personal beliefs exemption from mandated school-entry immunizations. METHOD We used cross-sectional data collected from a stratified random sample of 315 schools with low, middle, and high rates of personal beliefs exemptions. We described schools' awareness and specific knowledge of the new legislation and tested for differences across school types. We additionally tested for associations between outcome variables and school and respondent characteristics using ordered logit and negative binomial regression. Finally, we described schools' plans and needs for implementing the new legislation. RESULTS Elementary school staff reported an overall low level of awareness and knowledge about the new legislation and could identify few of its features. We observed, however, that across the exemption-level strata, respondents from high-PBE schools reported significantly higher awareness, knowledge and feature identification compared to respondents from low-PBE schools. Multivariate analyses revealed only one significant association with awareness, knowledge and identification: respondent role. Support staff roles were associated with lower odds of having high self-rated awareness or knowledge compared to health workers, as well as with a reduced log count of features identified. Though most school officials were able to identify a communication plan, schools were still in need of resources and support for successful implementation, in particular, the need for information on the new law. CONCLUSION Schools need additional information and support from state and local agencies in order to successfully implement and enforce California's new school immunization law. In particular, our results suggest the need to ensure information on the new law reaches all levels of school staff.
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Affiliation(s)
- Marissa Wheeler
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 235L Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104, United States
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 235L Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104, United States.
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Affiliation(s)
- Douglas S. Diekema
- Department of Pediatrics, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington 98101;
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West-Oram P. Freedom of conscience and health care in the United States of america: the conflict between public health and religious liberty in the patient protection and affordable care act. HEALTH CARE ANALYSIS 2014; 21:237-47. [PMID: 23539432 DOI: 10.1007/s10728-013-0251-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The recent confirmation of the constitutionality of the Obama administration's Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether or not to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties.
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Yang YT, Debold V. A longitudinal analysis of the effect of nonmedical exemption law and vaccine uptake on vaccine-targeted disease rates. Am J Public Health 2013; 104:371-7. [PMID: 24328666 DOI: 10.2105/ajph.2013.301538] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed how nonmedical exemption (NME) laws and annual uptake of vaccines required for school or daycare entry affect annual incidence rates for 5 vaccine-targeted diseases: pertussis, measles, mumps, Haemophilus influenzae type B, and hepatitis B. METHODS We employed longitudinal mixed-effects models to examine 2001-2008 vaccine-targeted disease data obtained from the National Notifiable Disease Surveillance System. Key explanatory variables were state-level vaccine-specific uptake rates from the National Immunization Survey and a state NME law restrictiveness level. RESULTS NME law restrictiveness and vaccine uptake were not associated with disease incidence rate for hepatitis B, Haemophilus influenzae type B, measles, or mumps. Pertussis incidence rate, however, was negatively associated with NME law restrictiveness (b = -0.20; P = .03) and diphtheria-pertussis-tetanus vaccine uptake (b = -0.01; P = .05). CONCLUSIONS State NME laws and vaccine uptake rates did not appear to influence lower-incidence diseases but may influence reported disease rates for higher-incidence diseases. If all states increased their NME law restrictiveness by 1 level and diphtheria-pertussis-tetanus uptake by 1%, national annual pertussis cases could decrease by 1.14% (171 cases) and 0.04% (5 cases), respectively.
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Affiliation(s)
- Y Tony Yang
- Y. Tony Yang and Vicky Debold are with the Department of Health Administration and Policy, George Mason University, Fairfax, VA
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27
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Shelton RC, Snavely AC, De Jesus M, Othus MD, Allen JD. HPV vaccine decision-making and acceptance: does religion play a role? JOURNAL OF RELIGION AND HEALTH 2013; 52:1120-30. [PMID: 22076049 PMCID: PMC4616263 DOI: 10.1007/s10943-011-9553-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We conducted a web-based survey among 476 white, Black, and Hispanic parents or caregivers with daughter(s) between the ages of 9-17 to better understand how religion influences HPV vaccine acceptance. Catholic parents were more likely than nonaffiliated parents to have already vaccinated their daughters (vs. being undecided) (OR = 3.26, 95% CI = 1.06, 10.06). Parents with frequent attendance at religious services were more likely than parents who do not attend services to have decided against vaccination (vs. being undecided) (OR = 2.92, 95% CI = 1.25, 6.84). Directions for research and implications for interventions are addressed.
