ENGL 138T SEC 003

Keep Kids Healthy

Mandatory Immunizations for School-Age Children

Alex Koehl
4-12-2020
KEEP KIDS HEALTHY
Mandatory Immunizations for School-Age Children

Abstract
Hepatitis B is an illness that begins with a virus that attacks one’s liver. 1 The infection
causes 1 million deaths every year. 2 While many people with this infection can treat and survive
Hepatitis B, it can quickly spread through pregnancy, sexual intercourse, drug use, or contact
with an infected person’s blood. 3 However, Hepatitis B can be prevented entirely by receiving a
vaccine as a child. However, in 2017, only 73 percent of children got this
vaccination. 4 Consideration of opposing views and critiques of vaccinations will afford greater
insight to those writing the policy on mandatory vaccinations. Moreover, recognizing the recent
decline in vaccinations and acknowledging the consequences (epidemics) will help to better
inform the American public on the necessity, importance, and benefits of vaccinations.

Recent Influx in Outbreaks

Epidemics are growing in intensity and frequency.

By the start of the 21st century, measles had been eradicated from the American society. 5
A disease that once brough skin rashes, pinky eye, diarrhea and fevers to kids was thought to be
removed. However, the disease laid dormant until 2019 when over 1000 new cases had spread
across 31 states. 6

To drive out measles, a vaccine was created. When enough of the population gained
immunity to the illness, health organizations declared it eradicated. However, to keep new cases
of an eradicated disease from sprouting, it would take the commitment of the public to keep
themselves and their children protected. Because the American people did not uphold their
commitment, measles made its way back into society.

1
“What Is Hepatitis B,” Hepatitis B Foundation, https://www.hepb.org/what-is-hepatitis-b/what-is-hepb/
2
Ibid
3
Ibid
4
Holly A. Hill, et al. “Vaccine Coverage Among Children Aged 19-35 Months – United States, 2017,” Center for
Disease Control and Prevention 67, no. 40 (2018): 1123-1128, http://dx.doi.org/10.15585/mmwr.mm6740a4
5
“Measles History,” Center for Disease Control and Prevention, February 5, 2018,
https://www.cdc.gov/measles/about/history.html
6
“Measles Cases and Outbreaks,” Center for Disease Control and Prevention, April 6, 2020,
https://www.cdc.gov/measles/cases-outbreaks.html

[1]
 The problem is children are not required to receive vaccines in many states, increasing
the susceptibility of children to contract viruses that can put them and the public at risk of
outbreaks, epidemics, or pandemics that lead to death. While current legislation strongly
encourages vaccinations, recent influenza (flu) seasons suggests that more steps taken will
decrease the impact of viruses on the lives of the American public. U.S. News and World
Report state that measles, the latest virus to reemerge after a period of eradication, is “so
contagious you can get it just by being in the same room as an infected person.” 7 Measles, which
is a dangerous virus that “can cause brain damage, seizures, or even death,” has reappeared
because not all children are vaccinated. Without a strict and broad implementation of policy that
mandates vaccinations for all children, or an even more significant number of children, it is not
unlikely that another epidemic will begin. Almost 77 million children attend a U.S. school
making educational systems the widest platform to vaccinate American children. 8

Educational Systems Mandate Vaccinations

The change in vaccinations requirements.

Mandatory vaccines are commonplace in schools. For example, measles/mumps/rubella

and varicella shots for chickenpox are required for all kindergarteners in Pennsylvania. 9 Despite
labeling vaccines as compulsory, many states have loose implementation of their vaccine
policies and allow for exception to the rules.

Figure 1: Only 5 U.S. States have taken away non-medical

exemptions
Immunization Action Coalition, Non-Medical State Exemptions From School Immunization Requirements, 2019, National Conference of State
Legislature, January 3, 2020, image, https://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx

7
Chai Woodham. “Why Adults Shouldn’t Skip Vaccines,” U.S. News and World Report, April 6, 2015,
https://health.usnews.com/health-news/health-wellness/articles/2015/04/06/why-adults-shouldnt-skip-vaccines
8
“Census Bureau Reports Nearly 77 Million Students enrolled in U.S. Schools,” United States Census Bureau,
December 3, 2019, https://www.census.gov/newsroom/press-releases/2019/school-enrollment.html
9
“Growing Up with Vaccines: What Should Parents Know?” Center for Disease Control and Prevention,
https://www.cdc.gov/vaccines/growing/school-vaccinations.html

