titles for essays about vaccines

111 Vaccination Research Topics & Best Vaccine Essay Topics

Welcome to our list of vaccination research topics! This page contains only the best vaccine topics for essays and papers on child immunization, COVID-19, and other issues. Feel free to pick the catchiest research title about vaccines from our list!

🏆 Best Essay Topics on Vaccination

🔎 easy vaccination research paper topics, 👍 good vaccination research topics & essay examples, 🎓 most interesting research titles about vaccines, 💡 simple vaccine essay topics.

Advantages and Disadvantages of Vaccination
Should Vaccinations Be Required for Public School Students?
Teaching Plan: Immunizations and Vaccinations
Vaccinations Against COVID-19 in Canada: A Structural-Functionalism Perspective
Mandatory Vaccination: Benefits and Reasons
An Outbreak of the Irrational: Refusion from Measles Disease Vaccination
Vaccination and Immunization Promotion
Childhood Vaccination: Ethical Case Study The problem of moral behavior of nurses in situations of a difficult choice, decision-making, or conflict is actively discussed in the scholarly medical literature.
Benefits of Vaccination against Coronavirus Among the numerous recent healthcare advancements, vaccines occupy a specific place for their unique benefits for individuals and society in general.
Human Papillomavirus (HPV) Vaccination for All The health care system in the United States introduced HPV to the public in 2006 following its approval by the Food and Drug Administration.
COVID-19: Information About Vaccination This work investigates the phenomenon of vaccine development in the context of a coronavirus pandemic and discusses the progress already achieved.
COVID-19: Mandatory Vaccination The autonomy of nurses who refuse vaccinations has become a widespread precedent throughout the medical community.
Quality Improvement Initiative – Influenza Vaccination The main one is vaccination, which is a major concern since only around 60% of healthcare workers worldwide agree with mandatory flu vaccination.
Q.I. Program for Vaccination Among Healthcare Workers The paper analyzes the necessary QI tools to achieve the initiative of increasing the percentage of healthcare workers given influenza vaccination.
Poliovirus and Importance of Vaccination The type of vaccination used for poliovirus plays a significant role in its effectiveness. In particular, the oral poliovirus vaccine deems insufficiently effective.
Vaccination and Associated Advantages Vaccines work with an individual’s natural immunity to build protection against infections, thus reducing the risks of getting infected.
Public Schools and Vaccination of Youth Vaccines could be described as safety measures to prevent illnesses by stimulating an immune system to produce a prepared defense against a particular sickness.
The Importance and the Benefits of Vaccinating Children Vaccination is the most effective safe strategy for preventing infectious diseases and reducing disability and mortality from infectious pathology.
HPV Anti-Vaxxers Policy: Anti-Vaccination Attitudes Smoking and drinking are risk factors for developing OPSCC, and competing illnesses are a likely cause of mortality in this population.
Vaccination Issue Concerning the COVID-19 Pandemic This paper discusses the current vaccination issue concerning the COVID-19 pandemic. Large numbers of patients worldwide refuse vaccines.
Mandatory COVID-19 Vaccination for Healthcare Employees Employees must be aware of the danger posed by the disease and undergo any procedures that will benefit the patient.
The Effect of Vaccinated Travel Lanes in Singapore The recent introduction of Vaccinated Travel Lanes (or VTL) in Singapore allows passengers with recognized vaccination certificates to use airlines on special terms.
Vaccination and Its Economic Implications The development of vaccines has significant implications for the pharmaceutical market. Disease prevention eliminates the need to create drugs to treat them.
The COVID-19 Vaccination and Racial Issues The hypothesis for the present research is that even in developed countries, the COVID-19 vaccine doses may be distributed unequally among white people and racial minorities.
The COVID-19 Anti-Vaccination Decision This paper is about how people argue against the COVID-19 vaccination, how they live with it, and how the rest of society is trying to adapt to the anti-vaccine decision.
The COVID-19 Vaccination Hesitancy: Rhetorical Analysis This rhetorical analysis paper focuses on a video, presented by John Oliver, which discusses the prevalent skepticism surrounding the COVID-19 vaccination process in the US.
Ineffective COVID-19 Vaccination in Afro-Americans The present work shows the essence of comprehending African American subcultures and history to help raise COVID-19 vaccine awareness and acceptance.
COVID-19 Debate: Masks for Vaccinated After reviewing credible sources regarding COVID-19 measures of prevention, it is clear that masks should not be mandatory for individuals who are vaccinated.
Vaccination of Healthcare Workers Vaccination is the most effective way of protection against COVID-19: a highly contagious disease often followed by a set of serious complications.
COVID-19 Vaccination: Necessity of Excessiveness Despite the risks and rare opposition, mass vaccination continues to be an essential step toward stopping the COVID-19 virus from impacting the world.
Measles Vaccinations in Colorado State The paper states that with the outbreaks of measles nationwide, it is high time for state legislators to consider measures to combat the disease.
Should We Get Vaccinated for COVID-19? Vaccinations present the only viable option for preventing the transmission of COVID-19 as well as reducing the risks of adverse symptoms.
The COVID-19 Vaccination: Resistance and Protests Vaccination remains a pivotal prevention strategy against the COVID-19 pandemic. However, resistance to vaccination continues to dictate the ‘health politics’ of many nations.
Ethical Principles: Parents’ Vaccination Concerns This case study reviews the ethical and moral choices of doctors who aim to convince parents to vaccinate their children.
Importance of Employees Getting Vaccinated There is a need to ensure an effective vaccine is administered to employees to ensure that humans can interact freely for effective resumption of normal business activities.
The COVID-19 Vaccination: Side Effects The most significant side effect of the COVID-19 vaccination is severe allergy among patients who have never experienced any other kind of allergy.
COVID-19 Measures: Masks for Vaccinated The main point in the essay is that employees should continue to wear a mask in the workplace even after being fully vaccinated.
Autism and Vaccination: The False Health Claim One of the most popular false health claims concerns the relationship between autism and vaccination, suggesting that the latter causes the former.
Wearing a Mask after Vaccination Controversial issues regarding collective security during the COVID-19 pandemic often include discussions of if a sanitary mask fulfills the functions assigned to it or not.
Vaccination Against the Covid-19 Among Healthcare Professionals This paper investigates the adoption of Covid-19 vaccination among academics and resident doctors at the University of Drugs and Pharmacy “Nicolae Testimitanu” in Moldova.
Disease in Vaccinated Populations This academic work is a laboratory report summarizing the results of a practical simulation of the epidemiological dynamics of a simulated population.
“Should We Take a Selfie After Getting Vaccinated?” Summary The article’s central point “Should We Take a Selfie After Getting Vaccinated?” is that society is divided into groups with contrasting opinions on the issue.
COVID-19: Vaccination Program All healthcare workers need to get the COVID-19 vaccine when available because of their increased exposure to this deadly disease.
Racial Inequalities in the Context of Pandemic Vaccination To concretize the study, a current journalistic article in The New York Times was chosen to highlight racial inequalities in the context of pandemic vaccination.
Support for Seasonal Influenza Vaccination Requirement Among US Healthcare Personnel The study analyzes an article titled ‘New Approaches for Influenza Vaccination of Healthcare Workers’. The article focuses on the effectiveness of compulsory vaccination.
Americans’ Readiness to Coronavirus Vaccination The purpose of this paper is to summarize the statistic scales, considering whether Americans are ready to get a COVID-19 vaccine and the reasoning behind them.
Human Papillomavirus Vaccination in Children The purpose of this paper is the identification of Human Papillomavirus vaccination effectiveness among children of both genders from 9 to 18 years old.
Applying Ethical Principles in Determining Vaccination Decisions Vaccination is beneficial regardless of the adverse effects that come along. Communities should be sensitized through seminars on vaccines.
Vaccination: Child Immunization on the Government Level The experts say that the hesitancy to vaccinate children is one of the biggest threats to public health and the most dangerous mistakes a person can make.
Compulsory Vaccination for Staff of Nursing Homes Because the COVID-19 vaccine will soon be available for the public, officials must make getting it compulsory for the staff of nursing homes and long-term care facilities.
Seasonal Influenza Vaccination Program The following paper is focused on the Center for Disease Control (CDC) vaccination program on seasonal influenza.
The Benefits of Vaccination Outweigh the Risks Medical researchers have succeeded in producing vaccines to help bodies fight pathogens that might overwhelm them.
Mandatory Swine Flu Vaccination The swine flu vaccine is a vaccine that was developed to control the spread of the swine flu pandemic. These vaccines include Pandemix and Celvapan manufactured by Baxter.
The H1N1 Influenza Virus: Benefits of Vaccination The basic structure of an effective vaccine and the characteristics of virus mutations will help find a way to immunize against a new flu strain and prevent another epidemic.
Conflicted State of Mind: Vaccination and Ethics An increasing number of people have come to oppose vaccination on personal or ideological grounds, undermining the protection it provides.
Why Vaccination Is So Discussed Now? Vaccination is one of the most debatable topics since many arguments for and against immunization confuse young parents who want to take the right decision.
Vaccination Challenges and New Disease Outbreaks Vaccinations are the subject of heated debate in society because of their effectiveness, philosophical rationale, and religious relevance.
The Views on HPV Vaccination in Sweeden The purpose of this article is to outline the research on the views on HPV vaccination assessed by school nurses in Sweeden.
Health of Vaccinated and Unvaccinated Children The article by Mawson et al. evaluates the effectiveness of vaccination concerning improving the health of children when compared to infants who did not receive immunization.
Vaccinations for Children: Issues and Recommendations for Positive Change This paper discusses vaccinations for childrens, in particular, security, privacy, and confidentiality regulations, laws, and principles related to data management and access.
Human Papillomavirus Vaccination Among Adolescents Human papillomavirus (HPV) represents a significant threat to global health, which points to the need for implementing effective interventions targeted at its elimination.
Flu Vaccination Side Effects as a Cause of Refusal Flu vaccinations are considered to be an important part of population health programs in most developed countries.
Mandatory Vaccination of Children in the USA The issue of child immunization is particularly relevant to nursing, as nurses see the consequences of poor vaccination rates regularly.
Vaccination Misconceptions in Old Adults This research focuses on the importance of education to improve the older populace’s willingness to get influenza vaccinated.
Pharma Controversy Presentation: Vaccination and Autism Parents often associate MMR vaccination with autism. No qualitative evidence for the MMR vaccination-autism link.
Vaccination as a Public Health Policy Issue The controversy surrounding vaccination of children is caused primarily by the miscommunication between the scientific community and the general public.
2009 H1N1 Flu Pandemic, Vaccination and Rates Extensive studies of the virus confirmed that it possessed certain characteristics that had not been detected in similar viruses before.
Childhood Vaccination Policy in Florida This paper discusses the policy issue of childhood vaccination in Florida where parents can exempt their children from vaccinations due to religious reasons.
Childhood Vaccination: Policy-Priority Issues The issue of vaccinations is often discussed on an international level. Governments do not underestimate the importance of immunization.
Childhood Vaccination as Healthcare Priority Policy Issue This essay presents the controversial issue of childhood vaccination as a healthcare priority policy issue that requires the immediate attention of legislators.
Vaccines: Should Parents Avoid Vaccinating Their Children? In this research paper, we will try to establish the benefits of damages of child vaccination and draw a conclusion whether parents should or should not avoid vaccinating their children.
Vaccination and Its Effects on the Health Care System
Targeting Head and Neck Cancer by Vaccination
HPV Vaccination and Cancer Prevention
Mandatory Vaccination Requirements for School Children
Vaccination Programs and Its Impact on Public Health
The Humoral Immune Response to BCG Vaccination
Renaissance Island Anthrax Test Vaccination
The Benefits and Effects of the Gardasil Vaccination in Children
Social Psychological Reasons for Increasing Vaccination Rates
Ethics, Mandatory Vaccination, and the HPV Vaccine
Vaccination Crisis and Controversies of Africa
The MMR Vaccination and Autism
Anti Vaccination Movement and Its Effects on Children‘s Well
Vaccination Against Lyme Disease: Past, Present, and Future
The Ethical Theories and Issues Surrounding Vaccination in America
Immunological Mechanisms of Vaccination
Vaccination Coverage and Reasons for Non-vaccination in Istanbul
Correlates of Protection Induced by Vaccination
Public Doubts About Vaccination Safety and Resistance Against Vaccination
COVID-19 Vaccination Hesitancy in the United States: A Rapid National Assessment
The Issues Preventing the Proper Vaccination of Children in America
Measles Dynamics and Vaccination Diffusion
Smallpox Vaccination for Critical Public Service Workers
Vaccination Myths and Its Effects on the Public Eye
Childhood Immunizations and Universal Vaccination
State Required Vaccination and Its Effects on Children
The Anti Vaccination Movement Decreasing Child Safety
Vaccination and Effective Smallpox Vaccine
Prevnar Vaccination Production Process
Vaccination for Babies 0-6 Months
Disease Eradication: Private Versus Public Vaccination
The Ethical Issues and Morality of Flu Vaccination
Cultural and Social Factors of Vaccination
Vaccination Can Save the Nation
Service Members Anthrax Vaccine Vaccination
Svir Epidemic Models With Vaccination Strategies
The Contribution of Vaccination to Global Health: Past, Present and Future
Panuveitis Following Vaccination for COVID-19
Vaccination Against Coronaviruses in Domestic Animals
Complex Correlates of Protection After Vaccination

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StudyCorgi . 2022. "111 Vaccination Research Topics & Best Vaccine Essay Topics." May 10, 2022. https://studycorgi.com/ideas/vaccination-essay-topics/.

These essay examples and topics on Vaccination were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

This essay topic collection was updated on January 9, 2024 .

Home — Essay Samples — Nursing & Health — Public Health Issues — Vaccination

Essays on Vaccination

Vaccines essay topics and outline examples, essay title 1: "the vital role of vaccines in public health: debunking myths and upholding science".

Thesis Statement: Vaccines are a cornerstone of public health, and it is crucial to dispel misinformation and emphasize the overwhelming scientific evidence supporting their safety and efficacy.

Essay Outline:

Introduction
The History and Impact of Vaccines
Common Vaccine Myths and Misconceptions
Scientific Evidence Supporting Vaccines
Vaccine Safety and Adverse Effects
The Importance of Herd Immunity
Addressing Vaccine Hesitancy

Essay Title 2: "Vaccination Mandates: Balancing Individual Rights with Public Health"

Thesis Statement: While respecting individual rights is essential, vaccination mandates are a legitimate measure to safeguard public health and prevent outbreaks of vaccine-preventable diseases.

The Concept of Vaccination Mandates
Individual Rights and Autonomy
Public Health Concerns and Disease Prevention
Legal and Ethical Considerations
Case Studies of Vaccine Mandates
Opposition and Challenges to Mandates

Essay Title 3: "The Impact of Vaccine Disinformation on Public Health: A Global Challenge"

Thesis Statement: The proliferation of vaccine disinformation poses a significant threat to public health, and addressing this challenge is vital to ensure widespread vaccine acceptance and disease control.

The Spread and Impact of Vaccine Disinformation
Factors Contributing to Vaccine Hesitancy
The Role of Social Media and Online Platforms
Countering Vaccine Disinformation Efforts
Global Initiatives and Collaborations
Case Studies on Successful Interventions

The Benefits of Vaccination

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The Issues Surrounding Vaccination and Its Importance

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The Use of Vaccination – a Choice for Every One

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The Importance of Vaccines to Prevent Infectious Diseases

Advantages and disadvantages of the various types of vaccines, chickenpox: history, symptoms and treatment, the importance of increasing hpv vaccination in children, why is vaccination of human papillomavirus significant, debate on vaccination and autism, impact of media on parents' acceptance of immunization, the use of vaccines in modern medicine and the vaccination delimma, legal and ethical issues about the mmr vaccine, an argument in favor of using vaccines, the urgent need for a vaccine against zika virus, report on the measles disease and vaccination, yellow fever disease - what problems are caused by mosquitoes, chasing polio eradication: vaccine development, the examination of human sciences in connection to the effectiveness of vaccines, the different types of vaccines, vaccine types, should vaccinations be mandatory: future safety for children, should parents vaccinate their child, should vaccines be required to attend public school.

Vaccination, also known as immunization, is a medical procedure that involves the administration of a vaccine to stimulate the immune system and provide protection against specific infectious diseases. It is a preventive measure designed to enhance the body's natural defenses by introducing harmless fragments of the disease-causing agent or weakened or inactivated forms of the pathogen.

The mechanism of vaccination involves introducing a weakened or inactivated form of a disease-causing agent, such as a virus or bacterium, into the body. This prompts the immune system to recognize and respond to the pathogen. When a vaccine is administered, it stimulates the immune system to produce an immune response, similar to what would happen during a natural infection. The immune system recognizes the foreign antigens present in the vaccine and mounts a defense by producing antibodies and activating immune cells. These immune responses help the body develop immunity against the specific pathogen. Vaccination can also involve the use of genetically engineered proteins or pieces of the pathogen to stimulate an immune response. These components are known as antigens and can be derived from the outer coats of viruses or the cell walls of bacteria. By introducing these harmless components of the pathogen into the body, vaccines help the immune system recognize and remember the specific pathogen. This way, if the individual is later exposed to the actual disease-causing agent, their immune system can mount a rapid and effective response to neutralize or eliminate the pathogen, preventing the development of the disease or reducing its severity.

1. Inactivated Vaccines 2. Live Attenuated Vaccines 3. Subunit, Recombinant, and Conjugate Vaccines 4. mRNA Vaccines 5. Viral Vector Vaccines

The origin of vaccination can be traced back to ancient times, although the concept was not fully understood at the time. The practice of vaccination, as we know it today, began with the discovery of immunization against smallpox by Edward Jenner in the late 18th century. Jenner, an English physician, observed that milkmaids who had contracted cowpox, a much milder disease, seemed to be protected against smallpox. In 1796, he conducted an experiment where he took material from a cowpox sore and inoculated it into an eight-year-old boy named James Phipps. Afterward, Jenner exposed the boy to smallpox, but he did not develop the disease. This groundbreaking experiment led to the development of the smallpox vaccine. The term "vaccination" itself comes from the Latin word "vacca," meaning cow, as the original smallpox vaccine was derived from cowpox. Jenner's work paved the way for the development of vaccines against other infectious diseases, and vaccination quickly became a widely accepted method for preventing and controlling the spread of deadly diseases.

