Policy analysis.

For
 the
 past
 few
 decades,
 many
 people
 may
 have
 believed
 that
 
humans
 conquered
 infectious
 disease
 and
 the
 battle
 was
 over.
 
 The
 recent
 
measles
 outbreak
 across
 the
 United
 States
 is
 just
 one
 of
 many
 infectious,
 
reemerging
 diseases
 that
 have
 proven
 this
 argument
 wrong.
 Reemerging
 
diseases
 are
 diseases
 that
 were
 once
 major
 health
 problems
 but
 then
 
were
 either
 eradicated
 or
 declined
 significantly
 (Understanding
 Emerging
 
and
 Reemerging
 Diseases
 2007).
 Other
 reemerging
 diseases
 that
 are
 
beginning
 to
 cause
 health
 problems
 in
 the
 United
 States
 again
 are
 
diphtheria
 and
 pertussis.
 There
 is
 a
 common
 theme
 among
 these
 
reemerging
 diseases
 and
 that
 is
 they
 are
 all
 vaccine
 preventable.
 
Inadequate
 vaccination
 of
 individuals
 in
 the
 United
 States
 has
 contributed
 
to
 the
 resurgence
 of
 many
 diseases
 that
 were
 once
 eradicated
 or
 were
 on
 
their
 way
 out
 (Vaccines
 and
 the
 Law
 2014).
 In
 this
 policy
 brief,
 the
 
problem
 of
 reemergence
 of
 infectious
 diseases
 will
 be
 discussed
 and
 
followed
 by
 an
 evaluation
 of
 potential
 policies
 that
 can
 be
 implemented
 
to
 address
 the
 problem.
 

Environmental
 Implications
 of
 Reemerging
 Diseases
 

Policy
 Brief:
 Reemergence
 of
 Infectious
 

Diseases:
 Vaccines
 
 

as
 a
 Solution
 

Issue
 1,
 April
 8,
 2015
 

The
 environment
 plays
 a
 major
 role
 in
 the
 transmission
 of
 infectious
 diseases
 for
 two
 reasons.
 First,
 diseases
 
that
 had
 been
 eradicated
 in
 the
 United
 States
 like
 polio
 or
 measles
 can
 be
 brought
 back
 after
 travel
 to
 a
 
different
 country.
 
 The
 few
 recent
 cases
 of
 Ebola
 in
 the
 United
 States
 demonstrate
 how
 easy
 it
 is
 to
 bring
 
infectious
 diseases
 from
 around
 the
 world
 to
 the
 US.
 However,
 we
 need
 to
 also
 realize
 how
 easy
 it
 is
 to
 spread
 
disease
 across
 state
 boarders,
 similar
 to
 what
 happened
 in
 the
 recent
 measles
 outbreak.
 Thus,
 the
 agent
 is
 
spread
 from
 one
 location
 to
 another.
 Secondly,
 in
 some
 areas,
 people
 who
 refused
 vaccination
 are
 clustered
 
together
 and
 provide
 easy
 transmission
 of
 the
 infectious
 agent
 from
 person
 to
 person.
 
 

This brief was
designed:

• To provide
information
about the
importance of
vaccination

AND

• To reach
people who
are interested
in preventing
disease and
death through
effective
vaccine
policies

Introduction
 

2

Defining
 and
 Detailing
 the
 Problem
 

Reemergence
 of
 infectious
 diseases
 are
 occurring
 more
 frequently.
 For
 example,
 in
 2011
 the
 
United
 States
 experienced
 11
 outbreaks
 of
 measles
 followed
 by
 23
 measles
 outbreaks
 in
 2014
 and
 a
 
current,
 large,
 multi-­‐state
 measles
 outbreak
 in
 2015
 (Measles
 Cases
 and
 Outbreaks
 2015).
 These
 
outbreaks
 have
 caused
 significant
 problems
 for
 populations
 in
 the
 United
 States.
 Furthermore,
 the
 
measles
 outbreaks
 are
 just
 one
 sign
 of
 more
 to
 come.
 It
 would
 be
 safe
 to
 assume
 that
 if
 people
 are
 not
 
getting
 vaccinated
 against
 one
 thing,
 they
 are
 probably
 not
 getting
 vaccinated
 against
 others.
 If
 this
 
trend
 continues,
 the
 United
 States
 is
 likely
 to
 see
 more
 resurgence
 of
 infectious
 diseases
 that
 were
 once
 
a
 thing
 of
 the
 past.
 
