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Individual Rights & Vaccination Policy

Individual Rights & Vaccination Policy

A vaccination policy is a public health policy implemented to prevent the spread of infectious diseases. State or local governments typically implement these policies, but they can also be implemented by private institutions such as workplaces or schools. Since vaccines became widely available, many policies have been developed and implemented.

The main goal of implementing a vaccination policy is eradicating a disease, as smallpox did. This, on the other hand, can be a difficult feat to achieve or even confirm. Many governmental public health agencies (such as the CDC or ECDC) rely on vaccination policies to build herd immunity among their populations. Immunization advisory committees are typically in charge of providing information to those in positions of authority to make evidence-based decisions about vaccines and other health policies.

Vaccination policies vary by country, some mandating them and others strongly advising them. Some areas only require them for people who use government services such as welfare or public schools. A government or facility may cover all or part of the cost of vaccinations, as in a national vaccination schedule[3] or as a job requirement. [4] Vaccination cost-benefit analyses have revealed that there is an economic incentive to implement policies because vaccinations save the state time and money by reducing the burden preventable diseases and epidemics place on healthcare facilities and funds. [5] [6] [7]

Immunity, both individual and herd
svg herd immunity
Vaccination policies aim to produce immunity to preventable diseases. Aside from individual protection against illness, some vaccination policies aim to provide herd immunity to the community. Herd immunity refers to the idea that the pathogen will have trouble spreading when a significant part of the population has immunity against it, reducing the effect an infectious disease has on society. This protects those unable to get the vaccine due to medical conditions, such as immune disorders. [8] However, for herd immunity to be effective in a population, most vaccine-eligible people must be vaccinated. [9]

Vaccine-preventable diseases remain a common cause of childhood mortality, with an estimated three million deaths yearly.

[10] Each year, vaccination prevents between two and three million deaths worldwide, across all age groups, from diphtheria, tetanus, pertussis, and measles. [11]

Eradication of diseases

Malaria Clinic in Tanzania helped by SMS for Life.
With some vaccines, the goal of vaccination policies is to eradicate the disease – disappear it from Earth altogether. The World Health Organization (WHO) coordinated the effort to eradicate smallpox globally through vaccination; the last naturally occurring case of smallpox was in Somalia in 1977. [12] Endemic measles, mumps, and rubella have been eliminated through vaccination in Finland. [13] On 14 October 2010, the UN Food and Agriculture Organization declared that rinderpest had been eradicated. [14] The WHO is currently working to eradicate polio,[15] which was eliminated in Africa in August 2020 and remained only in Pakistan and Afghanistan. [16]

Individual versus group goals
The likely behavior of individuals when offered vaccines can be modeled economically using ideas from game theory.
[17] According to such models, individuals will attempt to minimize the risk of illness. They may seek vaccination for themselves or their children if they perceive a high threat of disease and a low risk of vaccination. [18] However, if a vaccination program successfully reduces the disease threat, it may reduce the perceived risk of disease enough so that an individual’s optimal strategy is to encourage everyone but their family to be vaccinated or (more generally) to refuse vaccination once vaccination rates reach a certain level, even if this level is below that optimal for the community. [19] [20] For example, a 2003 study predicted that a bioterrorist attack using smallpox would result in conditions where voluntary vaccination would be unlikely to reach the optimum level for the U.S. as a whole,[21] and a 2007 study predicted that severe influenza epidemics could not be prevented by voluntary vaccination without offering specific incentives. [22]

Governments often allow exemptions to mandatory vaccinations for religious or philosophical reasons, but decreased vaccination rates may cause loss of herd immunity, substantially increasing risks even to vaccinated individuals.

[23] However, mandatory vaccination policies raise ethical issues regarding parental rights and informed consent. [24]

Fractional dose vaccination is a strategy that trades societal benefit for individual vaccine efficacy [25] and has proven to be effective in randomized trials in poverty diseases [26]

[27] and in epidemiologic models[28] holds a significant potential for shortening the COVID-19 pandemic when vaccine supply is limited.


Compulsory vaccination
At various times, governments and other institutions have established policies requiring vaccination to reduce the risk of disease. An 1853 law required universal vaccination against smallpox in England and Wales, with fines levied against people who did not comply. [29] These policies stirred resistance from groups, collectively called anti-vaccinationists, who objected on ethical, political, medical safety, religious, and other grounds. [30] In the United States, the Supreme Court ruled in Jacobson v. Massachusetts (1905) that states have the authority to require vaccination against smallpox during a smallpox epidemic. [31] All fifty U.S states require that children be vaccinated to attend public school,[32] although 47 states provide exemptions based on religious or philosophical beliefs. [33]

Forced vaccination (as opposed to fines or refusal of services) is rare and typically happens only as an emergency measure during an outbreak. This has been reported in parts of China. [34] Compulsory vaccinations significantly reduce infection rates for the diseases they protect against. [29]

Common objections included the argument that governments should not infringe on individuals’ freedom to make medical decisions for themselves or their children or claims that proposed vaccinations were dangerous.