Public opinion on vaccination varies across different societies and individuals. Overall, vaccination has been widely accepted and supported by the majority of the population, recognizing its significant role in preventing and controlling infectious diseases. Vaccines have been instrumental in eradicating or significantly reducing the impact of diseases such as smallpox, polio, measles, and more. However, there are also pockets of skepticism and opposition towards vaccination, driven by various factors such as misinformation, fear, religious beliefs, or concerns about vaccine safety. This has led to the emergence of anti-vaccine movements and vaccine hesitancy in some communities. Public opinion on vaccination is influenced by various factors, including access to accurate information, trust in healthcare professionals and scientific research, cultural and religious beliefs, personal experiences, and the influence of social media and other communication channels. Efforts to promote vaccination and address vaccine hesitancy involve public health campaigns, education, and communication strategies to provide accurate information about vaccines, address concerns, and emphasize the importance of vaccination in protecting individual and public health.

1. Disease prevention 2. Herd immunity 3. Public health impact 4. Safety and effectiveness 5. Global impact

1. Vaccine safety concerns 2. Personal freedom and choice 3. Misinformation and skepticism 4. Religious or philosophical objections 5. Perception of low disease risk

1. According to the World Health Organization (WHO), vaccines prevent between 2-3 million deaths worldwide every year. 2. Smallpox is the only disease that has been totally eradicated through vaccination. 3. Vaccines have significantly reduced the global burden of infectious diseases. For instance, measles deaths decreased by 73% worldwide between 2000 and 2018. 4. The influenza vaccine helps reduce the risk of severe illness and hospitalization. In the United States, annual flu vaccination prevented an estimated 7.5 million flu illnesses during the 2019-2020 season. 5. The average vaccine takes around 10-15 years of research and development before it is widely available.

The topic of vaccination is of paramount importance when considering the impact it has had on public health. Writing an essay about vaccination provides an opportunity to explore the profound significance of this medical intervention. Vaccination has played a pivotal role in preventing and controlling infectious diseases, saving countless lives worldwide. By delving into the subject, one can highlight the historical development of vaccines, their mechanisms of action, and the scientific evidence supporting their effectiveness. Furthermore, examining the topic of vaccination allows for an exploration of the public health implications, including the concept of herd immunity and the role of vaccination in disease eradication efforts. It also provides a platform to address the various arguments surrounding vaccine hesitancy and vaccine refusal, shedding light on the importance of accurate information, education, and communication. Moreover, the essay can delve into the ethical considerations surrounding vaccination policies, such as balancing individual autonomy with the collective responsibility for public health. By exploring these aspects, one can foster a deeper understanding of the challenges, controversies, and potential solutions in promoting vaccination uptake.

1. American Academy of Pediatrics. (2018). Immunization information for parents. https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/default.aspx 2. Centers for Disease Control and Prevention. (2021). Vaccines & immunizations. https://www.cdc.gov/vaccines/index.html 3. Gust, D. A., Darling, N., Kennedy, A., & Schwartz, B. (2008). Parents with doubts about vaccines: Which vaccines and reasons why. Pediatrics, 122(4), 718-725. https://doi.org/10.1542/peds.2007-0538 4. Larson, H. J., de Figueiredo, A., Xiahong, Z., Schulz, W. S., Verger, P., Johnston, I. G., Cook, A. R., Jones, N. S., & the SAGE Working Group on Vaccine Hesitancy. (2016). The state of vaccine confidence 2016: Global insights through a 67-country survey. EBioMedicine, 12, 295-301. https://doi.org/10.1016/j.ebiom.2016.08.042 5. MacDonald, N. E., Hesitancy SAGE Working Group. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161-4164. https://doi.org/10.1016/j.vaccine.2015.04.036 6. Offit, P. A., Quarles, J., Gerber, M. A., Hackett, C. J., & Marcuse, E. K. (2002). Addressing parents' concerns: Do vaccines cause allergic or autoimmune diseases? Pediatrics, 110(6), 1113-1116. https://doi.org/10.1542/peds.110.6.1113 7. Omer, S. B., Salmon, D. A., Orenstein, W. A., deHart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360(19), 1981-1988. https://doi.org/10.1056/NEJMsa0806477 8. Smith, P. J., Humiston, S. G., Parnell, T., Vannice, K. S., & Salmon, D. A. (2011). The association between intentional delay of vaccine administration and timely childhood vaccination coverage. Public Health Reports, 126(Suppl 2), 135-146. https://doi.org/10.1177/00333549111260S219 9. World Health Organization. (2019). Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 10. World Health Organization. (2021). Immunization coverage. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage

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170 Vaccination Research Paper Topics For Stellar Students

Research papers are a monumental highlight in your academic journey. They are a critical milestone in your studies that must be tackled with the utmost care and stellar diligence. Vaccination topics are susceptible as you have to show complete mastery of all details.

If you are pursuing a medicine course, then vaccination research topics might be an excellent area of interest. A good research paper starts with a great topic, and we are here to help you nail that. We understand the significance of research papers, and that is why we have handpicked 170 out-of-the-box vaccination research paper topics, titles, and ideas to make your work seamless.

Debate Topics About Vaccination

What is reverse vaccinology?
Look at the ways of harnessing the participation of dendritic cells in tolerance and immunity
What are some of the approaches to advance cancer vaccines to clinical utility?
Highlight innovative therapeutic and vaccine approaches against respiratory pathogens
Examine immunity to malaria and vaccine strategies
Assess molecular vaccines against pathogens in the post-genomic era
Comprehending the limitations of today’s influenza vaccine strategies and further development of more efficient therapeutic and preventative interventions
Study HIV-associated persistent inflammation and immune activation
Analyze recent advances in respiratory virus infection
What is the novel approach for anti-tumor vaccines
Unravel the challenges and progress in the development of a B cell-based hepatitis C virus vaccine
What is the functional relevance of Tatraspanins in the immune system?
Look at advanced immunization technologies for next-generation vaccines
Evaluate epitope discovery and synthetic vaccine design
In what ways can tuberculosis be treated by targeting host immunity
What are the immunomodulatory effects of drugs in the treatment of immune-related diseases
Highlight natural antibodies in health and disease
Discuss different influenza virus vaccines and immunotherapy
What are some of the shadows of cancer immunotherapy
Understanding the therapeutical potential of extracellular vesicles
A review of the ethical theories and problems associated with vaccination in America
Do vaccines love the Darwinian fitness of immune cells

Vaccination Behavior Research Topics

Unraveling demand and supply effects on the up-take of influenza vaccinations
Point out new approaches to the seasonal flu vaccine
Exploring the impact of vaccination
Investigating patient experience with, and the use of, an electronic monitoring system to assess vaccination responses
A meta-analysis of interventions that enhance the use of adult immunization and cancer screening services
Do vaccines seem to work against bacterial and viral infections, and are they effective?
Gathering the evidence for the introduction of typhoid vaccine: worldwide vaccine testing
Explore molecular mimicry to broaden the immune response to carbohydrate antigens for vaccine development
Tumor-associated glycan and immune surveillance
Rational design and application of idiotope vaccines
Assessing the effects of vaccines on immune-deficient people
What are the impacts of rapid growth and deployment of high-volume vaccines for pandemic response

Anti-vaccination Research Paper Topics

Should the state impose vaccinations, or should the choice be left up to the child’s parents?
What is the connection between vaccination and autism?
Is natural immunity better than immunity through immunization?
Examining cultural perspectives on vaccination
Are they worth it? adverse effects of vaccination on children
To vaccinate or not against HPV? A content analysis of vocabularies of motives
Vaccines: religious and cultural arguments from an Islamic perspective
Anti-science populism or biomedicine’s unresolved knots? Comparing views on the movements against mandatory pediatric vaccines
An anthropological commentary on vaccine hesitancy, decision-making, and interventionism among religious minorities
Understanding attitudes to vaccination

Research Topics For Covid-19 Vaccination

Medical mistrust in the context of Covid-19: implications for intended care-seeking and quarantine policy support in the United States
What is the acceptability of the potential COVID-19 vaccine among smokers and non-smokers?
COVID-19 vaccine hesitancy in healthcare personnel: are there any differences among classifications
Discuss various options that one can use to convince people to get the covid-19 vaccine
Examining COVID-19 vaccine efficacy after the first dose: Pfizer, Moderna, AstraZeneca
Discuss the impacts of herd immunity during the covid-19 pandemic
What are some of the effects of covid-19 vaccination on transmission of disease?
Discuss whether antibodies generated through vaccination recognize all-new variants of covid-19
Investigate how the intensity of lockdowns accelerate or influence mutation of the COVID virus
Examine how the new covid-19 strain identified in England will affect the available vaccines.
Outline which immunoglobulin types can be used as the markers for covid-19 vaccination
Which is the best way to deal with swaps after completing vaccinations in nursing homes
How do we curb vaccine hesitancy among healthcare providers?
Which one is the more dangerous, covid-19 or covid-19 vaccine? What must be the individual decision?
Analyzing Ebola and the evolving ethics of quarantine
Break down some of the side effects of covid-19 vaccination
How long will immunity last after receiving the covid-19 vaccination?
Will, a covid-19 vaccine work for everyone? Are there people who cannot get vaccinated?
Is bivalent OPV immunization capable of mitigating the impact of covid-19?
What are the expected long-term side effects of the vaccination for covid-19?
Evaluate differences between the first and second doses of the covid-19 mRNA vaccine?
Examine the ingredients in the covid-19 mRNA vaccine
Can a person’s DNA change through mRNA vaccines?
Factors that stops the body from continuing to produce COVID-19 spike protein after getting a COVID-19 mRNA
Discuss whether a person vaccinated against covid-19 will be able to spread the virus to susceptible people
Investigating vaccination adverse outcomes and costs of vaccine injury claims(VICs): In the past, present, and during COVID-19.
Who gets cured: Covid-19 and the development of critical sociology and anthropology of cure
Development of perception and attitude scales related to COVID-19 pandemic
Does the mutation of the coronavirus affect the capacity of the vaccines to prevent disease?
A case-control study: finding a link between pre-existing antibodies got after the childhood vaccinations or past infections and COVID-19?
Queue questions: ethics of COVID-19 vaccine prioritization
Disparities between Black and White in H1N1 vaccination among adults in the U.S. in 2009: A cautionary tale for the COVID-19 pandemic
Autonomy and refusal in pandemics: What to do with those who refuse COVID-19 vaccines
Knowledge, attitude, and acceptance of a COVID-19 vaccine: a global cross-sectional study
Prospects of COVID-19 vaccine implementation in the U.S.: Challenges and potential solutions
What are the effects of COVID-19 vaccines on pregnant women?
Compare and contrast the efficacy of different covid-19 vaccines.
Ways to improve covid-19 vaccine acceptance
Determination of causation between COVID-19 vaccines and potential adverse effects

Vaccination Of Children Topics

What is the essence of increasing HPV vaccination among children?
Analyze the primary diseases that vaccines prevent in children
What will happen if a child’s vaccination schedule is delayed
Look at the vaccination schedule for children in the U.S.
Can children receive more than one vaccine at a time?
Examine revaccination outcomes of children with proximate vaccine seizures
What are the impacts of measles-containing vaccination in children with the severe underlying neurologic disease?
Evaluate the challenges involved in measuring immunization activity coverage among measles zero-dose children
What is the connection between the polio vaccine and the risk of cancer among children?
Do multiple vaccines affect babies’ health and immune system in an adverse war, or can their bodies handle them?
What are the various vaccination options available for children, and are they harmful to children’s overall health?
The case for further research and development: assessing the potential cost-effectiveness of microneedle patches in childhood measles vaccination programs
Evaluate the accuracy of parental recall of child immunization in an inner-city population
Evaluating maternal acculturation and childhood immunization levels among children in African-American families in Florida
Policy analysis: the impact of the vaccine for children’s program on child immunization delivery
The effect of managed care: investigating access of infant immunizations for poor inner-city families
Who takes up free flu shots? Investigating the effects of an expansion in coverage
What are the societal and parental values for the risks and benefits of childhood combination vaccines?
Looking into trends in vaccination intentions and risk perceptions: a longitudinal study of the first year of the H1N1 pandemic

Healthcare Topics About Vaccination

Conscious consideration of herd immunity in influenza vaccination decisions
A case study of ethnic or racial differences in Medicare experiences and immunization
What preservatives are used in vaccines
Discuss the relationship between vaccines and autism
What is the role of epidemiology in infection control?
How t design and select the most relevant immunogenic peptide sequences
Discuss why the Zika virus has not had a significant impact in Africa as compared to America
What are the advantages of using the phage display technology of antibodies versus hybridism technology?
Analyzing the impact and cost-effectiveness of vaccination programs in a country using mathematical models
Malaria vaccines: progress and problems
Malaria: cloning genes for antigens of plasmodium falciparum
Fighting profits on the pandemic: The fight for vaccines in today’s economic and geopolitical context
Molecular and biotechnological approaches to fish vaccines
Immunogenicity of a whole-cell pertussis vaccine with low lipopolysaccharide content in infants
Immunogrid: an integrative environment for large-scale simulation of the immune system for vaccine discovery, design, and optimization

Thesis Topics In Vaccination

Investigating challenges and opportunities in vaccine delivery, discovery, and development
Discuss classic methods of vaccine development
What are some of the current problems in vaccinology?
Assess some of the latest tools for vaccine development
Using cost-effectiveness analysis to support research and development portfolio prioritization for product innovations in measles vaccination
Communicating vaccine safety during the introduction and development of vaccines
Highlighting viral vectors for use in the development of biodefense vaccines
What is the role of US. military research programs in the invention of USA-approved vaccines for naturally occurring infectious diseases
Curbing outbreaks: utilizing international governmental risk pools to fund research and development of infectious disease medicines and vaccines
Vaccine stabilization: research commercialization and likely impacts
Exam the unequal interactions of the role of patient-centered care in the inequitable diffusion of medical innovation, the human papillomavirus(HPV) vaccine
A case study of the status of development of vaccines and vaccine research for malaria
Enteric infections vs vaccines: a public health and clinical research agenda for developing countries
A review of research and vaccine development for industry animals in third world countries
How the research-based industry approaches vaccine development and establishes priorities
A look at the status of vaccine research and development of a vaccine for HIV-1
Modeling a cost-effective vaccination strategy for the prevention of herpes zoster infection
Using an adequate T.B. vaccination regiment to identify immune responses associated with protection in the murine model
A systematic analysis of the link between vaccines and atopic dermatitis
Do vaccines provide better immunity than natural infections?
Is there a need to be vaccinated against a disease that is not available in your country or community
How to strengthen adult immunization via coordinated action
Using the general equilibrium method to assess the value of a malaria vaccine: An application to African countries
Who should take up free flu shots?
Evaluate the impact of vaccination among health care personnel
Retail clinics and their impact on vaccination in the U.S.
Discuss the societal values for the benefits and risks of childhood combination vaccines
How safe and effective is the synovial vaccine for people above 60 years
Evaluating vaccination effectiveness of group-specific fractional-dose strategies

Law Research Topics On Vaccination

Explain why there are age restrictions for Rotavirus vaccination?
Vaccination or hygiene : Which factor contributes to the decline of infectious diseases?
Outline the main factors that cause vaccine failure
Discuss why HIV is so hard to vaccinate in uninfected people?
In what ways do maternal vaccinations affect the fetal nervous system development
How to deliver malaria vaccine effectively and efficiently
Highlight the vaccines that are specifically licensed in the U.S. for pregnant women
How does an immune genetic algorithm work?
Evaluate the relationship between the success of artificial insemination and vaccination
Outline the reasons why vaccines underperform in low-income countries
Discuss U.S. immigration and vaccination policy
Assessing the effectiveness of compelled vaccination

Vaccination Ethical Topics

What are the requirements for a strain to be used as a vaccine?
What is the best way to administer vaccines in children?
Assessing the benefits of maternal vaccination on breastfed infants
Evaluating the pros and cons of intraperitoneal vaccination
Examine ways to measure the pattern of vaccination acceptance
Investigate Covid-19 transmission, vaccination rate, and the fate of resistant strains
Look into dark web marketplaces and covid-19 vaccines.
A close look at covid-19 vaccines and kidney diseases
Contextualizing the impact of covid-19 vaccine misinformation on vaccination intent in the U.S.
Examining behaviors and attitudes of medical students towards covid-19 vaccines

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An Overview of the Vaccine Debate

Looking at Both Sides of the Argument

There is a wealth of research demonstrating the efficacy and safety of vaccines —including how some have virtually eradicated infectious diseases that once killed millions. However, this has done little to sway those who believe that untold harms are being hidden from the American public.

The vaccine debate—including the argument as to whether vaccines are safe, effective, or could cause conditions like autism —has received a lot of attention from the media in recent years. With so much conflicting information being publicized, it can be a challenge to discern what is true and what is not. Therefore, it is important to learn the facts before making health decisions.

Claims and Controversy

Those who are part of the anti-vaccination movement include not only non-medical professionals but several scientists and healthcare providers who hold alternative views about vaccines and vaccination in general.

Some notable examples include:

British healthcare provider Andrew Wakefield, who in 1998 published research linking the MMR vaccine and autism . That study has since been retracted, and he was later removed from the medical registry in the United Kingdom for falsifying scientific data.
Pediatrician Bob Sears, who wrote the bestseller "The Vaccine Book: Making the Right Decision for your Child ," which suggested that many essential childhood vaccines were "optional." However, he was subsequently put on probation by the Medical Review Board of California in 2018 for alleged medical negligence and the inappropriate writing of medical exemptions for vaccinations.
Dr. Jane M. Orient, director of the Association of American Healthcare Providers and Surgeons, who was among the leading opponents of the COVID-19 vaccine and one of the leading proponents of using hydroxychloroquine to treat COVID-19 during the pandemic.

These opposing views and claims, along with other information promoted by the news and social media, have led some people to question whether they know everything they need to know about vaccines.

Common Concerns Regarding Vaccines

The arguments made against vaccines are not new and have been made well before the first vaccine was developed for smallpox back in the 18th century.

The following are some of the common arguments against vaccines:

Vaccines contain "toxic" ingredients that can lead to an assortment of chronic health conditions such as autism.
Vaccines are a tool of "Big Pharma," in which manufacturers are willing to profit off of harm to children.
Governments are "pharma shills," meaning they are bought off by pharmaceutical companies to hide cures or approve drugs that are not safe.
A child’s immune system is too immature to handle vaccines , leading the immune system to become overwhelmed and trigger an array of abnormal health conditions.
Natural immunity is best , suggesting that a natural infection that causes disease is "better" than receiving a vaccine that may cause mild side effects.
Vaccines are not tested properly , suggesting a (highly unethical) approach in which one group of people is given a vaccine, another group is not, and both are intentionally inoculated with the same virus or bacteria.
Infectious diseases have declined due in part to improved hygiene and sanitation , suggesting that hand-washing and other sanitary interventions are all that are needed to prevent epidemics.
Vaccines cause the body to "shed" virus , a claim that is medically true, although the amount of shed virus is rarely enough to cause infection.