 

The
 good
 news
 is
 many
 of
 them
 can
 be
 prevented
 with
 vaccinations.
 The
 bad
 news
 is
 many
 
people
 are
 choosing
 not
 to
 get
 vaccinated
 due
 to
 personal
 beliefs,
 religious
 beliefs,
 and
 medical
 reasons
 
(Vaccines
 and
 the
 Law
 2014).
 Many
 ethical
 controversies
 have
 been
 sparked
 by
 the
 idea
 of
 vaccinations,
 
and
 there
 are
 still
 debates
 in
 regards
 to
 the
 regulation
 and
 use
 of
 vaccines
 despite
 the
 fact
 they
 have
 
proven
 to
 be
 effective.
 
 The
 fact
 is,
 according
 to
 the
 World
 Health
 Organization,
 immunizations
 have
 
proven
 to
 be
 an
 effective
 tool
 for
 controlling
 and
 eliminating
 infectious
 diseases
 
worldwide,
 and
 is
 estimated
 to
 have
 prevented
 2-­‐3
 million
 deaths
 per
 year
 (2015).
 
 
Furthermore,
 they
 are
 one
 of
 the
 most
 cost-­‐effective
 health
 investments.
 The
 people
 of
 the
 United
 
States
 needs
 to
 use
 the
 technology
 that
 is
 available
 to
 protect
 themselves
 against
 life
 threatening
 
diseases
 that
 could
 present
 in
 the
 future.
 

 

Reemergence
 of
 infectious
 diseases
 are
 occurring
 more
 frequently.
 

3

1

After
 the
 smallpox
 
vaccine
 was
 developed,
 many
 
vaccination
 mandates
 began
 to
 
be
 developed.
 However,
 with
 
the
 decreasing
 incidence
 of
 
smallpox,
 regulations
 requiring
 
vaccinations
 began
 to
 loosen
 
and
 there
 was
 subsequent
 
reemergence
 of
 infectious
 
disease.
 Currently,
 there
 is
 no
 
federal
 law
 to
 mandate
 
vaccinations
 in
 the
 United
 
States,
 but
 all
 states
 require
 
certain
 vaccinations
 for
 
children
 to
 enter
 schools
 and
 
day
 care.
 (Government
 
Regulation
 2014).
 
 

Despite
 the
 fact
 the
 
Centers
 for
 Disease
 Control
 
and
 Prevention
 developed
 a
 
schedule
 of
 recommended
 
vaccinations
 for
 children,
 
states
 are
 not
 required
 to
 
abide
 by
 the
 
recommendations,
 and
 thus,
 
vaccination
 requirements
 
differ
 among
 the
 states.
 
Furthermore,
 many
 states
 
allow
 exemptions
 from
 
vaccinations
 due
 to
 religious
 or
 
personal
 beliefs
 (Vaccines
 and
 
the
 Law
 2014).
 The
 lack
 of
 
consistent
 and
 strict
 
regulations
 on
 vaccinations
 has
 
contributed
 to
 the
 
reemergence
 of
 dangerous
 
infectious
 diseases.
 People
 

2

need
 to
 return
 to
 one
 of
 the
 
oldest
 but
 most
 effective
 
methods
 of
 prevention,
 
vaccinations,
 in
 order
 to
 
protect
 themselves
 and
 the
 
population
 from
 life-­‐
threatening
 diseases.
 

There
 are
 several
 
ethical
 dilemmas
 involving
 the
 
rights
 of
 people
 when
 it
 comes
 
to
 regulating
 vaccinations.
 
Regardless,
 the
 health
 of
 a
 
population
 is
 a
 community
 
effort
 and
 so
 rights
 of
 
individuals
 may
 have
 to
 be
 
somewhat
 limited
 in
 order
 to
 
prevent
 harm
 and
 illness
 to
 
other
 members
 of
 the
 
community.
 Getting
 vaccinated
 
is
 not
 only
 important
 for
 an
 
individual’s
 health,
 but
 it
 is
 
also
 important
 to
 protect
 the
 
public’s
 health.
 People
 should
 
take
 all
 available
 precautions
 
to
 prevent
 themselves
 and
 
others
 from
 exposure
 to
 a
 life
 
threatening
 disease.
 It
 is
 
especially
 important
 to
 get
 
vaccinated
 when
 you
 can
 in
 
order
 to
 protect
 those
 who
 
cannot
 get
 vaccinated
 due
 to
 
age,
 their
 parent’s
 choices,
 or
 
medical
 reasons.
 When
 
enough
 people
 in
 the
 
population
 get
 vaccinated
 to
 
prevent
 other
 susceptible
 
unvaccinated
 people,
 herd
 

3

immunity
 is
 achieved
 (see
 
figure
 below).
 This
 is
 important
 
because
 this
 is
 sometimes
 the
 
only
 method
 of
 prevention
 for
 
some
 people
 who
 medically
 
cannot
 be
 vaccinate.
 Thus,
 
individual
 rights
 are
 important,
 
but
 

 

 “EVERY
 INDIVIDUAL’S
 RIGHTS
 

NEED
 TO
 BE
 BALANCED
 
AGAINST
 THE
 RIGHTS
 OF
 

OTHERS,
 AND
 THE
 RIGHTS
 OF
 
THE
 COMMUNITY
 AS
 A
 

WHOLE”
 (Vaccines
 and
 the
 Law
 
2014).
 

