Need to elaborate on the sections listed in red and add more content to support our stand on Parents vaccinating their children. Please add substantial content to strengthen our side. Only n

POSITION RESEARCH PAPER

1

POSITION RESEARCH PAPER 2

Position Paper Report

School

Team 2

Teacher

October 9, 2022

Should Parents be Allowed to Refuse Immunizations that are Required for Schools?

Section I: Statement of the Issue        

Underlying Problem

Immunization is a process through which the person is fortified or immunized against a particular disease or disorder. The underlying problem is that parental refusal to vaccinate their children is increasing and has serious public health consequences. The problem has come from the observations of the recent pandemic when parents refuse to vaccinate their children. WHY IS THIS A PUBLIC HEALTH CONSEQUENCE? https://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/not-vacc-risks-color-office.pdf WHAT EVIDENCE SHOWS AN INCREASE? https://www.statista.com/statistics/1092333/opinions-on-vaccines-being-more-dangerous-than-the-diseases-they-are-for-us/  

Controversial Issue

The controversial factor is whether parents should have the right to refuse vaccinating their children. Some parents do not want their children to be immunized and refuse it. No doubt, vaccination of children to immunize them against certain diseases is in the best interest of society at large. In this situation, it becomes controversial whether the parents have the right of refusal or if it is the government's right to make it mandatory. The issue is controversial because vaccinations are necessary for children, but whether parents’ refusal is a suitable approach needs to be addressed. WHY IS THIS CONTROVERSIAL? (Use the first two links, they talk about this) WHO DISAGREES WITH THEIR RIGHT? ( https://www.statista.com/statistics/1092333/opinions-on-vaccines-being-more-dangerous-than-the-diseases-they-are-for-us/ -there’s a study showing parents who think immunization should be required) 

Benefits of Solving the Problem

There will be a benefit to ending the debate of parents’ right to refuse vaccination. It will be clear whether the parents can make the decision. WHAT ARE THE BENEFITS? 

Priori Position

We take the position in favor of parents who have the right to refuse the immunization required for the school. WHY DO WE FEEL THIS WAY?

  Section II: Background and Evolution of the Issue

Origin of the Problem

The origin of parents' refusal of vaccination started from the beginning. (Ramzan, 2021) has presented research on the topic that almost 10 million lives were saved by vaccination from the 1960s-2015 and these vaccines were against various diseases. Vaccinations are always newly introduced after the spread of disease, and parents are not sure whether it will be safe for their children. The proper permission of medical experts, scientists, researchers, and international health-related organizations like WHO or CDC is taken to introduce vaccination for a certain disease. Still, the parents feel reluctant to give the dose of vaccination to the children. It is observed that the parents have certain reservations that the government usually considers. If the parents are satisfied with the justifications, they can allow the vaccination or immunization, but if they are not satisfied, the right of refusal remains in place. GIVE SOME EXAMPLES OF A HELPFUL VACCINE RELEASED AFTER A DISEASE. WHY DO THE PARENTS STILL FEEL RELUCTANT? WHAT RESERVATIONS ARE CONSIDERED? INTRODUCE RELIGION, LACK OF TRUST (SYPHILIS and POLIO), AND LACK OF EDUCATION. PSYCHOLOGICAL?

An example of trust broken between the parents and the government was the Cutter Polio vaccine incident. Cutter is a lab that was responsible for manufacturing Jonas Salk's vaccines. He had a detailed protocol for them to follow, but they chose to follow Sabin’s attenuated vaccine method. Instead of using Salk’s formaldehyde to inactivate Polio, they used Sabin’s attenuated strain which led to Polio becoming activated through the gut (Fitzpatrick, 2006). This error was costly. Two hundred children were paralyzed, and ten children died due to polio. Healthcare professionals did try to downplay this, with Surgeon General Leonard Andrew Scheele believing that the children were infected before the vaccination. This was a required vaccination for schools starting in the 1950s. It makes sense that parents would be skeptical of required vaccinations for their children from then on (Kurlander, 2022). The fault according to Paul A. Offit, an American Pediatrician who was a co-inventor of a rotavirus vaccine, goes to the federal government who sent inspectors to each lab to follow the manufacture of the Polio vaccines. Cutter’s Lab was the only one to not follow Salk’s protocol. 

