Vaccination policy refers to the health policy a government adopts in relation to vaccination. Vaccinations are voluntary in some countries and mandatory in some countries as part of the public health system. Some governments pay all or part of the costs of vaccinations for vaccines in a national vaccination schedule.
- 1 Goals of vaccination policies
- 2 Compulsory vaccination
- 3 Policies and history by country
- 4 References
Goals of vaccination policies
Immunity and herd immunity
Vaccination policies aim to produce immunity to preventable diseases. Besides individual protection from getting ill, some vaccination policies also aim to provide the community as a whole with herd immunity. Herd immunity refers to the idea that the pathogen will have trouble spreading when a significant part of the population has immunity against it. This protects those unable to get the vaccine due to health reasons, such as age, allergies and having received an organ transplant.
Eradication of disease
With some vaccines, a goal of vaccination policies is to eradicate the disease - make it disappear from Earth altogether. The World Health Organization coordinated the global effort to eradicate smallpox globally. Victory is also claimed for getting rid of endemic measles, mumps and rubella in Finland. The last naturally occurring case of smallpox occurred in Somalia in 1977. In 1988, the governing body of WHO targeted polio for eradication by the year 2000, but didn't succeed. The next eradication target would most likely be measles, which has declined since the introduction of measles vaccination in 1963.
Individual versus group goals
Rational individuals will attempt to minimize the risk of illness, and will seek vaccination for themselves or their children if they perceive a high threat of disease and a low risk to vaccination. However, if a vaccination program successfully reduces the disease threat, it may reduce the perceived risk of disease enough so that an individual's optimal strategy is to encourage everyone but their family to be vaccinated, or (more generally) to refuse vaccination at coverage levels below those optimal for the community. For example, a 2003 study found that a bioterrorist attack using smallpox would result in conditions where voluntary vaccination would be unlikely to reach the optimum level for the U.S. as a whole, and a 2007 study found that severe influenza epidemics cannot be prevented by voluntary vaccination without offering certain incentives. Governments often allow exemptions to mandatory vaccination for religious or philosophical reasons, but if too many of these exemptions are granted, the resulting free rider problem may cause loss of herd immunity, substantially increasing risks even to vaccinated individuals.
To eliminate the risk of disease outbreaks, at various times governments and other institutions established policies requiring vaccination. For example, an 1853 law required universal vaccination against smallpox in England and Wales, with fines levied on people who did not comply. In the United States, the Supreme Court ruled in Jacobson v. Massachusetts (1905) that states could compel vaccination for the common good. Contemporary U.S. policies usually require children receive vaccinations before entering school, although many states allow for religious and personal exemptions due to philosophical or health reasons. A few other countries also follow this practice. Compulsory vaccination greatly reduces infection rates for associated diseases. Beginning with nineteenth century early vaccination, these policies stirred resistance from a variety of groups, collectively called anti-vaccinationists, who objected on ethical, political, medical safety, religious, and other grounds. Common objections included claims of "excessive government intervention in personal matters" or that proposed vaccinations were not sufficiently safe. Many modern vaccination policies allow exemptions for people with compromised immune systems, allergies to vaccination components, or strongly held objections.
In 1904 in the city of Rio de Janeiro, Brazil, following an urban renewal program that displaced many poor, a government program of mandatory smallpox vaccination triggered the so-called Vaccine Revolt, several days of rioting with considerable property damage and a number of deaths.
Compulsory vaccination is a difficult policy issue, requiring authorities to balance public health with individual liberty:
"Vaccination is unique among de facto mandatory requirements in the modern era, requiring individuals to accept the injection of a medicine or medicinal agent into their bodies, and it has provoked a spirited opposition. This opposition began with the first vaccinations, has not ceased, and probably never will. From this realisation arises a difficult issue: how should the mainstream medical authorities approach the anti-vaccination movement? A passive reaction could be construed as endangering the health of society, whereas a heavy-handed approach can threaten the values of individual liberty and freedom of expression that we cherish."
Investigation of different types of vaccination policy finds strong evidence for the effectiveness of standing orders, allowing healthcare workers without prescription authority (such as nurses) to administer vaccines in defined circumstances; sufficient evidence for the effectiveness of requiring vaccinations before attending child care and school; and insufficient evidence to assess effectiveness of requiring vaccinations as a condition for hospital and other healthcare jobs.
Policies and history by country
|This section is incomplete. (October 2012)|
In Australia, a massive increase in vaccination rates was observed when the federal government made certain benefits (such as the universal 'Family Allowance' welfare payments for parents of children) dependent upon vaccination compliance. As well, children were not allowed into school unless they were either vaccinated or their parents completed a statutory declaration refusing to immunize them, after discussion with a doctor, and other bureaucracy. (Similar school-entry vaccination regulations have been in place in some parts of Canada for several years.)(missing citation)
Republic of Ireland
In Malaysia, mass vaccination is practised in public schools. The vaccines may be administered by a school nurse or a team of other medical staff from outside the school. All the children in a given school year are vaccinated as a cohort. For example, children may receive the oral polio vaccine in Year One of primary school (about six or seven years of age), the BCG in Year Six, and the MMR in Form Three of secondary school. Therefore, most people have received their core vaccines by the time they finish secondary school.
