1. Coalition Proposal Vaccination Policy for Infectious Disease Prevention and Control Scope of the Problem Vaccines have done an excellent job at preventing many diseases, some of which can be deadly if not prevented. When bacteria or viruses enter the body, they immediately begin to attack and multiply, which then causes an infection. The immune system will then fight off the infection and establish antibodies, which will help recognize and fight off the same disease in the future. For this very reason, it has been important for children to be vaccinated at an early age so that they may establish those antibodies their bodies need. Vaccines act as the disease so that the body may produce antibodies, but the good thing is that it won’t cause an infection (CDC, 2017). There are current policies that mandate vaccinations in the U.S., for example, all children are required to be up to date on their vaccines before beginning school. The problem is that there are many loopholes and exceptions to the rule, whether it’s due to religious reasons or other medical issues. Because of this, there are still many children and adults who have yet to be fully compliant with vaccine requirements Some important statistics to note (Johns Hopkins Medicine): · CDC estimated 2,700 new cases of hepatitis A in the U.S. · It is estimated that in 2011, 19,000 new cases of hepatitis B and 17,000 cases of hepatitis C occurred. · In 2012, nearly 10,000 new cases of tuberculosis were reported. · Approximately 36,000 people per year die from influenza and pneumonia. · 50,000 new cases of HIV infection occur annually. · In 2012, new cases of STD’s were reported, including HPV, Chlamydia, Gonorrhea, HIV, and Syphilis. Who is affected by this problem? Identify. Children are mainly affected by this problem due to parents’ hesitancy for vaccinations. Although law mandates for children to be vaccinated for school enrollment, parents have the option to use exemptions to avoid having their children vaccinated. Currently, medical exemptions are allowed for medical reasons in all states, and it is estimated that one to three percent of children are excused from vaccinations because of these exemptions. Parents have continued to use reasons to avoid vaccinations, for example, the belief that the decline in vaccine-preventable diseases is due to improved health care, hygiene, and sanitation (Ventola, C. L., 2016). Health disparities among Blacks, Hispanics, and Whites have played a huge role in terms of vaccination coverage. Studies have shown that health insurance has a direct impact on the vaccination coverage in adults, therefore, low-income families who can’t afford health insurance will most likely not get the vaccines they need. With that being said, uninsured prevalence was higher among non-Hispanic blacks (19.5%) and Hispanics (30.1%) compared with non-Hispanic whites (11.1%) (Lu, P., et al, 2015). What has been written on the issue and policy options? There ha.

1. 1. Coalition Proposal
Vaccination Policy for Infectious Disease Prevention and
Control
Scope of the Problem
Vaccines have done an excellent job at preventing many
diseases, some of which can be deadly if not prevented. When
bacteria or viruses enter the body, they immediately begin to
attack and multiply, which then causes an infection. The
immune system will then fight off the infection and establish
antibodies, which will help recognize and fight off the same
disease in the future. For this very reason, it has been important
for children to be vaccinated at an early age so that they may
establish those antibodies their bodies need. Vaccines act as the
disease so that the body may produce antibodies, but the good
thing is that it won’t cause an infection (CDC, 2017).
There are current policies that mandate vaccinations in the U.S.,
for example, all children are required to be up to date on their
vaccines before beginning school. The problem is that there are
many loopholes and exceptions to the rule, whether it’s due to
religious reasons or other medical issues. Because of this, there
are still many children and adults who have yet to be fully
compliant with vaccine requirements
Some important statistics to note (Johns Hopkins Medicine):
· CDC estimated 2,700 new cases of hepatitis A in the U.S.
· It is estimated that in 2011, 19,000 new cases of hepatitis B
and 17,000 cases of hepatitis C occurred.
· In 2012, nearly 10,000 new cases of tuberculosis were
reported.
· Approximately 36,000 people per year die from influenza and
pneumonia.
· 50,000 new cases of HIV infection occur annually.
· In 2012, new cases of STD’s were reported, including HPV,
Chlamydia, Gonorrhea, HIV, and Syphilis.
Who is affected by this problem? Identify.

