This document provides an overview of the history and science behind vaccines and vaccinations. It discusses how vaccines work to build immunity without causing illness. It then outlines the history of vaccines from their origins in the late 1700s through various controversies like those surrounding the DTP, MMR, and thimerosal vaccines. The document examines who needs vaccines and why, including various age groups, occupations, health conditions, and other factors. It also discusses reasons for and against vaccination as well as vaccines currently available in the U.S.

1. Vaccines and Vaccinations
Research Methods for Health Services
Julie DeSalva
Prof. Theresa Reboli
September 8th, 2015

2. How Do Vaccines Work? - Immunity
 Vaccines work by building
the body's immunity.
 Immunity is the body's
method of preventing
disease and is the function
of the immune system.
 The immune system
prevents disease by
identifying germs as
invaders by their antigens,
and produces antibodies in
response, which fight off
the germs.
 The first time the immune
system encounters a germ,
antibodies will be produced,
but they will not be produced
before the person becomes ill.
 However, the immune system
will "remember" this germ and
its specific antigens.
 If the same germ invades the
body again, the immune system
will react quickly and destroy it
before any illness can result
 ("Childhood Vaccines," 2015)

3. How Do Vaccines Work With Immunity?
 Vaccines cause immunity to
be built without a person
having to be sick in the first
place.
 Vaccines introduce a germ's
antigens to the body, but in a
killed or weakened form, so the
germ can't make a person sick,
but its antigens stay strong
enough to trigger the production
of antibodies and the building of
immunity.
 By building immunity this way,
vaccines prevent diseases
from causing suffering and
even death.
 This is especially important for
some people who cannot be
vaccinated, because they are
too young or their health isn't
strong enough. Others being
vaccinated keeps them safe.
 ("Childhood Vaccines,"
2015)

4. History of Vaccines and Vaccinations
Late 1700s - Mid 1800s
 1796 - Dr. Edward Jenner developed the first vaccine in
England. The vaccine was developed for immunity to smallpox
by using cowpox instead.
 While revolutionary for his time, Jenner's discovery was criticized as
being "unchristian," unsanitary, and a violation of personal freedom.
 1853 - Britain enacted the Vaccination Act of 1853, which
requires children from infancy to 3 mos. to be vaccinated
 1867 - Britain enacted the Act of 1867, which extended required age to
14 years old and added penalties for refusal to be vaccinated or to
vaccinate.
 These acts only added fuel to the fire that vaccination violated personal
liberty.
 The Anti Vaccination League and Anti-Compulsory Vaccination League
were formed in response.
("Opposition Has Existed as Long as Vaccination Itself," 2015)

5. History of Vaccines and Vaccinations
Mid 1800s - Late 1800s
 Other demonstrations of public criticism and opposition to vaccines
led to several changes, including the creation of a commission to
study vaccines, the removal of the penalties for failure to
vaccinate, and the inclusion of a "conscientious objector" clause,
which allowed parents who mistrusted vaccines to obtain an
exemption certificate.
 Late 1800s - Outbreaks of smallpox in the U.S. led to vaccination
campaigns and anti-vaccination activities, including the creation of
the Anti Vaccination Society of America in 1879, the New England
Anti Compulsory Vaccination League in 1882, and the Anti-
Vaccination League of New York City in 1885.
 Opponents to vaccination waged court battles to repeal vaccination
laws in many states, including Illinois, California, and Wisconsin.
 (Opposition Has Existed as Long as Vaccination Itself," 2015)

6. History of Vaccines and Vaccinations
Early 1900s - Mid 1900s
 1902 - The Cambridge, MA Board of Health issued a demand that all city
residents be vaccinated against smallpox, following an outbreak. One
resident, Henry Jacobson, refused, and the city filed criminal charges
against him. Jacobson lost his case locally and appealed to the U.S.
Supreme Court.
 The Supreme Court ruled in favor of the state in 1905, saying that the state
could enact mandatory laws to protect its population in the event of an
infectious disease.
 This was a landmark case, as it was the first U.S. Supreme Court case on the
power of states in the realm of public health.
 1915 - Similar justification to Jacobson v. Massachusetts was used when New
York City officials forcibly quarantined cook Mary Mallon ("Typhoid Mary")
after many of her patrons died of typhoid fever and she refused to change
her occupation. She was exiled to an island in the East River, where she
remained the rest of her life.
 ("Opposition Has Existed as Long as Vaccination Itself," 2015)

