Essay On Mandatory Vaccination Of Children

Public health policy is the intertwining of health and policy which impacts the general population (Porche, 2012). The legislative, executive, and judicial branches of government can make administrative decisions that can impact the actions, behaviors, or resources in a community. The impact of the administrative decisions can affect the health of a population (Porche, 2012). If the overall health of a population is poor then the effect is not only felt by the people themselves but can also impact the government (Ungvarsky, 2017). Therefore, the health of citizens is important to government entities. Most governments have set up public health policies to maintain and improve public health. A controversial public health policy is the mandatory vaccination of children. This paper will provide an analysis of this ethical issue, along with evaluating the ethical dimensions of mandatory vaccination. Lastly, justification will be provided for the importance of this public

health policy and the positive effects that have resulted from the implementation of this policy.
Analysis of Mandatory Vaccines for Children
The public health goal in mandatory vaccination of children is to reduce illness, hospitalization, and death of vaccine preventable diseases. Scientific evidence provides a strong consensus that vaccines for children are safe and effective (Gostin, 2015). Vaccinations are considered one of the greatest achievements in the 20th century due to an increase in child survival rates (Office of Disease Prevention and Health Promotion, 2014). Vaccinating children has prompted this decrease of infectious disease mortality. Panchuis et al. (2013) estimate that more than 100 million cases of contagious diseases have been prevented from 1924 to 2012 by the vaccination of children.
There are certain risks to consider in mandatory vaccination. Vaccines are just like medications in that they do have a risk of side effects. However, the Centers for Disease Control (2018) does point out that even though all vaccines can have side effects for the most part these side effects are minor in nature resulting in redness or swelling at the injection site. Some of the most common side effects reported could actually be a good sign that a person’s body is building antibodies due to receiving the vaccine. Serious side effects are considered to be rare, but to put this into perspective an example can be given. In one million doses of vaccine administered there may be only one or two serious adverse events (United States Department of Health and Human Services, 2017). The screening for contraindications prior to vaccine administration can play a major role in reducing adverse vaccine reactions, such as anaphylaxis. There is a Vaccine Adverse Event Reporting System (VAERS) that allows reporting of adverse events following vaccination, so that scientists may continue to monitor the safety of vaccines.
After examining the small risk for serious adverse reaction to vaccination, it is imperative to examine the risk at the other end of the spectrum. Herd immunity that results from vaccination is essential in protecting certain populations of people that cannot be vaccinated. The immunocompromised, young infants, and those whose immune system does not respond to vaccination rely heavily on the vaccination of those around them for protection against deadly, vaccine preventable diseases. It does not take many unvaccinated people to reduce the coverage threshold. Measles is a prime model because the herd immunity threshold is quite fragile and requires about 96-98% of the population to be vaccinated in order to achieve optimal protection (Hendrix, Sturm, Zimet, Meslin, 2016).
Children are required to be vaccinated against certain diseases before attending daycares, public schools, and even private schools. Each of the states have different laws in place for which vaccines are required. All states allow for medical exemptions of vaccination and most states will allow for religious exemptions. Religious exemption allows for a provision in the vaccine law for those parents that feel vaccinating their children will contradict sincere religious beliefs (National Conference of States Legislators, 2017). There are only 18 states that allow for philosophical exemptions in which parents can refuse to vaccinate based on moral or personal beliefs (National Conference of States Legislators, 2017). Gostin (2015) reports that research has shown that states with lenient exemption protocol have a 50% higher pertussis rate. Families that opt out of vaccination tend to cluster in a community, such as a religious community. The clustering of unvaccinated children in a community will erode herd immunity and can expedite disease outbreaks (Gostin, 2015).
Universal vaccination of children is endorsed by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Research has shown that vaccines are safe and cost-effective ways to prevent disease. Healthcare providers feel a sense of responsibility in educating parents and ensuring that vaccination records are in compliance. Compliance with vaccination is not only for the health benefit of the patient, but the community as a whole. The Supreme Court upheld a smallpox vaccine mandate in Jacobson v. Massachusetts in 1905 (Gostin, 2015). The mandate required people who had not been vaccinated in the last five years to be vaccinated or pay a fine. The Supreme court ruled that the vaccine mandate did not infringe on any rights secured by the Federal Constitution (Gostin, 2015). The court found the mandate to be reasonable due to the impeding threat of smallpox and the protection of the public (Rowlands, 2018).

Evaluation of the Ethical Dimensions of Mandatory Vaccines for Children
There are several ethical dimensions that must be considered with the mandatory vaccination of children. The ethical dimensions include liberty, social justice, utility, and paternalism. Liberty is concept that allows for people to make decisions of their free will and take responsibility for their own actions. However, liberty does not allow people to make decisions that can harm others. Caplan (2013) provides a unique outlook in that liberty does not release a person from the liability of the harmful consequences of choosing not to vaccinate. For example, a drunk driver is in a motor vehicle accident that harms another human being. The drunken driver would then be liable for the action that was triggered with a poor decision. The same comparison could be made for unvaccinated people, as they pose a threat to society. Sending an unvaccinated child to daycare with newborns can cause death and disability (Caplan, 2013).
Social justice is a responsibility of society to ensure that there is equal distribution of healthcare (Rowlands, 2018). Healthcare should be available to all citizens and not just provided for the wealthy. The federal Vaccines for Children Program provides vaccine free of charge for children that are uninsured, underinsured, have Medicaid, or are an Alaskan/Native American. This ensures that underserved children have access to vaccines and not just those children that come from wealthy families.
Utility and paternalism are both important to ethical dimensions to consider with mandatory vaccination.

Utility is the greatest good for the greatest number of people. Paternalism occurs when a person’s rights are restricted for the sake of the public’s health. Mandating vaccination of children allows for a greater number of people to be vaccinated which helps with herd immunity. Herd immunity is essential for infants, the immunocompromised, and for those people whose immune system does not respond to vaccination. As discussed earlier in this paper, some vaccines have a fragile threshold and require a larger number in the population to be vaccinated to prevent outbreaks. A detrimental effect can occur when a person does not consider the common good of the community by vaccinating. This detrimental effect will have an impact on the overall well-being of the community, each individual’s well-being, as well as the individual’s well-being that chose not to vaccinate (Hendrix et al.,

2016).
Justification of Mandatory Vaccines for Children
According to the Centers for Disease Control and Prevention (2017), for the 2016-2017 school year there was a reported 94.5% of Kindergarten students who were up to date on the state required number of diphtheria, tetanus, and acellular pertussis, 94% were up to date on measles, mumps, and rubella, and 93.8% were up to date on varicella. The median average of Kindergarten students that had an exemption for vaccination was around 2% which has remained consistent since 2015-16 school year (CDC, 2017). The high vaccination rates provide evidence that most people feel that vaccination is a necessity to protect the public health from some serious diseases.