This document discusses the history and effectiveness of vaccines. It begins by explaining how Edward Jenner developed the smallpox vaccine in the 1790s and established the concept of using a weakened form of a disease to induce immunity. It then discusses common misconceptions and debates around vaccines, highlighting Andrew Wakefield's discredited 1998 study linking the MMR vaccine to autism. Finally, it emphasizes the importance of nurses educating patients and addressing concerns in order to promote informed decision making around vaccinations.

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Vaccinations: To Have or Have Not
By Sarah Wilkins, SN
University of North Carolina Wilmington
NSG 322 Professional Nursing Practice of the Baccalaureate Nurse
October 16, 2015

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Vaccines: To Have or Have Not
Ever since the institution of the vaccination in 1970s, vaccines have been a source of
major discussion among circles of healthcare providers, concerned parents, and the general
population. There have been countless debates among people about vaccines’ potency,
effectiveness, and potential for adverse effects. Not only have vaccines been shown to have
occasional side effects, but there have been concerns that they may be linked to an even more
significant issue: autism in children. This concept has sparked heated conversations among
numerous individuals, whether in the media or in schools or amongst a circle of young parents.
As nurses, it is our job to educate the public on the significance and safety of vaccines, their
benefits and drawbacks, and the surrounding ideas, whether true or false. Because nursing is a
holistic discipline, it is important for nurses to address any issues and concerns that our clients
may have. To do this, we must first acquire an understanding of vaccines and how they work,
the knowledge of the debates and their points of view; and lastly we must be able to explain and
clarify to them the research surrounding vaccines and their effects, to help them in making an
informed decision about vaccinations.
Firstly, we must understand how vaccines work. Developed by Edward Jenner in the
1790s, vaccines were originally developed to protect against a strong disease by using a form of
a weak disease as an antibody instigator (Riedel, 2005). In Jenner’s time, the population-at-large
was being ravaged by the deadly disease smallpox; but the dairymaids, because of the constant
interactions with cowpox (a weaker form of the disease, typically manifested in bovines), had
developed a mild form of cowpox, which had given them sufficient antibodies to prevent them
from acquiring smallpox. Jenner was fascinated by this idea: that the weaker form of the disease
could serve as protection against the stronger form. He began experimenting, and he

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hypothesized that the pus in the blisters on the hands of the milkmaids was the protective agent
against the fatal smallpox disease. After testing his results on a few participants, he was lauded
as having discovered a way to immunize people against smallpox. In addition, he had shown
that the pus from the blisters from the cow was not just transmissible for vaccines from animal-
to-human, but also that it was useful and effective human-to-human. This was a major
breakthrough for science in that time, and Jenner was heralded as the “Father of Immunology.”
Vaccines are given in one of two ways: an inactivated (dead) form, or an attenuated (live)
form. An example of an inactive vaccine form is Salk injected polio vaccine (IPV); this is
compared with the Sabin oral polio vaccine (OPV). Though the Sabin polio is a live vaccine
form, it is a very weak, mild form of the disease, similar to cowpox being used for protection
against smallpox. When a person receives a vaccination (inactive or attenuated), their immune
system has a primary response initially. This is triggered upon the first exposure to the antigen
in the vaccine. There is a latent period for the lack of antibodies, but considerable activity
occurs. Eventually, antibodies are synthesized against the antigen presented to the cells by the
vaccine, and these antibodies are stored for later usage. After the primary response occurs, on
second exposure to the antigen in its natural disease-producing form, a secondary response will
occur. An anamnestic (memory) response is generated, and the response time is much shorter
than the primary response was. This is a result of the body’s remembrance of the antigen and
preparation for more immediate reaction to a dangerous threat. However, despite the efficiency
of vaccines to generate antibody responses, the actual disease itself is the strongest way to issue
more antibodies; therefore, often with vaccinations, people need booster shots to continually re-
instigate the antibodies within the immune system.