The impact of anti-vaccination claims has been profound. For example, it has led to a resurgence of measles in the United States and Europe, despite the fact that the disease was declared eliminated in the U.S. back in 2000.

Studies have suggested that the anti-vaccination movement has cast doubt on the importance of childhood vaccinations among large sectors of the population. The added burden of the COVID-19 pandemic has led to further declines in vaccination rates.

There is also concern that the same repercussions may affect COVID-19 vaccination rates—both domestically and abroad. Ultimately, vaccine rates must be high for herd immunity to be effective.

According to a study from the Centers for Disease Control and Prevention (CDC), the rate of complete recommended vaccination among babies age 5 months has declined from 66.6% in 2016 to 49.7% by May 2020. Declines in vaccination coverage were seen in other age groups as well.

Benefits of Vaccination

Of the vaccines recommended by the CDC, the benefits of immunization are seen to overwhelmingly outweigh the potential risks. While there are some people who may need to avoid certain vaccines due to underlying health conditions, the vast majority can do so safely.

According to the U.S. Department of Health and Human Services, there are five important reasons why your child should get the recommended vaccines:

Immunizations can save your child’s life . Consider that polio once killed up to 30% of those who developed paralytic symptoms. Due to polio vaccination, the disease is no longer a public health concern in the United States.
Vaccination is very safe and effective . Injection site pain and mild, flu-like symptoms may occur with vaccine shots. However, serious side effects , such as a severe allergic reaction, are very rare.
Immunization protects others . Because respiratory viruses can spread easily among children, getting your child vaccinated not only protects your child but prevents the further spread of disease.
Immunizations can save you time and money . According to the non-profit Borgen Project, the average cost of a measles vaccination around the world is roughly $1.76, whereas the average cost of treating measles is $307. In the end, the cost of prevention is invariably smaller than the cost of treatment.
Immunization protects future generations . Smallpox vaccinations have led to the eradication of smallpox . Rubella (German measles) vaccinations have helped eliminate birth defects caused by infection of pregnant mothers in the developed world. With persistence and increased community uptake, measles could one day be declared eliminated (again) as well.

A Word From Verywell

If you have any questions or concerns about vaccinations, do not hesitate to speak with your healthcare provider or your child's pediatrician.

If a vaccine on the immunization schedule has been missed, speak to a healthcare provider before seeking the vaccination on your own (such as at a pharmacy or clinic). In some cases, additional doses may be needed.

Vaccines Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

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Eggerton L. Lancet retracts 12-year-old article linking autism to MMR vaccines . CMAJ . 2010 Mar 9; 182(4):e199-200. doi:10.1503/cmaj.109-3179

Park A. Doctor behind vaccine-autism link loses license . Time .

Offit PA, Moser CA. The problem with Dr Bob's alternative vaccine schedule . Pediatrics. 2009 Jan;123 (1):e164-e169. doi:10.1542/peds.2008-2189

Before the Medical Board of California, Department of Consumer Affairs, State of California. In the Matter of the Accusation Against Robert William Sears, M.D., Case No. 800-2015-012268 .

Stolberg SG. Anti-vaccine doctor has been invited to testify before Senate committee . The New York Times.

Wolfe RM, Sharp LK. Anti-vaccinationists past and present . BMJ. 2002;325(7361):430-2. doi:10.1136/bmj.325.7361.430

Agley J, Xiao Y. Misinformation about COVID-19: Evidence for differential latent profiles and a strong association with trust in science . BMC Public Health. 2021;21:89. doi:10.1186/s12889-020-10103-x

Centers for Disease Control and Prevention. Measles history .

Hussain A, Ali S, Ahmed M, Hussain S. The anti-vaccination movement: a regression in modern medicine . Cureus . 2018;10(7): e2919. doi:10.7759/cureus.2919

Bramer CA, Kimmins LM, Swanson R, et al. Decline in child vaccination coverage during the COVID-19 pandemic — Michigan Care Improvement Registry, May 2016–May 2020 . MMWR. 2020 May;69(20):630-1. doi:10.15585/mmwr.mm6920e1

Centers for Disease Control and Prevention. Why vaccinate .

Centers for Disease Control and Prevention. Poliomyelitis .

Centers for Disease Control and Prevention. Making the vaccine decision .

Borgen Project. What is the cost of measles in the developed world? .

By Vincent Iannelli, MD Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.

MANDATORY VACCINATION: WHY WE STILL GOT TO GET FOLKS TO TAKE THEIR SHOTS

Ben Balding

Class of 2006

April 27, 2006

This paper is submitted in satisfaction of the Food and Drug Law course paper and the Harvard Law School 3L Written Work Requirement

Vaccination is widely considered one of the greatest medical achievements of modern civilization. Childhood diseases that were commonplace less than a generation ago are now increasingly rare because of vaccines. In order to be effective at eliminating communicable diseases, vaccines must be administered to sufficient levels of persons in the community. Because of this, public health officials have mandated vaccination for certain diseases as a condition to school attendance. The overwhelming effectiveness of vaccination programs may lead individuals to ignore the benefits of vaccination and focus more on the risk of side effects. Moreover, some have criticized the coercive nature of these programs. These objections may lead to an unacceptably high number of exemptions, which can compromise vaccination programs and leave the population susceptible to outbreaks.

This paper explores vaccination programs with an eye toward greater public safety without ignoring the reality of a small but committed group of vaccine critics. The paper begins with a discussion of the historical development of mandatory vaccination policies and the issues posed by exemptions. It then addresses some of these issues in the context of vaccine safety. It also seeks solution by framing the discussion in economic terms. It concludes by recommending stricter enforcement of mandatory requirements for most vaccines and greater dissemination of information on the continued importance of vaccination.

Introduction.

Vaccination is widely considered one of the greatest medical achievements of modern civilization. Childhood diseases that were commonplace less than a generation ago are now increasingly rare because of vaccines. The smallpox vaccine has eradicated a disease that was responsible for centuries of outbreaks and had a 30% fatality rate. [1] Physical handicaps resulting from polio can still be observed on some of those who were children before Jonas Salk developed a vaccine in 1955. Formerly common childhood diseases are now rarely observed. Even ear infections may soon be prevented by vaccination. [2] The widespread success of vaccinations has led one medical report to comment that “[n]ext to clean water, no single intervention has had so profound an effect on reducing mortality from childhood diseases as has the widespread introduction of vaccines.” [3]

The story of modern vaccination begins with Edward Jenner’s development of the vaccine for smallpox, one of the most feared diseases in recent history. At first, vaccination was optional and not everyone chose to vaccinate. [4] In time, states would allow municipalities to mandate vaccination in time of outbreak in order to protect the public from epidemics. [5] A further step was taken when states imposed smallpox vaccination as a prerequisite for attending public schools. [6] These requirements were amended in time as new vaccines were developed. [7] At some point actual outbreaks and epidemics ceased to be the trigger for mandatory vaccination, and prevention became the overriding justification. [8] Most states today require vaccination for a multitude of childhood diseases, including measles, diphtheria, pertussis, polio, and now even chickenpox. [9]

Because of the success and the mandatory nature of vaccination, most people would probably not consider vaccination an optional method of medical treatment. For most parents, the “decision” to vaccinate is equivalent to the “decision” to feed one’s child. [10] Typically, a doctor informs parents of the school vaccination schedule and the parents consent to having their child vaccinated. Since the vaccination schedule usually corresponds to the scheduled doctor visits for infants, full compliance with mandatory vaccination schedules is typically not a problem and can usually be substantially accomplished by age two. [11]

For some parents, however, vaccination is no routine matter. [12] From the time of Jenner’s smallpox vaccine, vaccination has had its critics. [13] In the two centuries since that time, many different types of objections have been raised. Some have questioned the scientific qualifications of mass immunization. [14] Others have focused on the personal liberty interests at stake and have objected to the paternalistic nature of government imposition of what is viewed as a personal medical choice. [15] Still others have opposed vaccination for personal or religious reasons. [16]

Today, some parents raise similar objections. The idea that a potentially harmful substance is being placed directly into the bloodstream raises a red flag for some. Additionally, the decline of many diseases for which vaccination is still mandated may make some parents skeptical of the continued wisdom of subjecting a child to a vaccine, even if the vaccine is considered extremely safe. This skepticism grows when some point to the correlation between vaccinations and conditions such as SIDS and autism. Whether or not such a correlation is scientifically significant, many parents simply wonder if it is wise to vaccinate against a disease unlikely to afflict their child if any chance exists that the vaccine will cause autism, SIDS, or any other side effect. [17]

Since the efficacy of a particular vaccine corresponds directly with the percentage of a given population that has been vaccinated, proponents of mandatory vaccination have sought to convince those with reservations about vaccines that vaccination is the right choice. The Center for Disease Control has attempted to allay possible reservations parents may have with vaccinations by rebutting some of the commonly held fears about vaccines. [18] The CDC has pointed out, for example, that most adverse effects from vaccines are “minor and temporary, such as a sore arm or mild fever.” [19] Because vaccination often involves the introduction of a harmful live (although seriously weakened) organism into the patient, vaccination can never be 100% safe. Serious side effects usually occur only between one per thousands to one per millions of doses, while some serious reactions and death occur so rarely that accurate risk assessment is difficult. [20] The CDC has also responded to many of the other concerns raised about the need for vaccination, and the FDA continually works to ensure vaccine safety and efficacy, but many still harbor reservations toward vaccination.

This paper will endeavor to discuss some of the most common objections to vaccination programs in general while trying to shed light on the veracity and tenability of these objections. Part I will discuss the nature of mandatory vaccination programs in this country; both scientific and historical issues will play a key part in this discussion. Part II will describe the role of the FDA and other governmental bodies in the overall vaccination picture. Part III will attempt to utilize multiple analytical tools in search of possible solutions to the dangers posed by those who may attempt to opt out of vaccination programs. It will first examine vaccination through the lens of an old television show episode. It will then adopt an economic analytical framework to discuss the balance between individual and general welfare in the context of vaccination. Part IV will conclude with some observations on how the goal of greater public health might be achieved without completely neglecting the concerns of many in the community regarding the prudence of using a medical technique that by definition relies on a degree of coercion.

I. MANDATORY VACCINATION

Historical background.

Jenner’s smallpox vaccine led to the research and development of vaccines for other widespread and epidemic diseases. The twentieth century saw the development of vaccines for such diseases as polio, diphtheria, tetanus, pertussis, measles, and others. [21] As with the smallpox vaccine, many of these vaccines soon found their way into vaccination programs mandated by the government, albeit through a somewhat different pathway.

Mandatory smallpox vaccination programs typically arose through state police power legislation authorizing municipalities to deal with outbreaks. [22] Typically, when a local municipality decided that the threat of outbreak was sufficient to exercise this authority it would require vaccination of everyone in the community (with a possible exception for individuals who could demonstrate uncommonly high health risks from receiving the vaccine, although this exception sometimes applied only to children) and fine and/or quarantine those who refused to be vaccinated. [23] When other diseases became preventable by vaccination, outbreak ceased to be the trigger for mandatory vaccination. Rather, because of their cost-efficiency and their ability to reduce and ultimately eliminate disease, vaccination programs became an important part of general public health policy. [24]

Most of the time, vaccination programs are accomplished through the dual efforts of national entities (which tend to develop and recommend vaccines) and state legislatures and local boards of health (which usually implement these recommended vaccines through vaccination programs). [25] It is not entirely accurate to refer to this as “mandatory vaccination,” as typically individual states will not criminally punish parents for not vaccinating their children or forcefully subject individuals to vaccination. [26] Instead, states typically condition school enrollment on proof of vaccination. [27] Though it may be a high price to pay, home schooling is usually an available means parents have if they wish to bypass these vaccination requirements. Moreover, most states grant exemptions to vaccination requirements for religious reasons and some even grant exemptions for philosophical reasons (in addition, every state exempts from school vaccination requirements individuals who cannot be vaccinated for medical reasons). [28]

The connection between school enrollment and vaccination programs may now seem obvious. Public health officials, faced with a means of protecting the general population from the harmful disease smallpox, realized that mass vaccination could lead to a sufficient level of immunity to eliminate the risk of outbreak, even for those in the community unable to vaccinate (because of medical reasons, for instance). [29] Because of the concept of herd immunity, public health officials considering the proper utilization of vaccines were dealing with a medical procedure quite out of the ordinary. Since vaccination itself does not typically provide 100% immunity to a disease, vaccinated individuals can still contract the disease. [30] Yet because of herd immunity, if a sufficient level of vaccination within a population is attained, the entire population will no longer be susceptible to the disease. In this way, vaccination came to be viewed not only as a personal medical choice but also as a step taken to improve the overall health of the population.

With the rise of public schooling in the mid- to late-nineteenth century, cities decided to condition public school attendance on smallpox vaccination. [31] By the latter part of the century, many states had adopted this practice. [32] Such a policy makes sense when one considers the increased risk of infectious disease in public areas like cities in general and schools in particular. By mandating vaccination for school attendance, of course, the state would eventually have ensured the vaccination of the entire population by the time the initially vaccinated generation became the oldest living one.

These vaccination schemes have faced challenges, both legal and social, throughout their existence. [33] The reasons for such challenges have ranged from personal liberty interests to doubts about the efficacy of vaccines. [34] State courts in the nineteenth century typically upheld both the enactment of mandatory vaccination programs and the delegation of power to local authorities. [35] More importantly for the future of mandatory vaccination policy, two important Supreme Court decisions in the early part of the twentieth century affirmed the power of state governments both to mandate vaccination and to delegate a broad degree of authority to local municipalities and health boards to carry out particular vaccination programs.

Judicial Approval

In 1905 the Court held in Jacobson v. Massachusetts [36] that the general police power of states is broad enough to overcome a Due Process claim brought by an individual who claimed his personal liberty interests were unconstitutionally invaded by the mandatory smallpox vaccination program in question. [37] In an opinion by Justice Harlan, the Court ruled that the constitutional guarantee of liberty “does not import an absolute right in each person, to be, at all times and in all circumstances wholly free from restraint.” [38]

This case still represents the initial constitutional basis of most mandatory vaccination legislation. Many states still provide for the governor or a public health official to mandate vaccination for all in the event of an outbreak. [39] Individuals who cannot vaccinate for health reasons or who refuse to vaccinate may be quarantined in order to protect the population in some states. [40] These laws gained greater relevance following the terrorist attacks of 9/11 and the increased public concerns regarding bioterrorism. For the most part, however, mandatory vaccination laws in the name of outbreak control have given way to vaccination requirements as a prerequisite for school attendance.

The issue of school vaccination came before the Court nearly two decades after Jacobson . In Zucht v. King [41] , the plaintiff challenged a general grant of authority from Texas to local boards of health to condition school entry on proof of vaccination. [42] To differentiate the case from Jacobson , the plaintiff noted that the San Antonio ordinances mandated vaccination even in the absence of evidence of outbreak. [43] The Court, speaking this time through Justice Brandeis, upheld the validity of the ordinances as well as the broad grant of authority to local health boards. [44] On the issue of the state’s power to mandate vaccination, he merely cited Jacobson : “[l]ong before this suit was instituted, Jacobson v. Massachusetts...had settled that it is within the police power of a state to provide for compulsory vaccination.” [45] As for entrusting a broad degree of authority on local health officials, he noted that Jacobson and other cases had affirmed that a state may “delegate to a municipality authority to determine under what conditions health regulations shall become operative.” [46] This delegation includes the permission to vest municipal officials with “broad discretion in matters affecting the application and enforcement of a health law.” [47] In summary, the Court found that these ordinances were valid assignments of “that broad discretion required for the protection of the public health.” [48] The language of the opinion emphasizes the importance of the public health as the key justification for mandatory vaccination.

Zucht , along with Jacobson , thus became the legal foundation for the mandatory vaccination laws of the twentieth century. Modern school vaccination laws and policies have grown from early mandatory smallpox vaccination laws:

The early successes of school vaccination laws against most political, legal, and social challenges helped lay the foundation for modern immunization statutes. Since the introduction of smallpox vaccination policies in the mid-to-late 1800s, states have amended them to include additional diseases as new vaccines become available. [49]

Though various amendments and additions have been made to mandatory vaccination laws throughout their history, the past half century has experienced the true culmination of mandatory vaccination policy. Public health officials have been able to institute a scheme for near-universal vaccination:

Many existing school vaccination laws were enacted in response to the transmission of measles in schools in the 1960s and 1970s. State legislatures at that time were influenced by the significantly lower incidence rates of measles among school children in states that strictly enforced vaccination requirements and school exclusions in outbreak situations without significant community opposition. Rather than having health departments require immunization in emergency conditions, legislatures acted to prevent disease by mandatory immunization as a condition of enrollment or attendance in schools or licensed day care facilities. [50]

Moreover, states have not been completely left to implement the recommended immunization schedule. [51] Though school requirements are still a state matter, national public health officials are typically able to enact their recommendations through federally funded immunization plans. [52] These plans require states to implement and enforce federally recommended immunization requirements before the states can receive federal funds. [53] The current recommended vaccination schedule appears below.

Recommended Childhood and Adolescent Immunization Schedule [54]

Challenges and concessions.

While school vaccination requirements have been credited with bringing about the control and elimination of many devastating childhood diseases, critics have continued to voice concerns and raise legal and political challenges to the entire process of mandatory vaccination.

Personal Liberty Concerns

One key argument against mandatory school vaccination has always focused on government intrusion into what is considered a personal medical choice. [55] Just as the government cannot force a person to have surgery to repair a torn ligament, for example, the government should not be able to force parents to vaccinate their children if the parents believe that vaccination is not the best medical decision. One prominent critic of mandatory vaccination has stated her organization’s goal as simply providing parents with choices: “[w]e believe that health care consumers should have the right to choose the type of preventive health care that they want to use – including choosing whether to use one, ten, or no vaccines.” [56] Other objections along similar bases argue that mandatory vaccination violates the medical ethic of informed consent or even that school district control over mandatory vaccination policies amounts to the unlawful practice of medicine without a license. [57]

The typical counterargument given by the public health officials is to point out that one’s decision to vaccinate, unlike one’s decision whether to undergo surgery, affects the health of others in the community. [58] To allow parents the right to choose not to vaccinate is to infringe on the ability of other parents to raise their children in a society free of certain deadly diseases. From a legal standpoint, Jacobson still seems to have settled the issue that at least under some circumstances, the government may force an individual to receive a vaccination.

Although public health officials have the legal authority to mandate vaccination for the public health under Jacobson, they should be very mindful of the personal liberty concerns just stated. Those with such views often cling to them vigorously. [59] As certain vaccine-preventable diseases decline, such concerns become even stronger. For this reason, it is important for public health officials to support their mandatory vaccination programs with justifiable arguments rather than simply citing legal precedent or historical tradition in support of their exercise of power. Fortunately for public health officials, the benefits provided by vaccination programs can be utilized to justify the existence of such programs.