 

When
 the
 health
 of
 the
 entire
 
public
 comes
 into
 play,
 it
 may
 
be
 necessary
 to
 impose
 on
 
individual
 liberty
 for
 the
 
benefit
 of
 the
 community.
 

With
 that
 being
 said,
 
there
 are
 several
 policy
 
options
 for
 vaccine
 regulation
 
including:
 enacting
 consistent
 
laws
 and
 requirements
 
throughout
 the
 United
 States
 
and
 tighter
 regulations
 on
 
exemptions
 from
 vaccination.
 

 

Alternative
 Policies
 
There
 is
 an
 improved
 policy
 option
 for
 vaccine
 

regulation
 involving
 enacting
 a
 consistent
 law
 and
 
requirements
 throughout
 the
 United
 States
 and
 making
 

it
 harder
 for
 people
 to
 opt
 out
 of
 vaccinations.
 

4

 

Herd
 Immunity:
 ”
 When
 a
 critical
 portion
 of
 a
 community
 is
 immunized
 against
 a
 contagious
 disease,
 most
 
members
 of
 the
 community
 are
 protected
 against
 that
 disease
 because
 there
 is
 little
 opportunity
 for
 an
 

outbreak”
 (Community
 Immunity
 n.d.)
 

“
 

Evaluation
 Criteria
 
 
Policies
 to
 regulate
 

vaccines
 will
 be
 evaluated
 using
 
the
 criteria
 of
 cost
 effectiveness,
 
population,
 health
 costs,
 
wellness,
 and
 constituent
 
approval
 (Staley
 2015).
 

Evaluation
 of
 Alternative
 
Policies
 
 

Tightening
 the
 regulation
 
of
 vaccinations
 and
 reducing
 the
 
number
 of
 exemptions
 through
 a
 
federal
 law:
 Although
 individuals
 
have
 their
 rights,
 sometimes
 they
 
must
 be
 imposed
 upon
 to
 protect
 
others.
 For
 example,
 parents
 
should
 have
 the
 freedom
 to
 
determine
 how
 to
 raise
 a
 child.
 
However,
 children
 also
 have
 
rights
 too
 and
 when
 a
 parent
 
refuses
 to
 vaccinate
 them,
 
 

their
 health
 and
 the
 health
 of
 
others
 are
 being
 put
 in
 danger.
 
 
The
 law
 has
 the
 right
 to
 intervene
 
to
 protect
 vulnerable
 people
 
including
 children
 (Vaccines
 and
 
the
 Law
 2014).
 Therefore,
 a
 
federal
 law
 with
 stricter
 
regulations
 on
 vaccinations
 is
 
part
 of
 the
 duty
 of
 the
 
government
 to
 protect
 
vulnerable
 populations.
 Another
 
reason
 as
 to
 why
 this
 law
 would
 
be
 beneficial
 is
 because
 the
 costs
 
associated
 with
 treating
 a
 disease
 
are
 much
 higher
 than
 the
 costs
 of
 
getting
 vaccinated
 (both
 
financially
 and
 physically).
 While
 
there
 are
 some
 risks
 that
 are
 
associated
 with
 vaccinations,
 
they
 are
 very
 rare
 and
 the
 risks
 
and
 likelihood
 of
 contracting
 the
 
disease
 is
 much
 higher.
 
 Thus,
 the
 
benefits
 of
 vaccination
 far
 
outweigh
 the
 risks,
 and
 the
 cost
 
effectiveness
 of
 vaccines
 has
 
 

proven
 to
 be
 substantial.
 
Additionally,
 contracting
 an
 
infectious
 disease
 that
 could
 have
 
been
 prevented
 with
 a
 
vaccination
 will
 require
 lost
 days
 
of
 productivity
 and
 an
 overall
 
unwell
 feeling.
 Thus
 enacting
 a
 
law
 to
 require
 tighter
 regualtions
 
of
 vaccinations
 will
 prevent
 
people
 from
 having
 to
 experience
 
this.
 

The
 only
 potential
 
problem
 with
 this
 law
 is
 
constituent
 approval.
 However,
 
like
 with
 most
 things,
 not
 
everyone
 will
 be
 happy
 especially
 
when
 it
 involves
 imposing
 on
 
their
 personal
 freedom.
 

It
 is
 important
 to
 remember
 
that
 this
 law
 is
 being
 
enacted
 to
 protect
 

everyone
 from
 harm.
 