In August 2022, the FDA allowed the emergency use authorization of the bivalent COVID-19 boosters. They even qualified for the booster (Pfizer) to be given to children older than 12 years old. This bivalent version of the vaccination contains the mRNA common in the Omicron variant. The Omicron variant has been causing the most cases in the USA during the summer of 2022. With school season coming up soon, the FDA rushed the approval process by pushing an emergency use authorization. This is a risky call because we are unsure of the side effects and severity of these vaccinations can cause. When a new drug is produced, it is supposed to be tested on animals to evaluate the safety of the vaccine. Then the clinical trials move on to healthy adult subjects to ensure vaccination’s effectiveness. The last clinical trial moves on a target population to test the drug's efficacy. Finally, the results are sent to the FDA for review. With the FDA approval, the manufacturer will decide to enter the drug into the market. Leaving these trials in the dark from the public will cause parents not to trust the government and its decisions. This shows the government's inconsistency, for they have not learned from the Polio incident.

Current Affairs

The parents' reasons for refusing the vaccination or immunization have been explained by different authors and are published in journals. (Farhad Ali Khattak, 2021) Has presented the reasons for parents' refusal of their children's immunization. The parents' education was one of the significant reasons for refusing the vaccination of children. In the study, almost a quarter of parents (231) refused their children's immunization, and most were unable to read or write. It shows that education and awareness are necessary for the parents to decide. (GET STATISTIC EVIDENCE ON THIS) The study revealed another reason, such as the vaccine's adverse reaction on the children. The vaccination reacts differently towards different individuals, so parents need to analyze whether they want immunization for their children or not. They might hear the rumor that a child has died, which may be the reason for refusal. (WHAT ADVERSE REACTIONS?)

(Harman, 2022) have published the results of a study that different factors are responsible for parents' refusal to vaccinate their children. Whether parents have the right or not is another level of debate. Still, there is a considerable ratio of parents in this country who think immunization is not better for their children. (What is the considerable ratio- give example). The parents claim them as the decision makers for the family and refuse to have the vaccination for their children. The first reason is the loss of trust in the medical sector because people are afraid. The parents do not want to lose their children or see them in pain as the side effects of vaccination. Several incidents are reported due to negligence of the medical sector, which is why the parents do not agree to allow immunization for their children. The risks and effects of vaccines are the other reasons parents refuse the vaccination. The research participants shared their experiences regarding the side effects of immunization, or they had the stories of their friends and relatives. The fear of seeing the adverse reaction to the vaccine among children is a significant reason, and parents advocate using their rights in such situations. (WHAT IS THE ADVERSE REACTION). The data were collected during the coronavirus, and the vaccination was new, so the parents did not agree to use immunized injections or doses among their children. The side effects were already known as fever and nausea, but the parents did not agree to take the risk. Parents' health perceptions and practices are also the reasons to refuse the immunization, and it was shown that the participants were in favor that the parents must not be pressured to delay their rights.

(Aedh, 2022) has conducted a cross-sectional study to determine and discuss the response and attitude of parents toward the coronavirus vaccines. (WHAT DID THE STUDY SAY- give facts). The vaccination and the relevant attitudes are not new topics to discuss, but it is observed that the coronavirus is a recent case, and it has led parents to make various decisions for their children. The parents have two schools of thought. Some parents immediately had their children receive the immunization as the coronavirus rapidly spread. On the other hand, some parents did not allow their children to get vaccinated. Distrust and doubt about the quality of vaccination played an essential part in the refusal. The children are the responsibility of the parents, and they never want them to be hurt in any way which is why the parents have the right to refuse. Principal Stakeholders

Ultimately, parents are the stakeholders in immunizing their children while the government is also a significant stakeholder because it cannot neglect the health and welfare of the public at large. Specifically, CDC is the principal stakeholder agency in the government and parents are the stakeholders of the children and the decision of immunization, so as necessary, the parents must be counseled. CDC suggests that providers/pharmacists talk to them and remind them of the importance of vaccination. The need of the hour is not to debate whether the parents have rights or not, but it is essential to convince them. The parents must be informed that there will be no side effects, and the government should provide the proper training to parents to understand the critical need for vaccination.

Section III: Identification and Evaluation of Alternatives (pros & cons)

Many people come to the U.S. for the luxury of having the freedom of choice. Although parents should have the full right to control their children's lives by choosing whether or not they want them vaccinated, they also need to consider everyone else's lives. Salmon stated, "Children who have exemptions to these laws are at greater risk for contracting VPDs and transmitting the disease to children too young to be vaccinated." Refusing vaccination puts their children at risk and affects others in the community, including vulnerable children too young to be vaccinated. Most parents have their reasoning as to why they refuse to immunize their children. Most parents are concerned about the safety and efficacy of vaccines and distrust the healthcare system. Many factors influence parents' decisions, such as religion; their religious convictions forbid ingesting anything into one's body—uninsured families who don't have insurance and refuse to pay for any vaccination cost. Parents who have trouble speaking English, thus they won't accept anything without fully understanding what their children are receiving. And some refuse vaccinations because of the possible side effects their children might experience. Moreover, parents' educational background plays an essential role in their decision regarding vaccinating their children. Napolitano stated, "it found more than half of unvaccinated American adults who reported strong hesitancy to the vaccine had a high school education or less." Therefore, some people don't realize how effective those vaccinations are due to their poor educational background. The Washington Post mentioned, "The more time doctors spent talking about the vaccination, the study found, the more suspicious and worried the parents got about the vaccine" Patients frequently become fearful and overthink their children's treatments when doctors talk to them in complex language, which makes them uncomfortable with using scientific terminology. And this is precisely how people who have trouble speaking English feel most of them imagine when it comes to their children's health when they don't understand what the doctor is saying. And we have those extreme parents who refuse immunization without any reason; they argue that their children should be exempt from getting any vaccine.