[2]
 These state policies arrived after the Supreme Court ruling from 1923 decided that all
states must require vaccinations for children to attend school. 10 The decision stated that it was up
to the individual states to determine which vaccinations would be compulsory. 11 By 2019,
however, only five states had removed all personal beliefs and religious exemptions for
mandatory vaccinations. 12 Therefore, only children in those states need to receive all
vaccinations to attend school. Forty-five states still allow a religious exemption, and 15 states
still allow a personal exemption. 13

With a growing number of children opting not to receive any vaccines, particular
vaccines, or not finishing vaccinations, more children are being put at risk during school or
extracurriculars unbeknownst to them or their families. These children can become infected
themselves or bring home illnesses to parents or siblings who may not be vaccinated. Children
who are immunocompromised or have underlying illnesses can easily contract a severe and life-
threatening disease from an unvaccinated child, therefore it takes entire community to protect
everyone else.

Community-Focused Response
Looking after individual interests can have negative effects.

When it comes to maintaining public health, the term “it takes a village” is true. The
recent outbreak of measles has reinforced the importance of vaccines to protect everyone’s
health. While many vaccines skeptics
remark on the strength of children’s
immune systems, “the measles virus
is highly infections and [has a] 90%
secondary attack rate among
immunocompromised individuals and
unvaccinated populations.” 14 Even a
healthy individual will likely contract
Figure 2: Measles cases are increasing despite scientists’ beliefs
that the disease was eradicated the measles virus if they did not get
Mikhel Hiltzik, Number of Measles Cases Reported Each Year, Los Angeles Times, vaccinated for it. Though children
March 11, 2019, image, https://www.latimes.com/business/hiltzik/la-fi-hiltzik-vaccine-
measles-20190311-story.html may survive this illness, the

10
“The Supreme Court on Vaccination Laws,” American Journal of Public Health (N.Y.) 13, 2 (1923): 120-121,
https://doi.org.10.2105/ajph.13.2.120
11
Ibid
12
“States with Religious and Philosophical Exemptions from School Immunization Requirements,” National
Conference of State Legislatures, January 3, 2020, https://www.ncsl.org/research/health/school-immunization-
exemption-state-laws.aspx
13
Ibid
14
Adekunle Sanyaolu, et al. “Measles Outbreak in Unvaccinated and Partially Vaccinated Children and Adults in
The United States and Canada (2018-2019),” Journal of Health Care Organization, (2019),
https://doi.org/10.1177/0046958019894098

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symptoms of measles can be uncomfortable and painful and keep kids out of school or activities.
As the graph suggests, measles cases increase as fewer people receive the vaccine.

The measles outbreak is just one experience with diseases that were once eradicated.
More children are now introduced to diseases that have not been present in American society in
many years. 2012 saw the largest outbreak of Pertussis since 1955. 15 Children who are not
protected from these illnesses may contract novel viruses or strains of viruses that do not have a
vaccine.

An unvaccinated child may build up their immune system and form antibodies to protect
them during the cold and flu season. Nevertheless, this does not ensure that every unvaccinated
child is protected from every strain of the flu. During the 2012-2013 flu season, over 100 kids
died due to flu-related symptoms, and 90 percent of them were not vaccinated. 16 Though
antivaccination families may believe that they are doing what is in the best interest of their
children, it is not clear if it is in the best interest of their communities. Immunocompromised
children might not know they are susceptible to illnesses. Children who contract an illness from
an unvaccinated peer can unknowingly spread it to at-risk family members. Alternatively,
unvaccinated children can spread their illness to other unvaccinated children. To combat this, the
message against vaccinations must be addressed and changed.

Vaccination Opposition
The impact of antivaccination messages is the distrust of Americans.

While the population has a statistically significant portion that distrust the literature and
research regarding vaccinations, the opposition makes a minority group across the United States.
For those who do not believe in vaccines, nicknamed “anti-vaxxers,” it is a matter of religious
and personal beliefs, safety concerns, and education. 17 Those who did not vaccinate because of
religious beliefs commonly stated that the ingredients in vaccines were not acceptable in their
religion. 18 Many antivaccination families held the personal belief that “natural immunity” was
better protection than medicine. 19 The safety concerns are that vaccines contain dangerous
components that could lead to autism and brain damage; however, those ingredients, such as

15
Jeanne Spencer, et al. “Vaccine Adverse Events: Separating Myth from Reality,” American Family Physician 95,
no. 12 (2017): 786-794, https://www.aafp.org/afp/2017/0615/p786.html
16
“CDC Reports About 90 Percent of Children Who Died from the Flu This Season Were Not Vaccinated,”
Influenza, Center for Disease Control and Prevention, last modified July 24, 2013,
https://www.cdc.gov/flu/spotlights/2012-2013/children-flu-deaths.htm
17
Chephra McKee, et al. “Exploring the Reasons Behind Parental Refusal of Vaccines,” Journal of Pediatric
Pharmacology and Therapeutics 21, no. 2 (2016): 104-109, https://doi.org.10.5863/1551-6776-21.2.104
18
Ibid
19
Ibid

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Thimerosal, have not been included in any vaccines since before 2006. 20 Others felt that there
was not enough information on vaccinations to make an informed decision for their child.

