Comparing Child Vaccination Policies in Mexico and the US

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This analysis includes a diverse comparison of the infrastructure, policies, resources, and
influences regarding the vaccination of children in Mexico and the United States. In order to
portray my findings in a representative manner, I have utilized publicly-accessible information
provided by credible institutions in both countries. To fully understand the policies and
procedures in Mexico, I conducted a trip to a rural community in Jalisco to collect information
from medical professionals themselves in the form of questionnaires. personal correspondence,
and local medical documentation. In doing this, I have included some personal insight and
misconceptions that I possessed prior to the trip and how this has enlightened my knowledge on
Mexican healthcare infrastructure. To conclude, I mention other political and ethical influences
that can impact a country’s proper usage of vaccination. The overall intention of the paper is to
educate the reader on these policies and procedures in place, influences that affect this essential
medical advancement, and how personal prejudices can sometimes hinder the truth.
Contents
1 Introduction 4
1.1 Initial Project Intentions
1.2 Trip to Guadalajara
1.2.a Logistics and Preliminary Contacts

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1.2.b The Experience
1.3 Addressing a Misconception
1.4 Revised Project Intentions
2 Mexico and Vaccination 16
2.1 History and Progression
2.2 Current Vaccination Policy
2.2.a Organization
2.2.b Administration
2.3 La Concepciónde Buenos Aires and Dr. Isauro Ramos Rubio
2.4 Social Pressures
3 The United States and Vaccination 26
3.2.a Organization
3.2.b Administration
4 Brief Analysis and External Influence 33
4.1 Analysis of Similarities and Discrepancies
4.2 External Influence
4.2.a Cuba and the Lung Cancer Vaccine
4.2.b Testing Vaccines in Third World Countries
5 Conclusions 43
5.1 Personal Prejudices and Project Intentions Revisited
5.2 Is vaccination conducted in an unbiased, ethical manner?
5.3 Future Implications
6 Supplemental Materials 45
7 Citations 56

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1. Introduction
1.1 Initial Project Intentions
In order to incorporate my knowledge and skills from both my major and minor fields of
study—physiology and Spanish language—, my thesis focuses on cultural differences and their
physiological application between Mexico and the United States of America. From extensive
classroom knowledge of and personal interest in the immune system, I decided that studying a
pertinent public health issue, like vaccination, would be a relevant endeavor with enormous
growth potential in social and scientific realms. Now, connecting this issue to Mexican culture is
not as daunting as it sounds, as my roommate, David Cerna, has familial connections in a small
town outside the major Mexican city of Guadalajara with a private-practicing doctor. To my
delight, the physician was willing to share his information and graciously invited me to venture

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South and conduct interviews with him and other professionals to facilitate collecting relevant,
empirical data that could not be found anywhere but Mexico itself.
Initially, I had desired to focus my investigations on vaccination and the social perception
of this medical advancement (i.e. beliefs, taboos, superstitions or stigmas that instigate fear of
vaccination of children). I wanted to determine if external factors exist in Mexico that deem
vaccination unnecessary, such as religion, culture, or other beliefs not prevalent in the United
States. Through the development and administration of a questionnaire to the medical
professional in Mexico (Dr. Isauro Ramos Rubio), as well as later interviewing him in person, I
have gained an eye-opening amount of knowledge pertaining to the Mexican health
administration system and policies which will allow me to compare it to those of what I am
familiar with in the United States.
1.2 Trip to Guadalajara, Mexico
Logistics and Preliminary Contacts
As my field of study is located over one thousand miles away, it was important to do an
extensive amount of preliminary research on the logistics of the trip, financial obligations,
schedule in Mexico, contacts to meet, coordinating work/school, time of year, and the weather.
Choosing a method of travel to Guadalajara was also an important decision that had to be made
(Refer to Figure 1 in Supplemental Materials). As a college student with minimal funds
available, price was without a doubt a major determinant in selecting our means of
transportation. Due to time restraints, school, work, and coordinating with the Cerna’s family,
the ideal time of year for the trip was during a holiday break. We finally agreed on the end of
winter break, and we chose to travel from January 6th to January 11th. Also, due to the weather
being much colder than Tucson during that time of the year, it was critical to pack accordingly.

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In addition to the travel expenses, it is important to keep in mind that in most parts of
rural Mexico, only pesos are accepted, there are not many ATMs available, and
credit/debit/ATM cards are accepted by very few businesses. To avoid any problems or
ridiculous ATM fees, it is advised to exchange dollars for pesos prior to departure and bring a
sufficient amount.
Establishing contacts in the town prior to the trip was something that facilitated my time
abroad. Prior to communication with Dr. Isauro Ramos Rubio, I drafted and shared with him (via
email), a questionnaire encompassing questions regarding perceptions, stigmas, fears or
superstitions of vaccination found in his community (Refer to Figure 2 in Supplemental
Materials). After completion, he suggested that we meet in person to discuss ideas and
information relevant to my investigation. This gave me a reliable contact that was expecting my
arrival and would also put me in contact with others. In addition, I had high hopes of contacting
the local health center that was run by the federal government. I sent out emails to the Secretary
of Health in search of information or suggestions for my studies but received no responses.
Luckily, when arriving in the town and speaking with Dr. Isauro, I felt more at ease when
approaching the federal establishment in person in search of information and, to my delight, they
were extremely welcoming and open to sharing information and resources.
The Experience
From the onset of preparing for my travels, this project was unique from that of my
colleagues’ due to the extensive assortment of preparations and considerations to be made prior
to departure for Mexico. My field work was based in a foreign country, near completely removed
from American culture. Electing Mexico as my foreign test group was a subjective choice, as my
investigations could also possess relevance if conducted in other parts of the world with different

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culture and medical practices. However, due to financial and time restraints, Mexico was chosen
as the most practical option due to its proximity, as well as my connections with the Cerna
family.
The travel time was one full day, from the time that my roommate David, his father
Salvador, and I departed in my vehicle from Phoenix, Arizona, United States (headed to the
Rodolfo Sánchez Taboada International Airport in Mexicali, Baja California, Mexico) until we
approached the dirt roads of La Concepción de Buenos Aires, Jalisco, Mexico. The airport
experience in Mexicali seemed to be a little less technologically-advanced than those of the
United States, as the security checkpoint was very nonchalant and simplistic. In addition, we
were bussed from the only terminal in the airport to board the plane from the runway. The airport
in Guadalajara however, was an extremely busy airport with terminals in every direction and
luxurious shops in the waiting area; this made it seem comparable to, say, Sky Harbor Airport in
Phoenix, Arizona.
After the flight to Guadalajara, we were greeted by family members and were transported
by car to La Concepción de Buenos Aires. (*A mere observation noted: there seems to be very
lenient traffic laws in comparison to the United States and hence the roads can sometimes be
used, or at least be perceived, in a chaotic manner; it is important to remember that not every
country enforces the same traffic laws and when you leave your comfort zone, you must to be
willing to adapt.*) While admiring the mountainside views of Lake Chapala (the largest
freshwater lake in Mexico) during the car ride, I was also enjoying participating in (to the best of
my Spanish-speaking ability) emotional conversations among the Cerna family as they had not
seen each other in years.

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Coming from only classroom-based Spanish knowledge initially, this trip required me to
prepare and practice my Spanish in various settings outside of the lecture hall. To accomplish
this, I continued on taking classes in the Spanish department related to translation and
interpretation. In an effort to practice my oral communication skills, I began practice conversing
with my roommate David on a daily basis. These improvement skills not only would assist me in
improving my oral proficiency, but they were essential in the development of certain resources,
such as the questionnaire I drafted and sent to Dr. Isauro. Communicating with certain people of
the town I found to be an exhausting process as the use of slang and colloquial phrases is very
common, as it is with various dialects of Spanish. During my experiences with Dr. Isauro and the
Centro de Salud, I almost found it easier to understand and communicate, as less “street talk”
was used in these professional settings. In addition, it turned out that Dr. Isauro speaks a fair
amount of English, and at times when the Spanish was getting too advanced, we could attempt to
clarify in English.
Immediately, I was placed a tad outside of my “communicative comfort level” and
realized I had to adapt quickly, not only to complete my investigations, but to be able to share
ideas with the people around me. This forced me to be content with making minor mistakes with
my Spanish when speaking, as well as asking for repetitions or clarifications while listening.
Even though this felt like pure annoyance and naïveté on my end, the people of the town were
ecstatic that I was proficient enough to talk to them and were more than willing to correct me and
add to my vocabulary.
Once settled in our residence, I immediately began taking in the immense differences that
were present in all aspects of daily routine. The house where I resided was an antique, outdoor-
style home with a large open courtyard containing the kitchen and living room, a style of houses