2. Children are mainly affected by this problem due to parents’
hesitancy for vaccinations. Although law mandates for children
to be vaccinated for school enrollment, parents have the option
to use exemptions to avoid having their children vaccinated.
Currently, medical exemptions are allowed for medical reasons
in all states, and it is estimated that one to three percent of
children are excused from vaccinations because of these
exemptions. Parents have continued to use reasons to avoid
vaccinations, for example, the belief that the decline in vaccine-
preventable diseases is due to improved health care, hygiene,
and sanitation (Ventola, C. L., 2016).
Health disparities among Blacks, Hispanics, and Whites have
played a huge role in terms of vaccination coverage. Studies
have shown that health insurance has a direct impact on the
vaccination coverage in adults, therefore, low-income families
who can’t afford health insurance will most likely not get the
vaccines they need. With that being said, uninsured prevalence
was higher among non-Hispanic blacks (19.5%) and Hispanics
(30.1%) compared with non-Hispanic whites (11.1%) (Lu, P., et
al, 2015).
What has been written on the issue and policy options?
There has been much has been written in the media about
vaccination policy in the United States. In 2016, an article in
the American Journal of Public Health described the ethics of
vaccination policy and the thin line between parent autonomy to
decide whether their children are administered vaccines and the
importance of herd immunity. Many parents incorrectly believe
that vaccines can cause side effects such as autism or ADHD
and refuse to get their children vaccinated, this decreases herd
immunity and put the health of the public at risk. In light on
this dilemma there are approaches that can be implemented to
begin to solve the problem. From a policy perspective, it may
mean reevaluating the ease with which non-medical exemptions
are handled, with increased attention toward ensuring that
parents are making informed decisions, especially when they
opt out of vaccination (Hendrix, Sturm, Zimet & Meslin, 2016).

3. An article in the Los Angeles Times also examined the
issue of vaccine exemptions. They stated that when California
passed SB 277 which did away with personal-belief exemptions
the number of medical exemptions increased three-fold (Khan,
2017). This indicates that parents who could no longer claim
personal exemptions went doctor shopping for doctors who
would loosely interpret the requirements for medical
exemptions.
The Harvard Health Blog highlights the physical,
economic, and social cost of not vaccinating both infants and
adults. Preventable diseases are not always a case of getting
sick, going to the hospital, and then getting sent home with
some medication. They can cause life long disabilities that
require costly ongoing treatments and potentially round the
clock care. Dr. Claire McCarthy supports vaccinating as many
people as possible with as few exemptions, both personal and
medical, as possible.
What is the economic impact of the problem?
The economic impact of not vaccinating infants and
adults can add up quickly. According to data from the Centers
for Disease Control and Prevention (CDC), the cost of all of
these vaccines is approximately $1,200 if obtained through CDC
contracts, and about $1,600 if obtained through private
insurance. In comparison, the average cost of a hospitalization
to care for a baby with dehydration from rotavirus is $3,000-
$5,000. More serious diseases can have even great economic
implications. For example, he inpatient care unit costs
abstracted from median values of the NIS ranged from $5,770
for a hospitalized case of influenza to $15,600 for a hospitalized
case of invasive meningococcal disease (Ozawa et al., 2016).
A study published in JAMA Pediatrics estimated that if
the vaccination rate of children between ages 2 and 11 for
measles, mumps, and rubella dropped by 5% it would lead to
150 more cases of measles. This could cost over $2 million from
local and state public health institutions (Lo & Hotez, 2017).
The number would be even higher if those outside of that age

4. range were taken into account. According to the Bureau of
Labor Statistics, the average hourly wage in the US is about $26
an hour. That means that every day off to care for a sick child is
a lost $208 in wages, not to mention lost productivity
(McCarthy, 2017). The total current economic burden was
estimated at approximately $9 billion in 2015 from vaccine-
preventable diseases relevant to ten vaccines recommended for
U.S adults. 95% of that burden was for directs costs associated
with either inpatient or outpatient treatments. The remaining 5%
was due to productivity losses as a result of wages lost during
the course of treatment.
What work is being done by governmental and nongovernmental
agencies?
The mission of getting as many people vaccinated as
possible requires the cooperation of both governmental and
nongovernmental agencies. A governmental agency that is
working to prevent disease, disability and death through
immunization is the National Center for Immunization and
Respiratory Disease (NCIRD). The NCIRD is a center of the
Centers for Disease Control and Prevention which is under the
Department of Health and Human Services. Vaccines are
provided through the NCIRD’s Vaccines for Children (VFC)
Program. This program is a federally funded entitlement
program that provides vaccines at no cost to eligible children.
In order to be eligible the child must be younger than 19 years
of age and is one of the following: medicaid eligible, uninsured,
underinsured, or American Indiana or Alaska Native.
Nongovernmental agencies are also working to prevent
the spread of infectious diseases that can be prevented with
vaccines. The volunteer-based advocacy organization, Families
Fighting Flu (FFF), is committed to preventing flu. They share
stories from families whose children have died or who have had
complications from influenza and provide programs for
improving vaccination for flu. The FFF website has free
educational materials such as posters and fact sheets for schools
and doctors offices available with the hope that more people