Safety Accountability Concerns

A variation on the consumer choice challenge to mandatory school vaccination requirements tends to accuse the public health community of conspiring with or at least willfully acquiescing to powerful vaccine manufacturers at the expense of citizens. [60] Mandatory programs, the argument goes, eliminate any accountability from vaccine manufacturers that the free market might otherwise provide. [61] Both the safety and efficacy of vaccines fail to improve because manufacturers do not have to respond to consumer concerns. [62] Mandatory programs thus prevent better vaccines. A prominent critic of these programs has stated that if mandatory vaccination programs are ended, “we will have the ability to put economic pressure on the drug companies and on the health agencies to do a better job with vaccine safety and efficacy.” [63]

The strength of this argument lies in its apparent lack of hostility toward vaccines per se. Given the historical success of vaccination in eradicating smallpox and in reducing or eliminating the risk of other childhood diseases, any critique of mandatory vaccination programs that focuses on the use of vaccines generally is likely to be dismissed by those in the field of public health. By focusing on the economic drawbacks inherent in a mandatory vaccination program and how those drawbacks can negatively affect the quality of vaccines, this argument may gain more traction. Indeed, all sides of this debate claim to desire both safer and more effective vaccines.

The response to this argument, I would imagine, would be to emphasize the drawbacks of opening up the “market” in this case. Because vaccination programs depend on a sufficient percentage of the community being vaccinated, complete consumer choice carries with it problems that might be absent in a standard market. As for vaccine quality, FDA regulation is in place to ensure a sufficient level of safety and efficacy to accomplish the goals of vaccination. [64] The pressure faced by vaccine manufacturers to obtain and maintain FDA approval should provide a check sufficient to guarantee proper vaccine quality. If not, the answer should be to raise FDA standards, rather than to jettison the entire mandatory vaccination process and with it the likelihood of maintaining a sufficient level of immunity among the population.

This response might be unacceptable to those concerned. If the connection between public health officials entrusted with implementing the mandatory vaccination schedule and FDA regulators entrusted with ensuring the safety and efficacy of vaccines is seen as too close, proposing higher FDA standards as a solution may not allay concerns. The independence and integrity of FDA is therefore critical in this arena, just as it is in other areas of public health.

Concern of Unknown Risks

In what may be a combination of the two challenges previously discussed, many individuals challenge vaccine programs because of a lack of information about vaccines. [65] Many people, for example, legitimately question the wisdom of forced vaccination before long-term effects of a vaccine are studied. One website that purports “to provide a wide range of news and views on vaccination and vaccination policy” has summarized this challenge to vaccines simply as opposing the idea of “a parent, any parent, being forced to do something that has even a remote chance of harming their child.” [66] Since long-term (ten or more years down the road) and low-risk (on the order of one-per-million or less, for example) side effects may truly be unknown, this concern does present a challenge for public health officials. [67]

Unfortunately, even the best studies are unable to fully determine all long-term consequences of vaccination. In addition, “[t]here is no such thing as a ‘perfect’ vaccine which protects everyone who receives it AND is entirely safe for everyone.” [68] Therefore, it is true that mandatory vaccination probably forces some parents to inject their children with a substance that will cause some unknown harm.

As with the other objections to mandatory vaccination, however, this objection suffers from a critical flaw. Mandatory school vaccination requirements are not justified solely on the benefit they provide to the recipient. Instead, it is the benefit they provide to the community as a whole by ensuring a sufficient level of vaccination to prevent outbreak that justifies their intrusive nature on individual medical decision-making. [69] For this reason, if public health officials did not enact the mandatory vaccination program, they would be forcing on parents a system that had at least a “remote chance of harming their child.” [70] Because the decision to enact a community-wide vaccination program must be made at the general level if it is to be made at all, and because some children will undoubtedly suffer some health consequences regardless of which policy is chosen, individuals will always be able to raise this argument against mandatory vaccination programs.

A better critique of these programs would focus on whether mandatory vaccination causes more overall harm than a voluntary system; that is, is it better when viewed at the general, rather than the individual, level? Ironically, the very success of vaccination programs in reducing the incidence of once-prominent diseases has led some to ignore the overall and continuing benefit of community vaccination (herd immunity). [71] But for parents to decry the “remote chance” of harm from vaccination while ignoring the very real chance of outbreak in an under-vaccinated population is to reframe the issue entirely.

Other Concerns

Other challenges to vaccination laws have cited strongly held religious or philosophical positions against vaccination in general. Such challenges require a different type of response from public health officials; often the options are limited to overriding such objections and excluding children of parents adhering to such positions from public schools (which is constitutionally permissible under Jacobson and its progeny) or creating exemptions to vaccination requirements (which is detrimental to the overall goals of mandatory vaccination if a sufficient number of exemptors exist). Reactions to such religious and philosophical concerns vary from state to state, with a general trend toward greater accommodation of objectors.

In response to these and other challenges to mandatory vaccination laws, states have enacted various exemptions to vaccination requirements for school entry. Actual enforcement varies by state.

All states provide exemptions for those with medical risks associated with vaccines. [72] If certain contraindications indicate a likelihood of harm from a particular vaccine, the exemption will be allowed. [73] Because such cases are rare and exemptions relatively easy to enforce, there usually is very little risk of compromising the efficacy of the overall vaccination program by granting these exemptions. [74] The ability to grant medical exemptions while still maintaining sufficient levels of vaccination to provide community-wide immunity is one of the great accomplishments of the vaccination system. [75]

In addition to medical exemptions, almost every state grants religious exemptions for those with sincere religious beliefs opposing vaccination. [76] Individual states tend to vary with regard to the level of religious conviction necessary to obtain a religious exemption. Such exemptions reflect the sometimes uneasy balance between mandatory vaccination programs and First Amendment Free Exercise rights, even though the Supreme Court has validated the right of states to mandate vaccination without providing for such exemptions. [77] West Virginia, for example, does not provide religious exemptions. [78]

Some religious exemption statutes have spurred challenges on Establishment Clause grounds by those who claim they favor organized or recognized religions over the sincerely held religious views of others. [79] These challenges, if successful, would lead to the invalidation of many religious exemption statutes. Rather than decrease the number of religious exemptors, however, this may actually lead to more religious exemptors. The political climate of our day, along with the experience of a few states already (such as Arkansas), suggests that legislatures may respond to invalidation of religious exemption statutes that require adherence to an organized religion by drafting more general and expansive religious exemption statutes. [80] By subjugating religion to compulsory vaccination, courts may actually be helping to bring about a system with even more religious exemptors, thereby harming the very vaccination programs to which religious objections had been subordinated. [81]

Philosophical

The possibility that some parents who strongly oppose vaccination for other than religious reasons has led to other means of exempting from mandatory vaccination programs. In some states, people may avoid vaccination requirements by way of philosophical exemptions. [82] In California, for example, a parent need only “submit a letter or affidavit stating that the immunization is contrary to his or her beliefs” to exempt their child from vaccination requirements. [83] “Where available, parents are taking advantage of such exemptions with growing regularity; and in states offering both exemptions, the number of philosophical exemptions far exceeds the number of religious and medical exemptions.” [84]

States without philosophical exemptions, moreover, are often lax with their enforcement of religious exemptions. [85] Because of this, parents in these states can usually submit insincere affidavits purporting to object to vaccination for religious reasons and local health officials, unconcerned with delving into the sincerity of such affidavits, will widely grant exemptions. [86] In most states, therefore, persistent parents can usually find some way to exempt their children from vaccination requirements. If all else fails and vaccination is still regarded as unacceptable to the parent, the option of home schooling may provide a final avenue of evading these school vaccination requirements.

Dangers of Widespread Exemptions

The ease with which non-medical exemptions can typically be obtained has raised concerns among many that the benefits of widespread immunization are being compromised. [87] Because of the nature of medical exemptions, unvaccinated persons in a community with only medical exemptions would be expected to be few and dispersed. Herd immunity can be attained, and protection is ensured for both the vaccinated majority and the unvaccinated few. [88] Broadly granted philosophical and religious exemptions make herd immunity more difficult to attain and increase the risk to the community. This risk is exacerbated by the fact that many of those who apply for such exemptions “will cluster together in one geographic area.” [89] This cluster effect tends to increase the likelihood of serious outbreaks:

Recent studies have shown that clusters of exemptors, who are significantly more susceptible to contracting vaccine preventable illnesses, pose an increased risk of spread of diseases not only to their unimmunized peers, but also to the surrounding, largely vaccinated population. [90]

Given that many childhood diseases seem to be in decline, exemptors may fail to realize the continued value of vaccination. As the mumps outbreak in Iowa makes clear, however, vaccination programs take time and are at risk if vaccination rates fall. Other diseases are still prevalent in other parts of the world, and outbreaks can still occur in this country due to the prevalence of international travel. Ever though measles is rarely observed in the US, for example, the World Health Organization has reported that nearly 900,000 measles-related deaths occurred in developing countries in 1999. [91] Until diseases are eradicated globally, it may be necessary to continue vaccination.

Because many of the aforementioned risks are frequently underappreciated by those who seek exemptions, some have suggested a combination of stricter enforcement of exemption requirements and increased public knowledge of the reasons underlying childhood vaccination requirements. [92] Knowledge is indeed essential to the resolution of this problem. The easier it is to obtain an exemption, the less likely individuals are to understand and appreciate the importance of widespread participation to the success of a vaccination program. Greater public appreciation of the need for such participation (even for diseases that seem to be in retreat), along with greater information on the safety of vaccines can go a long way toward increasing public health in this area. [93]

Partial Exemptors – A Modern Phenomenon

The availability of exemptions has led to other interesting developments in the vaccination debate. Recently, for example, challenges have been raised against the need for mandatory chickenpox and hepatitis B vaccines. Diseases such as these, which are either not greatly feared (chickenpox) or transmitted primarily through voluntary rather than involuntary contact (hepatitis B), do not fit neatly into the typical justification for mandatory vaccination. [94] Nevertheless, public health officials have decided that recently-developed vaccines for these diseases should be placed on the recommended schedule. This has given rise to a significant number of partial exemptors – those who are not opposed to vaccination requirements per se, but who oppose particular vaccines on the schedule. Such a position may not have been comprehended by those who drafted the religious and philosophical exemptions, which seem to assume that a parent’s opposition is to vaccination generally, rather than to a specific vaccine. [95]

Because the religious exemption is usually constructed to apply to those who oppose vaccination generally because of sincere religious beliefs, would-be partial exemptors have difficulty fulfilling their optimal desires. In states without a philosophical objection, parents must choose either to accept the entirety of the recommended schedule of vaccines or to obtain a religious exemption for all vaccinations. [96] Parents who live in states with a philosophical exemption are much more able to tailor their objection to those vaccines with which they disagree. [97]

From the standpoint of a public health official, this presents two possible worlds. In the world with traditional religious exemptors but no philosophical exemptors, overall percentages of vaccinations would be relatively equal from vaccine to vaccine, and higher vaccination rates would be obtained for diseases associated with more objectionable vaccines at the expense of lower vaccination rates for diseases associated with less objectionable vaccines. [98] By contrast, in the world with philosophical exemptors, the public health official would observe higher vaccination rates for the less objectionable vaccines and lower vaccination rates for the more objectionable vaccines. [99]

The difference between these two worlds can have far-reaching implications. If parents are forced to make the all-or-nothing choice, a significant enough number could choose to forego vaccines (including some which they would otherwise accept) that herd immunity is lost, even for less objectionable vaccinations. On the other hand, a significant enough number could accept the more objectionable vaccinations to bring about herd immunity for those diseases. Though the public health official might prefer a world in which neither religious nor philosophical exemptions exist, such a world may not be possible. Therefore, the official should determine which of the two possible worlds provides a greater overall level of safety for the society. In addition, potential public reaction to a vaccine should cause the public health official to consider the ramifications the addition of a vaccine to the schedule will have on those vaccines already on the schedule.

Because partial exemptors have the potential to sway the balance between herd immunity and vulnerability, public health officials must take account of their concerns. Unlike in years past, today the development of a new vaccine presents public health officials with a choice that can affect other vaccines on the recommended schedule. Though the possibility for a chickenpox- and Hepatitis-B-free nation may seem tempting, officials should now consider the possible consequences of mandating such “borderline” vaccines. Parents who might otherwise vaccinate according to the old schedule might have second thoughts about the new vaccines on the schedule and seek means of avoiding the new requirements. If no means exist for avoiding the new vaccines other than complete exemption on religious grounds, parents who would subsequently pursue such exemptions would bring about a lower level of immunization for older diseases.

Studies may be necessary in the above situation to determine whether herd immunity status could be in jeopardy for those diseases for which vaccines are already on the schedule. While one solution might be to provide parents with greater ability to tailor their individual vaccination desires, such a solution would undermine the efficacy of newly scheduled vaccines. In addition, greater levels of flexibility in vaccination choice would undermine public understanding of the community-based nature of vaccination. I think it might be worth sacrificing the efficacy of the newer vaccines in order to maintain that of the more established ones. The public might be willing to suffer the possibility of chickenpox outbreaks, for example, in order to prevent an even minor epidemic of diphtheria or the measles.

Again, information should play a key role in the resolution of this issue. Many of the websites urging parents to carefully consider the vaccination decision do not inform parents that their decision to vaccinate may affect the overall health of the community. [100] The CDC, for its part, does urge parents to take note of this concern. [101] The very persons who most need to know of this concern (those seeking exemptions), however, are often those most likely to distrust CDC publications. For supposed citizen-oriented websites to urge individuals to make vaccination choices without considering how such decisions affect the community is irresponsible, especially given the scientific stability of the concept of herd immunity.

II. THE ROLE OF THE FEDERAL GOVERNMENT

Some of the problems posed to vaccination programs by exemptors and others could be partially solved through greater public awareness of the stringent safety and efficacy testing done on vaccines before they may enter the market. This section summarizes the role of FDA in the context of vaccination programs. In addition, this section will discuss other ways in which the federal government gets involved in the vaccination issue, concluding with a brief synopsis of the no-fault compensation scheme enacted pursuant to the National Childhood Vaccine Injury Act of 1986. [102]

FDA Regulation

Though state governments determine which vaccinations are mandatory for school attendance, the federal government plays a key role in vaccination. Perhaps most importantly, the federal government regulates the safety and effectiveness of all vaccines. The FDA’s Center for Biologics Evaluation and Research (CBER) is charged with this critical task. [103] The role of CBER ranges from pre-approval testing of potential vaccines to facility inspection to continued oversight and sampling after approval. [104] Regulation of vaccines can be more stringent than for other biologics or drugs. [105] Even after a vaccine is licensed, for example, FDA oversight is prevalent. [106] Since vaccines are derived from living organisms and are particularly susceptible to contamination and other environmental factors, manufacturers usually must submit samples of each vaccine lot for testing before release. [107]

Before a vaccine can even be licensed for distribution and use, it must go through an extensive testing process relatively similar to that of drugs and other biologics. [108] First, a new vaccine must be tested for safety on animals. [109] The vaccine manufacturer next must file an Investigational New Drug application (IND) with the FDA. [110] Studies are then undertaken to ensure safety before any human testing takes place. [111] In addition, the IND must describe the studies intended for humans. [112]

Once these initial steps are completed, proposed vaccines must undergo three phases of clinical trials, in which the vaccine is tested on humans. [113] Phase 1 testing looks only for very serious or very common problems. [114] A small number of subjects (usually less than 100) are closely monitored, usually for only a few months. [115] Testing expands in Phase 2 to begin evaluating efficacy, as well as to further test safety. [116] Phase 2 trials can last up to two years and typically include hundreds of subjects. [117] The final stage of testing, Phase 3, further studies safety and effectiveness. [118] Thousands of people may be involved in this stage of testing, and if successful it can lead to application for FDA licensing. [119]

Once the clinical trials are completed, the FDA can examine the results of the tests to determine whether the vaccine is safe and effective enough to be placed on the market. [120] At any point in the process, the FDA may halt ongoing studies if safety concerns require such action. [121] The FDA also reviews the data from the studies and inspects the manufacturing facility. [122] At this point the vaccine may be licensed.

As stated above, the FDA’s role in protecting the safety and effectiveness of vaccines does not end at the licensing stage. [123] Before any vaccines from a particular lot can be released, the manufacturer must typically submit samples for potency, safety, and purity testing. [124] Periodic facility inspections also continue for the duration of the license. [125] Furthermore, formal post-market studies may be conducted in order to identify problems that would not show up in pre-market clinical testing. [126] These tests are referred to as Phase 4 tests and are not mandatory, but can help identify problems that may only occur very infrequently. [127] Post-marketing surveillance programs are important because manufacturers are “never going to be able to do studies big enough to detect risks that might happen at a level of one in 100,000 or one in 1 million.” [128]

The Vaccine Adverse Event Reporting System (VAERS) is another valuable tool in identifying problems with a vaccine once it has been approved for the market. [129] VAERS was developed following Congress’s enactment of the National Childhood Vaccine Injury Act of 1986 and has become a very useful tool for identifying possible adverse effects that would otherwise escape detection. [130] VAERS allows anyone to report a problem that may be associated with any vaccine. [131]

It is important to keep in mind that VAERS is simply a reporting system. Experts and others use the data in VAERS to attempt to determine whether a vaccine actually causes a particular adverse effect, but the events that VAERS documents are not all caused by vaccines. It is therefore easy to understand why VAERS encourages doctors and others to report any adverse event that may be related to a vaccine. “VAERS is designed to detect signals or warnings that there might be a problem rather than to answer questions about what caused the adverse event.” [132] It is important to keep these facts in mind when looking at VAERS data, as many of the adverse effects may be completely unrelated to the vaccine in question. Often the effects are correlated with, but unrelated to, vaccination simply because many of the problems reported are those usually associated with events happening during the vaccination period (the first few years of life). [133]

Used correctly, VAERS can lead to useful studies and the discovery of potentially rare adverse effects. [134] VAERS can also be used to monitor individual lots of a vaccine. [135] Unfortunately, by encouraging individuals to report any adverse effect that may possibly have been caused by a vaccine, VAERS can provide ammunition for those claiming a definite link between a vaccine and a particular adverse effect, even if the data is silent on whether such a link exists. [136] While VAERS is in place to help identify actual risks associated with vaccines, these risks cannot be accurately assessed solely on the basis of reported incidents of adverse effects. [137]

The real value of VAERS lies in the testing and hypotheses that are developed in response to the data that has been reported. Because of the serious adverse effects already occurring during the typical vaccination period, it will often be easy and convenient to point to the correlation between vaccines and reported adverse events. Lost in the picture is the foundational proposition that VAERS is, at its core, a data collection system. To forego scientific inquiry and point instead to simple correlation may be convenient, but it is unwise. [138]

The recent public discussion surrounding the use of thimerosal as a preservative in vaccines helps to illustrate the importance of the FDA and other factors in furthering the goals of vaccine safety and public confidence in the entire safety regulatory process. Thimerosal is a mercury-containing organic compound that for many years has been used as a preservative in vaccines to help prevent contamination with microbes that could potentially be fatal. [139] Recently, fears that mercury at very low levels may be toxic to the brain have raised concern among many in the public about allowing the use of thimerosal in vaccines. [140] Many began to fear a connection between thimerosal and autism. [141] Standard FDA testing of lots, as well as studies measuring the amount of mercury contained in the standard immunization schedule versus accepted safe amounts, did not lead to safety concerns sufficient to pull thimerosal from the market. [142] Though one committee (the Immunization Safety Review Committee, commissioned by the Institute of Medicine) concluded that a theoretical link between thimerosal and autism was biologically plausible, most health experts continue to assert that there simply is no scientific evidence of a link between the two. [143]

During this time period FDA performed additional tests to verify or refute the supposed link between thimerosal and autism. [144] In 1999, FDA performed a comprehensive study and review of thimerosal use in vaccines for children. This review revealed no risk from thimerosal use, other than “local hypersensitivity reactions.” [145] Indeed, none of the standard safety protocols in place suggested or required that FDA pull thimerosal from the market. This is not to say, however, that no risk existed. As is clear from the foregoing summary of FDA vaccine approval, not all adverse effects will be known from clinical trials. [146] It may take years or longer to assess some of the risks of vaccines, including the risk of thimerosal as a preservative. [147]

Continued public concern over the safety of thimerosal caused FDA to begin to work with vaccine manufacturers in order to reduce or eliminate thimerosal from vaccines as a precautionary measure. [148] About this time, the American Academy of Pediatrics and the Public Health Service urged the removal of thimerosal from vaccines. [149] Today, with the exception of the inactivated influenza vaccine, all recommended childhood vaccines are either thimerosal free or contain only trace amounts of the compound. [150] Even though the risk may not have been as great as feared by the public or even existent at all, if the new vaccines are equally effective, the elimination of thimerosal from vaccines can probably be seen as a safety improvement, albeit at the expense of the added research and development needed to create the new thimerosal-free vaccines.