Do parents realize the importance of vaccinating their children? Are they aware of a vaccine's approval process for safety and efficacy? Before a vaccine is approved, it is subjected to a long and careful review by scientists, doctors, and healthcare professionals. Imagine a world without vaccines. The disease would spread quickly; people would be afraid to contact others, and parents would hold children back from playing with other children. Vaccines have changed the world several times. They protect future generations. A few generations ago, diseases like polio or smallpox killed or severely disabled many people. These diseases have been significantly reduced due to vaccinations.

If we stopped vaccinating, the diseases would start coming back. All those diseases are still active in some parts of the world. If we don't stay vaccinated, the diseases will come back. On the other hand, healthcare providers throw a lot of information to their patients where they have many options leading them to avoid getting their children vaccinated. One of the main reasons why parents refuse it is their distrust of the healthcare system. Parents are worried about the safety and efficacy of those vaccines. But parents don't realize they are putting their children at greater risk by refusing immunizations; diseases pick out vulnerable people first, so babies and young kids would be first. Moreover, parents should not be allowed to refuse immunizations. To provide a safe environment, every child needs to be vaccinated. Vaccines have scientifically proven throughout the decades how effective and necessary they are. When everyone is vaccinated, it makes it harder for a disease to spread. If a person infected with the disease comes in contact with people vaccinated, the disease will have little opportunity to spread. Community immunity is the type of protection created when many people are vaccinated. It means that many of us are protecting each other, especially the most vulnerable among us, such as those children.

Section V: Implementation and Recommendations

Actions Needed

As one of the complaints listed above, parents need to be able to trust the government and healthcare officials. There were multiple instances where the government has hidden information from the public that affected their health, like the Flint Michigan incident and the Polio vaccine trials. It is required for healthcare professionals to provide information to the parent, so they understand the importance of certain vaccinations. If the parent refuses the immunization application, then it is a failure for the government not to show adequate information to the public.

With all these instances of distrust and hidden information from the public, parents don't want to vaccinate their children with everything the government requires for school. The action needed by the government right now is to follow the protocols of FDA rules. This is about the health of our generation; rushing processes like this can cause severe damage to a population like Flint, Michigan, and Cutter lab accidents. The evidence needs to be clear and publicly accessible. This way, the parents are well educated on the subject and can make the correct decisions on their children's health. Even if they refuse the vaccination, they can at least make good points with the information they have learned and challenge the healthcare professionals' knowledge. This could open a legitimate discussion about vaccinations and their contents.

Promoting the importance of immunizations is another critical solution to this issue. We hardly ever see these types of advertisements on television or social media. Visual advertising is what catches people's attention. Vaccines are one of the most excellent tools to prevent infectious diseases and their serious complications. And so, promoting it on T.V. would show that before a vaccine is licensed and recommended for use, it goes through a complex process to ensure it is both safe and effective. This includes preclinical work in the laboratory to demonstrate the vaccine can induce a protective immune response so that those parents will know how safe and effective those vaccines are. Not only promoting it on social media but also promoting “community protection" in public health law and communications and restoring broad societal trust in vaccination for those who don't have access to social media.

Another way is to have healthcare professionals use simple language when speaking to their patients. The government should encourage physicians to commit to listening to and understanding barriers to vaccination and the concerns of parents to make vaccination services more accessible and user-friendly. Every patient needs to feel comfortable and safe when speaking to their physician, which will break the barrier between physicians and patients.

Stakeholder Support

This will not only be in the best interest of parents as the stakeholders but also the providers too. They will benefit from the health of the public being ameliorated. The only way for this to happen is for the public to be aware of the truth and not hide valuable information. Such valuable information will help more parents to immunize their children and patients to immunize themselves. With this outcome, the stakeholders will benefit.

