This document summarizes the controversy around vaccines and vaccinations. It discusses how vaccines work by building immunity without causing illness. It then reviews the history of vaccines from Edward Jenner's smallpox vaccine to modern mandatory vaccination laws and outbreaks that renewed opposition. Groups with differing needs and concerns regarding vaccines are identified. Both sides of the debate, including evidence for vaccination's success reducing disease and public trust concerns, are outlined. The current vaccine schedule and status is presented, along with the potential for new vaccines against HIV/AIDS, malaria, tuberculosis, and chronic diseases in the future.

1. Vaccines and Vaccinations
Research Methods for Health Services
Julie DeSalva
Prof. Theresa Reboli
September 5th
, 2015

2. Vaccines and vaccinations are a controversial health care tool, praised for their ability to
prevent serious infectious diseases and denounced as causing other diseases and an imposition
upon the freedoms of individuals. To understand this topic, one must know about how vaccines
work, what their history has been, who is currently involved or invested in the controversy, what
supporting evidence exists for each side, what their current status is in the United States, and
what the future may hold for them. These subjects will be discussed in the following paragraphs.
First, one should understand how vaccines work. Vaccines work by building an
immunity. Immunity itself is the body's method for preventing disease, and this is accomplished
by the body's immune system. The immune system prevents disease by identifying pathogens, or
germs, as being invaders, identifying these invaders by their antigens, and producing proteins
called antibodies which fight off the invaders (“Childhood Vaccines,” 2014). The first time a
person is infected by a pathogen, antibodies are produced by the immune system, but this is not
immediate, so illness will still result. However, the immune system will then “remember” the
pathogen and its specific antigens. Should the same pathogen enter the body at future time, the
immune system will then be able to react quickly, producing antibodies before the pathogen can
cause illness. This process is called immunity (“Childhood Vaccines,” 2014). Vaccines work
with this process, by introducing a pathogen's antigens to the body and the immune system, but,
instead of live, disease-causing pathogens, vaccines deliver a dose of either killed pathogens or
pathogens that have weakened to where they cannot cause illness, while the antigens remain
strong enough to prompt the production of antibodies and cause immunity. In short, vaccines
cause immunity to be built without a person having to become ill in the first place. By building
immunity in vaccinated individuals, vaccines prevent many illnesses that used to cause a great
deal of suffering and death, especially in vulnerable children, as some can be too young for

3. certain vaccines, and in those who cannot receive vaccines for health reasons, and vaccines also
provide a cost benefit, as they are cheaper to employ than treating a vaccine-preventable disease
(“Childhood Vaccines,” 2014).
Now that vaccines and the way they work has been explained, the history of vaccines and
vaccination will be elaborated upon. The first vaccine was developed by an English doctor
named Edward Jenner in 1796 (Oshinsky, 2015). Jenner had experimented with a way to prevent
smallpox, and found that he could protect a person from smallpox infection by, instead, infecting
him/her with the lymph from a cowpox blister. His discovery was revolutionary for his time
period, but, even then, it was met with public criticism. The reasons behind the criticism ranged
from concerns about how sanitary the process was, considering that it involved inserting an
infected individual's lymph into an uninfected individual's flesh; to how the process was
“unchristian,” as the cure originated from animals; to skepticism about whether smallpox was
really caused by pathogens, and not decaying material in the air; and, finally, to feelings that
being vaccinated was a violation of personal liberty (“Opposition Has Existed As Long as
Vaccination Itself,” 2015). Further objections to vaccination on the basis of personal liberty and
autonomy only increased with the development of mandatory vaccination policies by
governments, such as Britain's Vaccination Act of 1853, which required children from infancy to
3 months to be vaccinated, and the Act of 1867, which extended the age to 14 years and added
penalties for those who refused to vaccinate or be vaccinated. The Anti Vaccination League and
the Anti-Compulsory Vaccination League were created in response to these laws. Other
demonstrations of public criticism of and opposition to vaccines lead to several changes,
including the creation of a commission to study vaccines, the removal of penalties for failure to
vaccinate, and the inclusion of a “conscientious objector” clause, which allowed parents who