Science proves the importance of vaccinations for the well-being of all children.
Vaccines are designed to build antibodies against antigens from dangerous diseases. 21 Vaccine
injuries, such as autism, have been disproven. 22 Those who have dangerous allergic reactions to
individual ingredients can receive other vaccinations to prevent them. 23 Otherwise, there is a
minimal chance that a child will suffer any injury or severe illness after getting a vaccine. 24
However, not vaccinating children will cause outbreaks and have adverse effects on
communities. Some state governments recognize this. The latest legislation includes the 2019
Washington State House Bill 1683, which “removes the personal belief exemption for measles,
mumps, and rubella for public schools, private schools, and daycare centers.” 25 New York
removed the religious exemption for public school immunization requirements the same year,
making all vaccines mandatory for every child. 26

It is difficult to appease the masses on a polarizing issue such as this one. The crux of the
argument is the safety and health of all children versus the personal beliefs of families. An article
from the Journal of Pediatric Pharmacology and Therapeutics presents the main fears or
objections antivaccination families have. Vaccines’ ingredients can change to combat religious
beliefs. While personal beliefs are valid, scientific studies and the experience of other
unvaccinated children prove that vaccinations are more effective than natural immunity. The
safety concerns of individuals can be addressed and disproven through scientific studies, such as
one published in American Family Physician. 27 Moreover, more education can be provided to
families who are not aware of the benefits and necessity of vaccines. Without a change in the
perspective of vaccines, concerning outcomes lie on the horizon, such as epidemics and
pandemics that could result in high mortality rates.

20
Chephra McKee, et al. “Exploring the Reasons Behind Parental Refusal of Vaccines,” Journal of Pediatric
Pharmacology and Therapeutics 21, no. 2 (2016): 104-109, https://doi.org.10.5863/1551-6776-21.2.104
21
“Why Are Childhood Vaccines So Important,” Vaccines and Immunizations, Center for Disease Control and
Prevention, last modified May 16, 2018, https://www.cdc.gov/vaccines/vac-gen/howvpd.htm
22
“Vaccines Do Not Cause Autism,” Center for Disease Control and Prevention,
https://www.cdc.gov/vaccinesafety/concerns/autism.html#
23
Jeanne Spencer, et al. “Vaccine Adverse Events: Separating Myth from Reality,” American Family Physician 95,
no. 12 (2017): 786-794, https://www.aafp.org/afp/2017/0615/p786.html
24
Ibid
25
“States with Religious and Philosophical Exemptions from School Immunization Requirements,” National
Conference of State Legislatures, January 3, 2020, https://www.ncsl.org/research/health/school-immunization-
exemption-state-laws.aspx
26
Ibid
27
Jeanne Spencer, et al. “Vaccine Adverse Events: Separating Myth from Reality,” American Family Physician 95,
no. 12 (2017): 786-794, https://www.aafp.org/afp/2017/0615/p786.html

[5]
The Domino Effect
The current system will end in outbreaks, epidemics, and pandemics unless it is improved upon.

Pandemics and
epidemics are dangerous to all
facets of society. Mass illness
in short periods of time leads to
a debilitated economy, overrun
hospitals, and large death tolls
on the population. As the graph
exemplifies, deaths due to
tetanus contraction has
increased as the number of
cases increases. Though a
tetanus vaccine does exist, as
fewer people choose to receive
it, more cases arise, and more Figure 3: As the number of children getting vaccinated
cases can reach susceptible decreases, the number of cases and deaths increases.
populations. Moreover, as cases CDC, Number of Reported Cases of Tetanus, Survival Status of Patients and Average
Annual Incidence Rates by Age Group in The United States, 2009-2015, American
spread the likelihood that Academy of Pediatrics, July 3, 2019, image,
https://www.aappublications.org/news/2019/07/03/mmwr070319
diseases can mutate and
overcome existing vaccines increases. As the domino effect suggests, this can lead to more
outbreaks, epidemics, and pandemics that societies are not prepared for.