[30] Many modern vaccination policies allow exemptions for people with compromised immune systems, allergies to vaccination components, or firmly held objections. [35]

In 1904, in Rio de Janeiro, Brazil, following an urban renewal program that displaced many poor, a government program of mandatory smallpox vaccination triggered the Vaccine Revolt, several days of rioting with considerable property damage and several deaths.


Compulsory vaccination is a complex policy issue, requiring authorities to balance public health with individual liberty:

Vaccination is unique among de facto mandatory requirements in the modern era, requiring individuals to accept the injection of medicine or medicinal agent into their bodies. It has provoked spirited opposition. This opposition began with the first vaccinations, has not ceased, and probably never will. From this realization arises a problematic issue: how should the mainstream medical authorities approach the anti-vaccination movement? A passive reaction could be construed as endangering the health of society. In contrast, a heavy-handed approach can threaten the values of individual liberty and freedom of expression we cherish. [30]

An ethical dilemma may emerge when healthcare providers attempt to persuade vaccine-hesitant families to receive vaccinations, as this persuasion may lead to violating their autonomy.

[9] Investigation of different types of vaccination policy finds strong evidence that standing orders and allowing healthcare workers without prescription authority (such as nurses) to administer vaccines in defined circumstances increase vaccination rates, and sufficient evidence that requiring vaccinations before attending childcare and schools also do so. [37] There is also evidence that mandatory vaccination policies for healthcare workers, for instance, for influenza shots, increase uptake. [38] Public health professionals argue that compulsory vaccination is necessary for severe circumstances, but it should be approached carefully to avoid polarizing the population and decreasing trust in the long term. [39]

Many countries (Canada, Germany, Japan, and the United States) have specific requirements for reporting vaccine-related adverse effects; others (Australia, France, and the United Kingdom) include vaccines under their general requirements for reporting injuries associated with medical treatments.

[40] Several countries have both compulsory vaccination and national programs for the compensation of injuries alleged to have been caused by a vaccination. [41]

In November 2021, during a COVID-19 outbreak, Austria banned unvaccinated individuals from leaving their homes apart from going to work, buying essential supplies, or exercising, to reduce the spread of the disease.

[42] During the fourth wave of the COVID-19 pandemic, with a low vaccination rate compared to the rest of Western Europe (79%), the Austrian government made vaccination mandatory. [43] [42]

Parents’ versus children’s rights
Medical ethicist Arthur Caplan argues that children have a right to the best available medical care, including vaccines, regardless of parental opinions toward vaccines, saying, “Arguments about medical freedom and choice are at odds with the human and constitutional rights of children. When parents don’t protect them, governments must.” [44] [45] However, government entities, such as Child Protective Services, can intervene only when the parents directly harm their child via abuse or neglect, considering a child cannot give or take away consent. Although withholding medical care meets the criteria of abuse or neglect, refusing vaccinations does not, as the child is not being harmed directly. [46]

To prevent the spread of disease by unvaccinated individuals, some schools and doctors’ surgeries have prohibited unvaccinated children from being enrolled, even where not required by law.
Doctors who refuse to treat unvaccinated children harm the child and public health and may be considered unethical when parents cannot find another provider.

Opinion on this is divided, with the largest professional association, the American Academy of Pediatrics, saying that exclusion of unvaccinated children may be an option under narrowly defined circumstances. [50]

One historical example is the 1990–91 Philadelphia measles outbreak, which led to the deaths of nine children in an anti-vaccination faith healing community. Court orders were obtained to have infected children given life-saving medical treatment, against their parent’s wishes, and for healthy children to be vaccinated without parental consent.
Individual Rights & Vaccination Policy
In schools and daycare
Vaccination requirements for access to daycare and schools increase vaccine uptake in the United States, and there is evidence that these requirements may decrease disease.
[53]: 661 However, most studies of mandatory vaccination took place in the US, and the cultural climate in the United States is quite different from other industrialized nations. [53]: 665 A study shows that many European countries have whooping cough vaccination rates as high as those in the United States despite no mandates. [54] [55] Canada has a similar vaccination to the US despite 13 states having no vaccine mandates, which may, in part, be due to vaccination programs taking place in a school in Canada. [53]: 664

Deliberate naturally acquired immunity through infection.
In the United Kingdom, children are not vaccinated against chickenpox despite the availability of a vaccine since the 1990s. This is because evidence suggests that naturally acquired immunity provides superior immunity to the immunity acquired through vaccination. [citation needed] Modelling predicted that vaccinating children would increase the number of cases among adults, and the Joint Committee on Vaccination and Immunisation was concerned that more pregnant women would become infected. [56]: 10

Planning vaccination policy
Vaccination committees
Vaccination policy is typically proposed by national[57][58] or supranational[59] advisory committees on immunization and, in many cases, is regulated by the government.