4. mistrusted the safety or efficacy of a vaccine to obtain an exemption certificate (“Opposition Has
Existed As Long as Vaccination Itself,” 2015). American outbreaks of smallpox in the late 1800s
brought about vaccination campaigns and anti-vaccination activities, which included 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. In
states that included Illinois, California, and Wisconsin, American vaccination opponents waged
court battles to repeal vaccination laws, which culminated in 1902 in Cambridge, Massachusetts.
The Cambridge board of health had demanded that all city residents be vaccinated against
smallpox, following an outbreak there. One resident, Henry Jacobson, refused, and Cambridge
filed criminal charges against him. Jacobson lost his case locally, and appealed to the U.S.
Supreme Court. The Supreme Court ended up ruling in the state's favor 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 law (“Opposition Has Existed As Long as Vaccination Itself,” 2015).
Similar justification was used in 1915, when New York City officials forcibly quarantined the
cook Mary Mallon, colloquially known as “Typhoid Mary,” because many of her patrons had
died of typhoid fever and she refused to change her occupation. She was exiled to an island in
the East River, where she lived for the remaining 23 years of her life (“Opposition Has Existed
As Long as Vaccination Itself,” 2015). As time went on, more vaccines were devised to prevent
infectious diseases: for polio in the 1950s and for measles, mumps, and rubella in the 1960s.
Using the justifications from Jacobson v. Massachusetts, by 1980, all 50 states had enacted laws
commanding mandatory vaccination of school children for these vaccine-preventable diseases,
with the only exceptions made for medical or specific non-medical reasons, like religious beliefs,

5. even though these were rarely used (Oshinsky, 2015). This time, compliance was easy overall,
as these vaccines worked, with new infections of polio in the U.S. disappearing, the global
eradication of smallpox, and measles infections going from over 500,000 American children
infected in 1962, with 48,000 of those children requiring hospitalization and 450 succumbing to
the disease and dying, to the annual number of measles infections dropping to less than 100 in
1997 (Oshinsky, 2015). However, this success did not go unchalleneged forever, as the anti-
vaccination movement once again gained steam during the international Diphtheria, Tetanus, and
Pertussis (DTP) vaccine controversy in the mid-1970s following a report from the Great Ormond
Street Hospital for Sick Children in London which alleged that neurological disorders had
resulted from DTP vaccination in 36 children. This controversy resulted in a decrease in
vaccination rates and three major epidemics of pertussis (also known as whooping cough) in the
United Kingdom, which required a study of every child between the age of 2 months and 36
months who had been hospitalized for neurological illness in the U.K. to understand whether or
not vaccination was associated with an increased risk of neurological illness. The results found a
very low risk of neurological illness with vaccination. However, the increased media attention to
the alleged risks of the DTP vaccine caused controversy in the U.S., resulting in a biased
documentary, DTP: Vaccination Roulette, in 1982 and a similarly biased book, A Shot in the
Dark, in 1991 (“Opposition Has Existed As Long as Vaccination Itself,” 2015). Controversy
over vaccination really gained a foothold almost 25 years after the beginning of the DTP
controversy, once again beginning in the U.K. A British doctor, Andrew Wakefield, published a
report in the Lancet in 1998 that alleged a connection between bowel disease, autism, and the
Measles, Mumps, and Rubella (MMR) vaccine. The allegations were seized upon by the media,
which sparked public alarm and upheaval over the safety of the MMR vaccine. Later, in 2004,

6. the Lancet stated that it should not have published Wakefield's work, and the General Medical
Council, which is an independent regulator for doctors in the U.K., found that Wakefield had
been guilty of a major conflict of interest, as he had been paid by a law firm to find if there was
evidence to support the litigation case of parents who believed their children had been harmed by
vaccination. Eventually, in 2010, the Lancet formally retracted the report after the British
General Medical Council ruled against Wakefield, which resulted in his being struck from the
medical register in Great Britain and forbidden to practice medicine there. Furthermore, a series
of reports by Brian Deer, a journalist, described evidence that Wakefield had falsified data, which
is scientific fraud, and that Wakefield had hoped to receive financial gain from his investigations.
Also, in response to the Wakefield report, multiple research studies were conducted to determine
the safety of the MMR vaccine; none of the studies found a connection between MMR
vaccination and autism (“Opposition Has Existed As Long as Vaccination Itself,” 2015). Another
controversy involving vaccination that arose during the 1990s was over whether thimerosal, a
mercury compound used as a preservative in some vaccines, was linked to autism. In response,
in 1999, leading American public health and medical organizations and vaccine manufacturers
agreed that the use of thimerosal in vaccines should be reduced or eliminated. Also, the Institute
of Medicine's Immunization Safety Review Committee published a report in 2001 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, and a more recent report from the committee favored rejection of the theory that
thimerosal-containing vaccines causes autism (“Opposition Has Existed As Long as Vaccination
Itself,” 2015). In any case, the claims of a link between vaccinations and various conditions has
had a very negative effect on vaccination rates, with vaccination rates below the level necessary