CMS stands for Center for Medicaid and Medicare Services. Medicaid and Medicare are responsible for covering the vaccines and not paying a single cent from the patient. So how does the provider make money if there is no copay for these expensive concoctions? CMS pays the providers on a dose-administered basis. For example, for each COVID-19 dose given, CMS will pay the provider $80 (Oregon 2020). It's frustrating to have a parent refuse immunizations because their child's safety could be in danger now and because the provider misses out on reimbursement from purchasing the vaccinations. If parents had more knowledge available to them about vaccinations, the provider would make ends meet in the vaccination business (Hut, 2022).

So, for the sake of money and the public's health, providers should take the time to explain to the parent why vaccination is essential for the child and other children at the school. As mentioned above, parents who are well educated and understand the process will accept the immunization for their child. This does mean that the parents need to meet the providers halfway. They need to speak about their concerns about vaccinations so a discussion can be had. Most anti-vaccine parents reply no and with no willingness to change their minds. Research reputable sources and talk to the provider about them so more information can be shared.

With the belief that parents are the ultimate deciders of their children's immunization, We believe that parents are allowed to refuse vaccinations for school. We believed in this thought because they should be fully educated on these procedures. If they are not given a proper description of the reason for the vaccination, they can rightfully refuse without religious or medical reasoning. With instances like Flint Michigan, and Cutter's lab's error costing hundreds of children's lives, it is reasonable for parents to be reluctant to vaccinate. However, after much research, immunizations save more lives than take, so our position has changed. Parents should not be allowed to refuse immunizations for school unless exempted by religious/medical reasons. To get more parents on board with vaccinations, it is for doctors to take the time to explain the importance of them, use layman's terms, and for the media to advertise the shots.

References

Aedh, A. I. (2022). Parents Attitudes, Their Acceptance of the COVID-19 Vaccines for Children

and the Contributing Factors in Najran, Saudi Arabia: A Cross-Sectional Survey. Vaccines, 10(1264). DOI: https://doi.org/10.3390/vaccines10081264

Commissioner, O. of the. (n.d.). Coronavirus (COVID-19) update: FDA authorizes Moderna,

Pfizer-BioNTech bivalent COVID-19 vaccines for booster doses. U.S. Food and Drug Administration. Retrieved September 27, 2022, from https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-pfizer-biontech-bivalent-covid-19-vaccines-use#:~:text=With%20today's%20authorization%2C%20the%20FDA,years%20of%20age%20and%20older%2C

Farhad Ali Khattak, K. R. (2021). Prevalence of Parental refusal rate and its associated factors in

routine immunization using WHO Vaccine Hesitancy tool: A Cross-sectional study at district Bannu, K.P., Pakistan. International Journal of Infectious Diseases, 104, 117-124. doi: https://doi.org/10.1016/j.ijid.2020.12.029

Fitzpatrick, M. (2006, March). The Cutter Incident: How America's first polio vaccine led to a

growing vaccine crisis. Journal of the Royal Society of Medicine. Retrieved October 14,

2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383764/

Harman, J. N. (2022). Why do parents refuse childhood vaccination? Reasons reported in

Finland. Scandinavian Journal of Public Health, 50(4), 490-496. doi: https://doi.org/10.1177/14034948211004323

Hut, N. (2022). Providers that administer the COVID-19 vaccine are getting a payment bump

from CMS. hfma. Retrieved October 6, 2022, from https://www.hfma.org/topics/coronavirus/providers-that-administer-the-covid-19-vaccine-are-getting-a-pay.html#:~:text=Effective%20March%2015%2C%20providers%20will,is%20from%20%2445%20to%20%2480.

Kurlander , C., & Juhl , R. P. (2022, September 13). Lessons from how the polio vaccine went

from the lab to the public that Americans can learn from today. The Conversation. Retrieved October 6, 2022, from https://theconversation.com/lessons-from-how-the-polio-vaccine-went-from-the-lab-to-the-public-that-americans-can-learn-from-today-145604#:~:text=Clinical%20trials&text=It%20began%20on%20April%2023,Francis%2C%20independently%20monitored%20the%20study.

November 08, 2018, M. D. (2022, July 18). Flint water crisis: Everything you need to know.

NRDC. Retrieved September 22, 2022, from https://www.nrdc.org/stories/flint-water-crisis-everything-you-need-know

Obama Drinks Flint Water. (2016). YouTube. Retrieved October 5, 2022, from

https://youtu.be/u2ZynkD3N_k.

Oregon, B. (2020, May 12). Vaccine myth: Vaccines are just money-makers for Big Pharma &

Doctors. Boost Oregon. Retrieved October 6, 2022, from http://www.boostoregon.org/blog/vaccine-myth-vaccines-are-just-moneymakers-for-big-pharma-and-doctors

Ramzan, V. K. (2021). Vaccines and vaccination: history and emerging issues. Human Vaccines

& Immunotherapeutics, 7(21), 5255-5268. doi:https://doi.org/10.1080/21645515.2021.1977057

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