Running Head – Vaccinated Children
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Unvaccinated Children Should Not be Allowed to Attend Public Schools
Marie Hackshaw
Health Services Policy Issues
The Pennsylvania State University
Running Head – Vaccinated Children
Unvaccinated Children Should Not Be Allowed to Attend Public Schools
Since the 1950s and 60s, most states have mandated laws requiring their citizens to be
vaccinated as children. There are many people who oppose this law because of many different
reasons, and refuse to have their children vaccinated. They cite religious, medical, and
philosophical reasons for this refusal. It is extremely dangerous for unvaccinated children to be
in the vicinity of other children and it is detrimental to the community as a whole. This issue
brief will address the severity of allowing unvaccinated children to attend public schools, and
why this should be prohibited.
About Vaccinations and Their History
Children are required to be vaccinated for many different diseases between the ages of
about six months and fourteen years old. The typical required vaccinations include tetanus,
diphtheria, polio, measles, mumps, rubella, hepatitis B, varicella (chickenpox), and
meningococcal conjugate (“State Vaccination Requirements,” 2007). These immunizations have
been highly suggested or required since the 1950s and 1960s, when the polio and smallpox
vaccines became popular. Smallpox was eradicated in the United States in the 1970s, which
increased the popularity and seriousness of many vaccinations. This is when states began
implementing laws to have children vaccinated before attending schools. There is no federal law
mandating vaccination, but every state has some type of law regarding vaccines.
Ever since states began mandating immunizations, people have found reasons to disagree
and create exceptions to these laws. The most common exceptions include medical or religious
reasons and a few states also allow for some philosophical reasons. One popular reason that
religious individuals site to be exempt from immunization, specifically Islamic and Jewish
people, is because the vaccines use ingredients from certain animals that these religions regard as
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Running Head – Vaccinated Children
“unclean.” Medical exemptions are usually because of pediatric cancer, AIDs, or other diseases
that cause the immune system to be dangerously low and vaccinations are therefore deemed
unsafe.
Since the early 2000s when the vaccine for HPV known as Gardasil was introduced to the
United States and becoming required for young girls (11-12 years old), there has been an
increase in the amount of parents deciding to not vaccinate their children and oppose
immunization. The Gardasil vaccine is different than the other mandated vaccines because it
protects against HPV, a sexually transmitted disease. Parents are using the fact that Gardasil is
for sexually transmitted diseases as an excuse to not provide their children with any
immunizations.
Issues with Vaccinations
The most well-known stigma against vaccinations is the theory that vaccinations may
cause autism. According to the centers for Disease Control and Prevention, from the early
1990s, signs of autism increased in young children. There was an idea that this was because of
an ingredient used in many child vaccinations called thimerosal, which is used as a preservative.
In 2001, thimerosal was removed from all vaccines except one line of influenza vaccines, which
also have a thimerosal-free alternative (Madison et al., 2002). Multiple studies have been done
and concluded that autism has no relation to the vaccines that one receives as a child (Cook, et al,
2005). Autism is not the only serious concern with vaccinating a child, it is also extremely
expensive, and especially for those who are uninsured.
Vaccinations come at a debilitating financial cost. A set of single vaccines can cost
upwards of $200 for those who are uninsured, and most parents (with only one child) will have
to buy at least six sets of vaccines. Many parents use the financial burden as an excuse to not
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vaccinate their children, especially those that are uninsured. Vaccines present extremely steep
costs for uninsured families with multiple children.
The Issue
The main concern to be addressed is the danger of allowing unvaccinated children to
attend public schools and be in the vicinity of other children. With the exception of children at
risk of serious health effects because of vaccines, other theoretical reasons for being exempt
from child immunizations should not be considered grounds for exemption. Children are
extremely vulnerable to these illnesses and it is a severe issue to allow them to go unvaccinated.
An example of the severity of allowing children to be unvaccinated occurred in Nigeria
regarding the polio and measles vaccines. In the early 2000s, leaders in Nigeria directed their
people to not vaccinate their children for measles and polio because of Islamic beliefs. In just
three months, there were over 20,000 measles cases, 600 deaths from measles, and over half of
all new polio cases in the world (Grais et al., 2007). These outbreaks continued for years and
spread to the surrounding states.