 

5

The
 recommended
 policy
 
is
 to
 tighten
 regulations
 on
 
vaccines
 and
 to
 reduce
 
exemptions
 to
 those
 who
 
medically
 are
 unable
 to
 get
 
vaccinated.
 
 

Again,
 while
 the
 rights
 of
 
individuals
 are
 important,
 there
 is
 
a
 balance
 that
 must
 be
 
maintained
 with
 the
 rights
 of
 
others
 in
 the
 community
 in
 order
 
to
 protect
 the
 public’s
 health.
 

People
 who
 chose
 to
 opt
 
out
 of
 vaccines
 and
 now
 are
 
required
 to
 get
 them
 by
 the
 new
 
policy
 should
 be
 reminded
 that
 
vaccines
 undergo
 extensive
 
testing
 and
 clinical
 trials
 before
 
they
 are
 put
 on
 the
 market
 and
 
administered
 to
 people
 (Vaccines
 
and
 the
 Law
 2014).
 Furthermore,
 
choosing
 not
 to
 vaccinate
 puts
 an
 
individual
 at
 risk
 for
 contracting
 a
 
harmful
 and
 even
 deadly
 
pathogen.
 Even
 if
 an
 individual
 
takes
 extra
 health
 precautions
 
after
 they
 refuse
 to
 get
 
vaccinated,
 such
 as
 staying
 away
 
from
 sick
 people,
 the
 individual
 
cannot
 fully
 protect
 his
 or
 herself
 
from
 the
 unexpected
 such
 
bioterrorist
 attacks
 where
 
infectious
 pathogens
 are
 used
 as
 
a
 deadly
 weapon.
 
 

It
 is
 also
 important
 to
 
remember
 that
 although
 certain
 
diseases
 have
 been
 eradicated
 in
 
the
 United
 States,
 the
 current
 
ease
 of
 traveling
 around
 the
 
world
 provides
 the
 opportunity
 
for
 many
 different,
 dangerous,
 
infectious
 diseases
 to
 be
 acquired
 
in
 a
 different
 country
 and
 

Conclusion
 

The
 Target
 
Population.
 

The
 target
 population
 for
 the
 
recommended
 policy
 is
 the
 
United
 States.
 Specifically,
 
adults
 who
 have
 not
 been
 
vaccinated
 and
 parents
 who
 
have
 previously
 decided
 to
 
not
 vaccinate
 their
 children.
 

The
 Goal.
 

Herd
 immunity
 is
 the
 goal
 of
 the
 
new
 policy
 recommendation
 so
 
that
 when
 a
 reemerging
 disease
 

is
 reintroduced
 into
 the
 
population,
 the
 disease
 cannot
 
spread
 and
 the
 public’s
 health
 is
 
prevented.
 This
 is
 especially
 
important
 for
 people
 who
 

physically
 cannot
 get
 vaccinated
 
instead
 of
 just
 choosing
 not
 to.
 

The
 recent
 measles
 outbreak
 in
 
the
 United
 States
 is
 a
 reminder
 of
 
how
 easy
 an
 infectious
 disease
 
can
 be
 acquired
 and
 spread
 
among
 a
 population,
 especially
 
when
 introduced
 into
 areas
 
where
 people
 have
 not
 been
 
vaccinated.
 

 

Policy
 Recommendation
 

The
 enactment
 of
 a
 
federal
 law
 that
 is
 consistent
 
between
 states
 with
 tight
 
regulations
 on
 vaccinations
 is
 
important
 to
 protect
 the
 health
 
of
 the
 public.
 While
 it
 may
 
impinge
 slightly
 on
 individual
 
rights,
 it
 is
 for
 the
 overall
 good
 of
 
the
 community.
 
 The
 recent
 
resurgence
 of
 infectious
 diseases
 
of
 the
 past
 indicate
 a
 need
 for
 
policy
 change
 sooner
 rather
 than
 
later.
 

 

References
 

Staley,
 J.
 2015.
 Policy
 Analysis
 [PowerPoint
 Slides].
 Retrieved
 from
 Kent
 State
 Blackboard
 

Community
 Immunity
 (“Herd
 Immunity”).
 (n.d.).
 Retrieved
 April
 8,
 2015,
 from
 

http://www.vaccines.gov/basics/protection/
 

Government
 Regulation.
 (2014,
 July
 31).
 Retrieved
 from
 History
 of
 Vaccines
 April
 8,
 2015,
 from
 

http://www.historyofvaccines.org/content/articles/government-­‐regulation
 

Immunization.
 (n.d.).
 Retrieved
 from
 the
 World
 Health
 Organization
 April
 8,
 2015
 from
 

http://www.who.int/topics/immunization/en/
 

Measles
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