5. will understand the safety, effectiveness, and importance of
receiving the flu vaccine every year.
Provide and describe a specific policy solution that can be
addressed by an elected official
A policy solution that can be addressed by an elected
official is the elimination of personal exemptions for
vaccinations. In 2015, California passed SB 277 which provides
a means for the eventual achievement of total immunization of
appropriate age groups against the top 10 childhood diseases as
well as any other disease deemed appropriate by the department,
taking into consideration the recommendations of the Advisory
Committee on Immunization Practices of the United States
Department of Health and Human Services, the American
Academy of Pediatrics, and the American Academy of Family
Physicians (SB. 277, 2015-2016). The bill also eliminates
personal exemptions for vaccinations and makes medical
exemptions the only exemptions allowed. Under this change no
student shall be permitted to any public school, nursery school,
or daycare without the proper vaccinations unless there is a
medical necessity for not having the vaccinations at that time.
Coalition Membership Description
Our target in this description is to identify 3 stakeholders
that work together to help the Immunization Action Coalition
(IAC) with our mission. The Immunization Action Coalition
works to increase immunization rates and prevent disease. With
the help of our partners this has been made possible by creating
and distributing educational materials for healthcare
professionals and the public. Our efforts enhance the delivery of
safe and effective immunization services.
The following 3 are stakeholders involved with our coalition:
· Centers for Disease Control and Prevention (CDC), National

6. Center for Immunization and Respiratory Diseases (NCIRD)
NCIRD is the lead center of CDC for the prevention of disease,
disability, and death through immunization. NCIRD's website
includes a wealth of resources about vaccines and influenza for
healthcare professionals, state and local health departments, and
the general public (CDC,2018).
· National Association of County & City Health Officials
(NACCHO)
NACCHO is the national organization representing local health
departments. NACCHO supports effective local public health
practice and systems, including immunizations
(NACCHO,2017).
· National Foundation for Infectious Diseases (NFID)
NFID is a nonprofit organization dedicated to education of the
public and healthcare professionals about the prevention and
treatment of infectious diseases. NFID provides information and
resources about vaccines (NFID,2018).
· Centers for Disease Control and Prevention (CDC), National
Center for Immunization and Respiratory Disease (NCIRD)
Founded in 1993, the NCIRD is responsible for planning,
coordination, and the conducting of immunization activity in the
United States. The mission of the National Center for
Immunization and Respiratory Diseases is the prevention of
disease through immunization and by control of respiratory and
related diseases.Our entity provides consultation, training,
statistical, promotional, educational, epidemiological, and
technical services to assist state and local health departments
across the US in planning, developing, contracting and
implementing immunization programs. The NCIRD is also
tasked to support and supervise state and local agencies actively
working on immunizations in their particular areas (CDC,2018).
The NCIRD can contribute to the Immunization Action
Coalition through many different avenues one of which is

7. funding. Backed by the CDC, the NCIRD has access to funds
through grants and CDC budgeting. Secondly, being a well-
established program that is well embedded into state and local
agencies throughout the United States and has a great deal of
experience in healthcare promotion campaigns will help the IAC
with our overall goal to reach the public and educate on
vaccination and why it is important.
· National Association of County & City Health Officials
(NACCHO)
The National Association of County Health Officials was
founded in 1965. In early 1984, the organization grew and
opened its own office. In 1994, it was renamed to National
Association of County and City Health Officials (NACCHO).
Our mission is to support efforts that protect and improve the
health of all people and all communities. We go about this by
promoting national policy, developing resources and programs,
seeking health equity, and supporting effective local public
health practice and systems (NACCHO,2018). Today, NACCHO
is made up of nearly 3,000 local health departments across the
United States. Our main focuses on being a leader, partner, and
voice for change for local health departments around the nation.
The National Association of County and City Health Officials
can contribute greatly to the mission of the Immunization
Action Coalition. The IAC having a partner that can help
influence policy in local governments will translate to more
support from elected officials and local agencies.
· National Foundation for Infectious Diseases (NFID)
The National Foundation for Infectious Disease was founded in
1972 and its mission is to educate the public and healthcare
professionals about causes, prevention, and treatment of
infectious diseases. The NFID has many publications including
a quarterly newsletter named the The Double Helix which
provides updated on NFID initiatives and promotes upcoming