7. to contain a contagious disease in some areas, and most outbreaks occurring where the
exemptions are the easiest to obtain and where unvaccinated children converge (Oshinsky, 2015).
The situation is not improving as of yet: this year, an outbreak of measles in the U.S., which had
over 140 cases in February, added a new spark to the bonfire of controversy (Oshinsky, 2015).
With the history of vaccines and vaccination in mind, it should be easy to guess what
groups of people are most involved or invested in the controversy. The Centers for Disease
Control and Prevention lists 16 different groups of people who have different needs and concerns
with vaccines and vaccinations, according to their own vulnerability or the vulnerability of their
loved ones. They are: infants and toddlers, children between the ages of 2 and 10, preteens and
teens, college students and young adults, adults, pregnant women, families adopting children,
parents, child-friendly locations, health care professionals and providers, health care workers,
people who have specific diseases and/or conditions, health program managers, travelers, certain
racial and ethnic populations, and refugees and immigrants (“Specific Groups of People,” 2015).
The reasons why each group needs certain vaccines varies. Infants, toddlers, and children
between the ages of 2 and 10 need vaccination, as they are generally very vulnerable to the
contagious diseases vaccines prevent, due to not being exposed to the pathogens or their antigens
before (“Specific Groups of People,” 2015). Parents and pregnant women need vaccination, as
they are responsible for the health of vulnerable children, they need information about
vaccination to ensure that they have their children vaccinated as necessary, and infants can be
infected by contagious diseases during pregnancy, childbirth, and breastfeeding (“Specific
Groups of People,” 2015). It is best for these adults to plan for their own vaccinations, so as to
keep their children safe. Preteens, teens, college students, and young adults need vaccines as
they mature and begin interacting in activities that can easily spread disease, like kissing or

8. sexual contact (“Specific Groups of People,” 2015). Health care workers, professionals, and
providers and health program managers need vaccinations, due to their close contact with many
people in various states of health, and they may be exposed to a contagious disease from infected
patients, or may unknowingly transmit contagious diseases if they are unvaccinated and infected
(“Specific Groups of People,” 2015). Child-friendly locations need vaccinations, as they are
areas where many children may gather and spread contagious diseases if not kept in check
(“Specific Groups of People,” 2015). People with specific diseases and/or conditions need
vaccinations, as they may be in vulnerable health due to their diseases and/or conditions
(“Specific Groups of People,” 2015). People from certain racial or ethnic groups may need
vaccinations, as vaccination rates can vary widely between racial and ethnic groups (“Specific
Groups of People,” 2015). Travelers, refugees, immigrants, and families adopting children need
vaccinations, as they may be or have been exposed to contagious diseases in their journeys
(“Specific Groups of People,” 2015). Furthermore, there are those who should not receive
vaccines or certain vaccines in particular, including: those with severe, life-threatening allergies
to the components of the 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, like steroids, that affect the immune system, and, sometimes,
women who are pregnant or breastfeeding (“Who Should NOT Get Vaccinated?,” 2015).
There is some strong evidence to support each side of the controversy over vaccines and
vaccinations. The strongest evidence for vaccination is the success vaccination has in reducing
and eliminating infectious diseases, like diphtheria, pertussis, measles, mumps, and rubella,
which used to strike people in the hundreds of thousands annually in the U.S. during the 1800s

9. and early 1900s. Many people in the U.S. nowadays aren't concerned with these diseases or with
contracting them. Vaccination also benefit others, in maintaining a high level of herd immunity,
which shields those who cannot receive vaccines (National Institute of Allergy and Infectious
Diseases, 2014). The major evidence against vaccination is that the public no longer has a strong
base of trust in vaccines and vaccinations, especially confused and concerned parents who want
to protect their children from harm (Kennedy et al., 2011, p. 1152). Individuals also dislike
government intrusion into their freedom to choose what they do with their bodies or their
families' bodies, that is, their bodily autonomy (Kluck, 2010).
Given these concerns, that leaves the question of the current status of vaccines and
vaccinations. As of 2015, there are vaccines available, in many combinations, in the U.S. for 24
contagious diseases: 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, and smallpox (“List of Vaccines
used in the U.S.,” 2015). In response to the increasing levels of unvaccinated patients, some
doctors have begun to discontinue or consider discontinuing their relationships with patients who
refuse to be vaccinated or vaccinate their families (Omer, 2011).
Despite the currently gloomy outlook, progress for vaccines is marching ever forward.
The first or better vaccines may be available to the public for HIV/AIDS, malaria, and
tuberculosis within the next two decades (Nossal, 2011). This is crucial, as no vaccine exists yet
for the pandemic of HIV/AIDS, malaria still holds many developing nations in its grip and a
vaccine for malaria could provide the basis for other parasite vaccines, and tuberculosis is still
incredibly difficult to prevent. Furthermore, vaccines may yet be devised in the next twenty to

10. fifty years for the scourges of chronic diseases like autoimmune disorders and cancer (Nossal,
2011). This would alleviate a great deal of burden on the health care system.
In the end, it does not seem like the controversy over vaccines and vaccination will abate
any time soon. Much work has to be done to combat the public distrust in these health care tools
before vaccination levels may rise to adequate levels again. All of the groups that have a concern
about vaccination must be considered. More work is necessary to create new and better
vaccines. It is a long road ahead.

11. Works Cited
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
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)
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