7. History of Vaccines and Vaccinations
Mid 1900s to Late 1900s
 1950s - 1960s - More vaccines were created to prevent infectious
diseases: Polio in the 1950s, and measles, mumps, and rubella in the
1960s
 1980 - Using justifications from Jacobson v. Massachusetts, all 50
states had enacted laws demanding mandatory vaccination of
schoolchildren for vaccine-preventable diseases, with the only
exceptions made for medical or specific non-medical reasons, like
religious beliefs, although these were rarely used.
 Compliance was easily sought, as the vaccines worked, with new
infections of polio in the U.S. disappearing, the global eradication of
smallpox, and measles infections going from 500,000+ American children
in 1962 (with 48,000 hospitalizations and 450 deaths), to an annual
number of measles infections dropping to >100 in 1997.
 (Oshinsky, 2015)

8. History of Vaccines and Vaccinations
The DTP Controversy
 Mid 1970s - A report from the Great Ormond Street Hospital for Sick Children
in London alleged that neurological disorders had resulted from Diphtheria,
Tetanus, and Pertussis (DTP) vaccinations in 36 children.
 This resulted in an international controversy, allowing the anti-vaccination
movement to gain ground once more. A decrease in vaccination rates and 3
major epidemics of pertussis ("whooping cough") resulted from this controversy
in the U.K.
 The U.K. launched a study of every child between the age of 2 mos. and 36 mos.
who had been hospitalized for neurological illness in the U.K., to understand
whether the vaccine was associated with an increased risk of neurological illness.
The results found a very low risk of neurological illness with vaccination.
 Increased media attention to alleged risks of the DTP vaccine caused controversy
in the U.S.
 ("Opposition Has Existed as Long as Vaccination Itself," 2015)

9. History of Vaccines and Vaccination
The Wakefield Report and the MMR Controversy - 1
 1998 - Dr. Andrew Wakefield published a report in the Lancet that
alleged a connection between bowel disease, autism, and the
measles, mumps, and rubella (MMR) vaccine.
 The allegations were seized upon by the media, sparking public alarm and
upheaval over the safety of the MMR vaccine.
 2004 - The Lancet said it should not have published Wakefield's work.
 The General Medical Council, an independent regulator for doctors in
the U.K., found Wakefield guilty of conflict of interest, as he had
been paid by a law firm to find evidence to support the litigation case
of parents who believed their children had been harmed by
vaccination.
 ("Opposition Has Existed as Long as Vaccination Itself," 2015)

10. History of Vaccines and Vaccination
The Wakefield Report and the MMR Controversy - 2
 2010 - The General Medical Council struck Wakefield from the medical
register in Great Britain and forbade him from practicing medicine
there. The Lancet formally retracted Wakefield's report following
this.
 A series of reports by journalist Brian Deer found evidence that
Wakefield had falsified data, a form of scientific fraud, and that
Wakefield had hoped to receive financial gain from his investigations.
 As a result of the Wakefield report, multiple research studies have
been conducted to determine the safety of the MMR vaccine.
 None of these studies found a connection between the MMR vaccine and
autism.
 ("Opposition Has Existed as Long as Vaccination Itself," 2015)

11. History of Vaccines and Vaccinations
The Thimerosal Controversy
 1990s - Debate arose over thimerosal, a mercury compound used as a
preservative for vaccines, and whether it was linked to autism.
 1999 - Leading American public health and medical organizations and
vaccine manufacturers agreed that the use of thimerosal should be
reduced or eliminated.
 2001 - The Institute of Medicine's Immunization Safety Review
Committee published a report that stated that there was neither
enough evidence to prove nor to disprove the claim that thimerosal in
childhood vaccines caused attention deficit hyperactivity disorder,
speech or language delays, or autism.
 A more recent report from the committee favored rejection of the theory
that thimerosal-containing vaccines cause autism.
 ("Opposition Has Existed as Long as Vaccination Itself," 2015).