8. activities in the infectious disease community. Also, the NFID
has call to action publications that educate and encourage
readers to take the proper steps to dealing with different disease
topics (NFID,2018).
The IAC can benefit from partnering with the NFID because of
its strategies and tactics used to reach the public effectively and
intuitively. Their programs in place that reach out to healthcare
workers are also effective, with the use of webinars and
providing continuing education so that healthcare workers are
getting the latest news and research findings available.
References
Hendrix, K. S., Sturm, L. A., Zimet, G. D., & Meslin, E. M.
(2016). Ethics and Childhood Vaccination Policy in the
United States. American Journal of Public Health, 106(2), 273–
278. http://doi.org/10.2105/AJPH.2015.302952
Khan, A. (2017). After California got rid of personal
exemptions for vaccines, medical exemptions went way up.
Retrieved from http://www.latimes.com/science/sciencenow/la-
sci-sn-vaccine-medical-exemptions-20170905-story.html
Lo, N., & Hotez, P. (2017). Public Health and Economic

9. Consequences of Vaccine Hesitancy for Measles in the United
States. JAMA Pediatrics, 171(9), 887. doi:
10.1001/jamapediatrics.2017.1695
McCarthy, C. (2017). Why vaccines are important for our
country’s financial health, too [Blog]. Retrieved from
https://www.health.harvard.edu/blog/why-vaccines-are-
important-for-our-countrys-financial-health-too-2017042511659
Ozawa, S., Portnoy, A., Getaneh, H., Clark, S., Knoll, M., &
Bishai, D. et al. (2016). Modeling The Economic Burden Of
Adult Vaccine-Preventable Diseases In The United States.
Health Affairs, 35(11), 2124-2132. doi:
10.1377/hlthaff.2016.0462
Pan, R. (2015-2016) SB 277: Public health: vaccinations.
Retrieved from: https://
leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=20
1520160SB277
nd.). Statistics of Infectious Diseases. Johns Hopkins Medicine.
Retrieved from
https://www.hopkinsmedicine.org/healthlibrary/conditions/infec
tious_diseases/statistics_of_infectious_disease_85,P00650
(2017). How Vaccines Prevent Diseases. Centers for Disease
Control and Prevention. Retrieved from
https://www.cdc.gov/vaccines/parents/vaccine-
decision/index.html
Lu, P., O’Halloran, A., Williams, W. W., Lindley, M. C.,
Farrall, S., & Bridges, C. B. (2015). Racial and ethnic
disparities in vaccination coverage among adult
populations. American Journal of Preventive Medicine, 49(6
Suppl 4), S412–S425.
http://doi.org/10.1016/j.amepre.2015.03.005
Ventola, C. L. (2016). Immunization in the United States:
Recommendations, Barriers, and Measures to Improve
Compliance: Part 1: Childhood Vaccinations. Pharmacy and
Therapeutics, 41(7), 426–436.
Hendrix, K. S., Sturm, L. A., Zimet, G. D., & Meslin, E. M.
(2016). Ethics and Childhood Vaccination Policy in the

10. United States. American Journal of Public Health, 106(2), 273–
278. http://doi.org/10.2105/AJPH.2015.302952
Khan, A. (2017). After California got rid of personal
exemptions for vaccines, medical exemptions went way up.
Retrieved from http://www.latimes.com/science/sciencenow/la-
sci-sn-vaccine-medical-exemptions-20170905-story.html
Lo, N., & Hotez, P. (2017). Public Health and Economic
Consequences of Vaccine Hesitancy for Measles in the United
States. JAMA Pediatrics, 171(9), 887. doi:
10.1001/jamapediatrics.2017.1695
McCarthy, C. (2017). Why vaccines are important for our
country’s financial health, too [Blog]. Retrieved from
https://www.health.harvard.edu/blog/why-vaccines-are-
important-for-our-countrys-financial-health-too-2017042511659