Unvaccinated children who travel abroad pose a risk of bringing bacteria back to the
United States. In 2009, there was an outbreak of mumps in the United Kingdom. This caused
the last known and largest mumps outbreak to occur in the United States in July of 2009 when a
young boy traveled to the United Kingdom on a family vacation and contracted mumps. He
brought the disease back to the United States and this instance is linked to more than 4000 cases
of mumps in July 2009 (“Mumps Outbreaks,” 2009).
Another example is the measles outbreak in the United States in 2013. The Centers for
Disease Control and Prevention reports about 60 cases of measles every year, but in 2013 there
were 189 documented cases. About 28% of those infected with measles had reported traveling to
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other countries recently. They then brought the disease to the United States where other people
contracted it. Measles was thought to have been eliminated in 2000 and this was the highest
known year of measles since 1996 (“Measles Outbreaks,” 2012).
Children are especially susceptible to diseases such as measles, mumps, rubella, and
influenza, and experience much more severe effects from them. Based on the above information,
it is clear that allowing parents to exempt their children from vaccinations is incredibly
dangerous. With the number of unvaccinated children rising, the United States must begin
implementing stronger laws mandating vaccinated children
What is Being Debated?
The main debate in this issue is whether or not it is against parents’ basic human rights to
be forced to vaccinate their children. The United States sits on a foundation of freedom and
those opposed to vaccines use their basic human rights as a weapon against the rules of child
vaccinations.
The other side of this argument is the idea that parents expect a certain level of safety for
their children when in the hands of the public. There are many laws that regulate safety in public
institutions, for instance building codes and having proper fire escapes and alarms. Allowing
unvaccinated children into public schools puts the other children in danger. Infectious diseases
are extremely contagious and often deadly in young children. The fact that these diseases are
mostly eradicated in the United States should provide parents comfort, unless there are a plethora
of unvaccinated children sharing a playground or sharing food with other children.
Another debate is whether or not herd immunity is enough in the instance of children.
Herd immunity, also known as “community immunity,” occurs when a high percentage (usually
greater than 80%) of a population is vaccinated or immune to a disease. When such a high
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percent of a population is immune, those who are not immune (or are unvaccinated) have a level
or protection against the disease. The diseases have a hard time spreading in a community where
a high population is immune because there are not as many vulnerable people. This is especially
important in a community with those who cannot be vaccinated, for example, a community with
a child who has pediatric cancer (Fine, Eames, Heymann, 2011).
Herd immunity can successfully eradicate a disease’s presence in a community, but is it
enough? Only requiring herd immunity can still have devastating effects on children if they
contract a preventable infectious disease.
C. Key Policy Options and Strategies
This chart shows the key policy options and strategies recommended to solve the issue of
children remaining unvaccinated. These policies are explained in further detail below.
Name
No exemptions
Flu Initiative
Catch-up
Program
Definition
Strengths
Weaknesses
Results
Creating a policy to
mandate vaccines
before entrance to
school, regardless of
religious of
philosophical beliefs
Free flu vaccines for all
students in a school
Public schools could have
herd immunity, all
children would be
protected against
infectious diseases
The difficulty in requiring
parents to go against their
religious beliefs in
mandating all students be
vaccinated
No known results
All students would be
immunized against the flu
Schools providing
vaccinations for
children who are not
yet vaccinated before
their entrance to school
Eliminating cost as an
excuse to leave children
unvaccinated
There are multiple other
vaccines that are required
other than just the flu
Does not eliminate the
religious and
philosophical excuses
Increased number of
students vaccinated
against the flu
No known results
Sources: (CDC, 2007), (PDH, 2013)
A policy for mandating immunizations for all children, regardless of their parents’
religious or philosophical beliefs, has not yet been attempted in the United States. There are
requirements set by state laws, but many parents still find ways around these laws (PHD, 2013).