Rather than quell the existing safety concerns, this action led many of those who had decried the use of thimerosal to accuse FDA of participating in a cover-up to protect vaccine manufacturers. [151] Government agencies, for their part, continue to claim that vaccines with thimerosal are as safe as thimerosal-free vaccines, suggesting that the added development may have been superfluous. [152] While this may be so, the availability and now prevalence of thimerosal-free vaccines does provide the scientific and medical community with a new means of assessing the possible autism-causing effects of thimerosal. Namely, since thimerosal is suspected to cause autism within the first few years of life (the routine vaccination calendar), those who were vaccinated in the years since thimerosal-free vaccines have comprised the overwhelming majority of vaccines (that is, those born after 2001) would be expected to experience lower incidences of autism than the groups vaccinated with thimerosal-containing vaccines. [153]

In spite of the potentially costly decision to encourage the development of thimerosal-free vaccines when there is no sufficient safety concern to pull thimerosal from the market, FDA and other government officials have had little success in assuaging the fears and concerns of thimerosal critics. [154] Scientific arguments often fail to persuade, either because they are inconclusive or because of a perceived bias favoring vaccine manufacturers. [155] To back up their own arguments, thimerosal critics rarely point to scientific studies. [156] Instead, their reasoning seems to stem more from anecdotal evidence and comparison of thimerosal (which contains ethyl-mercury) to methyl-mercury-containing fish. [157] Representative Dan Burton (R-Indiana), a key supporter of the fight against thimerosal, explained that his belief in the toxicity of thimerosal stemmed from a personal episode: “[m]y grandson received nine shots in one day, seven of which contained thimerosal, which is 50 percent mercury as you know, and he became autistic a short time later.” [158] Others point to the rise in autism rates in the past twenty years and put the onus on the medical community to prove that this rise is not due to thimerosal. [159]

The response of health officials has been to ask why the burden should be placed on them to disprove a link between thimerosal and autism; cell phones, ultrasound, or diet soda could just as easily be the culprit. [160] Indeed, the typical response to those charging vaccination with causing many of the adverse effects occurring in life’s first few years is to point out that usually such accusations are based on nothing more than the temporal proximity of the vaccine and the illness. Some have suggested that the rates of autism may be on the rise not because of thimerosal, but because of generally more accurate diagnosis of the affliction. [161] In the past, an autistic child may have been wrongfully diagnosed with other mental disorders. [162] Figures showing a correlation between the rise in autism and the drop in other diagnosed mental disorders bolster such assertions, and suggest that vaccination may simply be a convenient scapegoat. [163]

As the thimerosal issue makes clear, vaccines often provoke strong feelings amongst various segments of the population. [164] Proper consideration of public reaction to its actions is a delicate aspect of FDA regulation of vaccine safety. To complicate matters further, one can easily imagine an equally vehement response and similar claims of conspiracy had the FDA not worked to reduce thimerosal from vaccines as a precautionary measure. Indeed, public confidence in the safety of vaccines is often influenced by factors outside the typical FDA calculus. Though FDA must act in the interests of the general safety regardless of public opinion, it may sometimes be necessary for FDA to consider public opinion, at least when exercising discretionary oversight. After all, the entire VAERS system is to a large extent dependant on public cooperation. Nevertheless, when the choice is between FDA popularity and doing what is right for the safety of Americans, the FDA should not allow itself to be swayed by a misinformed public.

Vaccine Injury Compensation Program

Congressional reaction to safety concerns goes beyond the adverse reporting system VAERS. The National Childhood Vaccine Injury Act of 1986, which created VAERS, also created a no-fault compensation scheme for people injured or killed by vaccines as an alternative to the traditional tort system. [165] This system was intended to efficiently and rapidly compensate those who are actually injured by vaccines while maintaining an environment in which further vaccine research and safety improvement could exist. The situation giving rise to this compensation program sounds remarkably similar to the more recent concerns surrounding thimerosal:

In the early 1980's, reports of harmful side effects following the DTP (diphtheria, tetanus, pertussis) vaccine posed major liability concerns for vaccine companies and health care providers, and caused many to question the safety of the DTP vaccine. Parents began filing many more lawsuits against vaccine companies and health care providers. Vaccination rates among children began to fall and many companies that develop and produce vaccines decided to leave the marketplace, creating significant vaccine shortages and a real threat to the Nation’s health. [166]

Funding for the no-fault compensation scheme initially came from Congressional grants of federal tax dollars totaling $110 million per year. [167] Since October 1, 1988, funding has proceeded from the Vaccine Injury Compensation Trust Fund, which is funded by a $0.75 excise tax on all doses of vaccines covered under the program. [168]

One may wonder what makes vaccines worthy of an alternative dispute resolution system. Perhaps it is the result of the power of the vaccine manufacturing lobby or simply an attempt by Congress to pass some legislation in the face of strong public sentiment. Although these reasons may appear plausible, it seems more likely to me that the Act created this no-fault compensation scheme because of the mandatory nature of vaccination. For those injured by other medical devices or drugs, the traditional tort system or medical insurance seem the proper means of addressing the issue. When people are told to undertake a medical procedure they may not agree with because it helps further a public goal, however, it may make sense to have a system in place whereby they can obtain relief quickly if harmed by the procedure. Moreover, because certain vaccines may be closely associated with particular adverse effects, the efficiency of a no-fault scheme may trump the standard fact-finding processes of the legal system. The government has chosen to enact such a no-fault scheme, and err on the side of compensation.

III. ANALYTICAL MEANS OF ADDRESSING THE ISSUE

The concerns and problems raised in the context of mandatory vaccination programs do not readily suggest a simple answer. In examining the issue, I came across two particularly useful tools for analyzing the problem. The first comes from an old episode of The Andy Griffith Show in which a local farmer refused to accept a vaccination from the local nurse. In addition to providing substantial entertainment to the viewer, the characters can be viewed metaphorically to represent the various parties in the mandatory vaccination debate. The episode’s solution, in turn, sheds some light on the current debate.

This section will also utilize the analytical framework of economic analysis. Though not as enjoyable a topic as The Andy Griffith Show, economic theory helps to reshape the vaccination discussion and greatly facilitates the process of assessing the various positions.

“We got to get folks to take their shots” – Sheriff Andy Taylor [169]

The Andy Griffith Show addressed the concept of popular resistance to universal vaccination over forty years ago. In “The County Nurse,” Sheriff Andy Taylor confronted a local nurse who was trying to bring everyone up to date on their tetanus shots. Not surprisingly, at least to Andy, many of the mountain farmers had not been inoculated. The naïve nurse would soon discover the reason for the low vaccination rate.

Rafe Hollister, one of the leading farmers in Mayberry, had little use for modern medicine or doctors in general. “We don’t need any nurse, nobody gets sick up here.” [170] Thermometers? “I know when I got a fever, I’m hot.” [171] Stethoscopes? “I know my heart’s beating, I’m alive ain’t I?” [172] But his strongest objection was saved for vaccinations: “I ain’t never been jabbed and I ain’t fixin’ to be.” [173] Such were the views that the nurse was up against in her attempt to achieve 100% vaccination rates.

Rafe Hollister

Rafe Hollister’s reasons for opposing vaccination went beyond his desire to avoid getting “jabbed.” He was a farmer who lived off the land, and when he got sick he let his body fight the sickness naturally. His daddy had lived to the age of hundred and he aimed to do the same. [174] The concept of a vaccination was certainly something foreign to him, as was the idea that a health official could force him to do anything. Even in the wake of the nurse’s impassioned plea to accept a shot that could someday save his life, he retorted simply, “I done alright before you come around and I’m doing alright now.” [175]

Although the county nurse was not acting pursuant to a mandatory vaccination program, under the circumstances her attempts to get Rafe inoculated were pretty forceful. The nurse was accompanied by the local sheriff to Rafe’s farm to try to convince him to take the shot, and when he refused, the sheriff and nurse continued to attempt to make him acquiesce. When Deputy Barney Fife heard of Rafe’s stubbornness, he insisted the nurse return to Rafe’s farm with him to force Rafe to take the shot. After all, boasted the deputy, “Rafe Hollister’s like a child and he’s gotta be treated like one...I’ll make him take his shot.” [176] When the deputy arrived at Rafe’s farm yelling that he was forcing Rafe to accept the vaccination, Rafe decided to fight the mandatory vaccination by drawing his rifle and forcing the deputy to leave the farm.

In a classic manifestation of the early spirit of the television series, Sheriff Andy Taylor finally convinced Rafe to take the shot through a little reverse psychology. Andy began by facetiously praising Rafe’s refusal to take the shot as stemming from Rafe’s desire for immortality. Namely, by refusing to take the shot, Rafe was sure to become the impetus for all the other townspeople not to neglect to take their shots. Unfortunately for Rafe, this heroic stature would only be achieved posthumously, as he will have succumbed to a violent and painful death from tetanus. As Andy explained to Rafe, someday, after getting cut by a rusty saw or bitten by an animal, without the shot he’ll “be a cinch to go.” [177] Eschewing the chance to be a dead hero, Rafe finally took the shot.

Sheriff Andy Taylor

Vaccination has changed the modern world. Indeed, it has led to the elimination or significant decline of many diseases that once posed significant and potentially deadly health risks. Public health officials in the United States have managed to institute a program that, though subject to variations on a state by state basis, essentially mandates certain vaccinations as a requirement for school attendance. While these vaccination programs are touted by most public health officials, a significant number of people oppose mandatory vaccination. The County Nurse episode helps illuminate the perspectives of the various sides of the issue, as well as one possible solution.

The nurse herself represents the public health officials. Though she is not implementing a mandatory vaccination program, her stated goal is to inoculate 100% of the population. [178] As mentioned above, she has the assistance of local law enforcement and she is quite persistent. Rafe Hollister, the stubborn farmer, represents those within the community who oppose or resist mandatory vaccination programs. His reasons initially rest on a general reluctance to stray from natural medicine. In this way he represents the contingent of society that scientists and medical researchers will always find difficult to convince of any developments in the medical field. In many ways, he is comparable to the plaintiff in Jacobson . Andy and Barney can be seen as the arms of the state that are entrusted with carrying out the general vaccination plan. Their varying styles can be seen as varying state requirements and enforcement options for vaccination.

Though these comparisons may seem elementary and of little value, the character development that the characters undertake during the episode greatly increases the episode’s usefulness as a surrogate for real world concerns and issues. Rafe resists the shot initially not only because he distrusts medicine in general, but also because he resents the idea that a county nurse can make him do anything. Many who resist mandatory vaccination schemes do so because of personal liberty concerns; they do not want the government to tell them what to do, especially in the context of personal medical decisions. Just as Rafe’s stance becomes more vehement the harder the nurse attempts to convince him, many who oppose mandatory vaccination see the persistence of the medical community as evidence of blind adherence to a potentially dangerous system, or worse yet as an active promotion of the special interests of the vaccine manufacturers. [179] The episode does not paint the nurse in this way at all, however. Rather, after seeing how strongly Rafe opposes vaccination, the nurse passionately pleads with him to reconsider. Her stance truly seems to stem from a genuine concern that he not suffer the potentially terrible effects of the disease. [180] As before, he refuses; this seems to illustrate that the stance of some may be so strong that they will never accept vaccination on the basis of arguments advanced by government officials.

Barney Fife’s insistence that Rafe accept the shot demonstrates the lack of understanding among many in the government and in the general population as to the vehemence with which those opposing mandatory vaccination hold to their views. His paternalistic stand only serves to exacerbate the situation with Rafe. Indeed, Barney Fife helps to illustrate that there cannot be a one-way solution to the issue of mandatory vaccination.

Andy Taylor’s method of convincing, which eventually carried the day, may not be very conducive to real-world implementation. After all, it is unrealistic to think that reverse psychology will convince those currently opposed to vaccination programs to change their minds. What I think is important to notice, however, is the role information can play in this issue. Andy finally convinces Rafe Hollister to take his shot after describing the horrible effects of the disease and how likely Rafe is to contract it. Similarly, any solution to the issue of mandatory vaccination holdouts must rely on increased information dissemination. That the information in the episode came from a trustworthy source may also have been crucial, which seems to imply that public health officials may need to work more closely with local personnel in order to obtain higher vaccination rates.

Because this episode deals with the vaccine for tetanus, a non-communicable disease, the usual community-based arguments in favor of vaccination do not enter the equation. Extra-personal consequences of Rafe’s decision to vaccinate do exist, however. Most importantly, as the unofficial leader of the farming community, his decision will be followed by the other farmers. This is shown both in Andy’s assurances to the nurse that Rafe is the most important of the farmers to convince on the issue and later, after Rafe has decided to get the shot, in his promise to the nurse that all she has to do is come with him and he’ll get all the farmers to take their shots. Perhaps those parents who support vaccination can help bring about higher vaccination rates by being more vocal and persistent with their neighbors who oppose vaccination programs.

Economic Analysis

Economic analysis [181] provides a useful theoretical basis for evaluating the competing sides of the vaccination debate. Arguments regarding the wisdom of the current vaccination policy can often be recast as economic questions involving a cost-benefit analysis.

When an epidemic breaks out, for example, the benefits of vaccination (protection from the disease both for the individual and for society through herd immunity) seem more clearly to outweigh the costs (potential side effects of the vaccine, decreased ability of the immune system to defend the body from variant strands of the disease, or personal or religious objection). Vaccination rates would, therefore, be expected to be highest during such epidemics. Consequently, those few who continue to oppose vaccination during such epidemics would be expected to do so for only the strongest reasons. This is due to the fact that in economic terms, the opponent of vaccination would have to believe that the benefits of vaccination still do not outweigh the costs, even during an epidemic. This might stem from a relative undervaluation of the benefits of vaccination (perhaps due to a belief that contracting the disease would not be so bad) or a relative overvaluation of the costs of vaccination (possibly due to the greater cost to the conscience of the personal or religious opponent of vaccination) or some combination of both. Medical exemptions directly illustrate this cost-benefit analysis: for a person likely to suffer serious side effects from a vaccine, the cost of vaccination is much greater than the cost to the average individual. Even in a time of epidemic, therefore, vaccination might not be rational for such an individual.

This economic analysis of vaccination is well illustrated by the facts of Jacobson v. Massachusetts [182] , the first Supreme Court case addressing the constitutionality of mandatory vaccination legislation. The case involved a Massachusetts statute allowing local authorities to mandate vaccination for smallpox if necessary for the public health and safety. [183] Subsequently, and upon a determination that smallpox was “prevalent to some extent” and “continues to increase,” the city of Cambridge passed a mandatory vaccination ordinance. [184] This ordinance represented the economic determination that the benefit of mandatory vaccination outweighed the cost of supplying vaccines, finding and prosecuting holdouts (such as Jacobson), and the decreased liberty of individuals to be permitted to decide whether to vaccinate.

Jacobson subsequently challenged his prosecution under the ordinance by claiming it to be an unconstitutional denial of his liberty under the 14th Amendment (as well as in violation of the Preamble and the “spirit” of the Constitution, arguments that were summarily dismissed). [185] In economic terms, this may simply indicate that he viewed the cost of accepting a forced vaccination (perhaps of any kind, in any circumstance) as greater than any possible benefit. A closer look at his arguments, however, suggests that he may have performed a more detailed cost-benefit analysis. One can easily convert the various arguments he attempted to advance into economic costs. Among these arguments were the likelihood of vaccination to bring about “serious and permanent injury” and occasional death, the inability of an individual to assess the risk of vaccination in a particular case, and the potential impurity of vaccines and inability to test such impurity, among others. [186] At the very least, it would appear that Jacobson attributed a greater than average cost to vaccination.

The statute also provided that ordinances mandating vaccination provide an exception for “children who present a certificate, signed by a registered physician, that they are unfit subjects for vaccination.” [187] This reflects the state’s determination that the cost of forcing vaccination upon those more likely to suffer adverse side effects outweighed the benefit of completely universal vaccination. Given the determination that near-universal vaccination was required to provide the desired benefit, one would expect that the state expected to grant relatively few medical exemptions (or at least few enough not to seriously compromise the goal of providing protection against smallpox through vaccination).

In rejecting Jacobson’s liberty challenge to the ordinance, the Court endorsed the concept that the State’s cost-benefit analysis can supersede that of the individual, at least in the area of public health. The Court’s decision, in fact, makes irrelevant any individual cost-benefit analysis in the face of a comprehensive mandatory vaccination program.