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This type of immunity against a disease is called artificial active immunity (Baxter,
2015). It is artificial because it is not received via contraction of the disease itself. However,
there may occasionally be a mild form of the disease, as seen with the cowpox example, as a
potential side effect. Side effects are not unusual to experience, since a person is receiving that
disease itself, though in weaker form. It is active immunity because there has been an exposure
to an antigen, complete with a latent period, a synthesis of antibodies, and an anamnestic
response with long-term protection. In passive immunity, there is no antigen exposure, and the
antibodies are transferred rather than produced, resulting in no memory and very short-term,
immediate protection.
There are some diseases that have been nearly eradicated from the population since the
introduction of vaccines for these diseases. This is a result of herd immunity. Herd immunity is
the mass vaccination of a population of people, for the purpose of disease eradication (Fine,
Eames, & Heymann, 2015). The concept behind herd immunity is quite simple: if a large
number of the population is vaccinated, the few unvaccinated people will be largely protected,
since the vaccine will be actively repressing the disease. However, due to the nature of artificial
immunity properties, this does not guarantee that those unvaccinated are completely protected.
If people who are vaccinated do not receive a booster for certain vaccines, it is possible that they
can contract the disease anyway. Their immune system will not have the antibodies needed to
fight off infection, and thus will be vulnerable to attack. This puts the unvaccinated population
at risk as well, leading to a potential epidemic. Therefore, while herd immunity is extremely
beneficial to the population-at-large, it is only effective when the majority are compliant with
vaccine recommendations with scheduled boosters. However, in the concept of herd immunity,
the unvaccinated population mentioned typically refers to infants or toddlers too young to have

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all their vaccinations yet. It is through these young ones that the potential for epidemic can
occur; this is why herd immunity is a focus for public health policy (Willingham, 2015).
Vaccines contain the potential for great protection against highly transmissible diseases.
Unfortunately, many people refuse this option. When vaccines have been shown to be capable
of preventing such epidemics as polio, diphtheria, whooping, cough, or smallpox, what would
instigate refusals? A leading cause of vaccine protests originated from the publication of an
article published by Andrew Wakefield, British surgeon and medical researcher.
In 1998, Wakefield published an article that reported there was a definitive connection
between the measles, mumps, and rubella (MMR) vaccine and the contraction of autism and a
bowel disease (Godlee, 2011). His article was published in The Lancet, and it received
considerable attention in the scientific community and the media. People who had previously
been skeptical of vaccines and the risk for side effects used this information to question the use
of vaccines, the healthcare providers offering them, and the entire concept of vaccination.
Indeed, much attention and focus was given to the article, and it sparked a variety of responses
from the public, the media, and the healthcare world.
Despite the numerous flaws with the “evidence” presented within the article, the anti-
vaccine audiences flocked to the media and other sources to protest against vaccines. The
general population did little to research the veracity and credibility of Wakefield’s claims.
Scientists, however, quickly undertook the necessary research for verifying or disproving the
research conducted by Wakefield and his team. Scientists were unable to replicate Wakefield’s
findings, and eventually it was determined that he had falsified data, and violated key principles
of statistical analysis of data (Andrade & Chittaranjan, 2011).

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When investigations began, there were some shocking results discovered. Wakefield had
received financial support and compensation from people who were bringing lawsuits against
pharmaceutical companies who manufactured vaccines (Andrade & Chittaranjan, 2011). In
short, Wakefield’s article was largely funded as a bribe to bring claims against companies that
manufactured vaccines. Initially, The Lancet did not retract the article, nor did they bring
charges against Wakefield et.al for their misuse of data and unethical bribery. However, 10 of
the 12 co-authors of the paper did retract the original data’s interpretation. In 2010, over a
decade after its publication, the Wakefield article was retracted completely, and the data was
then admitted to be incorrect in several aspects. In addition, Wakefield et.al were found guilty of
violations of ethical scientific conduct and inappropriate use of data. The retraction was
published on the editors’ behalf in a minor, nameless paragraph in the journal (Andrade &
Chittaranjan, 2011).
Eventually, it was discovered that Wakefield et.al were guilty of deliberate
misconstruction of data and evidence (Andrade & Chittaranjan, 2011). However, a considerable
amount of funding had been spent to refute the evidence presented by the Wakefield article, and
much damage had been done by it. Parents had anxiously refused to vaccinate their children, out
of fear that the link between vaccines and autism was reality. This resulted in numerous
outbreaks of once-controlled diseases. Children were unnecessarily exposed to the threats and
dangers of imminent diseases, and the “Wakefield saga” has been called “one of the most serious
frauds in medical history” (Andrade & Chittaranjan, 2011).
In light of the Wakefield article and the ensuing drama that surrounded the case, it is
important to keep vaccinations and side effects or potential adverse effects in mind as pertains to
safety of the individuals receiving the vaccination. For example, there are relationships that have