Vaccination strategy models
Predictive vaccination strategy models
[61] play an important role in predicting the effectiveness of vaccination strategies at the population level. They may, e.g., compare the sequence of age groups to be vaccinated and study the outcome in terms of caseload, deaths, length of a pandemic,[62] healthcare system load,[63] and economic impact. [64]

Evaluating vaccination policy
Vaccines as a positive externality
Promoting high levels of vaccination produces the protective effect of herd immunity and positive externalities in society.
[65] Large-scale vaccination is a public good in that the benefits obtained by an individual from large-scale vaccination are both non-rivalrous and non-excludable. Given these traits, individuals may avoid vaccination costs by “free-riding”[65] the benefits of vaccinating others. [65] [66] [67] The costs and benefits to individuals and society have been studied and critiqued in stable and changing population designs. [68] [69] [70] Other surveys have indicated that free-riding incentives exist in individual decisions [71]. A separate study that looked at parental vaccination choice found that parents were less likely to vaccinate their children if their children’s friends had already been vaccinated.

Trust in vaccination
Trust in vaccines and the health system is an essential element of public health programs that aim to deliver life-saving vaccines. Trust in vaccination and health care is an essential indicator of government work and the effectiveness of social policy. Success in overcoming diseases and vaccination depends on trust in vaccines and health care. The lack of trust in vaccines and immunization programs can lead to vaccine refusal, risking disease outbreaks, and challenging immunization goals in high- and low-income settings. Today, the medical and scientific communities face a significant challenge where vaccines are concerned, namely enhancing the trust with which the general public regards the entire endeavor. Indeed, earning the public’s trust in public health is a big challenge. Accurately studying the trust in vaccines, and understanding the factors that affect the reduction of trust, allows authorities to build an effective vaccine campaign and communication strategies to fight the disease. Trust is a crucial parameter to work with before and while undertaking any vaccine campaign. The state is responsible for providing brilliant communication and informing a population about diseases, vaccines, and the risks of both. The WHO recommends that states work long-term to build population resilience against vaccine myths and scares, to develop a strong campaign that is well prepared to respond to any event that may erode trust, and respond immediately to any event which may erode trust in health authorities. [73]

Cost-benefit: United States
The first economic analysis of routine childhood immunizations in the United States took place in 2001 and reported cost savings over the lifetime of children born that year.
[74] Other analyses of the economic costs and potential benefits to individuals and society have since been evaluated. [75] [76] In 2014, the American Academy of Pediatrics published a decision analysis that evaluated direct costs, such as program costs, vaccine costs, administrative burden, adverse vaccine-linked reactions, and transportation time lost to parents. [76] The study focused on several infectious diseases, including diphtheria, tetanus, pertussis, measles, hepatitis A and B, and varicella (chickenpox), but did not include seasonal flu vaccines. Estimated costs and benefits were adjusted to 2009 dollars and projected at three percent interest over time. [76] Of the theoretical group of 4,261,494 babies, beginning in 2009, who had followed a standard childhood immunization schedule under the Advisory Committee on Immunization Practices guidelines, “will prevent ∼42,000 early deaths and 20 million cases of the disease, with net savings of $13.5 billion in direct costs and $68.8 billion in total societal costs, respectively.” [76] In the United States and other nations,[77][78][79] there is an economic incentive and “global value” to invest in preventive vaccination programs, especially in children, as a means to prevent early infant and childhood deaths. [80] Socioeconomic disparities have been found to hinder reasonable access to vaccinations in the U.S… It has also been found that even where such status is not a factor, “racial ethnic minority adults are less likely than whites to receive preventive care including vaccination.” [81] [82]

Cost-benefit for older adults
There is an economic incentive to establish vaccination programs for older adults as the general population is aging due to increasing life expectancy and decreasing birth rates.
[83] Vaccinations can reduce the issues linked with polypharmacy and antibiotic-resistant bacteria in the older demographic with comorbidities by preventing infectious diseases and decreasing the necessity of polypharmacy and antibiotics. [84] [85] One study in Western Europe found that the estimated cost of vaccinating one person over a lifetime against 10–17 potentially debilitating pathogens would be between €443–€3,395 (€493–3,778 in 2022; $502–3,849 USD). [86] Another study found that if 75% of adults over 65 were vaccinated against seasonal influenza, 3.2–3.8 million cases and 35,000–52,000 influenza-related deaths could be avoided, and €438–558 million saved annually, solely on the European continent.
School board trustees are requesting public comment before they vote on a vaccination policy for all children in a local school district. Should individual rights (e.g., parents’ rights to decide whether to vaccinate their children) be compromised to control the spread of communicable diseases for the good of society?

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