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not typically seen in Tucson. Another characteristic trait of this pueblo was la plaza, or “main
square”, where the town gathers for festivals, markets, or other community activities. Lastly,
something that was evident from the local culture was the enthusiasm of the people and their
inherent welcoming spirit and good nature. People in the pueblo greet each other by name with a
smile on their face, and in my experience, it seemed to be extremely genuine.
This photo depicts David (middle) and me (left) enjoying his grandfather’s mariachi-style guitar.
During the first days in the town, the Cernas and I toured the city, as well as a few nearby
towns (La Manzanilla and Mazamitla). It was beyond fascinating being immersed in such
authentic parts of Mexico that have very little external pressure from American influence (i.e. big
business, labor factories, consumer goods, etc.). During the night time, because it was early
January, we caught La Concepción in the middle of their annual fiestas, or “ parties”, that
celebrate the new year they have been blessed with. Every night for two weeks the town gathers
in la plaza with live music, carnival rides, and tents of food vendors, bars, and shops lining the
main square to socialize with friends, dance, eat, and drink tequila. This art of celebration is

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relatively rare in the United States (at least in my personal experience), and it duly highlighted
the optimism, good intentions, and general love for one another that is inherently present in the
people of La Concepción.
This photo depicts the first night with the whole Cerna family during the fiestas.
The last few days of my trip were spent preparing to interview with Dr. Isauro Ramos
Rubio, gathering my information from Isauro and other health establishments that agreed to
speak with me. Meeting Dr. Isauro was one-of-a-kind experience. As a physician for many years,
he occupies the best known, private-practice medical clinic in La Concepción, holding the
official title of director of the El hospital la capilla s.a. de c.v. From talking to the people of the
the town, I immediately found out that Isauro was one of the most respected professionals in the
town and everyone knew of him. When we met, he was unbelievably welcoming and invited me

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and Salvador into his office (Salvador was present just in case Isauro and I couldn’t understand
each other). Before he had time to close the door, he was already beginning to layout the major
points of Mexican vaccination protocol. In addition, he began to discuss foreign vaccination
policies (concerning Mexico, the United States, and others) that are relevant to my
investigations.
After absorbing everything we discussed, I was given multiple contacts of other
physicians whom I could further interrogate, as well as the contact for the Centro de Salud Local,
or the local public health center. Later that day, I solicited the additional contacts and found the
Centro de Salud to be very welcoming, as they provided me with photocopies of template
vaccination cards for patients, medical charts, and other literature concerning the administration
of vaccines. In addition, both Isauro and the Centro de Salud, instructed that I further examine
literature that was provided to the public by the government and other credible institutions that
was readily available via the Internet.
1.3 Addressing a Misconception
Traveling to Mexico and witnessing the healthcare system first-hand, through my
research on vaccination, is an experience that has shined a light on a personal misconception or
prejudice of mine. Personally, with the way that the United States’ media sources portray illegal
immigration, domestic job security, drug cartels/war, and border violence it is tempting to
subconsciously associate Mexico with a country that possesses major social, economical, and
political issues internally. (This is especially true growing up in a conservative state like Arizona,
constantly dealing with media coverage of issues at the Mexican Border). Additionally, I have
visited various parts of Mexico during non research-based trips— Nogales, Puerto Peñasco,

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Puerto Vallarta, and Cabo San Lucas— and I have always noted high levels of poverty, high
unemployment, and low hygiene. Needless to say, Mexico does indeed have major political,
economical, and social problems; however, it is unfair to assume that an important public health
issue, like vaccination of children, is being completely ignored. All of these media-induced
beliefs and personal experiences seem to have prejudiced me on my expectations for how the
healthcare system would be conducted in Mexico. After conducting my research, I discovered
that these influencing factors were really not representative of actual current administration and
regulation of vaccination as a country.
One major observation made concerning the medical aspect of my visit was the
modernity and organization of the healthcare facilities in this area of Mexico. I am not
insinuating that I expected the clinics to be conducted in an inefficient, barbaric manner;
however, I was fascinated by the documentation utilized by the medical personnel, as well as its
availability to patients, faculty, epidemiological research, and, to my benefit, an international
undergraduate student conducting research. Another aspect that was unexpected was the
organizational resources available at levels of practice: private, clinical, state, and national. More
notably, when I conducted my interview with Dr. Isauro, I quickly learned that the vaccination of
infants is something that follows very strict criteria, and will, much more often than not, end up
in the proper vaccination schedule for a child from birth to adolescence. This is due to the recent
implementation, and consequent growing support and popularity, of the Program of Universal
Vaccination by the federal government over the last two decades.
Another misconception that I had had to do my initial intentions for the project. Through
personal experience, media, friends, and education, I had always considered the Mexican people
very spiritual, superstitious people. This lead me to believe that when it comes to a parent’s

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decision to vaccinate their child, there would be a plethora of factors (cultural beliefs, home
remedies, religious beliefs, superstitions, personal beliefs) that discourage vaccination and would
therefore yield a population that contested the administration of vaccination. After speaking with
Dr. Isauro and other professionals about these issues, it is evident that a majority of Mexican
people have collectively decided that vaccination is essential, an important public health policy
not to be pushed aside by beliefs or feelings against the practice. I had to travel to La Concepción
de Buenos Aires, speak in person with Dr. Isauro, and be able to observe conditions on site to
realize that the existing conditions would not support my original idea of analyzing perceptions,
fears, and stigmas because Mexico is almost universally pro-vaccination. Upon returning to the
United States, it was pertinent to redress my original plans for my thesis to account for my
prejudice and compare Mexican and American vaccination policies and procedures objectively.
1.4 Revised Project Intentions
After addressing my prejudices and misconceptions, I changed my focus in order to
utilize the data collected in Mexico, while simultaneously providing the reader with informative,
accurate information. Instead of focusing on the differences present among the perception of
vaccination in Mexico and the United States, I would briefly outline the progression of
vaccination seen in both societies, as well as describe federal literature, resources, institutions,
organizations, and recommendations provided by both governments for its citizens. The outline
will include important scientific accomplishments (research for and preparation of vaccines),
organization of the policies and regulations at various levels, administration of the vaccines, and
overall effect on targeted population.
So, after briefly outlining the infrastructure of the vaccination system for both countries,
I will analyze the distinct differences and similarities of the two systems, which will cover

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discrepancies among the recommendations and procedures demonstrated in the literature
provided by federal entities or other credible institutions. Since I did not have the opportunity to
study any other areas of Mexico to have a larger sample, it is unrealistic to draw conclusions
regarding the perception of vaccination of the entire Mexican population. This is because my
conclusions would be based solely on one research-related experience in a single, small town
located in a very large, populous country. It is important to keep in mind that typically literature
provided by the government, or international organizations like the WHO, will consist of
information that most accurately represents the whole country. To make this analysis more
personal, I will mention my findings based on the rapport that I had with healthcare professionals
in La Concepción de Buenos Aires to aid the reader in gaining insight into one society’s
tolerance and advocacy of vaccination and its government involvement. While this does not
represent the entire country, it does offer an accurate, although personal view on the matter in
rural Mexico .
Under the advice of Dr. Isauro, I also decided to include a brief section on other topics
that can affect the vaccination system of a country. He emphasized that I research the United
States and their various political and ethical decisions regarding the testing and approval of
certain vaccines. Soon it was evident that the controversy of Cuba’s lung cancer vaccine, as well
as the unethical actions associated with testing trial vaccines on humans in third world countries
would be an excellent supplement to my data. These topics are extremely interesting,
controversial, and relevant to my overall thesis; I have included them because it has become
obvious to me that vaccination, a beneficial medical advancement, can also be associated with
political corruption and a lack of ethics .

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2. Mexicoand Vaccination
When looking at Mexico’s progression into the top tier of countries that place an
immense amount of effort into the support of vaccination, there are certain benchmark events of
the twentieth century that are worth discussing. Mexico gradually began to adapt to the idea of
vaccination as conceived by Edward Jenner and Louis Pasteur and their pioneering work in the
late 18th century. Towards the end of the twentieth century, the government began addressing a
structured vaccination policy as one of the central issues of public health, alongside supplying
large rural areas with clean drinking water. Initially, the vaccination refusal rates among the
population were high. The Mexican government decided that a practical vaccination program
had to be implemented into society [1]. Mexico has incorporated universal vaccination policies
as quickly as politically, economically, and socially possible to reduce the amount of people
dying from preventable diseases; it has even made most vaccines free of charge as an incentive
[7]. To align Mexico’s progression with the rest of the world, I have first included a chronology
of vaccination around the world.