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Affiliation(s)
- Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 548, New York, NY, 10032, USA,
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Okeibunor JC, Akanmori BD, Balcha GM, Mihigo R, Vaz RM, Nshimirimana D. Enhancing access to immunization services and exploiting the benefits of recent innovations in the African region. Vaccine 2013; 31:3772-6. [PMID: 23800541 DOI: 10.1016/j.vaccine.2013.06.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/11/2013] [Accepted: 06/11/2013] [Indexed: 11/28/2022]
Abstract
The African Regional Office of the World Health Organization (WHO AFRO) organized the annual regional conference on immunization (ARCI) from 10 to 12 December 2012 in Dar es Salaam, Tanzania, under the theme, "Innovations, access and the right of all to vaccines". The meeting reviewed the status of immunization in the region and identified all innovations, strategies and technologies available and how these could be fully utilized to enhance the access and the rights of all to vaccines. Over 50 oral presentations were made in plenary and parallel sessions of the conference which was attended by over 200 participants drawn from national immunization programs, academia, public health experts and immunization partners. In addition there were 40 poster presentations. This manuscript summarizes of the meeting, highlighting the innovations in immunization being piloted or scaled-up, their impact and suggesting ways to further improve immunization service delivery for the eradication, elimination and control of vaccine-preventable diseases in the region.
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Affiliation(s)
- J C Okeibunor
- Immunization and Vaccines Development Cluster, WHO Regional Office for Africa, Box 06 Djoue, Brazzaville, Congo.
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Randall LH, Curran EA, Omer SB. Legal considerations surrounding mandatory influenza vaccination for healthcare workers in the United States. Vaccine 2013; 31:1771-6. [PMID: 23415931 DOI: 10.1016/j.vaccine.2013.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/23/2013] [Accepted: 02/01/2013] [Indexed: 11/17/2022]
Abstract
Recent years have brought increased focus on the desirability of vaccinating more healthcare workers against influenza. The concern that novel 2009 H1N1 influenza A would spark a particularly severe influenza season in 2009-2010 spurred several institutions and one state to institute mandatory vaccination policies for healthcare workers, and several new mandates have been introduced since then. Some healthcare workers, however, have voiced objections in the media and in legal proceedings. This paper reviews the characteristics of influenza and how it is transmitted in the healthcare setting; surveys possible constitutional, administrative, and common law arguments against mandates; assesses the viability of those arguments; and identifies potential new legal strategies to support influenza vaccine mandates. It is intended to assist those involved in the regulation and administration of public and private healthcare institutions who may be considering approaches to mandates but have concerns about legal challenges.
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Omer SB. Applying Kass's public health ethics framework to mandatory health care worker immunization: the devil is in the details. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:55-57. [PMID: 23952839 DOI: 10.1080/15265161.2013.825122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Saad B Omer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Antommaria AHM. An ethical analysis of mandatory influenza vaccination of health care personnel: implementing fairly and balancing benefits and burdens. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:30-37. [PMID: 23952830 DOI: 10.1080/15265161.2013.814731] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Health care institutions have paid increasing attention to preventing nosocomial transmission of influenza through vaccination of health care personnel. While multifaceted voluntary interventions have increased vaccination rates, proponents of mandatory programs contend the rates remain unacceptably low. Conventional bioethical analyses of mandatory programs are inadequate; they fail to account for the obligations of nonprofessional personnel or to justify the weights assigned to different ethical principles. Using an ethics framework for public health permits a fuller analysis. The framework's focus on fairness accentuates the potential differences between the risk of transmitting infection and employment status, and the need to equitably evaluate exemptions. The framework's emphasis on balancing benefits and burdens highlights the need to justify a specific goal and questions the need to exclude all nonmedical exemptions. While mandatory vaccination programs are justifiable, greater attention should be paid to their implementation.
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Luyten J, Vandevelde A, Van Damme P, Beutels P. Vaccination Policy and Ethical Challenges Posed by Herd Immunity, Suboptimal Uptake and Subgroup Targeting. Public Health Ethics 2011. [DOI: 10.1093/phe/phr032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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A statement regarding personal belief exemption from immunization mandates: from the Pediatric Infectious Diseases Society, March 2011. Pediatr Infect Dis J 2011; 30:606-7. [PMID: 21673549 DOI: 10.1097/inf.0b013e318224949e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Colgrove J, Abiola S, Mello MM. HPV vaccination mandates--lawmaking amid political and scientific controversy. N Engl J Med 2010; 363:785-91. [PMID: 20818883 DOI: 10.1056/nejmsr1003547] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- James Colgrove
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
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Choi BK, Manning ML. The immunization status of home-schooled children in America. J Pediatr Health Care 2010; 24:42-7. [PMID: 20122477 DOI: 10.1016/j.pedhc.2009.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 01/27/2009] [Accepted: 02/05/2009] [Indexed: 10/20/2022]
Abstract
The immunization of children against a vast number of life-threatening infectious agents has been hailed as one of the greatest public health interventions of the twentieth century. In America, the morbidity and mortality associated with many common childhood infectious diseases has all but vanished. State-based school entry vaccination laws play a significant role in achieving high immunization rates among children and adolescents. Alarmingly, there is no consistent regulation in place to monitor the immunization status of the ever-growing home-schooled population. It is widely unknown whether the nearly 2 million home-schooled children are adequately immunized. As the home schooling movement continues to gain ground in the United States, pediatric nurse practitioners in the primary care setting will play an important role in protecting the health of these children, as well as the public's health.