If a policy were to be made regarding vaccinations, it could require that religious and
philosophical reasons are not valid for putting other children in danger. If parents still decided to
resist, they would not be allowed to enroll their children in public schools. With the new
Running Head – Vaccinated Children
Affordable Care Act being implemented and more families being insured, there are fewer
excuses available for why children are still remaining unvaccinated. The only exception for this
new policy would be if a child has a serious health issue that could be complicated by
immunizations.
Vaccinations have been required in order to attend schools starting in 1850 when the
smallpox vaccine was created (Malone & Hinman, 2011). It took until the 1960s for all 50 states
to have vaccination requirements for children. By the 1980 school year, all 50 states had laws
requiring schools to enforce children to be vaccinated in order to attend (Malone & Hinman,
2011). After these laws were put in place, smallpox, polio, measles, and mumps were
eradicated. In the past it is shown that mandating vaccines has a positive impact on herd
immunity and children’s safety in schools.
School Flu Initiative
A program that many schools are adopting is the School Flu Initiative. Through this
program, students without a flu vaccine will be provided with that vaccine at their school. The
Department of Health is providing these vaccines in the hopes that no students will be vulnerable
to the flu (“School Children Immunizations,” 2013). This initiative only covers the flu vaccine
and not the multiple other required vaccines.
School Immunization Catch-up Program
The final option for assisting in getting more children vaccinated is to create a “catch-up”
program for school districts. In 2008, Pennsylvania began pushing for a program to provide
vaccines for those families who could not afford them (“School Children Immunizations,” 2013).
Other states have followed Pennsylvania in implementing this program (“School Children
Immunizations,” 2013). With the catch-up program, formally known as the School Immunization
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Catch-Up Program (SICU), students entering kindergarten without immunizations will be
provided with these shots by the school district. The program includes vaccines for Hepatitis B,
meningitis, varicella (flu), and tetanus/diphtheria (“School Children Immunizations,” 2013).
This does not include the entire set of required vaccines by law. By implementing this program
across the United States, the excuse from parents that they cannot afford vaccines could be
avoided. The school districts work closely with the Department of Health and the Division of
Immunizations to pay for these vaccines. Appropriate documents must be shown to prove that
the family cannot pay for their own vaccines through their medical provider.
There is no evidence to assume that this program is successful lowering the number of
unvaccinated children at schools. While there are no requirements for a school to enter this
program, the government can only allocate resources that are available with the funds that are
available. This program also does not address the issue of parents finding excuses to not
vaccinate their children.
Recommendation
With the government willing to help provide these immunizations for children, it is
highly recommended for schools to take advantage of this program. The goal is to lower the
percent of students in schools who are unvaccinated. Since 2004, this number has been steadily
increasing (“School Children Immunizations,” 2013). By providing a set of vaccines at no cost,
this number will hopefully decline. If there are enough vaccinated children, herd immunity can
be reached and the bacterium that causes harmful illnesses and even death in children can be
eliminated in the United States.
Future Directions and Forecasting
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Running Head – Vaccinated Children
Without acting now, the number of unvaccinated children will continue to increase into
the future. The severity of having vulnerable people is detrimental to our youth. An example of
how quickly these diseases can affect our population is the instance of a measles outbreak at the
mega church in Newark, Texas (Neporant, 2013). A preacher at this church began urging its
members to not vaccinate their youth in fear of autism and other religious reasons. This church
is believed to be the reason for a measles outbreak in Texas. In just a few months, there were
twenty confirmed cases of measles in the church (Neporant, 2013). If parents continue to neglect
vaccinated their children, these types of outbreaks could happen at a much larger scale (Grais, et.
al, 2007)(“Measles Outbreaks,” 2009)(“Mumps Outbreaks,” 2009). This is not the only known
outbreak of an infectious disease in the United States and certainly not in countries that could
bring it to the United States. As shown above, these diseases are extremely contagious and could
spread to children in days.
The questions being presented for the Congressperson to consider are as followed: what
could be the impact of allowing parents to continue to not vaccinate their children because of
philosophical and religious reasons? Is a required catch-up program in school districts enough of
a change to prevent the spread of infectious diseases?