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Important Years of Advancement in Vaccination Worldwide [6]
1796 Edward Jenner successfully administers a smallpox vaccination his first willing
recipient, James Phipps
1884 Louis Pasteur creates the first vaccine against rabies and was used in humans the
following year
1908 Poliovirus is identified as the cause of polio in Austria by Karl Landsteiner, MD
and Erwin Popper, MD
1909 Calmette and Guerin develop the Bacillus Calmette-Guérin vaccine, which is used
against Tuberculosis, and was first tested in humans in 1921
1925 Madsen prepares the first vaccine against whooping cough
1936 Max Theiler develops the vaccine for yellow fever
1948 Vaccines for whooping cough and diphtheria
1963 The United States and others approve a vaccine for measles
1966 The World Health organization establishes a goal of eradicating smallpox through
vaccination
1980 Vaccinations for Hepatitis B are available, however due to elevated price per unit, only a
few countries adopted, and in 1986 a recombinant vaccination was discovered
1994 World Health Organization deemed the western hemisphere polio free

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1998 The Children’s Vaccine Program was established at the WHO’s Program for Appropriate
Technology in Health, which aimed at vaccinating children in developing countries
against influenza, hepatitis B, rotavirus, and pneumococcal
These global medical advancements shown previously forced Mexico to adapt if the
country wished to maintain high standards in public health, similar to those in developed
countries. The diseases highlighted above shows the preventable diseases that were affecting
countries prior to adopting these policies [19]. After studying indisputable statistics of disease
fatality before and after vaccination, Mexico immediately began experimenting with and
adopting vaccination policies of their own. Below is a brief timeline of these adaptations of
vaccination policies.
Important Years of Advancement in Vaccination in Mexico [1]
1804 Dr. Francisco Balmis introduces a vaccine against smallpox to Mexico
1908 Mexico realizes the utmost importance in vaccination and pass a law centralized through
the National Bacteriological Institute that created opportunities for research of infectious
diseases and preparation of vaccines in a safe manner
1926 Presidential decree makes vaccinations against smallpox mandatory for most public
institutions
1951 Mexico begins the use of the BCG vaccine against Tuberculosis
1954 Development and advances of the DPT vaccine regimen (Diphtheria, Pertussis, and
Tetanus)
1962 The employment of the oral vaccine against Poliomyelitis
1970 The beginning of development of Measles vaccines with inactivated virus particles

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1973 National Program of Immunization is created and offers a regimen of 5 vaccines
combating 7 illness
1980 Mexico realizes it needs to spread awareness and creates vaccination workshops, a
National Day of Vaccination and eventually a National Vaccination Week (which is
now currently generalized as National Health Week)
1991 The Mexican government creates a national advice council for vaccination know as
(CONAVA) as well as establishes the Program of Universal Vaccination
Mexico has finally joined the worldwide bandwagon and implemented a universal
vaccination program, a quite a successful decision that eventually will allow Mexico to join the
large group of countries that have reached 90% coverage of DTP3 vaccine [21]. Despite proper
vaccination for public school admission not being mandated by law, the vast majority of parents
elect for a proper vaccination schedule [8]. With continuous improvements in vaccination policy
in the 1980s and 90s, 1996 presented the last documented case of measles in Mexico. Controlling
diseases like this, along with rubella, mumps, diphtheria, hepatitis B, and haemophilus influenzae
type B has progressed tremendously into the current, proper administration of triple viral SRP
and pentavalent regimens (DPT + HB + Hib) [1]. These have been fundamental in placing
current Mexico in a competitive position for national vaccination coverage percentage against
common preventable diseases [21].
2.2 Current Mexican Vaccination Policy
Organization
Mexico’s vaccination system is run by the Secretary of Health, a branch of the federal
government. Recently, in 2015, an official set of guidelines was released by the government

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which outlines the premise and goals of the program of universal vaccination, although
vaccination is not legally mandatory. These goals are quite simply to consolidate the actions of
protection, promotion of health, and, most relevant to this thesis, prevention of preventable
diseases. Also emphasized is the assurance of effective, quality healthcare to all Mexican
citizens. Going along with the wellbeing of Mexican citizens, also mentioned in the guidelines is
the importance of vaccination to prevent risks for vulnerable members of society and to eliminate
the social and economic gaps that can obstruct proper vaccination regimens for the members of
the country. The numerical goals that the federal government is hoping to achieve are 95%
vaccination rates of the following vaccines: BCG, anti hepatitis B, acellular DPT, anti
pneumococcus, rotavirus, triple viral vaccine(SRP). All of these vaccines are given at certain
predetermined ages from infancy to around age 6. The Mexican government also hopes to
eradicate Poliomyelitis by targeting its associated virus, as well as being cautious with using an
inactivated virus when developing the vaccine [17]. Besides eradication of all diseases (which is
very unlikely, potentially impossible), the best method Mexico has found to control the general
public’s health is to maintain epidemiological control of certain illness such as whooping cough,
diphtheria, and non-neonatal tetanus. It is also of utmost relevance that Mexico target viruses,
such as haemophilus influenzae type B, that have negative long term effects without treatment
such as meningitis, pneumonia, and septic arthritis. Lastly the government established a registry
to keep track of adverse events that occur with vaccination and keep proper documentation in
order to develop strategies to avoid these situations [18].
In order to maintain an informed and situationally-conscious entity in charge of the
supervision of the practice of vaccination, it is important that the people who establish the rules
and regulations are responsible and able. To do this, Mexico has chosen to establish a national

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entity known as Consejo Nacional de Vacunación (CONAVA) (National Council for
Vaccination). This is a national council whose primary objectives are to prevent, control,
eliminate, and avoid illness that are preventable. It is constructed of Mexican scientists and
doctors, coming from public as well as private institutions, who consider themselves experts on
vaccination. This national council works in coordination with the state entity responsible for
vaccination supervision known as Consejo Estatal de Vacunación (COEVA) (State Council for
Vaccination). The state council focuses primarily on state and municipal rates of vaccination,
regulation of the supply and administration of vaccines, upkeep of an official registry of applied
dosages of vaccines, assurance of proper vaccine distribution in their appropriate district, and the
promotion of the National Health Weeks. With these two entities working side-by-side, results
have improved over the last 10 to 20 years. The coverage rates of Mexican children being
vaccinated show staggering positive results (an example being >95% national coverage of DPT
by age four). [18]
Administration
Using the federal recommendations available on the Secretary of Health’s website, I
prepared a rough example of the current vaccination scheme for healthy children (See Figure 3
in Supplemental Materials). Mexican citizens are highly encouraged to follow these
recommendations to ensure the highest vaccine efficacy [18]. It is also possible for people not
healthy enough for vaccination or who object to the use of vaccines not to comply with some or
all recommendations [8].

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In addition, referencing the same available resource as before, I constructed an
approximate example of a vaccination scheme for adolescents and adults (See Figure 4 in
Supplemental Materials). For adults, it is important to verify you have received a proper
vaccination regimen as a child, as this will determine what is necessary as an adult. You may
also choose to get boosters of certain vaccines, thereby strengthening the efficacy. The vaccine
for human papillomavirus and Td are examples of a vaccinations that are administered later in
the child's development into an adult. Pneumococcal polysaccharide is an example of a
vaccination that is specifically targeted to protect the elderly [18].
Currently, vaccines are administered at all hospitals, local clinics, and private practices in
most cities in all Mexican states. They are typically administered free of charge to invalidate
financial excuses. Any health professional must report all administrations of a vaccine, as well as
any diagnosis of diseases preventable by vaccination, to the national health registry in order to
evaluate epidemiological data and prevent outbreaks [8].
2.3 La Concepción de Buenos Aires and Dr. Isauro Ramos Rubio
Conducting research through the internet has proven to be a useful method to learn about
foreign countries due to the extensive amount of information available. However, to really
understand what is going on with regards to national vaccination policies and procedures, it is
essential to travel to the area of interest and talk to people who have first-hand experience. For
my investigation, I highly anticipated my trip to La Concepción de Buenos Aires to discuss
vaccination policy face-to-face with a knowledgeable health professional, such as Dr. Isauro.
Once we finally met, he proceeded to give me an informative lecture that lasted for around an
hour. To my benefit, Dr. Isauro was a very generous and insightful professional who had an

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extensive amount of information and was willing to share it. We discussed issues of cost, fields
of occupations that require vaccination, religion's’ influence on vaccination policies, and
procedures medical professionals follow when reporting to the national registry [8].
Dr. Isauro (right) and myself after our insightful interview.
After our interview, Dr. Isauro put me in contact with various health professionals in the
area, including staff at the local public health center of La Concepción. This allowed me to
access and photocopy documents such as vaccination coverage reports from the CONAVA, a
template of the currently used vaccination record form f, and copies of age-specific
immunization record books provided by the Federal Government at birth (See Figure 5 and 6 in
Supplemental Materials). Guidance from Dr. Isauro’s lesson and my findings at the health

22
center clarified my prior prejudices. They also made clear the relevance that external factors,
such as politics and ethics, could have to my thesis.