12. Vaccines and Vaccinations - Present
 Claims of links between vaccines and various conditions, whether
proven or disproven, have had a very negative effect on vaccination
rates, with vaccination rates below the level necessary to contain an
infectious disease in some areas.
 Most outbreaks are occurring in areas where exemptions are the easiest
to obtain and where unvaccinated children converge.
 The situation is not improving: as of this year, 2015, an outbreak of
measles in the U.S. already had 140+ cases by February. This most
recent outbreak has only added more fuel to an already vigorous fire.
 (Oshinsky, 2015)

13. Who Needs Vaccines and Why? - 1
 Infants and Toddlers: Vulnerable due to being very young and not having been
exposed to certain germs and their antigens yet. They need to be immunized for
their safety.
 Children between the ages of 2 and 10: Vulnerable due to being young and possibly
not exposed to certain germs and their antigens. They need to be immunized for
their safety.
 Preteens and Teens: Vulnerable to exposure from being immature and beginning to
engage in activities that can easily spread disease, like kissing and sexual activity.
They need to be immunized for their safety.
 College Students: Vulnerable to exposure to germs from close contact, kissing, and
sexual activity. They need to be immunized for their safety.
 Young Adults: Vulnerable to exposure to germs from close contact, kissing, and
sexual activity. They need to be immunized for their safety.
 Parents: Responsible for the health of vulnerable children, and they need info about
vaccination so that their children receive appropriate vaccines on time. They need
to plan their own vaccinations to keep their children safe.
 ("Specific Groups of People," 2015)

14. Who Needs Vaccines and Why? - 2
 Pregnant Women: Responsible for the health of vulnerable children, and they need
info about vaccination so that their children receive appropriate vaccines on time.
Also, some infectious diseases can pass from mother to child during pregnancy,
childbirth, and breastfeeding. They need to plan their own vaccinations prior to
pregnancy, if possible, to keep their children safe.
 Health Care Workers: Vulnerable to exposure to germs and their antigens due to
contact with patients with many different diseases and conditions. Responsible for
the health of their vulnerable patients. They may unknowingly transmit infectious
diseases if they are not properly vaccinated and become infected. They should be
immunized for their own and their patients’ sakes.
 Health Care Professionals: Vulnerable to exposure to germs and their antigens due to
contact with patients with many different diseases and conditions. Responsible for
the health of their vulnerable patients. They may unknowingly transmit infectious
diseases if they are not properly vaccinated and become infected. They should be
immunized for their own and their patients’ sakes.
 ("Specific Groups of People," 2015)

15. Who Needs Vaccines and Why? - 3
 Health Program Managers: Responsible for ensuring the health of populations. May
be vulnerable to exposure to germs and their antigens due to contact with health
care workers and health care professionals who are easily exposed to diseases. They
should be immunized for their own, their workers, and their populations’ sakes.
 Child-Friendly Locations: Responsible for providing safe areas. Vulnerable to
becoming a hotspot for transmission of germs, as they are places where many
children can gather and easily spread disease. Their workers should be immunized
for their clients’ sakes.
 People With Certain Health Conditions: Vulnerable to exposure to germs and their
antigens due to their health conditions (such as diabetes, heart disease, lung
disease, renal disease, or HIV/AIDS infection). They need to be immunized for their
safety.
 People from Certain Racial and Ethnic Groups: Vulnerable to exposure to germs and
their antigens due to disparities in vaccination rates across racial and ethnic groups,
often due to poor access to health resources, provider biases, poor health literacy,
etc. They need to be immunized for their safety.
 ("Specific Groups of People," 2015)

16. Who Needs Vaccines and Why? - 4
 Travelers: Vulnerable to exposure to germs and their antigens due to disparities in
vaccination rates in other countries, often due to their populations having poor
access to health resources and poor health literacy. They need to be immunized for
their safety.
 Refugees: Vulnerable to exposure to germs and their antigens due to disparities in
vaccination rates in other countries, often due to their populations having poor
access to health resources and poor health literacy. They need to be immunized for
their safety.
 Immigrants: Vulnerable to exposure to germs and their antigens due to disparities in
vaccination rates in other countries, often due to their populations having poor
access to health resources and poor health literacy. They need to be immunized for
their safety.
 Families Adopting International Children: Vulnerable to exposure to germs and their
antigens due to disparities in vaccination rates in other countries, often due to their
populations having poor access to health resources and poor health literacy. They
need to be immunized for their own and their adopted children’s safety.
 (“Specific Groups of People,” 2015)