Various vaccination-related developments in the century since Jacobson can also be cast in an economic analytical framework. Certainly the benefit from vaccination disappears when a disease has been eradicated, which explains why the smallpox vaccine is no longer mandated. Any cost greater than zero (the likely benefit of smallpox vaccination at this point, barring of course a reintroduction of the disease using laboratory samples) will suffice to outweigh this benefit. [188] The success of vaccination policies, however, may lead to an undervaluation of the benefit of continuing to vaccinate due to the lack of visible instances of the disease. [189] This problem may be compounded when vaccines are mandated for diseases which are not associated with high mortality rates, such as chickenpox. A further complication to the cost-benefit analysis arises when assessing vaccination policy for diseases such as Hepatitis B, which is spread typically through voluntary contact. In such a case, an individual who feels highly unlikely to engage in the behavior giving rise to the risk of the disease might rationally see very minimal benefit from vaccination, while the state may view widespread vaccination as the most cost-effective method of dealing with the disease. [190]

Altruism and Free Riding

Given the continuing policy of vaccinating for diseases that have become relatively rare in recent decades, one might expect individual cost-benefit analyses to increasingly come into conflict with the societal policy. Several factors, however, serve to counteract this possibility. Perhaps most significantly, it is likely that many parents defer on the question of vaccination and accept the cost-benefit analysis of the state (communicated to the individual through the vaccination schedule and through doctor’s recommendations) as their own. Along the same lines, many individuals might not strongly consider the pros and cons involved in vaccinating; if the possibility exists for contracting a disease, and a vaccination is available, the decision may already be made. [191] A third possibility implicates a factor that I have not yet mentioned in relation to the individual cost-benefit analysis: altruism.

Some have proposed that altruism may bridge the gap between incompatible cost-benefit analyses of states and individuals. [192] Whereas typical medical decisions affect only the patient making the decision, it is pointed out, medical decisions regarding vaccine-preventable diseases usually implicate outside interests. [193] A patient thinking only of his own interests may forego vaccination if he feels the risk from vaccination outweighs the personal benefit. Altruism, it is argued, may present a separate benefit for such an individual. [194] Though the individual may not consider the risk of contracting the disease high enough by itself to justify vaccination, he may still vaccinate in order to help accomplish the public goal of eliminating the threat of an epidemic. Public health officials hope that comprehensive vaccination will produce herd immunity. [195] Thus the individual who may otherwise forego vaccination might undertake it in order to “do his part” for the community at large. Individuals who cannot vaccinate are particularly dependent on this sort of altruistic behavior, as they often have no other protection from the disease. [196]

Working against this altruistic behavior is the temptation of individuals to enjoy the benefit conferred on them by herd immunity without undertaking the cost of being vaccinated personally. [197] This is widely referred to as “free riding,” and greatly undermines the goal of comprehensive vaccination. Since herd immunity is supposed to create a level of protection sufficient for even those few who are not vaccinated, a small number of free riders might not pose a significant problem. As described earlier in this paper, comprehensive vaccination programs are designed to work even though some members of society cannot be vaccinated. [198] The problem arises when the number of free riders becomes sufficiently high to compromise the ability of the society to achieve herd immunity. Since the average citizen (one with no greater reason to avoid vaccination than any other member of society) could always choose to free ride if immunization were voluntary, herd immunity might never be achieved. This is one of the key arguments advanced in support of government mandated vaccinations. [199]

Ex Ante Versus Ex Post

The concepts of altruism and especially free riding emphasize the importance of ex ante (before the fact) versus ex post (after the fact) decision making in the context of vaccination. One of the main benefits of economic analysis is that it requires decisions to be justified ex ante. Public health officials, for example, are faced with the decision of whether to mandate vaccination for a particular disease at a time when all adverse effects cannot be known. They must weigh the possible consequences of allowing a disease to continue against the possible known and unknown adverse effects of a vaccine that may have just entered the market. When this decision is made properly, the benefit of the vaccination program will have outweighed the cost. The benefit is manifested in lower or no occurrences of the disease, while the cost is seen most directly in those children who have actually experienced adverse effects as a result of the vaccine. If the benefit is greater than the cost from an ex ante perspective, to the economist there should be no second-guessing of the vaccination program. [200]

The economist, of course, is not the parent. Parents who decry mandatory vaccination as the cause of their child’s adverse reaction are typically viewing the situation ex post. That the program has been implemented assumes that the sum of these adverse reactions was an acceptable alternative to non-implementation, and should therefore not be allowed to undermine public confidence in the program. When one surveys the landscape of the vaccination issue, however, objections are usually of the ex post variety. Since it is harder to appreciate the absence of an epidemic than the presence of a child suffering a vaccine-related injury, it is easy to look at the issue solely ex post. In the interests of public safety, such reasoning should be avoided.

This is not to imply that all critics of mandatory vaccination are on unsound theoretical footing. In fact, those whose objections are marked by a distrust of the government authorities in charge of implementing vaccination programs can be seen as questioning only the ex ante judgment of the officials. If this is so, they are actually on firmer ground than those who object to the programs because they feel their child was harmed by the vaccine. Ex ante critiques are valuable because they can bring about change in the system at a time when it can still prove useful.

The National Vaccine Injury Compensation Program represents a theoretically sound program under these criteria. Economically, it represents the idea that some of the costs of mandatory vaccination programs known only ex post will be compensated by all those who share the benefits ex ante. The excise tax, paid ex ante by all who receive the vaccine, is used to compensate anyone who experiences certain adverse effects ex post. This is simply an example of the government distributing the costs of the vaccination program across the spectrum of those who receive the benefit, rather than an ex post complaint by those on whom the costs have fallen.

Other Issues

The modern trend toward more widely-granted exemptions represents government acquiescence toward a certain degree of free riding. Should such exemptions proliferate too widely, herd immunity may indeed be lost and a recalculation of the cost-benefit analysis of individuals will be necessary. In the face of a greater potential to contract disease, the benefit of vaccination grows significantly, while the cost of accepting the vaccine remains the same. Likewise, from the standpoint of the government, the cost of allowing widespread exemptions will eventually overtake the benefit of permitting such exemptions if that cost suddenly includes serious risk of epidemic.

The risks associated with non-vaccination can be illustrated through a rather simplified mathematical example. [201] Suppose a school with 1,000 students is exposed to a measles outbreak. 990 of the students have received all of their measles shots, and so are fully immunized. Suppose further that the measles vaccine is 99% effective; that is, it produces complete immunity in 99% of patients. [202] Therefore, 10 out of the 990 who have been fully immunized will be susceptible to the disease. In addition, all 10 of the 1,000 students who had not been fully immunized will be susceptible to measles. Therefore, 20 out of 1,000 students will get the disease. Although the number of infected students who were vaccinated is equal to the number who were not, this example demonstrates that vaccination can be very effective even if it sometimes does not produce immunity in an individual. If no one had been vaccinated, 980 more students would probably have caught the measles. It is also important to note that this example assumes an epidemic; in reality, herd immunity would probably be attained at this level of inoculation and none of the 1,000 students would have caught the disease.

IV. CONCLUSION

Vaccines have immeasurably improved our quality of life. They have led to the eradication of deadly diseases like smallpox and the near elimination of diseases such as diphtheria, polio, and measles. Outbreaks of vaccine-preventable diseases, such as mumps, are infrequent and are also quite newsworthy on the rare occasion that they do occur. And people like Rafe Hollister can survive a run-in with a rusty saw or an animal bite.

The life-saving benefits of vaccination often overshadow the vast economic and personal benefits it has helped provide. Jonas Salk’s cure for polio has spared generations from a life hindered by the devastating physical handicaps of that terrible affliction. Children no longer must miss vast stretches of school to overcome a debilitating battle with pertussis (although there is no doubt that some children lament this decline in excused absences from school). Parents no longer have to spend restless hours worrying as their children suffer the body’s natural response to disease. In economic terms, this translates directly into fewer missed hours of work and less administrative difficulty, leading to a generally more productive society.

For all the benefits of vaccines, of course, it is important not to ignore the costs. The National Vaccine Injury Compensation Program is one way of dealing with the economic costs of vaccination, but this may provide little solace to the parent of a child who has been injured by a vaccine for a disease that is seemingly in decline. Side effects with very low probability will sometimes occur; though from a community-wide view this possibility is acceptable, for the individual who experiences the adverse effect the vaccination may not have been the best medical decision. Many who view natural immunity as a rite of passage for children might not desire a means of bypassing the disease entirely.

Some may accuse public health officials of dreaming for an unreachable day when all diseases are controlled by vaccination. Zeal on the part of public health officials, however, should not overshadow the actual benefits of vaccination generally. Soon may come the day when diphtheria, like smallpox, will be eradicated globally. At that point, it can be removed from the vaccination schedule and future generations will reap the benefits of vaccination while undertaking none of the costs.

This prospect, I think, sheds light on the ultimate solution to vaccination issues that have been discussed in this paper. Highly communicable and especially terrible diseases should continue on the vaccination schedule until they are virtually eliminated. The eventual elimination of these scourges will someday make vaccination unnecessary, and the costs of vaccination will drop to zero. Until that time, officials should seek stricter enforcement of the mandatory vaccination laws and should tighten down on non-medical exemptions. At the same time, information campaigns should be considered in the interest of reminding the public of the continued importance and relevance of vaccine programs. Though risks are unavoidable when dealing with vaccines, parents should constantly be reminded that immunity depends on a high level of cooperation. This will hopefully keep immunization rates high, at least for the most harmful diseases.

Meanwhile, public health officials may be wise to consider an alternate stance toward somewhat less-important vaccines such as Hepatitis B and varicella (chickenpox). [203] With such diseases it may be worthwhile to wait longer before placing the vaccines on the recommended schedule. This will undoubtedly make herd immunity more difficult if not impossible to attain, while simultaneously announcing to parents that undertaking the vaccine in question is a personal medical decision. Most of those who choose to vaccinate (and accept the risk of adverse effects from these newer vaccines) will still acquire immunity. Without a mandatory program in place, however, one would still expect to see regular occurrences of the disease. Given the relatively high likelihood of outbreak under these circumstances, a percentage of those who vaccinate will probably get the disease. They will likely turn to those who did not vaccinate at all and see them as the cause of the outbreak. In time, social pressures may lead to greater vaccination rates, and the time may be ripe for greater acceptance of mandatory vaccination for the disease.

One significant benefit to this approach lies in its natural tendency to point out to parents the importance of receiving the more important vaccines. When some vaccines are mandatory and others are not, the distinction between the two types of vaccines is impossible to neglect. It would hopefully make parents think more carefully before attempting to gain an insincere exemption. This approach would fail to satisfy those who want parents to have the option to choose “one, ten, or no vaccines,” [204] but it would at least allow an element of choice for some vaccines while hopefully maintaining a sufficient level of immunization for the more important vaccines. It is also important to remember that parents with serious reservations about any vaccines will usually have the option of home schooling. Overall, this approach might have the advantage of winning over those who only partially object to the vaccination schedule, thus helping bring about a greater chance of herd immunity for diseases associated with less objectionable vaccines.

Vaccination certainly is unique among medical treatments, both for its incredible potential and its coercive nature. It is unfortunate that questionable evidence has led many concerned parents to question the wisdom of vaccination programs that still serve important goals. Given the importance of public support for the achievement of these goals, however, public health officials must account for sometimes questionable concerns in determining vaccination policy. Greater information dissemination, combined with more sharply drawn (and potentially vaccine-specific) guidelines, can hopefully further the important goals of vaccination policy.

[1] Center for Disease Control, “Smallpox Disease Overview,” at http://www.bt.cdc.gov/agent/smallpox/overview/disease-facts.asp (last visited April 27, 2006).

[2] GlaxoSmithKline is currently developing an ear infection vaccine and plans to seek regulatory approval shortly. Jessica Said, “Vaccine Could End Children’s Ear Infections,” CNN online article, March 3, 2006 (on file with author).

[3] Institute of Medicine. CP Howson, et al. eds. Adverse Effects of Pertussis and Rubella Vaccines. Washington, DC: National Academy Press; 1991, at 1.

[4] James G. Hodge, Jr. and Lawrence O. Gostin, School Vaccination Requirements: Historical, Social, and Legal Perspectives , 90 Ky. L. J. 831, 867 (2001).

[5] See, e.g., Jacobson v. Massachusetts , 197 U.S. 11 (1905).

[6] Hodge and Gostin, supra note 4, at 867.

[7] Id. at 868.

[8] “Rather than having health departments require immunization in emergency conditions, legislatures acted to prevent disease by mandatory immunization as a condition of enrollment or attendance in schools or licensed day care facilities.” Id.

[9] See id. ; see also infra Part I (chart describing the current recommended vaccination schedule).

[10] The Center for Disease Control has gone so far as to suggest that “to have a medical intervention as effective as vaccination in preventing disease not use it would be unconscionable.” Center for Disease Control, National Immunization Program publication, “Six Common Misconceptions About Vaccination and How to Respond to Them,” at http://www.cdc.gov/nip/publications/6mishome.htm (last visited April 27, 2006) (hereinafter “Six Common Misconceptions”).

[11] Center for Disease Control, National Immunization Program publication, “Ten Things You Need to Know about Immunizations,” at http://www.cdc.gov/nip/publications/fs/gen/shouldknow.htm (last visited April 27, 2006).

[12] This is not to imply that parents who vaccinate without carefully considering the pros and cons of vaccination are in the wrong. The health and safety of a child is of paramount importance to most parents, and every parent must make decisions that affect the welfare of the child. Most parents approach such decisions with a sincere desire to promote the child’s best interests, and this desire is no different in the context of vaccination.

[13] “Despite its utility, vaccination has provoked popular resistance from the beginning.” Hodge and Gostin, supra note 4, at 834.

[14] “Some opponents express valid scientific objections about effectiveness or need for mass vaccinations; some fear harmful effects arising from the introduction of foreign particles into the human body; and others worry that vaccination actually transmits, rather than prevents, disease, or weakens the immune system.” Id.

[15] See, e.g. , Jacobson v. Massachusetts , 197 U.S. 11 (1905) (constitutional challenge to government mandated smallpox vaccination); “Six Common Misconceptions,” supra note 10 (“[s]ome see mandatory vaccination as interference by the government into what they believe should be a personal choice”).

[16] “Six Common Misconceptions,” supra note 10.

[17] A more detailed explanation of this subject appears in Part I of this paper.

[21] See, e.g. , “Ten Things You Need to Know about Immunizations,” supra note 11.

[22] Angie A. Welborn, “Mandatory Vaccinations: Precedent and Current Laws,” CRS Report for Congress, at http://www.fas.org/sgp/crs/RS21414.pdf (last updated Jan. 18, 2005).

[23] For a typical scenario of public health response to outbreak, see the facts of Jacobson v. Massachusetts , 197 U.S. 11 (1905).

[24] Hodge and Gostin, supra note 4, at 833-34.

[25] Id. at 867-68.

[26] Id. at 833.

[29] This level of immunity is often referred to as “herd immunity,” the concept that not everyone in a population must be vaccinated in order for the entire population to be protected. Abi Berger, “How Does Herd Immunity Work?” 319 BMJ 1466 (1999). “As long as a sufficient number of children are immunised against each disease for which there is a vaccine, protection against that disease will be conferred on everybody.” Id. Also, the level of vaccination necessary to attain herd immunity increases as the infectivity of the disease increases. Id. Highly infectious diseases, therefore, require higher levels of immunity for herd immunity to occur. Id. The concept of herd immunity will arise throughout this paper, with particular emphasis in Part III.

[30] This is evidenced by the fact that in time of outbreak, the vaccinated population can still be susceptible to the disease, although usually the vaccinated population is far less susceptible to the disease than the unvaccinated population. Vaccines typically produce the desired antibody in an individual around 90% of the time, with actual percentages varying from vaccine to vaccine. Some vaccines, moreover, lose their efficacy and require boosters. These concepts will be further developed throughout this paper.

[31] Hodge and Gostin, supra note 4, at 850-51.

[32] Id. at 851.

[33] Id. at 834.

[34] Id. at 834-35.

[35] See, e.g. , Duffield v. Sch. Dist. , 29 A. 742 (Penn. 1894).

[36] 197 U.S. 11 (1905).

[38] Id. at 26.

[39] Welborn, supra note 22.

[41] 260 U.S. 174 (1922).

[42] Id. at 175.

[43] Id. (“[t]he bill charges that there was then no occasion for requiring vaccination” and that the ordinances “in effect, mak[e] vaccination compulsory”).

[45] Id. at 176.

[48] Id. at 177.

[49] Hodge and Gostin, supra note 4, at 867-68.

[50] Id. at 868.

[51] The schedule of immunizations is published by the Center for Disease Control, and follows the recommendations of the Advisory Committee on Immunizations Practices, the American Academy of Pediatrics’ Committee on Infectious Diseases, and the American Academy of Family Physicians. Id.

[52] Id. at 869.

[54] Based on chart publicized by Center for Disease Control, approved by Advisory Committee on Immunization Practices, American Academy of Pediatrics, American Academy of Family Physicians, available at http://www.cispimmunize.org/IZSchedule_2006.pdf (last visited April 27, 2006).

[55] Indeed, the law in Jacobson was challenged for this reason.

[56] Statement of Barbara Fisher, founder of National Vaccine Information Center, quoted in Neenyah Ostrom, “First Do No Harm,” at http://www.chronicillnet.org/online/Fisher.html (last visited April 27, 2006).

[57] K.N.O.W. Vaccines, Vaccine Awareness of Florida fact sheet, at http://www.know-vaccines.org/vaccine_fact.html (last visited April 27, 2006).

[58] The most direct way in which this occurs surrounds the concept of herd immunity, as discussed elsewhere throughout this paper. If a sufficient number of persons in the community does not vaccinate, herd immunity may be unattainable and others may be put at risk.

[59] See, e.g. , the discussion in Part III involving The Andy Griffith Show.

[60] See Statement of Barbara Fisher, quoted in Ostrom, supra note 56. See also “Autism and Vaccines: Activists Wage a Nasty Campaign to Silence Scientists,” Wall Street Journal, February 16, 2004, at http://www.opinionjournal.com/forms/printThis.html?id=110004700 (last visited April 27, 2006) (citing vaccination critics who had accused the vaccination-defending writers of “having an ‘industry profit promoting agenda’”).

[61] See Statement of Barbara Fisher, quoted in Ostrom, supra note 56.

[64] See the discussion in Part II regarding vaccine safety.

[65] See, e.g. , “Six Common Misconceptions,” supra note 10.

[66] Mission Statement of Vaccination News website, at http://www.vaccinationnews.com (last visited April 27, 2006).