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One thing duly noted from my discussion with Dr. Isauro is that Mexico is a country that
is fully embracing vaccination as a sincere public health benefit, perhaps more than the United
States. As an example, if an organization wants to be nationally recognized as a religion, they
must submit their beliefs to the federal government; if there is anything that discourages the use
of vaccination, the religion is not legally allowed to exist. Vaccination is not mandatory in
Mexico, however regulations have been established at the federal level by the National Council
for Vaccination in order to protect the overall health of the public. As a generalization, Mexico
tends to require proper immunization for people who hold occupations in government jobs,
social workers, or others who interact with people frequently (doctors being a great example). In
addition to people who hold these occupations, Mexico also deems it necessary to vaccinate its
military personnel and incarcerated citizens in order to protect the institution itself (i.e. infecting
the entire military or an entire correctional facility) [8].
With so much government push for vaccination, as well as the incentive of cost-free
vaccination schedules, it was inevitable that the country adopted the proper usage of this medical
tool [18].Initially, my presumptions regarding widespread social, cultural, and religious
opposition to vaccination in rural Mexico were prejudiced. I was amazed to find that, according
to my experience in La Concepción, the general public of the town was very accepting of
vaccination. Besides, Dr. Isauro mentioned the existence of social pressure among children in
school (to the extent that if there is a child in school that is not properly vaccinated, the news will
spread just as gossip does and cause social exclusion of the individual) [8].

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3. The United States and Vaccination
When analyzing the United States and their progression into the current infrastructure of
vaccination, it is no coincidence that the adaptation patterns will be similar to those of other
countries, such as Mexico [6]. There will exist, however, certain scientific research endeavors, as
well as timeframes, that will set the United States in a unique light. To begin, I have included a
few important years of the United States researching vaccines (research in other countries will be
mentioned in order to establish a reference) It also includes the establishment institutions to
regulate vaccinations, as well as any other important occurrences that are related to the
vaccination policies and procedures [11].
Important Years of Advancement for Vaccination in the United States [6] [11]
1796 Edward Jenner successfully administered a smallpox vaccination his first willing
recipient, James Phipps in England
1800 After studying medicine in England, Benjamin Waterhouse brings Jenner’s news of
success of to the United States, performs the first U.S. vaccination of smallpox on his
children, and strongly encouraged vaccination publicly.
1803 The term “vaccination” is termed by the Royal Jennerian Society, as Jenner insisted it
be based off the latin root for cow (vacca), as this is the animal from where the vaccine
originated. Also, President James Madison signs an act, “An Act to Encourage
Vaccination”, which ultimately established a National Vaccine Agency, which
Baltimore Physician James Smith as National Vaccine Agent

25
1876 The New York Board of Health establishes vaccine farms in New Jersey with the hopes
to increase vaccination production and availability
1885 Louis Pasteur successfully performs post-exposure immunization for rabies on a human
subject in France
1894 First major Polio outbreak in Vermont. Also, early use of cholera antitoxin by young
physicians from serum obtained in Europe, with early development of United States
production the following year
1905 First United States Supreme Court Case regarding vaccination, Jefferson v.
Massachusetts, in which the Federal government upheld that the power to enforce
compulsory vaccination laws lie in the hands of the State governments
1908 Poliovirus is identified as the cause of polio in Austria by Karl Landsteiner, MD and
Erwin Popper, MD . Also the first county health departments are formed in the United
States
1922 Zucht v. King another lawsuit regarding school immunization requirements, ending
with the courts supporting Texas’s decision to require proof of smallpox vaccination to
attend public or private school
1936 Max Theiler develops the vaccine for Yellow Fever and began testing in human patients
in 1937 in the United States
1945 Influenza vaccination approved for use in military personnel, and civilian use in 1946
thanks to the work of Dr. Thomas Francis Jr., MD, and Jonas Salk, MD.
1946 The United States establishes the Center for Disease Control and Prevention, or better
known as the CDC

26
1948 First DTP vaccine developed against Diphtheria, Tetanus and Pertussis, which will later
be replaced by an acellular version
1949 Last reported Smallpox case in the United States, as the illness continued to affect the
world until the 1970s
1953 Thomas Weller isolates Varicella virus in the United States
1960 Robert Weller, son of Thomas Weller, isolates Rubella virus in the United States
1964 The United States forms the Advisory Committee on Immunization Practices, or
ACIP, which is a branch of the CDC that specializes in vaccination
1966 CDC announces measles eradication plan
1971 CDC discourages use of smallpox vaccine as the chances of contraction are so small,
Nixon also announced the establishment of the National Center for Toxicology
Research, or ACTR, to be headed by the Food and Drug Administration, or FDA
which will be the federal oversight on the research and production of vaccines
1973 MMR (Measles, Mumps, Rubella) live vaccine licensed in United States
1988 Congress passed into law the National Vaccine Program, which aimed to coordinate
programs like the AID, NIH, CDC, the Department of Defense, and the FDA in the
research and monitorization of vaccination
1993 The National Immunization Program was created as a separate program that was to
answer directly to the CDC but act as a liaison between federal and state institutions
1994 World Health Organization deemed the western hemisphere polio free
2003 Project Bioshield Act of 2003 was enacted, which allowed an amount in the range of
$500 billion to go toward vaccination and other biohazard research in fear of
bioterrorism

27
2004 The 8th report of the Immunization Safety Review Committee as issued by the Institute
of Medicine which rejected relationships between MMR vaccine and autism.
Notable from the preceding timeline, the United States has significantly contributed to
research and scientific testing of many vaccines that are standard around the world. These
various organizations, centers, projects, and administrations that have gradually been put into
place by the federal government over the last two hundred years are crucial to the
competitiveness found in medical research in the United States currently [11]. These entities
have become a bridge between the medical research labs and the healthcare system. As for laws
regarding citizen obligation, the United States decided to put the regulation of compulsory
vaccination laws (such as for admission to public school) in the hands of the state government.
This permits vaccination regulations to differ from state to state. However, most public
institutions, like schools, government organizations, and healthcare facilities have developed
laws regulating the vaccination of personnel, due to their greater risk of infecting others [12].
Organization
The organization of vaccination oversight at the federal level in the United States is
ultimately coordinated through two sectors of the federal government: the Food and Drug
Administration (FDA) and the Center for Disease Control and Prevention (CDC).
The CDC has the current focus of “supporting state and local health departments,
improving global health, implementing measures to decrease leading causes of death,
strengthening surveillance and epidemiology, and reforming health policies.” This has been
conducted through the establishment of the Advisory Committee on Immunization Practices

28
(ACIP), a branch of the CDC that acts as decision-making committee for the federal regulation
organization. It consists of a group of medical and public health experts, allowing a vast amount
of input while assigning vaccination schedule recommendations for an entire country. In their
position, they are obligated to produce a standard recommended immunization schedule for
United States citizens, from newborn to adolescence, as well as a schedule for adults. This
committee also offers information on precautions and contraindications that come with
administering a vaccine to someone [2].
Meanwhile the FDA, with the establishment of the National Center for Toxicological
Research (NCTR), initially began a research program to study the effects of toxins on health and
the environment. Today this Center and its research data function as a major component in the
FDA’s ability to make science-based decisions regarding newly-discovered vaccines.
Essentially, the FDA deems potential vaccines acceptable for human testing through animal-
based evidence, as well as other human physiological safety precautions. After passing through
several phases of experimentation and carefully documenting things like potential intended
effects, unintended side effects, appropriate dosage, and efficacy, the FDA will then deem a
vaccine safe to go onto the market and will end up in hospitals, doctor’s offices, and clinics all
around the country [9].
While focusing most of the previous information on federal regulation of vaccination, it
is worth mentioning that federal regulation in legislation regarding immunization is limited and
most of the decision-making power is found at the level of the state governments. However, the
federal government may intervene if there is an issue that evolves into a Supreme Court case,
which has happened in a case (Zucht v. King) regarding school vaccination requirements. This
allowed the federal government to have the final say in an ethical debate over vaccination.