17. Who Should NOT Receive Some or All Vaccines?
 Some people should not receive vaccines or certain vaccines in particular.
These people include:
 Those with severe, life-threatening allergies to components in some vaccines.
 Those who have ever had Guillain Barré Syndrome.
 Those who have suffered adverse effects from previous vaccinations.
 Those with long-term heart, kidney, breathing, liver, or nervous system issues.
 Those in treatment for cancer.
 Those with HIV/AIDS.
 Those being treated with drugs (such as steroids) that affect the immune system.
 Sometimes, women who are pregnant or breastfeeding.
 ("Who Should NOT Get Vaccinated?," 2015)

18. Reasons For And Against Receiving Vaccines
Reasons for Receiving Vaccines
 Vaccination has had great success with
reducing and eliminating infectious
diseases, like diphtheria, pertussis,
measles, mumps, and rubella, which
used to strike hundreds of thousands of
people annually in the U.S. during the
1800s and early 1900s.
 Vaccination also benefits those who
cannot be vaccinated by maintaining a
high level of herd immunity.
 (National Institute of Allergy and
Infectious Diseases, 2014)
Reasons Against Receiving Vaccines
 The public no longer has a strong base
of trust in vaccines and vaccinations,
especially parents who may be
confused and concerned while trying
to protect their children from harm.
 (Kennedy et al., 2011, p. 1152)
 People dislike having the government
intrude into their freedom to choose
what they do with their bodies or their
families' bodies (i.e. their bodily
autonomy).
 (Kluck, 2010)

19. Vaccines Available in the U.S.
 Varicella (Chickenpox)
 Diphtheria
 Hib
 Hepatitis A
 Hepatitis B
 Seasonal influenza (Seasonal Flu)
 Measles
 Mumps
 Rubella
 Tetanus
 Pertussis (Whooping Cough)
 Japanese Encephalitis (JE)
 HPV
 Meningococcal
 Pneumococcal
 Rabies
 Rotavirus
 Polio
 Herpes Zoster (Shingles)
 Tuberculosis (TB)
 Yellow Fever
 Typhoid
 Anthrax
 Smallpox
There are vaccines available in many combinations and forms for
the following diseases:
("List of Vaccines Used in
the U.S.," 2015)

20. Solutions for Dropping Vaccination Rates
 Efforts should be focused in three areas:
 Implementation of a thorough research program into the
motivations of the American populace that opposes or is uncertain
of present vaccination policies, and into the trends of vaccination
acceptance.
 Testing of new methods for the reduction of childhood vaccination
opt-outs while retaining parents' freedom to make health decisions
for their children
 Organization of a well-funded effort into effective communication
with and active listening to concerned and confused parents.
 (Winsten & Serazin, 2013, A.15)

21. Future for Vaccines
 New or better vaccines could be available to the public for the
prevention of HIV/AIDS, malaria, and tuberculosis within the next
two decades.
 This is important, as there is no vaccine for HIV/AIDS or malaria, and
tuberculosis is incredibly hard to prevent and treat.
 There could be vaccines for the treatment of autoimmune disorders
(like insulin-dependent diabetes and celiac disease) and cancer
within the next twenty to fifty years.
 (Nossal, 2011)

22. Works Cited - 1
 Centers for Disease Control and Prevention. (2015, September 3). Vaccines and
immunizations: List of vaccines used in the United States. Retrieved from
http://www.cdc.gov/vaccines/vpd-vac/vaccines-list.htm
 Centers for Disease Control and Prevention. (2015, August 17). Vaccines and immunizations:
Who should not get vaccinated with these vaccines? Retrieved from
http://www.cdc.gov/vaccines/vpd-vac/should-not-vacc.htm
 Centers for Disease Control and Prevention. (2015, July 6). Vaccines and immunizations: For
specific groups of people. Retrieved from http://www.cdc.gov/vaccines/spec-
grps/default.htm
 Centers for Disease Control and Prevention. (2014, May 19). Vaccines and immunizations: Why
are childhood vaccines so important? Retrieved from http://www.cdc.gov/vaccines/vac-
gen/howvpd.htm
 Kennedy, A., LaVail, K., Nowak, G., Basket, M., & Landry, S. (2011). Confidence about
vaccines in the united states: Understanding parents' perceptions. Health Affairs, 30(6),
1151-9. Retrieved from http://search.proquest.com/docview/874621010