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Affiliation(s)
- Bonnie K Choi
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Abstract
OBJECTIVES We explore the attitudes and beliefs of parents who consciously choose not to vaccinate their children and the ways in which these parents process information on the pros and cons of vaccines. DESIGN In-depth, semistructured interviews were conducted. SAMPLE The study population consisted of 25 parents who do not vaccinate their children, identified through snowball and targeted sampling. METHODS Participants were asked about their processes and actions when choosing not to vaccinate their children. Interviews were taped and transcribed, and the content was analyzed for emergent themes. RESULTS Two predominant themes emerged in our data: a desire to collect information on vaccines and trust issues with the medical community. Evidence of sophisticated data collection and information processing was a repeated theme in the interview data. Simultaneously, while participants placed a high value on scientific knowledge, they also expressed high levels of distrust of the medical community. CONCLUSIONS The challenge for public health is to balance scientific data with popular epidemiology and to maintain legitimacy. Understanding the differences in lay versus expert knowledge has implications for crafting health messages. How experts frame knowledge for consumption has an important impact on this group and their decision-making processes.
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Mandates for adolescent immunizations: recommendations from the National Vaccine Advisory Committee. Am J Prev Med 2008; 35:145-51. [PMID: 18617083 DOI: 10.1016/j.amepre.2008.03.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 03/12/2008] [Accepted: 03/31/2008] [Indexed: 11/23/2022]
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Thompson JW, Tyson S, Card-Higginson P, Jacobs RF, Wheeler JG, Simpson P, Bost JE, Ryan KW, Salmon DA. Impact of addition of philosophical exemptions on childhood immunization rates. Am J Prev Med 2007; 32:194-201. [PMID: 17296471 DOI: 10.1016/j.amepre.2006.10.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 10/09/2006] [Accepted: 10/27/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although incidence of vaccine-preventable diseases has decreased, states' school immunization requirements are increasingly challenged. Subsequent to a federal court ruling affecting religious immunization exemptions to school requirements, new legislation made philosophical immunization exemptions available in Arkansas in 2003-2004. This retrospective study conducted in 2006 describes the impact of philosophical exemption legislation in Arkansas. METHODS Arkansas Division of Health data on immunization exemptions granted were linked to Department of Education data for all school attendees (grades K through 12) during 2 school years before the legislation (2001-2002 and 2002-2003 [Years 1 and 2, respectively]) and 2 years after philosophical exemptions were available (2003-2004 and 2004-2005 [Years 3 and 4, respectively]). Changes in numbers, types, and geographic distribution of exemptions granted are described. RESULTS The total number of exemptions granted increased by 23% (529 to 651) from Year 1 to 2; by 17% (total 764) from Year 2 to 3 after philosophical exemptions were allowed; and by another 50% from Year 3 to 4 (total 1145). Nonmedical exemptions accounted for 79% of exemptions granted in Years 1 and 2, 92% in Year 3, and 95% in Year 4. Importantly, nonmedical exemptions clustered geographically, suggesting concentrated risks for vaccine-preventable diseases in Arkansas communities. CONCLUSIONS Legislation allowing philosophical exemptions from school immunization requirements was linked to increased numbers of parents claiming nonmedical exemptions, potentially causing an increase in risk for vaccine-preventable diseases. Continued education and dialogue are needed to explore the balance between individual rights and the public's health.
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Affiliation(s)
- Joseph W Thompson
- Arkansas Center for Health Improvement, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72201, USA.
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Salmon DA, Teret SP, MacIntyre CR, Salisbury D, Burgess MA, Halsey NA. Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future. Lancet 2006; 367:436-42. [PMID: 16458770 DOI: 10.1016/s0140-6736(06)68144-0] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Compulsory vaccination has contributed to the success of immunisation programmes in the USA and Australia, yet the benefits from compulsory vaccination are not universally recognised. Some people--experts and the public alike--believe that the benefits of compulsory vaccination are outweighed by the associated ethical problems. A review of vaccination legislation in the UK, Australia, and the USA raises four main points. First, compulsory vaccination may be effective in preventing disease outbreaks, reaching and sustaining high immunisation coverage rates, and expediting the introduction of new vaccines. Second, to be effective, compulsory programmes must have a reliable supply of safe and effective vaccines and most people must be willing to be vaccinated. Third, allowance of exemptions to compulsory vaccination may limit public backlash. Finally, compulsory vaccination may increase the burden on governments to ensure the safety of vaccines. Nevertheless, although compulsory immunisation can be very effective, it might not be acceptable in some countries where high coverage has been achieved through other approaches or efforts, such as in Sweden, Norway, Denmark, the Netherlands, and the UK. These factors should be considered when compulsory vaccinations are being introduced or immunisation laws refined. Lessons learned from compulsory vaccination could be useful to other public-health programmes.
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Affiliation(s)
- Daniel A Salmon
- Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, FL 32608, USA.
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