29
Coincidently, the ruling of this case happened to be in favor of the state of Texas and the right of
a state to maintain vaccination requirements for public schooling. Other than the Supreme Court,
the federal government puts most of their effort into the institutions, departments, and
committees to maximize their influence vaccination of the country. (FDA, CDC, ACIP, ACTR,
Department of Defense, support of the WHO, etc.) [12].
Administration
Using information available to the public found on the website of the Center for Disease
Control and Prevention, I have drafted a rough example of the current vaccination scheme for
healthy children (See Figure 7 in Supplemental Materials). It is typical for parents to pursue
this schedule of vaccination for their child, the only exceptions being if someone is not healthy
enough for vaccination or a severe ethical issue with the use of vaccines is expressed [4].
For consistency, using information available on the CDC's website, I constructed an
approximate vaccination scheme for adolescents and adults (See Figure 8 in Supplemental
Materials). Besides minimal new vaccinations at a young age (Tdap, HPV, varicella) and the
few during older age (Zoster and both conjugates of the pneumococcal polysaccharide), the
majority of adult vaccination consists of a recommended annual shot against influenza and
receiving any vaccinations missed during a patient's childhood [3].
It is quite obvious from assessment of the previous information that the United States
government has been and still is placing a great deal of importance on spreading the success of
vaccination. This is visible through the work of federal entities such as the FDA, in charge of
overseeing the safety of vaccines for general public use, and CDC, in charge of creating

30
guidelines for the citizens with the assurance that these are recommendations by salient medical
professionals and the reference of epidemiological data. These entities are used to influence
society toward educating and informing people of the benefits of vaccination.
However, the federal government does not have much control on how states regulate the
legislation of vaccination and therefore can ultimately only provide recommendations and
resources [12]. The current state-by-state layout requiring proof of proper immunization for
admission to public schooling institutions is widely varied. All but three states (California, West
Virginia, and Mississippi) allow for religious exemption to this rule. As far as philosophical
exemptions to vaccination, there are currently 18 states that deem them legitimate [13]. The
alternative that a parent then must face is homeschooling their child and depriving them of a
traditional academic experience [12]. This places societal pressure on the parent when they are
making decisions regarding whether or not they will vaccinate their child in a traditional manner.
This pressure to vaccinate is not only limited to education, but also things like potential
occupational opportunities or future travel restrictions.
4. Brief Analysis and ExternalInfluence
4.1 Analysis of Similarities and Discrepancies
When comparing two countries’ vaccination infrastructures, there are various minute
details that differ between the two and can result in a skewed overall analysis (such as
differences in a recommended window period for a dosage of a certain vaccine). To avoid this, I
will aim to focus only on the distinguishing and impactful characteristics of both countries. This
brief analysis will be organized into three categories outlined in the previous sections: History &
Progression, Current Policy, and Social Pressure. Each category reveals unique similarities and

31
discrepancies between the two neighboring countries. The brief comparisons will provide
background information and reference for the following section concerning political influence
and unethical practices conducted in the name of vaccination.
History and Progression
The following are notable differences between the history and progression of organized
vaccinations in both countries: the appearance of the first compulsory laws, federal endorsement
of the tuberculosis vaccine, BCG, and the appearance of institutions and organizations to
promote vaccination benefits.
Mexico adopted compulsory Smallpox vaccination laws in 1926, a period where
smallpox was continuing to do damage in countries that did not administer vaccinations to their
citizens. This day in age, with the disease nearly eradicated thanks to the success of proper
vaccination, Mexico no longer abides by this outdated compulsory law [1]. In contrast, the
U.S.has always elected compulsory vaccination laws as a state’s decision. As early as the late
1800s, states enforced certain compulsory vaccination laws, and in 1905 the first U.S. Supreme
Court Case regarding this issue was put through trial [6].
As for the gradual appearance of BCG vaccine usage, Mexico begins integration into the
standard immunization regimen in 1951 [1]. Currently, it is grouped with the rest of the countries
that consider universal distribution of the BCG vaccine the most practical solution to fighting
tuberculosis [21]. On the other hand, the U.S. has refused adoption of this vaccine into the
recommended vaccination schedule. As an alternative, a skin test or chest x-ray is administered
to test if a patient has been exposed to tuberculosis; this test is also used to monitor the health
employees of hospitals, clinics, other health care facilities, and some public institutions on a
predetermined basis [4].

32
Mexico began developing and providing resources to their citizens during the 1970s, 80s,
and 90s. The most notable contributions being the establishment of CONAVA (federal advisory
component), COEVA, (state advisory component), and advances of public health awareness by
the Secretary of Health [1]. Moving at a slightly quicker pace due to economical and political
predispositions, the U.S. developed equivalent public resources primarily during 1940-1970; this
places them decades ahead of Mexico for the majority of public resource implementation [11].
The following are two essential aspects that are the similar when analyzing the history
and progression in both countries: the development & advancement in usage of DPT/DTP
regimen and the desire to spread the concept of universal vaccination.
The U.S. begins DPT/DTP research and preparations in 1948 with the intention of
preventing outbreaks of diseases like diphtheria, tetanus, and pertussis [6]. Mexico, with the
same public health intentions as the U.S., followed quickly and in 1954 started conducting their
own research, preparation, and administration [1]. Both countries eventually replace the whole-
cell pertussis component of the vaccine with a more effective, acellular equivalent in the 1990s;
this consequently lead to a decrease in prevalence and staggeringly high vaccination coverage
rates [4] [18].
The U.S. has always acknowledged the importance and efficacy of universal vaccination.
This is thoroughly demonstrated from the early 19th century, with Thomas Jefferson passing a
law that encouraged vaccination as early as 1803. By 1988, the National Vaccine Program was
passed into law by Congress to coordinate the various medical professionals, institutions, and
organizations into a cooperative force that advocated for universal vaccination practices [6]. In a
similar fashion, Mexico’s federal advisory council is the main entity supporting and advocating
for universal vaccination. It has always operated with the mission of improving the general

33
public’s health conditions using preventative measures, such as vaccination [18]. With statistics
clearly demonstrating correlation between vaccination usage and disease prevalence, Mexico
established the official program of universal vaccination in 1991. Its main objectives— to spread
awareness, increase support, and achieve universal coverage— are nearly identical to that of the
CDC in the United States [21] [17].

34
Organization & Administration
An analysis of the organization and administration of vaccination in large populations
(i.e. Mexico and the United States) reveals notable differences. One significant example includes
the difference in cost. Mexican citizens currently receive administration of most vaccines free of
charge [7], while United States citizens either possess health insurance coverage or bear the
financial burden themselves. Another notable difference is the presence of federal endorsement
or discouragement of vaccines, such as tuberculosis, meningococcal, and shingles vaccine.
Meningococcal and shingles are part of the recommended vaccination schedule in the U.S.
currently; however, Mexico does not provide the same recommendation to the public [3] [4]
[18]. The case is similar for the tuberculosis vaccine; Mexico strongly endorses its efficacy while
the United States does not provide recommendations regarding the vaccine [21].
Simultaneously, several similarities exist between the two infrastructures. Some aspects
of the current vaccination policy found in both locations are characteristic of other modern,
medically-advanced countries allocating time and resources into their public health. An
attributable characteristic noticed in both countries is the amount of publically available
resources from the federal government. From my experience researching readily-accessible,
public information, provided in large quantities on the government and institutional websites, I
concluded that the quantity of online resources available to each country is roughly equivalent.
This has expedited the process of finding reliable information from both countries tremendously.
Another obvious similarity is the basic administration procedures of vaccines that fight diseases
like hepatitis B, DTP, rotavirus, influenza, measles, mumps, and rubella [All citations except 8].
They are essentially identical among the two countries, as the current practices have proven
extremely effective when used precisely [21].