At this time, most children are vaccinated, yet there are still outbreaks. Therefore, the
alternatives to solving this issue are limited because policymakers must enforce vaccinations
beyond the amount that they are currently enforced if there is to be any change.

Though it is difficult, not resolving the issue could lead to the outbreak of more
eradicated viruses. No resolution could lead to the unnecessary death of more children in the
United States, or elsewhere. Not vaccinating children could increase the number of outbreaks or
epidemics and their frequencies. Overall, increasing the number of unvaccinated children will
only result in the number of avoidable disruptions to children’s school and extracurricular
activities. To avoid these outbreaks, it takes national leaders that can inform all without bias or
personal gain.

The public can stay informed by turning to the Center for Disease Control and Prevention
(CDC). They report on the benefits of vaccines and address common concerns of parents. The
CDC also provides information about types of vaccines and when to get them. The CDC receives
funds from the government and spreads information about diseases to protect public health. With

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its influence, funding, and intelligence, the CDC can scientifically back and implement
mandatory vaccinations for all.

Mandated Vaccinations for All

All vaccinations are mandatory unless a child has a clear medical exemption.

The proposed option is mandating that all children must receive all required
immunizations to go to any kind of school unless they present with one of the medical
exemptions that are designated by the state. The funding would solve the issue of not all children
receiving their vaccines or finishing their vaccine sequences. It would also eliminate the number
of families claiming religious or personal beliefs as a reason not to protect their children and
other children through immunizations.

For those whose religion withholds them from consuming certain ingredients, it may not
be possible for them to receive a vaccination. However, with a change to ingredients, those
children can be vaccinated. Others will argue that they have a right to consent what goes into
their bodies and their children’s bodies; therefore, the government cannot mandate a drug.
However, they cannot consent to the harm of other children who are impacted by their choice not
to vaccinate.

Since the policy is compulsory, it would require more vaccinations to become available
to more children, no matter their financial background or their insurance. Therefore, the federal
government would foot the bill on the back end through Medicare or other types of funding to
make sure that every family can afford to get vaccines.

Antivaccination families do not fall into a particular party; therefore, there are no party
affiliations tied to this issue. 28 However, the anti-vaxxer population is growing in numbers. If the
group reaches the majority of the country’s population or a more considerable minority than it is
right now, that could keep presidents, senators, or representatives from being voted for again if
they support fully mandatory immunizations. Though this is not an innately political issue,
implementing mandatory vaccines will set a new standard for public health and who controls it.

Setting A New American Health Standard

The government will set a precedent by dictating how to manage health and safety.

Mandatory vaccinations would set a precedent of authoritarian control over Americans. If

the government assumes the right to determine whether or not someone’s personal or religious

28
Jacqueline Olive, et al. “The State of The Antivaccine Movement in The United States: A Focused Examination
of Nonmedical Exemptions in States and Counties,” PLOS Medicine 15, no. 7 (2018),
https://doi.org/10.1371/journal.pmed.1002578

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beliefs are valid enough not to get a vaccine, the federal government could mandate other things
that would directly affect one’s body. Compulsory immunizations would set the precedent that
while Americans have the right to life and liberty, that life can be controlled entirely by the
standards set by the federal government. This policy may also precedent what is considered
public health, for worse or better. Mandatory vaccines can benefit the American people because
they will have continual access to life-preserving medicines and remedies. However, it could
lead to vaccine hoarding in pandemic situations in which there will be pressure on the federal
government to keep vaccines for U.S. citizens only because of the need to vaccinate more
people. So, to make a calculated approach towards implementation, the federal government
needs the support of research institutions that can provide credible information on vaccinations.
To set a precedent, the leaders of mandated vaccines must be involved with federal
organizations.

Federal Government Organizations as Leaders

Federal action takes federal-level funding to support.

This policy change is a national issue and requires the funding and support of national
institutions. The best option is pooling groups from the CDC and from the National Institute of
Health (NIH) to determine the best way to approach fully mandatory immunizations. These
institutions have access to research and data that can help inform the public about the benefits of
vaccinations. Potential sub-teams could come from each state’s Department of Health to work
with the CDC and NIH to create more options and a plan to implement the chosen
option. Another method would be turning to lobbyists or the public, such as physicians or
medical scientists, to convince representatives or senators to propose a new bill that would
impose fully mandatory immunizations. The policy takes a bill to implement; therefore, the
recommendation of mandatory immunizations will be kept in the Congressional Record. All
recommendations made by the policy leadership and sub-teams will be recorded internally
through their records and considered in the policy changes.