[67] As the discussion in Part II on vaccine safety demonstrates, pre-licensing testing for very rare adverse effects cannot take place if vaccines are ever to reach the market. Phase 4 post-licensing testing does exist, but may take years to discover extremely rare adverse effects.

[68] World Health Organization Immunization Safety page, “Adverse Events Following Immunization,” at http://www.who.int/immunization_safety/aefi/en/ (last visited April 27, 2006).

[69] As the recent mumps outbreak in Iowa demonstrates, not everyone who receives a vaccine develops immunity to the disease. For this reason, the success of vaccination depends on a sufficient level of vaccination in the community. When a significant percentage of the population has not received the vaccine, an outbreak can occur and even threaten some of those who have been vaccinated. See David Pitt, “Iowa Mumps Epidemic Continues to Broaden,” Associated Press, April 13, 2006, at http://www.breitbart.com/news/2006/04/13/D8GVGL600.html (last visited April 27, 2006). See also the above discussion of the history of vaccination.

[70] Mission Statement of Vaccination News website, supra note 66.

[71] See, e.g. , Ross D. Silverman, “No More Kidding Around: Restructuring Non-Medical Childhood Immunization Exemptions to Ensure Public Health Protection,” 12 Annals Health L. 277, 278-79 (2003).

[A]s risks of contracting many deadly and crippling diseases continue to decline to near negligible levels, and rates of childhood immunization continue to reach record levels, the public today places greater attention on the relative weaknesses and dangers of immunizations, and the systems through which they are administered.

[72] Hodge and Gostin, supra note 4, at 874.

[73] Usually this requires physician certification. Id.

[74] Indeed, the CDC itself presupposes the existence of medical exemptors in any broad mandatory vaccination program. See “Six Common Misconceptions,” supra note 10 (noting that the mandatory vaccination program can work to protect even those few who cannot vaccinate because of the possibility of adverse medical reactions).

[76] Hodge and Gostin, supra note 4, at 874.

[77] Jacobson v. Massachusetts , 197 U.S. 11 (1905). See also Employment Division v. Smith , 494 U.S. 872 (1990) (permitting neutral laws of general applicability that incidentally affect religion); Boone v. Boozman , 217 F.Supp.2d 938 (E.D. Ark. 2002) (“constitutionally-protected free exercise of religion does not excuse an individual from compulsory immunization...the right to free exercise of religion and parental rights are subordinated to society’s interest in protecting against the spread of disease”).

[78] W. Va. Code Sec. 16-3-4 (2004).

[79] See, e.g. , Boone v. Boozman , 217 F.Supp.2d 938 (E.D. Ark. 2002). The challenged Arkansas immunization statute exempted “individuals for whom ‘immunization conflicts with the religious tenets and practices of a recognized church or religious denomination of which [they are] an adherent or member.’” The statute was struck down under the Establishment Clause using the test laid out in Lemon v. Kurtzman , 403 U.S. 602 (1971). 217 F.Supp.2d at 950. The Arkansas legislature subsequently amended the exemption generally to allow for religious or philosophical objections without regard to recognized churches. Ark. Code Sec. 6-18-702(d).

[80] See Silverman, supra note 71, at 290-93.

[81] See id.

[82] Hodge and Gostin, supra note 4, at 874.

[83] Cal. Health and Safety Code Sec. 120365 (2003).

[84] Silverman, supra note 71, at 284.

[85] Id. at 285.

[87] See id.

[88] Recall that for those unable to vaccinate for medical reasons, herd immunity provides the only protection from the disease. See “Six Common Misconceptions,” supra note 10.

[89] Silverman, supra note 71, at 285.

[90] Id. The recent mumps outbreak may directly demonstrate this. Officials have pointed out that vaccination only confers immunity on 95% of patients, and of those affected in the recent outbreak, 25% have been vaccinated. See Pitt, supra note 69. The strong implication is that the 75% of those inflicted who were not vaccinated have put the entire community at risk.

[91] Center for Disease Control, National Immunization Program publication, “What Would Happen If We Stopped Vaccinations?” at http://www.cdc.gov/nip/publications/fs/gen/WhatIfStop.htm (last visited April 27, 2006).

[92] Silverman, supra note 71, at 293.

[93] Silverman suggests that eliminating philosophical and religious exemptions would do more harm than good. This approach, he believes, “would exacerbate feelings of animosity and skepticism toward vaccination and the public health system in general.” Id. at 293. On this score he is probably correct, and I agree that wider knowledge, at the very least, is a better initial response to this problem.

[94] Incidentally, it is worth mentioning that of the more longstanding vaccines, the tetanus vaccine stands out as unique. Tetanus is a very harmful disease with about a 20% fatality rate. “What Would Happen If We Stopped Vaccinations?” supra note 91. What makes it unique in the vaccine schedule is that tetanus is not contagious. That is, herd immunity is not attainable and cannot be used to justify mandatory tetanus vaccination. The reason for the general acceptance of the tetanus vaccine seems to stem both from the high risk of the disease and the fact that tetanus can only be prevented by immunization. In addition, the tetanus vaccine for infants has been combined with the vaccines for diphtheria and pertussis. On strictly public health grounds, however, the status of the tetanus shot on the compulsory vaccination schedule comes closest to government fiat of individual health decisions.

[95] Because medical risks may vary from vaccine to vaccine, and thus the justification for such exemptions remains even if the risk is to some but not all vaccines, medical exemptions are somewhat outside the scope of this discussion.

[96] Sean Coletti, Taking Account of Partial Exemptors in Vaccination Law, Policy, and Practice , 36 Conn. L. Rev. 1341, 1344 (2004).

[98] This follows directly from the all-or-nothing nature of the vaccination decision in this world.

[99] Again, this follows directly from the nature of the decision.

[100] See, e.g. , National Vaccine Information Center, at http://www.nvic.org (last visited April 27, 2006) (urging parents to consider eight questions before vaccinating, none of which inform parents of the effect their decision may have on others).

[101] See “Six Common Misconceptions,” supra note 10.

[102] 42 U.S.C. §§ 300aa-1 to 300aa-34.

[103] U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, “Vaccine Product Approval Process,” updated July 27, 2002, at http://www.fda.gov/cber/vaccine/vacappr.htm (last visited April 27, 2006) (hereinafter “Vaccine Product Approval Process”).

[104] See id.

[105] See, e.g. , Isadora Stehlin, “How FDA Works to Ensure Vaccine Safety,” FDA Consumer magazine (December 1995), at http://www.fda.gov/fdac/features/095_vacc.html (last visited April 27, 2006).

[106] “Licensing of a vaccine is only the beginning of FDA’s oversight.” Id.

[109] “Vaccine Product Approval Process,” supra note 103.

[112] Stehlin, supra note 105.

[115] Id. ; “Vaccine Product Approval Process,” supra note 103.

[116] Stehlin, supra note 105.

[118] “Vaccine Product Approval Process,” supra note 103.

[121] Id. ; Stehlin, supra note 105.

[123] Indeed, the National Immunization Program has confidently pointed to the FDA’s role in continued oversight of vaccines:

FDA would recall a lot of vaccine at the first sign of problems. There is no benefit to either the FDA or the manufacturer in allowing unsafe vaccine to remain on the market. The American public would not tolerate vaccines if they did not have to conform to the most rigorous safety standards. The mere fact that a vaccine lot [is] still in distribution says that the FDA considers it safe.

“Six Common Misconceptions,” supra note 10.

[124] “Vaccine Product Approval Process,” supra note 103.

[127] Stehlin, supra note 105.

[128] So states Susan Ellenberg, Ph.D., director of CBER’s division of biostatistics and epidemiology. Id.

[129] “Vaccine Product Approval Process,” supra note 103.

[130] Stehlin, supra note 105.

[136] See, e.g. , “Six Common Misconceptions,” supra note 10 (“[o]nly some of the reported health conditions are side effects related to vaccines. A certain number of VAERS reports of serious illnesses or death do occur by chance alone among persons who have been recently vaccinated”).

[137] “VAERS reports have many limitations since they often lack important information, such as laboratory results, used to establish a true association with the vaccine.” Id.

[138] “In summary, scientists are not able to identify a problem...based on VAERS reports alone without scientific analysis of other factors and data.” Id.

[139] U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, “Thimerosal in Vaccines,” at http://www.fda.gov/Cber/vaccine/thimerosal.htm (last updated Sept. 6, 2005).

[141] See, e.g. , Gardiner Harris and Anahad O’Connor, “On Autism’s Cause, It’s Parents vs. Research,” New York Times, June 25, 2005, at http://www.nytimes.com/2005/06/25/science/25autism.html (last visited April 27, 2006) (reporting the ongoing tension between parents of autistic children and the medical community over the use of thimerosal in vaccines).

[142] See, e.g. , Center for Disease Control, National Immunization Program publication, “Mercury and Vaccines (Thimerosal),” at http://www.cdc.gov/nip/vacsafe/concerns/thimerosal/default.htm (last visited April 27, 2006) (studies have failed to find any association between exposure to thimerosal in vaccines and autism); “On Autism’s Cause, It’s Parents vs. Research,” supra (noting that the amount of ethyl mercury in each childhood vaccine was once about the same as the amount of methyl mercury, a more toxic compound, found in an average tuna sandwich).

[143] “Thimerosal in Vaccines,” supra note 139.

[146] Stehlin, supra note 105.

[149] “On Autism’s Cause, It’s Parents vs. Research,” supra note 141.

[150] “Thimerosal in Vaccines,” supra note 139; see also “On Autism’s Cause, It’s Parents vs. Research,” supra note 141 (“[b]y 2001, no vaccine routinely administered to children in the United States had more than half a microgram of mercury – about what is found in an infant’s daily supply of breast milk”).

[151] “Autism and Vaccines: Activists Wage a Nasty Campaign to Silence Scientists,” Wall Street Journal editorial, February 16, 2004, at http://www.opinionjournal.com/forms/printThis.html?id=110004700 (last visited April 27, 2006).

[152] “On Autism’s Cause, It’s Parents vs. Research,” supra note 141.

[153] Indeed, one recent study has suggested that neurological disorders have decreased with the removal of thimerosal from most vaccines. See David A. Geier and Mark R. Geier, “Early Downward Trends in Neurodevelopmental Disorders Following Removal of Thimerosal-Containing Vaccines,” 11 J. Am. Physicians and Surgeons 8 (2006). This study should be taken with a grain of salt, however, as the Geiers are widely known thimerosal critics. Years before this study, Dr. Mark Geier called thimerosal use in vaccines the world’s “greatest catastrophe that’s ever happened, regardless of cause.” “On Autism’s Cause, It’s Parents vs. Research,” supra note 141. A witness in many vaccine cases, a judge once ruled that he was “a professional witness in areas for which he has no training, expertise and experience.” Id. Scientists have criticized his prior studies and even called his methods “voodoo science.” Id.

[155] See id.

[156] See “The Politics of Autism: Lawsuits and Emotion vs. Science and Childhood Vaccines,” Wall Street Journal editorial, Dec. 29, 2003, at http://www.opinionjournal.com/forms/printThis.html?id=110004487 (last visited April 27, 2006) (characterizing the position of thimerosal critics as “scientifically untenable”).

[157] See generally “On Autism’s Cause, It’s Parents vs. Research,” supra note 141.

[161] “The Politics of Autism,” supra note 156.

[162] Id. ; “Study: Autism Rise from Labeling, Not Epidemic,” April 3, 2006, at http://www.cnn.com/2006/EDUCATION/04/03/health.autism.reut/index.html (last visited April 27, 2006) (noting rise in diagnosed cases of autism since 1994 is correlated with fall in diagnosed cases of mental retardation and learning disabilities).

[163] The Politics of Autism,” supra note 156.

[164] See, e.g. , “Six Common Misconceptions,” supra note 10 (noting that many anti-vaccine publications claim vaccines are unsafe on the basis of sheer numbers of reports to VAERS without noting that many of them may not represent actual vaccine side-effects).

[165] National Vaccine Information Center, “The Vaccine Injury Compensation Program,” at http://www.909shot.com/Issues/Comp_Summary.htm (last visited April 27, 2006).

[166] Center for Disease Control, National Vaccine Program Office, Vaccine Fact Sheets, “National Vaccine Injury Compensation Program,” at http://www.hhs.gov/nvpo/factsheets/fs_tableIV_doc1.htm (last visited April 27, 2006).

[167] See National Vaccine Injury Compensation Program, at http://www.hrsa.gov/vaccinecompensation/ (last visited April 27, 2006).

[169] The Andy Griffith Show: The County Nurse (CBS television broadcast, March 19, 1962).

[177] Id. That is, there will be a high probability of death.

[179] See the discussion above in Part I of this paper.

[180] For example, she begs Rafe to consider his family and what his decision could mean to them. She literally appears to be on the verge of tears as he refuses.

[181] In utilizing the theoretical framework of economic analysis, it is useful to keep in mind a few foundational concepts. First, a policy or program (in this case mandatory vaccination) is desirable if the overall benefit to society as a whole outweighs the cost of the program, where benefits and costs include both monetary and non-monetary factors. Second, individuals making rational choices regarding vaccination will vaccinate when the benefits of vaccination outweigh the risks or costs of non-vaccination to the individual. This decision-making process can be skewed by externalities, such as an unforeseeable decrease in the effectiveness of a vaccine due to a reduction in vaccination by others unknown to the individual at the time of the decision.

[182] 197 U.S. 11 (1905).

[183] Id. at 12.

[185] Id. at 13, 22.

[186] Id. at 36.

[187] Id. at 12.

[188] As the CDC itself explains, “[e]ven one serious adverse effect in a million doses of vaccine cannot be justified if there is no benefit from the vaccination.” “Six Common Misconceptions,” supra note 10.

[189] In Japan in the 1970s, for instance, pertussis vaccination coverage fell from 80% to 20%, leading to an outbreak in 1979 resulting in 13,000 cases and 41 deaths. “What Would Happen If We Stopped Vaccinations?” supra note 91.

[190] Judge Richard Posner has suggested that this difference between sexually transmitted diseases and air- and water-borne diseases may imply a lesser imperative to eliminate sexually transmitted diseases:

[T]he externality created by sexually transmitted diseases is smaller than in the case of other contagious diseases. Sexually transmitted disease is spread primarily by voluntary contact, implying (to the economist) that a person is compensated...for assuming the risk of contracting the disease. Hence the number of cases of sexually transmitted diseases may be closer to the optimum than in the usual air-borne or water-borne or insect-borne epidemics.

Posner, Economic Analysis of Law 162. (6th Ed. 2003).

[191] Additionally, if vaccination rates are high, these individuals may assume that those in society who have already made the choice to vaccinate have performed a similar cost-benefit analysis. These individuals choose to vaccinate based simply on vaccination rates in the community. See John C. Hershey et al., The Roles of Altruism, Free Riding, and Bandwagoning in Vaccination Decisions , 59 Organizational Behavior and Human Processes 177, 178 (1994).

[192] See, e.g. , id. (behavioral survey studying various factors individuals use to make vaccination decisions).

[194] See id. at 178 (“[i]f a patient believes vaccination is in his own best interests, then he has two reasons to vaccinate. One is selfish, in that he will improve his own well being. The other is altruistic, in that he can improve the health prospects of those around him who might otherwise become infected if he is not vaccinated himself”).

[195] The concept of herd immunity is discussed in Part I. Note that “[i]n economic terms, herd immunity is a positive externality of vaccination. Altruistic individuals who recognize and value this externality may undergo vaccination partly to help others in addition to themselves.” Id. See also Berger, supra note 29 (“‘[h]erd immunity’...is the concept that not everybody in a population has to be immunised to protect everyone in that population. As long as a sufficient number of children are immunised against each disease for which there is a vaccine, protection against that disease will be conferred on everybody”).

[196] The CDC has pointed to this as one of the two most important reasons to vaccinate:

There is a small number of people who cannot be vaccinated (because of severe allergies to vaccine components, for example), and a small percentage of people don’t respond to vaccines. These people are susceptible to disease, and their only hope of protection is that people around them are immune and cannot pass disease along to them. A successful vaccination program, like a successful society, depends on the cooperation of every individual to ensure the good of all.

[197] In economic terms, “[w]idening vaccine use decreases each individual’s benefit from being vaccinated, but leaves unchanged each individual’s risk from the vaccination itself.” Hershey, supra note 191, at 178.

[198] “Six Common Misconceptions, supra note 10.

[199] Hershey, supra note 191, at 178.

[200] Suppose, for sake of example, that a vaccination program, if implemented, would save ten lives out of a thousand that would otherwise have perished without the program. Unfortunately, the vaccine will randomly cause death to five persons out of a thousand. From an ex ante perspective, the vaccination program should be implemented as it will save five lives overall. Concerns or complaints from those five persons who die (or their estates) represent ex post objections, and, though unfortunate, should not affect evaluations of the soundness of the program.

[201] This mathematical explanation is a slight variation of that found at CDC, “Six Common Misconceptions,” supra note __.

[202] Note that no vaccine is 100% effective, and vaccination efficacy rates for most childhood vaccinations range from 85 to 95%. Id. As stated in an earlier section, herd immunity is relied upon to protect those who do not develop full immunity from the vaccine.

[203] Given that these particular vaccines are already on the schedule, I think it would be unwise to remove them now. My analysis applies to comparable vaccines that may arise in the future – vaccines for those communicable diseases that do not pose relatively significant health risks. The definition of such diseases, of course, would be a matter of debate. Vaccines for noncommunicable diseases like ear infections would also fall within this rubric.

[204] Statement of Barbara Fisher, quoted in Ostrom, supra note 56.

Persuasive Essay Guide

Persuasive Essay About Covid19

How to Write a Persuasive Essay About Covid19 | Examples & Tips

11 min read

Steps to Write a Persuasive Essay About Covid-19

Here are the steps to help you write a persuasive essay on this topic, along with an example essay:

Step 1: Choose a Specific Thesis Statement

Your thesis statement should clearly state your position on a specific aspect of COVID-19. It should be debatable and clear. For example:

Step 2: Research and Gather Information

Collect reliable and up-to-date information from reputable sources to support your thesis statement. This may include statistics, expert opinions, and scientific studies. For instance:

COVID-19 vaccination effectiveness data
Information on vaccine mandates in different countries
Expert statements from health organizations like the WHO or CDC

Step 3: Outline Your Essay

Create a clear and organized outline to structure your essay. A persuasive essay typically follows this structure:

Introduction
Background Information
Body Paragraphs (with supporting evidence)
Counterarguments (addressing opposing views)

Step 4: Write the Introduction

In the introduction, grab your reader's attention and present your thesis statement. For example:

Step 5: Provide Background Information

Offer context and background information to help your readers understand the issue better. For instance:

Step 6: Develop Body Paragraphs

Each body paragraph should present a single point or piece of evidence that supports your thesis statement. Use clear topic sentences, evidence, and analysis. Here's an example:

Step 7: Address Counterarguments

Acknowledge opposing viewpoints and refute them with strong counterarguments. This demonstrates that you've considered different perspectives. For example:

Step 8: Write the Conclusion

Summarize your main points and restate your thesis statement in the conclusion. End with a strong call to action or thought-provoking statement. For instance:

Step 9: Revise and Proofread

Edit your essay for clarity, coherence, grammar, and spelling errors. Ensure that your argument flows logically.