35
Social Pressures
Changing the focus of my study was crucial if I desired to incorporate what data I was
able to collect from Isauro and other healthcare facilities into my thesis without making
assertions that would not reflect reality. I was determined to avoid making naive, misinforming
insertions that can be hideously inaccurate at depicting the larger population. To divert from this,
I will instead discuss examples of social pressures that were brought to my attention by Dr.
Isauro and professionals at the Centro de Salud.
In both populations, it has become customary to provide documentation of immunization
records as a requisite for access to a variety of social institutions, such as admission to public
school [7] [12] [13]. This can cause social pressure to surface in areas where access to important
resources is jeopardized by refusing vaccination. In Mexico, this social pressure works in favor
of vaccination. For example, a student attending a public school without providing proof of
vaccination is legally an acceptable scenario. Unfortunately, over time the student will become
ostracized by his or her classmates, sometimes to the point of verbal abuse. This typically exerts
enough social pressure on the child and his parents that vaccination is commonly sought out as a
final resort [7]. Comparatively, in the United States if a student fails to provide proof of
immunization, the likely scenario is that the student will be denied admission. Typically they are
then limited to three alternatives: move to a state with no requirements for students in public
school, homeschool the student, or properly vaccinate the student [12] [13].
In the United States,when providing medical information to any official institutions or
healthcare facility, the confidentiality is protected by federal law as a direct result of the
installment of HIPAA laws by the U.S. Congress [20]. On the opposite hand, it appears that

36
Mexico lacks effective legislature protecting patient confidentiality. Consequently, during my
brief visit to the Centro de Salud, I was allowed to witness a brief patient consultation, as well as
make photocopies of clinical vaccination documents with only a brief explanation of my
intentions (Refer to Figure 5 in Supplemental Materials).
Additionally in the United States, the supervision of legislation regarding vaccination lies
in the hands of the states. Furthermore, many states will require immunization requirements if:
the parents wish to send their children to public school, the child will get hired for certain
occupations during adulthood, the child travels abroad, or the child will be employed in a
different government institution. With the decision in the hands of the state, this allows for U.S.
vaccination policies to vary from state to state [12]. This is distinguishably different from that of
Mexico, where the federal government works with the state councils to create a uniform
vaccination program across the whole country [18]. Surprisingly, according to Dr. Isauro,
Mexico does not currently have any immunization requirements for admission to public schools
for toddlers. (Despite the fact that well over the majority would most likely opt for proper
administration.) Children are not required to be vaccinated to be educated during their youth,
however other consequences must be considered. During adulthood, certain social occupations,
such as government officials or politicians, will eventually require proof of adequate
immunization [8].

37
4.2 Political and Ethical Influence
Cuba and the Lung Cancer Vaccine
Medical advancements have the potential to be influenced by factors that, in essence,
have no medical reasoning or justifications. After formulating a short exposition of two
countries’ current use of vaccination, along with suggestions from Dr. Isauro, I decided to briefly
demonstrate how influences with minimal medical credibility, such as politics, can be impactful.
Over the last 40 years, Cuba, despite its poor economy, has been approaching the global frontier
of research and vaccine preparation [16]. Countries from all around the world eventually became
interested in the potential benefits of one vaccine in particular and gradually started conducting
investigations themselves to verify safety and efficacy [14]. Cuba made the vaccine readily
available to the public in 2011 and has demonstrated early success in lung cancer patients [16].
Unfortunately, during the 25 years Cuba was developing this particular vaccine, the
United States was participating in an ongoing embargo that ceased all relations between the two
countries. The embargo was set in place by the United States as a stern political sign of
disapproval of Cuba’s relations with the Soviet Union and the emerging threat of communism.
Although the embargo was not intended to hinder science or culture, it was effective in doing
both. With no collaboration among American and Cuban scientists possible, the United States
was not able to evaluate the potential lung cancer vaccine using the FDA’s drug trial process.
This resulted in the vaccine never appearing on the U.S. market, despite its proven success
internationally. In late 2014, U.S. President Barack Obama and Cuban President Raúl Castro
announced their resolution to restore diplomatic ties between the two countries. The removal of
the embargo allowed Roswell Park, the researcher responsible for the vaccine, to coordinate the
drug approval process with the FDA [16].

38
The United States has always embraced scientific exploration and the advancement of
fields like medicine and public health. However, when considering this brief period of history
and the consequences caused by U.S. and Cuban political decisions, it is clear that in some
circumstances, politics have precedence. Although Park had clearly demonstrated that the drug
was sufficiently safe and effective, the FDA would not give it fair consideration due to the
political bias present in the U.S. for the past few decades. In response, lung cancer patients
would travel, illegally if necessary, to Havana to treat their sickness. Additionally, The U.S.
conducted investigations on two potential lung cancer vaccines aside from that of Roswell Park.
In response to the dissolution of the embargo, efforts are being made to incorporate Park’s
vaccine into the U.S. market [16].
Testing Vaccines in Third World Countries
The development and progression of vaccination has controversial aspects associated
with the preparation and testing of vaccines, as well as the ethics that come along with this task.
Several countries around the world have used their political and economic power to take modern
medicine to the frontier of advancement by conducting clinical trials that are un-approved in
their own country [10]. Countries with a structured government will generally have a department
in charge of regulating vaccine-related matters. For some countries, approval for clinical trials of
vaccines is not permitted unless the vaccine’s safety and potential effectiveness is demonstrated
in cell culture and animal models [9]. The copious, strict criteria that these potential vaccines
must meet caused people to seek alternative methods of experimentation under certain
circumstances. This can be observed when recounting instances of experimental research
performed on unwilling and/or uniformed inhabitants of developing countries in Africa and Asia
[10].

39
“Minimum 40 Children Paralyzed After New Meningitis Vaccine.” I borrowed this tragic
headline from an article (originally from a French newspaper) published in late 2012 that
discusses an occurrence in Chad, Africa that clearly demonstrates how people living in
developing countries are used as human subjects for medical experimentation and the
consequences associated with this lack of regulation. Similarly, in India, schools for the tribal
children of the Khammam district in Telangana, were being transformed into HPV vaccine
testing sites. Months after receiving the vaccine, many schoolgirls became ill and some died.
Unethical behavior is strongly suspected during both these instances of experimentation, whether
it was through improper preparation and storage of the vaccines or improper education of the
vaccinator and/or recipient [10].
5. Conclusions
5.1 Personal Prejudices and Project Intentions Revisited
Completing this project has been a unique academic experience in which I gained
unforeseen personal insights regarding Mexican society and medical infrastructure. Aside from
clarifying misconceived ideas, I learned the significance of the value of the phrase “see for

40
yourself”, the value of good human values and behaviors, and the value of solid scientific
programs backed by social institutions and resources.
Originally I had desired to conduct research on Mexican society by attempting to collect
a representative amount of data from Mexican citizens and drawing conclusions from my
findings. However, after discussing my expectations with Professor Fatás-Cabeza, my thesis
director, calculating project logistics, and setting realistic expectations I realized my data and
findings in La Concepción would not be sufficient enough to be my only source of information.
Even if the findings supported the theory I had, they would be based solely in one small
community, consisting of less than .003% of the population of country. By addressing these
insights, and the surveys, observations, correspondence, and literature reviews I prepared and
used for this study, I have produced what I believe to be a clear and balanced exposition of my
observations and conclusions about vaccination, an interesting and relevant part of my scientific
and social interests.
5.2 Is vaccination conducted in an unbiased and ethical manner?
If I had been asked this question prior to completing this project, I am confident that my
answer would have been that the adoption of universal vaccination programs would pose ethical
questions throughout its progression and development into a modern system. This is due to many
inherent characteristics that vaccination possesses in regards to human experimentation,
drug/vaccine approval, recommendation periods, etc. Nevertheless, now, after conducting my
investigations on the vaccination system the United States and Mexico, and supplemental study

41
of foreign restrictions in Cuba and unregulated experimentation in Asia and Africa, my actual
answer to this question is derived from the same thought process as I predicted.
5.3 Future Implications
Electing to focus on vaccination protocol in two very large, diverse countries with limited
financial support and a two semester time restriction often placed me in a situation where I was
forced to omit very interesting information or ideas in order to keep my exposition concise and in
support of my thesis. Although these ideas and implications that were omitted on purpose, it does
not deem them inferior and often can lead to a future academic endeavor. Throughout the course
of completing this exposition, there are many intriguing tangents that I recommend researching if
you are interested in what is depicted in this thesis— similar investigations focused on countries
other than the United States and Mexico, investigations of Mexico and the United States focused
on a disease mortality, analysis of changes in worldwide health trends after implementation of
global health organizations like the WHO, and analysis of the occurrence of drug use associated
with cultural backgrounds
6. SupplementalMaterials
Figure 1
This chart displays travel options for Tucson, Arizona, United States to La Concepción de
Buenos Aires, Jalisco, Mexico (1,149 miles).
Modes of
Transportation
Price Pros Cons
Drive to Phoenix.
Flight from Phoenix
to Guadalajara (with
layover in Los
Angeles). Drive to La
-$400-$600 for the
plane ticket
(assuming it is
booked well in
advance otherwise
-Eliminates the issue
of bringing a car into
Mexico
-The fastest method
of travel
-Very expensive
- No use of personal
car while abroad,
limiting the
possibility of