Uniformity Is Essential
The current is system is not uniform leaving the American people without a clear standard.

To set a national standard, the federal government must work with states to implement a
fully mandatory vaccination program. When left to the states to implement, the rules and
expectations cannot all be the same. The fully mandatory immunizations will be implemented
through federal legislation that will remove state funding if the program is not implemented.
Then, with the following school year, all states must require all vaccinations to be completed for
any student looking to attend school. But because states do not currently have the same standards

[8]
on mandatory vaccinations, federal involvement will require all states to comply with the new
policies.

State Compliance
Health and safety are under state’s jurisdiction.

Federal implementation of vaccinations through educational systems challenges the

checks and balances system of the U.S. government. Though states have control over the well-
being of its residents, The Commerce and Spending Clause would allow the federal government
to threaten the removal of state funding or other benefits if vaccines are not made compulsory by
the next school year. 29 However, to ensure continuity, mandatory vaccines cannot be made at the
state level.

Communication with the American People

Education is the federal government’s best resource.

Educating the public about the uses, benefits, and need for vaccinations is the first step at
delivering this new policy to the masses. Many parents report feeling unaware of the science
behind vaccinations as their main reason for keeping them from their kids. 30 By giving free
resources to parents about vaccines, more families may feel inclined to receive vaccinations
willingly. Another step is determining what medical exemptions indeed inhibit a child from
getting an immunization. The federal government must work with doctors to determine strict
guidelines when determining when a child is entirely unable to receive a vaccine. To implement
this program, it would take a bill to pass in the House of Representatives and the Senate, which
would take agreement amongst all parties on the validity of the science and the importance of
vaccines in promoting public health. Therefore, all information should be presented unbiased and
not affiliated with any party. Mandatory vaccinations as a national requirement need to focus on
the welfare of children rather than personal or political gain.

In order to communicate this to the public, a policy change as drastic as mandatory

vaccines will take the approval of two different groups. First, it takes legislature to approve a bill
or policy change that will severely impact the American population. Once it has been approved
federally, communication must be sent to the public to have them approve of the changes.
Though it is the job of the government to make decisions that are in the best interest of all
citizens, not all people will agree on what is the best decision for them. Therefore, the American
people must approve this policy in order for it to be accepted and unchallenged in the future.

29
Wen Shen. “An Overview of State and Federal Authority to Impose Vaccination Requirements,” Congressional
Research Service, May 22, 2019, https://fas.org/sgp/crs/misc/LSB10300.pdf
30
Chephra McKee, et al. “Exploring the Reasons Behind Parental Refusal of Vaccines,” Journal of Pediatric
Pharmacology and Therapeutics 21, no. 2 (2016): 104-109, https://doi.org.10.5863/1551-6776-21.2.104

[9]
However, implementation should be swift and methodical to stop the rise in cases of eradicated
diseases.

Immediate Implementation
Swift action will bring about the best results.

Implementation will happen quickly to prepare for the next outbreak or pandemic. As
recent times have proven, the next pandemic is on the horizon, and often unpredictable.
Therefore, the federal government should intend to agree and pass a bill that would go into effect
the school year after the bill is passed. All state governments would have sufficient time to write
and pass their bills that would mimic the bill written by the federal legislature.

In order to approve this change, the American public needs to be more informed and
involved in the science behind vaccinations. Those involved in making and approving vaccines
can release more information about the benefits of receiving a vaccination as a child. This
information can be shared through the media. Sending out mail with information about the policy
itself and why mandatory vaccines will help the country is the first step in spreading awareness
about the issue and convincing members of the public of how mandatory vaccines will be
beneficial to their families. Information can also be posted throughout hospitals, doctors’ offices,
and schools to explain the changes. Because this is a widespread change, communication should
be shared in an organized fashion through the work of a communication team. Sending
information out in waves will help Americans adjust to the changes and understand why
mandatory vaccines are going to help their children stay safe. If the literature is informative, fair,
and effective, mandatory vaccinations can be accepted and supported by the public.

Protecting the American People

If successful, mandatory vaccines could protect millions of people.

If this plan is successful, states would have a uniform policy for mandatory vaccines for
all children without a medical exemption. States would have educational and informational
material to share with parents and doctors about the importance of this new policy in protecting
all American children. Once the policy takes effect, success would look like every child
receiving the necessary vaccines according to their age and grade. Overall, success would come
when all American children are vaccinated, and dangerous, deadly, and highly contagious
diseases are eradicated.

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