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Section E: Works Cited
Madsen, K. M., Hviid, A., Vestergaard, M., Schendel, D., Wohlfahrt, J., Thorsen, P., & Olsen, J. (2002,
November 7). A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism. The
New England Journal of Medicine, 347(19), X. Retrieved February 26, 2014, from ScienceDaily.
http://www.safeminds.org/research/library/20021107.pdf
Jansen, V. A., Stollenwerk, N., Jensen, H. J., Ramsay, M. E., Edmunds, W. J., & Rhodes, C. J. (2003, August
8). Measles Outbreaks in a Population with Declining Vaccine Uptake. Science Magazine, 301, 1.
Retrieved February 26, 2014, from GoogleScholar.
http://www2.imperial.ac.uk/~hjjens/jansen.301.804.pdf
Centers for Disease Control and Prevention. State Vaccination Requirements (2007, May 7). Retrieved
February 20, 2014
http://www.cdc.gov/vaccines/vac-gen/laws/state-reqs.htm
Mumps Outbreaks (2009, November 12). In Centers for Disease Control and Prevention. Retrieved
February 26, 2014
http://www.cdc.gov/mumps/outbreaks.html
Measles Outbreaks (2012, May 21). In Centers for Disease Control and Prevention. Retrieved February
26, 2014
http://www.cdc.gov/measles/outbreaks.html
Grais, R. F., Dubray, C., Gerstl, S., Guthmann, J. P., Djibo, A., Nargaye, K. D., & Coker, J. (2007, January 2).
Unacceptably High Mortality Related to Measles Epidemics in Niger, Nigeria, and Chad. PLOS Medicine,
10. doi:10.1371/journal.pmed.0040016
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0040016
American Academy of Pediatrics. (2013, October 23). Why Immunize Your Child. In Healthy Children.
Retrieved February 13, 2014, from GoogleScholar.
http://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Why-Immunize-YourChild.aspx?gclid=COjszYDpwbwCFREaOgodjBkAyA
Cook, C., Smeeth, L., & Fombonne, E. (2005). No evidence that the MMR vaccination causes autism or
other pervasive developmental disorders (Doctoral dissertation, Elseiver). 9 (2). Retrieved February 10,
2014, from ScienceDirect.
http://www.sciencedirect.com.ezaccess.libraries.psu.edu/science/article/pii/S1744224905000240
Funk, S., Salathe, M., & Jansen, V. A. (2010). Modelling the influence of human behaviour on the
spread of infectious diseases: a review (Doctoral dissertation, Journal of the Royal Society). 7 (50).
Retrieved February 9, 2014, from ProQuest.
http://rsif.royalsocietypublishing.org/content/7/50/1247.full
Shim, E., Chapman, G. B., Townsend, J. P., & Galvani, A. P. (2012). The influence of altruism on
influenza vaccination decisions (Doctoral dissertation, Journal of the Royal Society). 9 (74). Retrieved
February 10, 2014, from ProQuest.
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http://rsif.royalsocietypublishing.org/content/9/74/2234.full
Fine, P., Eames, K., & Heymann, D. L. (2011, January 4). Herd Immunity: A Rough Guide. Oxford Journals,
52(7), 911-916. Retrieved February 26, 2014, from GoogleScholar (10.1093/cid/cir007).
http://cid.oxfordjournals.org/content/52/7/911.full
Neporent, L. (2013, August 26). Texas Church Tied to Measles Outbreak Preaching Vaccinations. In ABC
News. Retrieved March 19, 2014.
http://abcnews.go.com/Health/texas-church-epicenter-measles-outbreak/story?id=20071644
School Children Immunizations (2013, August). In Pennsylvania Department of Health. Retrieved March
19, 2014
Malone, K. M., & Hinman, A. R. (2011, August 6). Vaccination mandates: the public health imperative and individual rights.
InCenters for Disease Control. Retrieved March 20, 2014, from http://www.cdc.gov/vaccines/imz-managers/guidespubs/downloads/vacc_mandates_chptr13.pdf
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