According to the Canadian Medical Association:
Slovenia has one of the world’s most aggressive and comprehensive vaccination programs. Its program is mandatory for nine designated diseases. Within the first three months of life, infants must be vaccinated for tuberculosis, tetanus, polio, pertussis, and Haemophilus influenza type B. Within 18 months, vaccines are required for measles, mumps and rubella, and finally, before a child starts school, the child must be vaccinated for hepatitis B.
While a medical exemption request can be submitted to a committee, such an application for reasons of religion or conscience wouldn’t be acceptable, and isn’t allowed, says Alenka Kraigher, head of the communicable diseases and environmental health center at Slovenia’s National Institute of Public Health.
Failure to comply results in a fine and compliance rates top 95%, Kraigher says, adding that for nonmandatory vaccines, such as the one for human papilloma virus, coverage is below 50%.
Mandatory vaccination against measles was introduced in 1968 and since 19780, all children receive 2 doses of vaccine with a compliance rate of more than 95%. For TBE, the vaccination rate in 2007 was estimated to be 12.4% of the general population in 2007. For comparison in neighboring Austria, 87% of the population is vaccinated against TBE.
According to the Canadian Medial Association:
Some nations, such as Latvia, say they have mandatory vaccination policies but contend that the notion of “mandatory” differs from that of other nations. “Vaccination is mandatory for state institutions and vaccination providers but for [the] public is recommended and offered free of charge,” Jurijs Perevoscikovs, head of the Epidemiological Safety and Public Health division of the Infectology Center of Latvia, writes in an email.
Vaccines that are not mandatory are not publicly funded, so the cost for those must be borne by parents or employers, she adds. Funded vaccinations include tuberculosis, diphtheria, measles, hepatitis B, human papilloma virus for 12-year-old girls, and tick-borne encephalitis until age 18 in endemic areas and for orphans.
Latvia also appears unique in that it compels health care providers to obtain the signatures of those who decline vaccination. Individuals have the right to refuse a vaccination, Perevoscikovs says. But if they do so, health providers have a duty to explain the health consequences and if the patient hasn’t been persuaded to change his mind, “the health care provider should draw up a refusal in writing which has to be confirmed with a signature by the person to be vaccinated.”
In the 2000s, public concern about the combined MMR vaccine against measles, mumps and rubella, sparked by media coverage of controversial research linking it to autism, caused a significant drop in vaccinations and a rise in the incidence of these diseases. Prime Minister Tony Blair refused to confirm whether his children had received the vaccine.
The Advisory Committee on Immunization Practices makes scientific recommendations which are generally followed by the federal government, state governments, and private health insurance companies.
States in the U.S. mandate immunization, or obtaining exemption, before children enroll in public school. Exemptions are typically for people who have compromised immune systems, allergies to the components used in vaccinations, or strongly held objections. All states but West Virginia and Mississippi allow religious exemptions, and twenty states allow parents to cite personal or philosophical objections. A widespread and growing number of parents falsely claim religious and philosophical beliefs to get vaccination exemptions, and an increasing number of disease outbreaks have come from communities where herd immunity was lost due to insufficient vaccination.
The American Academy of Pediatrics (AAP) notes the dilemma faced by many parents in that vaccines are a very safe and important health intervention, but are neither risk-free nor 100% effective. It advises physicians to respect the refusal of parents to vaccinate their child after adequate discussion, unless the child is put at significant risk of harm (e.g., during an epidemic, or after a deep and contaminated puncture wound); under such circumstances, the AAP states that parental refusal of immunization constitutes a form of medical neglect and should be reported to state child protective services agencies.
See Vaccination schedule for the vaccination schedule used in the United States.
Immunizations are often compulsory for military enlistment in the U.S.
All vaccines recommended by the U.S. government for its citizens are required for green card applicants. This requirement has stirred controversy when it applied to HPV vaccine because of the cost of the vaccine, and because the other thirteen required vaccines prevent diseases which are spread by a respiratory route and are considered highly contagious.
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In the United States, certain immunizations are mandated by state policies for school entry requirements, though parents may opt out of the vaccines on a state-by-state basis. In a push to eradicate Pertussis, Tetanus, Diphtheria, Polio, Measles, Mumps, Rubella, Varicella, and Hepatitis B from the population, schools across the United States require an updated immunization record for all incoming and returning students. While all states require an immunization record, this does not mean that all students must be vaccinated—this means all students must have a record stating whether they have been vaccinated or not. Again, opting out is a state-by-state law; some states allow parents to opt out for a variety of reasons, but all states do require an immunization record at schools (even if this record says the child received no vaccines). There are ethical debates and objections to the required immunizations because of different religious or philosophical beliefs and the infringement on individual liberties.
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