42
Concepción. this can jump to the
area of $900)
-$50 in gasoline for
the driving portions
commuting to other
areas of rural Jalisco
or urban Guadalajara.
Drive from Tucson to
La Concepción.
-$250-$400 in gas
depending on mileage
and prices along the
way
-$50-60 in Mexican
car insurance
-$150 for hotels
-The ability to
commute to other
nearby communities
- Travel on our own
schedules
-20 hour drive
-Driving through
certain portions of
northern Mexico can
be considered
dangerous under
certain circumstances
Drive to Mexicali.
Fly to Guadalajara.
Drive to La
Concepción.
-$100-$250 for plane
tickets
-$80-$150 in gasoline
-Cheapest method -Leaving a car
unattended in a
foreign country
**Pricings are estimates based on current gas prices, time in advance of booking, time of
year, etc. ****
Figure 2
This is a copy of the questionnaire I drafted and shared with Dr. Isauro prior to meeting. All of
his responses are noted in blue, italic text.
____________________
El cuestionario
Por favor, conteste a las preguntas que figuran a continuación. Comente a su gusto si tiene alguna
información que le parezca relevante o necesaria.
1.¿Hay servicios de sanidad pública y/e organizaciones profesionales que ofrezcan servicios de
vacunación? Y ¿Dónde?

43
__x__ Sí. Por favor, mencione las servicios que conozca. “Centro de salud local, secretaria de salud de
Jalisco. Consultorios médicos privados.”
____ No. Por favor, mencione las razones si las conoce.
____ No lo sabe con certeza.
2.¿Es usted parte de una red o una otra organización que me pueda ayudar a tener una idea más clara
de los factores culturales, económicos, religiosos y otros que influyen en la decisión de la gente sobre si
van a vacunar a sus hijos?
__x__ Sí. Explique por favor.
“Soy director del hospital la capilla s.a. de c v. institución privada que provee servicio de salud a la
comunidad desde más de 10 años previos a la fecha actual.”
____ No. Explique por favor.
3.En su opinión personal, ¿Cuáles son los factores culturales, económicos, religiosos, y otros que
influyen en la decisión de la gente sobre si van a vacunar a sus hijos? (Por favor, conteste esta pregunta
con tanto detalle como le sea posible)
__x__ culturales “Actualmente no existe rechazo a la vacunación, incluso los nuevos grupos religiosos
no se oponen a la vacunación de los hijos”
__x__ económicos “La infraestructura es limitada pero existe un programa automatizado entre el
certificado de nacimiento y el programa de vacunación de la población. Es decir cuando un niño nace,
se programa de forma automática su vacunación y al tiempo establecido la institución tiene la obligación
de buscar a él o sus familias para vacunarle o dar información adecuada.”
__x__ religiosos “Los grupos religiosos actuales no evitan la vacunación antes de esto la promueven”
__x__ otros “Pocas es la población que rechaza la vacunación de la BCG por saber que en los estados
únicos no se cuenta con ella pero la oposición es mínima.”
4.En su opinión, ¿hay diferencias en la percepción sobre vacunación infantil entre la población de un
núcleo urbano muy poblado como Guadalajara y un núcleo rural como La Concepción de Buenos Aires?
____ Sí. Las diferencias son.
__x__ No. Son similares porque. “Los programas son automáticos. Existe más vacunación de forma local
que en las urbes por el conocimiento de los niños y las familias al nacer.”
____ No lo sabe con certeza
5.¿Hay grupos en el pueblo de Buenos Aires que no creen en la administración de la vacunación infantil?
____ Sí, ¿Qué grupos son? ¿Cuáles son sus razones? ¿Qué acciones llevan a cabo?

44
__x__ No. En su opinión, ¿hay alguna razón porque no existen? “La cultura ha cambiado para la bien y
no se permiten la inserción de grupos ajenos a los cristianos en cualquiera de sus modalidades.”
6.Cuando alguien declina la vacunación de su hijo o hija, ¿generalmente, cuál es la razón más común
que dan los que se niegan?
____ Tener miedo de vacunación.
____ La religión.
____ Los medios de comunicación.
__x__ Otra, explique por favor. “En los raros casos de rechazo, se presenta por efectos adversos a las
vacunas, como guillan barre en las vacunas de polio. En la manzanilla de la paz, reacciones severas en
las vacunas anti influenza y dolor exacerbado en las vacunas de la hepatitis pero en general son
contados.”
7.¿Hay alguien que tema las vacunaciones porque haya recibido información sobre muertes durante la
aplicación de vacunas de tuberculosis, rotavirus, y hepatitis B? (Recientemente, en los Estados Unidos
los medios de comunicación prestaron gran atención a las muertes de dos niños por reacciones
adversas a vacunas. Es posible que esta noticia haya recibido más atención en los E.E.U.U que en las
zonas rurales de México, pero quiero saber si este es un factor relevante en su comunidad)
____ Sí. Explique por favor.
__x__ No. Explique por favor. “Se sabe los riesgos existen, el conocimiento se tiene de manera local por
la realización de guillan barre de forma local y no existe rechazo en la comunidad a esas vacunas.”
8.Los medios de comunicación, ¿tienen los medios la capacidad de influir en las decisiones de miembros
de su comunidad relacionadas con las vacunaciones de los niños y niñas?
__x__ Sí. Explique por favor. “Las campañas locales son apoyadas por los munícipes, y existe mucha
publicidad televisiva, además de local a favor y la cultura médica es muy específica en el cumplimiento
de las vacunas además es requisito en las escuelas para la aceptación, así como algunos otros trámites
administrativos, incluso religiosos.”
____ No. Explique por favor:
9.En su opinión, ¿influyen los grupos religiosos en las decisiones médicas de la gente?
__x__ Sí. Explique por favor. “A favor de su aplicación”
____ No. Explique por favor.

45
10. Si ha contestado “Sí” a la pregunta #9, por favor conteste las siguientes preguntas:
¿Qué grupos religiosos ejercen esta influencia? “Cristianos”
¿Qué medios usan los grupos religiosos para influir en las decisiones médicas de la gente? “Los
eventos locales, misas, fiestas patrias. Como requisito de admisión a trámites religiosos, además
de trámites de diferentes.”
¿Cuál de estas opciones le parece que describir mejor la situación?
____ La religión le dice a la gente como decidir en asuntos relacionados con las decisiones
médicas.
__x__ La religión tiene influencia en las decisiones, pero los padres tienen el poder de decidir.
____ La religión no tiene influencia en las decisiones.
____ Otra. Explique por favor.
11. Aparte de las razones religiosas, ¿hay alguna otra razón espiritual (creencias espirituales,
tradiciones, supersticiones) que influyan en las decisiones relacionadas con la vacunación?
__x__ No.
____ No lo sabe con certeza
. 12.¿Ha visto usted algún ejemplo de paciente que, por razones relacionadas con la religión u otras
creencias no quiere que su hijo o hija sea vacunado?
__x__ No.
13.¿Cree que la edad de los padres es un factor que influye en la decisión de vacunarse o no?
____ Sí. Explique porque la edad es un factor.
__x__ No. Explique por favor.