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been established between vaccinations and adverse reactions. Some relationships are stronger
than others, while some evidence is insignificant to support this causal relationship between
vaccines and adverse reactions; but scientists are extremely cautious in preparing vaccinations
and providing adequate information to the public who may be receiving these vaccines ((IOM),
2011).
However, it is for these reasons that people may choose not to vaccinate, either
themselves or their children. A study was conducted by the Expanded Program on
Immunization, by the World Health Organization (WHO), on the number of people who
vaccinate vs. the number of people who do not. The study also factored in their reasons for
doing or not doing. It was discovered that the majority of people who chose to comply with the
vaccination program were influenced by the mass media campaign (Asfandyar S., 2013). This
main reason was followed in support by several smaller reasons for compliance with the
vaccination-preventable diseases (VPDs). Many of those who complied stated that someone
they trusted could verify the effectiveness of the vaccine they had received. In addition, a
percentage of some of those who were compliant had observed other children who had
contracted VPD’s and, in efforts to prevent their children from acquiring these diseases, had been
compelled to vaccinate them (Asfandyar S., 2013).
The most common reason for non-compliance with the vaccination program was reported
as knowledge deficit (Asfandyar S., 2013). Among other refusal reasons were reports such as
knowing someone else who had not complied; not having sufficient time; religious reasons or
fears; anxiety over potential side effects; undeveloped trust between self and health facilities;
financial difficulties; or negative past experiences with healthcare workers (Asfandyar S., 2013).
These reasons for refusal are largely all preventable, aside from the “religious taboo” reason

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(which, as we will see, is preventable also). However, the main issue in non-compliance
appeared to be a knowledge deficit of vaccines, how they work, and their beneficial effects.
Nurses must be able to provide up-to-date, trustworthy information to the public,
specifically in areas that are vital to public health and wellness. Nurse can bridge the divide
between science and practice through teaching, educating and advocating for populations
unfamiliar with healthcare practices. As nurses, it is not only our duty, but also our privilege, to
be a source of honest, reliable information on policies or procedures pertinent to our field of
study. This includes vaccinations. Our patients and their families will be more holistically cared
for when we are prepared to discuss the potential pros and cons of a particular topic of
discrepancy, such as vaccines. Often, people’s past experiences influence their current beliefs
and knowledge about a topic, and if that experience was negative, they will likely have a
negative perception of that topic. All the secondary reasons cited by the article above for
noncompliance support the primary reason for noncompliance, knowledge deficit. The
secondary reasons are all contributors to why people have a lack of knowledge of vaccines and
how they work. If we can educate people in a friendly, informative, non-threatening
environment, it may be incredibly more useful than other techniques used to force compliance.
People may choose to vaccinate on their own, rather than being reminded multiple times that
compliance is desirable. This type of compliance is the kind that can eradicate a disease. When
people choose to do something, rather than be forced to do such, its benefits are more universal
and long-lasting.
Vaccines are largely able to prevent diseases. For example, the DTaP vaccine,
administered to children under the age of seven ((CDC), 2015). It is the vaccine protecting
against diphtheria, tetanus, and pertussis. All three of these diseases are difficult to endure,

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especially as a young child with a weaker immune system. A booster of the vaccine is needed
periodically, to reinforce the production and maintenance of antibodies. This booster vaccination
is called Tdap. It is not in all-capital letters because this signifies the strength: capital letters
indicate full strength of the dosage; whereas lowercase letters signify doses that have been
reduced ((CDC), 2015). The vaccine has been shown to be effective in protecting children and
adults from these three diseases, with minimal side effects. As with any medical procedure,
there is the potential for side effects; but the issue is whether or not those side effects pose a
greater threat than the actual procedure – in this case, the vaccination. Should a VPD become an
epidemic, it might be worth the risk of potential temporary side effects to receive the vaccine,
rather than risk the complications of a serious disease that is preventable by a vaccine!
Vaccines have proven themselves as controllers of preventable diseases, as well as
eradicators of a few life-threatening diseases (such as polio or smallpox). With the increased
non-compliance rate, these once-eradicated diseases are experiencing a return to ravage society.
It is important for us to educate people about the risks and benefits to vaccines, in order to help
them make an informed decision rather than a hasty, ill-informed one. Sometimes, people
choose to avoid vaccines out of “religious taboos,” the idea that it is religiously forbidden to take
a vaccine. This idea is promoted by religious leaders, who may also be uninformed about health
benefits. Therefore, it is our duty also to educate these religious leaders about vaccinations and
their helpfulness to the body and the population as a whole. If the population becomes stricken
with a fatal disease that was preventable through vaccines, that would defeat the purpose of
having religious leaders, after all! It is critical for us to be a resource to all who need direction or
information on topics which pertain to our specific fields of study. If we do not know the answer
to a question from a patient or family member, it would be our benefit to either research it