23. Works Cited - 2
 Kluck, S. (2010). Mandatory Vaccinations Deny Parents Their Rights. In N. Merino (Ed.), At Issue.
Should Vaccinations be Mandatory? Detroit: Greenhaven Press. (Reprinted from Mandatory Vaccines
Override Parental Rights, United Liberty, 2008, October 18) Retrieved from
http://ic.galegroup.com/ic/ovic/ViewpointsDetailsPage/ViewpointsDetailsWindow?failOverType=&
query=&prodId=OVIC&windowstate=normal&contentModules=&display-
query=&mode=view&displayGroupName=Viewpoints&limiter=&currPage=&disableHighlighting=true
&displayGroups=&sortBy=&search_within_results=&p=OVIC&action=e&catId=&activityType=&scanId
=&documentId=GALE%7CEJ3010616206&source=Bookmark&u=berkeleycoll&jsid=48d543880d3191fc2
8123cce6e3ae1e1
 National Institute of Allergy and Infectious Diseases. (2014). Vaccines Prevent Infectious Diseases. In
R. Espejo (Ed.), At Issue. Do Infectious Diseases Pose a Threat? Detroit: Greenhaven Press.
(Reprinted from Vaccines: Understanding, n.d.) Retrieved from
http://ic.galegroup.com/ic/ovic/ViewpointsDetailsPage/ViewpointsDetailsWindow?failOverType=&
query=&prodId=OVIC&windowstate=normal&contentModules=&display-
query=&mode=view&displayGroupName=Viewpoints&limiter=&currPage=&disableHighlighting=false
&displayGroups=&sortBy=&search_within_results=&p=OVIC&action=e&catId=&activityType=&scanId
=&documentId=GALE%7CEJ3010315225&source=Bookmark&u=berkeleycoll&jsid=ee9ef598c01b3c671
bb0b0a903082c2d
 Nossal, G. (2011). Vaccines of the future. Vaccine, 29, D111-D115.
doi:http://dx.doi.org/10.1016/j.vaccine.2011.06.089

24. Works Cited - 3
 Omer, S. B. (2011). Vaccination Refusal Endangers Public Health. In D. Haugen & S. Musser (Eds.),
Opposing Viewpoints. Epidemics. Detroit: Greenhaven Press. (Reprinted from New England Journal
of Medicine, 2009, May, 1981-1988) Retrieved from
http://ic.galegroup.com/ic/ovic/ViewpointsDetailsPage/ViewpointsDetailsWindow?failOverType=&
query=&prodId=OVIC&windowstate=normal&contentModules=&display-
query=&mode=view&displayGroupName=Viewpoints&limiter=&currPage=&disableHighlighting=false
&displayGroups=&sortBy=&search_within_results=&p=OVIC&action=e&catId=&activityType=&scanId
=&documentId=GALE%7CEJ3010133277&source=Bookmark&u=berkeleycoll&jsid=98403098015061c98
eacba8376c0608d
 Opposition to Vaccines Has Existed as Long as Vaccination Itself. (2015). In N. Merino (Ed.), At
Issue. Vaccines. Farmington Hills, MI: Greenhaven Press. (Reprinted from History of Anti-Vaccination
Movements, 2014) Retrieved from
http://ic.galegroup.com/ic/ovic/ViewpointsDetailsPage/ViewpointsDetailsWindow?failOverType=&
query=&prodId=OVIC&windowstate=normal&contentModules=&display-
query=&mode=view&displayGroupName=Viewpoints&limiter=&currPage=&disableHighlighting=true
&displayGroups=&sortBy=&search_within_results=&p=OVIC&action=e&catId=&activityType=&scanId
=&documentId=GALE%7CEJ3010938203&source=Bookmark&u=berkeleycoll&jsid=bb854fd8c18e9d089
ede278bb5d5848e
 Oshinsky, D. (2015, Feb 20). The return of the vaccine wars; the controversy over vaccines is as old
as vaccination itself. Wall Street Journal (Online) Retrieved from
http://search.proquest.com/docview/1656444670
 Winsten, J., & Serazin, E. (2013, Feb 07). Rolling back the war on vaccines. Wall Street Journal
Retrieved from http://search.proquest.com/docview/1284579027