46
Figure 3
National Vaccination Scheme for Healthy Children in Mexico
Birth- BCG (dose 1) and Hepatitis B (dose 1)
2 months- Acellular Pentavalent DPT Vaccine (dose 1), Hepatitis B (dose 2), Rotavirus (dose
1), Pneumococcal Vaccine (dose 1)
4 months- Acellular Pentavalent DPT Vaccine (dose 2), Rotavirus (dose 2), and
Pneumococcal Vaccine (dose 2)
6 months- Acellular Pentavalent DPT Vaccine (dose 3), Hepatitis B (dose 3), Rotavirus (dose
3), Influenza (dose 1)
7 months- Influenza (dose 2)
12 months- SRP (dose 1), Pneumococcal Vaccine (dose 3)
18 months- Acellular Pentavalent DPT Vaccine (dose 4)
2 years- Annual Influenza Reinforcement
3 years- Annual Influenza Reinforcement
4 years- DPT Reinforcement, Annual Influenza Reinforcement
5 years- Annual Influenza Reinforcement, Oral Polio Vaccine (dose 1)
6 years- SRP Reinforcement
10 or 11 years- Human Papillomavirus Vaccine
**note SRP is a Spanish abbreviation for Measles, Mumps, and Rubella, or MMR

47
Figure 4
National Vaccination Scheme for Healthy Adults in Mexico
Vaccination Illness Prevented Age
Td or dTpa Tetanus, Diphtheria, Pertussis Age 15, then every 10 years
VPH Human Papillomavirus Patient choice after age 10,
One more dosage after 1
month, again after 6
SR Measles, Rubella >18 years if never received as
a child
Antivaricella Varicella (Chicken Pox) Anytime >19 years, with a
booster 6 to 10 weeks after
Antiinfluenza Influenza Annually > 18 years
Pneumococcal Polysaccharide
(23 conjugates)
Infections caused by
streptococcus pneumoniae
50 years

48
Figure 5
This is a Scanned image of the current documentation provided by the CONAVA, currently in
use in the Centro de Salud in La Concepción. Names and Addresses have been removed to
maintain confidentiality.

49
Figure 6
This is scanned image of the coverage report, provided by the CONAVA, for the Centro de
Salud in La Concepción for a specific month in 2015. It is organized by age group and type of
vaccine and provides percentage data concerning coverage rates.

50
Figure 7
National Vaccination Scheme for Healthy Children in the United States
Birth- Hepatitis B (dose 1)
2 months- DTaP Vaccine (dose 1), Hepatitis B (dose 2), Rotavirus (dose 1), Pneumococcal
Vaccine (dose 1), Influenza (Hib) (dose 1)
4 months- DTaP Vaccine (dose 2), Rotavirus (dose 2), Pneumococcal Vaccine (dose 2),
Influenza (Hib) (dose 2), Poliovirus (dose 1)
6 months- Acellular Pentavalent DTP Vaccine (dose 3), Hepatitis B (dose 3), Rotavirus (dose
3), Pneumococcal Vaccine (dose 3), Poliovirus (dose 2)
12 months- Influenza (Hib) (dose 3), Pneumococcal Vaccine (dose 4), Poliovirus (dose 3),
Annual Influenza (IIV or LAIV), MMR (dose 1), Varicella (dose 1), Hepatitis A (dose 1)
18 months- Hepatitis A(dose 2), DTaP Vaccine (dose 4)
2 years- Annual Influenza (IIV or LAIV) reinforcement
3 years- Annual Influenza (IIV or LAIV) reinforcement
4 years- DTaP Vaccine (dose 5), Annual Influenza (IIV or LAIV) reinforcement,
5 years- Annual Influenza (IIV or LAIV) reinforcement, Varicella (dose 2),
6 years- MMR (dose 2)
11 years- Human Papillomavirus Vaccine (dose 1, part of 3 dose series), Meningococcal (dose
1), Tdap (dose 1, additional version of Acellular Pentavalent DTP Vaccine)

51
Figure 8
National Vaccination Scheme for Healthy Adults in the United States
Vaccination Illness Prevented Age
Substitute Tdap for TD Tetanus, Diphtheria Age 19, then every 10 years
HPV Human Papillomavirus Patient choice after age 19,
One more dosage after 1
month, again after 6
Triple Viral (MMR) Measles, Mumps, Rubella >18 years if never received as
a child or require booster
Varicella Varicella (Chicken Pox) Anytime >19 years, with a
booster 6 to 10 weeks after
Influenza Influenza Annually > 19 years
Zoster Shingles >60 years
(13 conjugates)
>65 years
(23 conjugates)
>65 years
7. Citations
[1] Banda, Luis Alberto Jordan. “Vacunación en México”. Universidad Autónoma De San Luis
Potosí Facultad De Enfermería Metodología De La Investigación Tercer Semestre Grupo “D”.

52
November 2009. <evirtual.uaslp.mx/ENF/220/31 Monografa/MONOGRAFIA LUIS.doc>.
February 2016.
[2] Centers for Disease Control and Preventions. “Our History- Our Story”. July 2015.
<http://www.cdc.gov/about/history/ourstory.htm> February 2016.
[3] Centers for Disease Control and Preventions. “Recommended Adult Immunization
Schedule”. 2016. <http://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-
schedule-bw.pdf>. February 2016.
[4] Centers for Disease Control and Preventions. “Recommended Immunization Schedules for
Persons Aged 0 Through 18 Years”. 2016.
<http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-
schedule.pdf>. February 2016.
[5] Centro de Vacunación Familiar. “Vacuna Contra La Tuberculosis (BCG)”. 2015.
<http://www.centrodevacunacion.com.mx/adolescentes.htm>. February 2016.
[6] The College of Physicians of Philadelphia. “Diseases and Vaccines- A Timeline ”A History of
Vaccines”. <http://www.historyofvaccines.org/content/timelines/diseases-and-vaccines>.
February 2016.
[7] Database of Global BCG Vaccination Policies and Practices. “The BCG World Atlas”. 2011.
<http://www.bcgatlas.org/>. February 2016.
[8] Dr. Ramos Rubio, Isauro. Personal Interview. 10 January 2016.
[9] Food and Drug Administration. “About the FDA” March 2015.
<http://www.fda.gov/AboutFDA/WhatWeDo/History/FOrgsHistory/NCTR/default.htm>. February
2016.
[10] Health Impact News. “Developing World – The WHO’s Private Vaccine“. April 2016.
<http://healthimpactnews.com/2015/developing-world-the-whos-private-vaccine-laboratory/>.
February 2016.
[11] Immunization Action Coalition. “Vaccine Timeline: Historic Dates and Events Related to
Vaccines and Immunizations”. <http://www.immunize.org/timeline/>. February 2016.

53
[12] National Congress of State Legislature. “Immunization Policy Issues Overview”. January
2015.
<http://www.ncsl.org/research/health/immunizations-policy-issues-overview.aspx>. February
2016.
[13] National Congress of State Legislature. “States with Religious and Philosophical
Exemptions from School Immunization Requirements”. January 2016.
<http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx>.
February 2016.
[14] Randal, Judith. “Cuban Vaccine Tested in Canadian Trial”. 2000 Journal of the National
Cancer Institute. <http://jnci.oxfordjournals.org/content/92/13/1037.full>. February 2016.
[15] Rueles, Alma Beade, et al., “Vacunas: Tu derecho y obligación de estar sana/o”.
Procuraduria Federal del Consumidor. October 2014.
<http://www.profeco.gob.mx/encuesta/brujula/bruj_2014/bol292_vacunas.asp>. February 2016
[16] Schumaker, Erin. “Cuba’s Had A Lung Cancer Vaccine For Years, And Now It’s Coming To
The U.S.”. February 2016. <http://www.huffingtonpost.com/2016/02/22/cuba-lung-cancer-
vaccine_n_7267518.html>. February 2016.
[17] La Secretaria de Salud.”Programa de Vacunación Universal y Semanas Nacionales de
Salud: Lineamientos Generales 2015”. Subsecretaría de Prevención y Promoción de la Salud:
Centro Nacional para la Salud de la Infancia y la adolescencia. 2015.
<http://www.censia.salud.gob.mx/contenidos/descargas/vacunas/Lineamientos_PVUySNS2015
.PDF> February 2016
[18] La Secretaría de Salud. “Vacunación Universal, Semanas Nacionales de Salud, Vacunas,
Esquema de Vacunación, Cartillas Nacionales de Salud, Coberturas de Vacunación y
CONAVA-Tope Overviews ”. La Secretaría de Salud. 2015.
<http://www.censia.salud.gob.mx/contenidos/vacunas/interm_vacunas.html>. February 2016
[19] U.S. Department of Health and Human Services. “Vaccines are Effective”.
<http://www.vaccines.gov/basics/effectiveness/index.html>. February 2016.

54
[20] U.S. Department of Health and Human Services. “Your Rights Under HIPAA”.
<http://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html>.
February 2016.
[21] World Health Organization. “WHO vaccine-preventable diseases: monitoring system. 2015
global summary”. January 2016.
<http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcou
ntry%5D%5B%5D=MEX&commit=OK>. February 2016.
[22] World Health Organization. “Reported Estimates of BCG Coverage”. January 2016.
<http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tscoveragebcg.html>.
February 2016.

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