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Pathogens Damage the Populations

Health and Economy
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Policy briefs

Justice Yilek
Mercy College of Health Sciences
Policy Brief
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Table of Contents
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Identify your audience………………………………………………………………..………3

Lesson……………………………………………………………..…………..……..3

Background……………………………………………………………..…..………..3

Problem Statement………………………………………………………….…..…3-4

Investigating in programs, policies, laws, and ethical issues for expanded capacity of
vaccinations for newborns and young children……………………………….…….….….4-6

State public health code and regulations…………………………………………….…….4-5

Economic and health care cost…………………………………………………….………5-6

Political development…………………………………………………………….………….6

Considerations for limitations….………………………………………………….………6-7

Recommendations……………………………………………………………….…….…..7-8

Process………………………………………………………………………………7

Government’s Responsibility to Society……………………………….…………7-8

Overall Solution………………………………………………………..……………8

Summary……………………………………………………………………….…………8-9

References…………………………………………………………………..………….…10
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Identify Audience and the Problem

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Audience

While focusing on first-time parents, but particularly first-time mothers in their third trimester,
there also needs to be a focus on the Iowa House and Senate. There are four individuals who this
will be directed toward, including the Democratic Senator in district 16, Nate Bouton;
Democratic Senate in district 17, Tony Bisignano; Democratic House Representative in district
32; and Democratic House in district 34, Bruce Hunter.

Lesson

Every child receives the right to life-saving immunizations and there is equitable progress toward
achieving the universal right to immunizations. Vaccinations cannot be restricted by the parents
financial situation or insurance policies. This right needs to be guaranteed universally without
discrimination.

Background

Vaccines have significantly contributed to worldwide reductions in morbidity and mortality by

reducing the incidence of serious infectious diseases. Today, people all over the world experience
the benefits of immunizations, beginning in infancy. Children may receive as many as 24
injections by 2 years of age and up to 5 injections in a single visit. Immunization schedules vary
around the world, however, with the variability being due in part to the different patterns of
disease that exist globally (Lopalco et al., 2009; WHO, 2012). Additionally, levels of antigens
and immunization timing and number differ. Some countries also have differing approaches to
postmarketing surveillance systems. Although the number of vaccinations recommended is
greater than ever before, the vaccines used in the current immunization schedule actually have
fewer antigens (inactivated or dead viruses and bacteria, altered bacterial toxins, or altered
bacterial toxins that cause disease and infection) because of developments in vaccine technology
(Offit el al., 2002). As the number of recommended vaccines has increased in recent years, some
parents and advocacy groups have expressed the concern that the immunization schedule is too
crowded and complex because of the increasing number of vaccines administered during the first
2 years of a child's life (Offit el al., 2002).

Problem Statement
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Vaccines are the most effective and cost-effective health intervention to date. Vaccines do not
just prevent serious health condition and death cased by preventable disease, they also prevent
long-term disabilities and impairments that may result from infectious diseases. With the lack of
knowledge, resources, material, and other personal beliefs— vaccinations are beginning to
decline more and more every day. This is a growing concern for many communities and pubic
health officials. Every $1 spent on immunizations saves $16 in avoided cost, however vaccines
are not cheap due to new vaccines and inflation.

Investigating in programs, policies, laws, and ethical issues for expanded

capacity of vaccinations for newborns and young children

State public health code and regulations

In the Title IV Public Health, Subtitle 2, Chapter 139A of Iowa Codes 139.A.8 Immunizations of
Children states that, “a parent or legal guardian shall assure that the person's minor children
residing in the state are adequately immunized against diphtheria, pertussis, tetanus,
poliomyelitis, rubeola, rubella, and varicella, according to recommendations provided by the
department subject to the provisions of subsections 3 and 4” (National Vaccine Information
Center, 2018). Children cannot be enrolled in any Iowa licensed childcare center, elementary, or
secondary schooling without evidence of adequate immunizations against these diseases
(National Vaccine Information Center, 2018).

An individual may be enrolled into an elementary or secondary school or licensed child care
center if they have begun the required immunizations and continues them. Evidence required
prior to enrollment in kindergarten or in a grade must be hepatitis type B immunization.

“Immunization is not required for a person's enrollment in any elementary or secondary school
or licensed child care center if either of the following applies:

(1) The applicant, or if the applicant is a minor, the applicant's parent or legal guardian,
submits to the admitting official a statement signed by a physician, advanced registered
nurse practitioner, or physician assistant who is licensed by the board of medicine, board
of nursing, or board of physician assistants that the immunizations required would be
injurious to the health and well-being of the applicant or any member of the applicant's
family.
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(2) The applicant, or if the applicant is a minor, the applicant's parent or legal guardian,
submits an affidavit signed by the applicant, or if the applicant is a minor, the applicant's
parent or legal guardian, stating that the immunization conflicts with the tenets and
practices of a recognized religious denomination of which the applicant is an adherent or
member” (National Vaccine Information Center, 2018).

In order to qualify for a religious exemption, the applicants legal guardian, must have notarized
certificate of immunization exemption from the parent’s/guardian’s signature attesting that it
conflicts with a religious belief and not the religious belief is “not based on philosophical,
scientific, moral, personal, or medical opposition to immunizations” (National Vaccine
Information Center, 2018). However, medical expeditions are also allowed.