Step 10: Cite Your Sources

Include proper citations and a bibliography page to give credit to your sources.

Remember to adjust your approach and arguments based on your target audience and the specific angle you want to take in your persuasive essay about COVID-19.

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Examples of Persuasive Essay About Covid19

When writing a persuasive essay about the Covid-19 pandemic, it’s important to consider how you want to present your argument. To help you get started, here are some example essays for you to read:

Check out some more PDF examples below:

Persuasive Essay About Covid-19 Pandemic

Sample Of Persuasive Essay About Covid-19

Persuasive Essay About Covid-19 In The Philippines - Example

If you're in search of a compelling persuasive essay on business, don't miss out on our “ persuasive essay about business ” blog!

Examples of Persuasive Essay About Covid-19 Vaccine

Covid19 vaccines are one of the ways to prevent the spread of Covid-19, but they have been a source of controversy. Different sides argue about the benefits or dangers of the new vaccines. Whatever your point of view is, writing a persuasive essay about it is a good way of organizing your thoughts and persuading others.

A persuasive essay about the Covid-19 vaccine could consider the benefits of getting vaccinated as well as the potential side effects.

Below are some examples of persuasive essays on getting vaccinated for Covid-19.

Covid19 Vaccine Persuasive Essay

Persuasive Essay on Covid Vaccines

Interested in thought-provoking discussions on abortion? Read our persuasive essay about abortion blog to eplore arguments!

Examples of Persuasive Essay About Covid-19 Integration

Covid19 has drastically changed the way people interact in schools, markets, and workplaces. In short, it has affected all aspects of life. However, people have started to learn to live with Covid19.

Writing a persuasive essay about it shouldn't be stressful. Read the sample essay below to get idea for your own essay about Covid19 integration.

Persuasive Essay About Working From Home During Covid19

Searching for the topic of Online Education? Our persuasive essay about online education is a must-read.

Examples of Argumentative Essay About Covid 19

Covid-19 has been an ever-evolving issue, with new developments and discoveries being made on a daily basis.

Writing an argumentative essay about such an issue is both interesting and challenging. It allows you to evaluate different aspects of the pandemic, as well as consider potential solutions.

Here are some examples of argumentative essays on Covid19.

Argumentative Essay About Covid19 Sample

Argumentative Essay About Covid19 With Introduction Body and Conclusion

Looking for a persuasive take on the topic of smoking? You'll find it all related arguments in out Persuasive Essay About Smoking blog!

Examples of Persuasive Speeches About Covid-19

Do you need to prepare a speech about Covid19 and need examples? We have them for you!

Persuasive speeches about Covid-19 can provide the audience with valuable insights on how to best handle the pandemic. They can be used to advocate for specific changes in policies or simply raise awareness about the virus.

Check out some examples of persuasive speeches on Covid-19:

Persuasive Speech About Covid-19 Example

Persuasive Speech About Vaccine For Covid-19

You can also read persuasive essay examples on other topics to master your persuasive techniques!

Tips to Write a Persuasive Essay About Covid-19

Writing a persuasive essay about COVID-19 requires a thoughtful approach to present your arguments effectively.

Here are some tips to help you craft a compelling persuasive essay on this topic:

Choose a Specific Angle

Start by narrowing down your focus. COVID-19 is a broad topic, so selecting a specific aspect or issue related to it will make your essay more persuasive and manageable. For example, you could focus on vaccination, public health measures, the economic impact, or misinformation.

Provide Credible Sources

Support your arguments with credible sources such as scientific studies, government reports, and reputable news outlets. Reliable sources enhance the credibility of your essay.

Use Persuasive Language

Employ persuasive techniques, such as ethos (establishing credibility), pathos (appealing to emotions), and logos (using logic and evidence). Use vivid examples and anecdotes to make your points relatable.

Organize Your Essay

Structure your essay involves creating a persuasive essay outline and establishing a logical flow from one point to the next. Each paragraph should focus on a single point, and transitions between paragraphs should be smooth and logical.

Emphasize Benefits

Highlight the benefits of your proposed actions or viewpoints. Explain how your suggestions can improve public health, safety, or well-being. Make it clear why your audience should support your position.

Use Visuals -H3

Incorporate graphs, charts, and statistics when applicable. Visual aids can reinforce your arguments and make complex data more accessible to your readers.

Call to Action

End your essay with a strong call to action. Encourage your readers to take a specific step or consider your viewpoint. Make it clear what you want them to do or think after reading your essay.

Revise and Edit

Proofread your essay for grammar, spelling, and clarity. Make sure your arguments are well-structured and that your writing flows smoothly.

Seek Feedback

Have someone else read your essay to get feedback. They may offer valuable insights and help you identify areas where your persuasive techniques can be improved.

Tough Essay Due? Hire Tough Writers!

Common Topics for a Persuasive Essay on COVID-19

Here are some persuasive essay topics on COVID-19:

The Importance of Vaccination Mandates for COVID-19 Control
Balancing Public Health and Personal Freedom During a Pandemic
The Economic Impact of Lockdowns vs. Public Health Benefits
The Role of Misinformation in Fueling Vaccine Hesitancy
Remote Learning vs. In-Person Education: What's Best for Students?
The Ethics of Vaccine Distribution: Prioritizing Vulnerable Populations
The Mental Health Crisis Amidst the COVID-19 Pandemic
The Long-Term Effects of COVID-19 on Healthcare Systems
Global Cooperation vs. Vaccine Nationalism in Fighting the Pandemic
The Future of Telemedicine: Expanding Healthcare Access Post-COVID-19

In search of more inspiring topics for your next persuasive essay? Our persuasive essay topics blog has plenty of ideas!

To sum it up,

You have read good sample essays and got some helpful tips. You now have the tools you needed to write a persuasive essay about Covid-19. So don't let the doubts stop you, start writing!

If you need professional writing help, don't worry! We've got that for you as well.

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Frequently Asked Questions

Are there any ethical considerations when writing a persuasive essay about covid-19.

Yes, there are ethical considerations when writing a persuasive essay about COVID-19. It's essential to ensure the information is accurate, not contribute to misinformation, and be sensitive to the pandemic's impact on individuals and communities. Additionally, respecting diverse viewpoints and emphasizing public health benefits can promote ethical communication.

What impact does COVID-19 have on society?

The impact of COVID-19 on society is far-reaching. It has led to job and economic losses, an increase in stress and mental health disorders, and changes in education systems. It has also had a negative effect on social interactions, as people have been asked to limit their contact with others.

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Title: Quantification of vaccine waning as a challenge effect

Abstract: Knowing whether vaccine protection wanes over time is important for health policy and drug development. However, quantifying waning effects is difficult. A simple contrast of vaccine efficacy at two different times compares different populations of individuals: those who were uninfected at the first time versus those who remain uninfected until the second time. Thus, the contrast of vaccine efficacy at early and late times can not be interpreted as a causal effect. We propose to quantify vaccine waning using the challenge effect, which is a contrast of outcomes under controlled exposures to the infectious agent following vaccination. We identify sharp bounds on the challenge effect under non-parametric assumptions that are broadly applicable in vaccine trials using routinely collected data. We demonstrate that the challenge effect can differ substantially from the conventional vaccine efficacy due to depletion of susceptible individuals from the risk set over time. Finally, we apply the methods to derive bounds on the waning of the BNT162b2 COVID-19 vaccine using data from a placebo-controlled randomized trial. Our estimates of the challenge effect suggest waning protection after 2 months beyond administration of the second vaccine dose.

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AstraZeneca withdraws COVID-19 vaccine citing a decline in demand

Small glass vial with label reading Astra Zeneca sits on bench next to a syringe

AstraZeneca has initiated the worldwide withdrawal of its COVID-19 vaccine due to a "surplus of available updated vaccines" since the pandemic.

"As multiple, variant COVID-19 vaccines have since been developed, there is a surplus of available updated vaccines," the Anglo-Swedish pharmaceutical company said.

The surplus had led to a decline in demand for its vaccine, known as Vaxzevria since 2021, which is no longer being manufactured or supplied, the company said.

The company said it would also proceed to withdraw the vaccine's marketing authorisations within Europe.

The AstraZeneca vaccine has not been available in Australia since March 21, 2023.

It was linked to a rare but serious side effect, thrombosis with thrombocytopenia syndrome (TSS), according to the Department of Health and Aged Care .

In TSS, a person develops blood clots (thrombosis), which can appear in different parts of the body, combined with a low blood platelet count.

Other COVID-19 vaccines are not associated with TSS.

After AstraZeneca-linked TSS cases were reported in March 2021 , the Australian Technical Advisory Group on Immunisation updated its advice to recommend a different vaccine for people under 50 due to their slightly higher risk of developing the condition.

From June 2021, an alternative to the AstraZeneca vaccine was recommended to people under 60.

The Department of Health estimated the rate of TSS from Vaxzevria to be about two in every 100,000 in people over 60, and about two to three in 100,000 in people under 60.

Cases were reported in all ages, some mild and others fatal .

Some 13 million AstraZeneca doses were administered in Australia, with 173 "probable" or "confirmed" cases of TSS reported to the Therapeutic Goods Administration (TGA), a Department of Health spokesperson said.

The TGA reported 14 deaths linked to a COVID-19 vaccination, eight of which were associated with a case of TSS, the spokesperson said. No new deaths were identified since 2022.

AstraZeneca admitted that the vaccine caused side-effects such as blood clotting in court documents relating to a UK class action, The Telegraph reported .

The application to withdraw the vaccine was made on March 5 and came into effect on May 7, the newspaper wrote .

AstraZeneca began moving into respiratory syncytial virus vaccines and obesity drugs through several deals last year after a slowdown in growth as COVID-19 medicine sales declined.

The latest advice by the Department of Health recommends one dose of a COVID-19 vaccine as a primary course for most Australians, or two doses for those at risk of severe illness.

A COVID-19 booster dose is recommended for people aged 65 years and over every 12 months.

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111 Vaccination Essay Topics & Research Titles about Vaccines
111 Vaccination Research Topics & Best Vaccine Essay Topics. Welcome to our list of vaccination research topics! This page contains only the best vaccine topics for essays and papers on child immunization, COVID-19, and other issues. Feel free to pick the catchiest research title about vaccines from our list!
Vaccination Essays
Vaccines Essay Topics and Outline Examples Essay Title 1: "The Vital Role of Vaccines in Public Health: Debunking Myths and Upholding Science" Thesis Statement: Vaccines are a cornerstone of public health, and it is crucial to dispel misinformation and emphasize the overwhelming scientific evidence supporting their safety and efficacy.
70 Vaccination Research Paper Topics
Vaccination Behavior Research Topics. Unraveling demand and supply effects on the up-take of influenza vaccinations. Point out new approaches to the seasonal flu vaccine. Exploring the impact of vaccination. Investigating patient experience with, and the use of, an electronic monitoring system to assess vaccination responses.
A Vaccine a Day to Keep the Doctor Away: A Research Essay on Vaccinations
An additional aspect of vaccines many parents are troubled with is the increase in suggested vaccines for young children. "Today, the CDC recommends that children receive vaccines for 10 diseases — plus the flu vaccine — by age 6, which can mean up to 37 separate shots. That compares to five vaccines for the same age group in 1995 ...
Vaccines Essays: Examples, Topics, & Outlines
Examples include the polio vaccine, and the rabies vaccine. The body creates antibodies that fight the disease, which allows the body to become immune to the disease. Most people credit Edward Jenner, a rural English doctor, for developing or discovering the modern concept of vaccines.
Vaccination Essays: Examples, Topics, & Outlines
Most pediatricians today hold that the manner in which the vaccine is administered is the key; while other specialists and experts maintain that it is the preservative (thimersol) in the vaccines, and still others contend that it is the vaccines themselves (Schulman, Daniel, 2005). ... Below are some recommendations for essay titles on Autism.
Vaccine Confidence, Coverage, and Hesitancy Worldwide: A Literature
of vaccines despite availability" (Macdonald, 2015, p. 34). After a thorough literature review, evidence reveals that there is a gap between perceived vaccine importance and perceived vaccine safety in developed nations as many survey respondents believe in the efficacy and importance of vaccines but lack confidence in the safety of vaccines.
The Importance of Global COVID-19 Vaccination
The 95% effectiveness actually means that people with the vaccine have a 95% lower risk of COVID-19 when compared to a control group. Without the vaccine, we would expect roughly 1% of the ...
Vaccination: Facts, Relevant Concepts, and Ethical Challenges
This first chapter introduces some ethically relevant concepts that illustrate why we need an "ethics of vaccination", such as "herd immunity", "public good", and "vaccine refusal". It argues that the choice whether to vaccinate oneself or one's children is by its own nature an "ethical" choice: it requires individuals to act not only or even not primarily to promote ...
The 100 top-cited studies on vaccine: a bibliometric analysis
Introduction. The vaccine is a biological preparation that provides active acquired immunity to a particular disease. 1 − 3 The main types of vaccines include live-attenuated vaccine, inactivated vaccine, subunit, recombinant, polysaccharide, and conjugate vaccine and toxoid vaccine. 4 Vaccines help protect millions of healthy people, 4-6 they are considered as the most economical and ...
Vaccines Essays: Examples, Topics, & Outlines
View our collection of vaccines essays. Find inspiration for topics, titles, outlines, & craft impactful vaccines papers. Read our vaccines papers today!
The Vaccine Debate: Questions and Concerns
Due to polio vaccination, the disease is no longer a public health concern in the United States. Vaccination is very safe and effective . Injection site pain and mild, flu-like symptoms may occur with vaccine shots. However, serious side effects, such as a severe allergic reaction, are very rare. Immunization protects others.
How to talk about vaccines
1. Listen with empathy. Start by listening with empathy to those who have questions around vaccination. Don't dismiss them, and acknowledge how they're feeling (without necessarily agreeing, for example "it's okay to have questions, or want more information before getting a vaccine"). 2. Ask open-ended questions.
Vaccines and immunization
Vaccines and immunization are vital for preventing and controlling many diseases that threaten global health. Learn more about the benefits, safety and challenges of vaccination from the World Health Organization, the leading authority on health issues. Explore the latest information on COVID-19 vaccines, polio eradication, maternal and child health, and more.
Vaccine Mandates Are Needed in the U.S.
Guest Essay. Vaccine Mandates Are Coming. Good. June 28, 2021. Smallpox vaccinations in the 1960s. ... Although the vaccines are already known to be safe and effective, after being given to ...
Vaccination is widely considered one of civilization's greatest modern
Vaccination is widely considered one of the greatest medical achievements of modern civilization. Childhood diseases that were commonplace less than a generation ago are now increasingly rare because of vaccines. In order to be effective at eliminating communicable diseases, vaccines must be administered to sufficient levels of persons in the community.
Vaccination Essay
Benefits of vaccinations The debate over vaccinations has been a prevalent one throughout the course of medical history. A vaccination is "the injection of a killed or weakened organism that produces immunity in the body against that organism" (vaccines.gov). Vaccines are designed to provide immunization to certain illnesses.
Persuasive Essay About Covid19
Examples of Persuasive Essay About Covid-19 Vaccine. Covid19 vaccines are one of the ways to prevent the spread of Covid-19, but they have been a source of controversy. Different sides argue about the benefits or dangers of the new vaccines. Whatever your point of view is, writing a persuasive essay about it is a good way of organizing your ...
Funny paper titles, COVID immunity and carbon storage
A health-care worker administers a COVID-19 vaccine in Rio de Janeiro, Brazil. ... Including a joke in the title of a scholarly paper could pay off in terms of citations, according to a study.
Covid 19 Essays: Examples, Topics, & Outlines
View our collection of covid 19 essays. Find inspiration for topics, titles, outlines, & craft impactful covid 19 papers. Read our covid 19 papers today! Homework Help ... efficacious vaccines have been developed and increasing numbers of consumers are recognizing the need to be vaccinated against this deadly disease to the point where many ...
Covid-19 Vaccine Argumentative Essay
Increasing Alcohol Consumption During the COVID-19 Pandemic The Impact of COVID-19 on the Economy in Malaysia, Especially on the Food Supply Chain: An Essay Modern-day Witch Hunts Examples 2023 Pros and Cons of Vaccinations: Argumentative Essay Death by Shot: Argumentative Essay on Vaccines Disadvantages of Covid-19 Vaccine Essay Why You Should ...
Arguments For and Against Vaccinations
Our children are safer and live longer thanks to the availability of these immunizations. Our government has put into place a stringent, organized system to ensure the vaccinations are safe and the side effects are known (Rhodes, 2013 ). Vaccines are safe, they are needed, and most importantly they save lives. References.
Thousands Believe Covid Vaccines Harmed Them. Is Anyone Listening
Dr. Zimmerman's account is among the more harrowing, but thousands of Americans believe they suffered serious side effects following Covid vaccination. As of April, just over 13,000 vaccine ...
Title: Quantification of vaccine waning as a challenge effect
Knowing whether vaccine protection wanes over time is important for health policy and drug development. However, quantifying waning effects is difficult. A simple contrast of vaccine efficacy at two different times compares different populations of individuals: those who were uninfected at the first time versus those who remain uninfected until the second time. Thus, the contrast of vaccine ...
AstraZeneca withdraws COVID-19 vaccine citing a decline in demand
A surplus of "available updated vaccines" has led to a decline in demand for Vaxzevria, the company said. The vaccine has been linked to a rare but serious side effect causing blood clotting and ...
Essay Title Generator
The essay title generator tool can help you come up with even more ideas for topics. Browse through the drop down menu and select various topics that you find interesting. Run the search for titles and then generate additional titles at the end of the search. After you do this process a few times, you will have a list of great essay topic ideas ...
Section 8:57-4.11
Section 8:57-4.11 - Poliovirus vaccine (a) Every child less than seven years of age shall have received at least three doses of live, trivalent, oral poliovirus vaccine (OPV), or inactivated poliovirus vaccine (IPV) either separately, in combination, or as a combination vaccine containing inactivated poliovirus, one dose of which shall have been given on or after the child's fourth birthday or ...
Stormy Daniels Takes the Stand
On today's episode. Jonah E. Bromwich, who covers criminal justice in New York for The New York Times. Stormy Daniels leaving court on Thursday, after a second day of cross-examination in the ...