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ourselves or find someone who has done significant research on the topic and profit from their
knowledge, to better educate our patients.
Evidence-based practice is key within the realm of nursing. If solutions have worked in
the past, and have been proven successful, this is the foundation on which we base the future.
By showing the public how vaccines have worked successfully in the past, it stands to reason
that they will work just as successfully in the future, for disease prevention or eradication.
Vaccines are a prophylactic measure; they are primary steps taken to ever prevent a disease from
occurring in a person’s immune system. This idea may be difficult to convey to some people, as
they might find it unwise to build up antibodies to something they have never contracted or
might possibly never contract. However, in the interest of universal safety, people have a greater
chance of being significantly less-bothered by diseases when they and their family members
have all received a vaccine. The argument that vaccines are linked to autism – or to a rare viral
disease, or any other disease in general – may be partially true; but research has not developed
any direct-causal links to threatening diseases or harmful conditions. When this has happened in
the past, the vaccine has been amended (removal of thiamin in vaccines due to a weak
correlation) and usage has continued. Vaccines that may be less beneficial or more harmful are
usually discontinued or occasionally, publicly not promoted (as with the ineffective-at-present
tuberculosis vaccine). But vaccines that are tested by evidence and by research and are proven
effective are encouraged and promoted as beneficial to society. The role of nurses is vital: they
must be willing and prepared to offer information on the vaccines commonly used in society
today. For instance, parents or would-be recipients of vaccines do not want to be informed
simply of the benefits of a particular vaccination. Often, it is helpful to know the risks involved,
whether those risks are high or low. This might encourage the population to accept vaccines

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with more certainty and favor. In addition, they might encourage others to receive the same
vaccine. However, total compliance is necessary; just because someone else vaccinated, it does
not protect the rest of society. Someone else’s vaccines do not register in another person’s
immune system. In sum, this is why herd immunity is a benefit to public health and safety, and
will continue to have beneficial effects in disease prevention for years to come.

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References
Institute of Medicine of the National Academies ((CDC), C. f. (2015, September 3). Vaccines and
Immunizations. Retrieved from Vaccines and Preventable Diseases:
http://www.cdc.gov/vaccines/vpd-vac/default.htm
(IOM), I. o. (2011). Adverse Effects of Vaccines:Evidence and Causality. Institute of Medicine. Retrieved
from http://www.hrsa.gov/vaccinecompensation/adverseeffects.pdf
Andrade, T., & Chittaranjan, S. R. (2011, April-June). The MMR vaccine and autism: Sensation,
refutation, retraction, and fraud. Retrieved from Indian Journal of Psychiatry: NCBI:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136032/
Asfandyar S. (2013). Reasons for non-vaccination in pediatric patients visiting tertiary care centers in a
polio-prone country. Pub Med Central,19.
Baxter,D. (2015). Active and passive immunity, vaccine types, excipients and licensing. Occupational
Medicine,552-556.
Fine, P., Eames,K., & Heymann, D. (2015). “Herd Immunity”: A Rough Guide. Clinical Infectious
Diseases,911-916.
Godlee, F. (2011, January 06). Wakefield’sarticle linking MMR vaccine and autismwas fraudulent.
Retrieved from The BMJ: http://www.bmj.com/content/342/bmj.c7452
Riedel, S. (2005). Edward Jenner and the History of Smallpox and Vaccination. National Center for
Biotechnology Information,21-25.
Willingham, E. (2015, October 8). 1 in 8 U.S. Kids Not Protected Against Measles:Report. Retrieved
from Health Day - News for Healthier Living: http://consumer.healthday.com/kids-health-
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measles-704033.html