Economic and health care cost

Studies show the cost-effectiveness of universal vaccinations of children. Many people question
how much would it cost for every child to be vaccinated for “everything” meaning 15 different
types of vaccines. The answer has shown to be roughly $250 billion (Lesaar, 2016) from birth to
age 19. Many ask if this is a realistic number, you might even be wondering that yourself,
however it is. Apple has pledged to return $250 billion in dividends to its shareholders,
Americans have contributed over $250 billion to 529 college saving plans, and in 2015 alone,
Americans gave more than $370 billion to charity (Lesaar, 2016).

Gavi lists projected 2017 per dose prices for 15 vaccines. The lowest provider cost for each
vaccine, the total price is just $18.58 and the contrast the highest provider price is $54.93 (Gavi,
2017). However, any realistic estimate for universal vaccinations though would also have to take
into account such costs as transportation, maintaining a cold chain, training personnel to
administer the vaccines, record-keeping, and more. For the diagram being used, it will round the
dose prices to $100 and if it were closer to $200 then double all the figures below.
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The study being reviewed for this portion is over hepatitis A. Socioeconomic improvements
increase widely when children are being vaccinated, improving the herd immunity. These
programs can be costly, but allow for a benefit to the economy and health of individuals.
Evaluated programs used a dynamic model that incorporated the changing epidemiology of
infection and the impact of vaccine-induced herd immunity. The results showed that
economically, “the program saved $23,989,963 annually at 95 percent coverage, allowing for
$3,429 per life year gained” (Lopez, Debbag, Coudeville, Baron-Papillon, & Armoni, 2007).

Political development

The World Health Organization (WHO) supports universal immunizations for certain disease to
control the population. These programs would usually target infants int he first year of life, so
that immunity is completed as early as possible before the risk of infection. WHO states that
other groups would consist of high risk groups, for example the elderly. WHO even states that
the target group may not be the group, but who the vaccine is suppose to protect. An example of
this would be rubella for all children and females of child bearing age in order to protect the
fetus. More information on this is located at http://www.who.int/mental_health/media/en/28.pdf?
ua=1.

Considerations for limitations

1. The mix of vaccines for any one country will surely vary from that for other countries.
For instance, the CDC lists 17 (not 15) vaccines recommended for American
children: cholera, Japanese encephalitis, and yellow fever are not recommended for
Americans, but influenza (IIV, LAIV), mumps, meningococcal, varicella (VAR), and
hepatitis A are. [Center for Disease Control and Prevention, 2018]
2. These vaccines could not be administered to a child all at one time, meaning additional
costs for travel, storage, etc.
3. Population density could be a major, inverse, cost factor.
4. Infrastructure (roads, communications, and electricity) varies greatly from country to
county.
5. Governments will surely contribute, either in funds or in-kind, to support such a universal
campaign, contributing to an overall cost reduction.
6. Per dosage vaccine costs will most likely fall if total dosage production reaches into the
hundreds of billions.
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7. As a simplifying assumption, we've looked at only one year (2017) but a campaign of this
magnitude will take many years, during which time there will be many millions more
children born, all of whom will need to be vaccinated as well.
8. Significant numbers of infants and children are already vaccinated, reducing the number
who would need to be vaccinated.
9. A campaign of this size is likely to spur innovations, e.g., eliminating the need for booster
shots, eliminating the need for a cold chain, developing a new pentavalent-type vaccine
combining several vaccines into a single dose.
10. It would be naive to assume that parents worldwide would automatically know about,
understand, and support vaccination. This campaign will need to be accompanied by a
large and sustained program of education. Which could also be a significant bonus;
having the opportunity to present vaccine education to parents across the globe could be
leveraged to educate on other health matters as well.

Recommendations

Process

In order to begin the process, we need to consider the limitations. Iowa can be the first to vote
towards universal vaccinations for the country— United States of America. The Center for
Disease Control and Prevention will begin with the top vaccinations in which parents are more
likely to give their children. This trial would allow for data to be collected determining whether
or not universal vaccinations are effective. If these vaccinations increase by 50 percent, the last
half of the vaccinations could be given universally. Although not every child can be given the
vaccination at once, it would be started by an effective date that will be decided in the future.
However, if children who are older than the date want to be vaccinated too, those statistics need
to be ran for a comparison.

Transportation becomes another barrier. Universal vaccinations need to be provided at all

nonprofit and for profit hospitals and clinics for equal access. Des Moines and other larger cities
in the state provide a well balance area of clinics and hospitals, however rural and lower
socioeconomic areas are the ones who suffer. Finding cheaper transportation or closer clinic that
offers these services will be needed especially in these areas, along with promotion and
education.

Government’s Responsibility to Society

Make use of international agreements, national laws and justice systems to challenge failure to
ensure immunizations. Advocate for the creation of legislation that guarantees vaccinations.
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Every child receives life-saving vaccines and creating the programs towards achieving the
universal right to immunizations. Government assistance program and services that allow these
vaccinations to be given, without hesitation of one’s financial situation or insurance policies.
This breaks down the barriers of unequal access to healthcare. According to the Ethical Practice
of Public Health, “Humans have a right to the resources necessary for health. The Public Health
Code of Ethics affirms Article 25 of the Universal Declaration of Human Rights, which states in
part, “Everyone has the right to a standard of living adequate for the health and well-being of
himself and his family”…” (Public Health Leadership Society, 2002).

Overall Solution

Vaccination are delivered through country health systems, catalyses improvements in primary
health care services and strengthen heath systems, including community health systems. Well
maintain buildings, appropriate monitoring and information is crucial for health system
components and are often overlooked by donors. This does not only empower and improve the
health of the community, but it can strengthen the economic system as well. Funding will need to
be provided for this through the local, state, federal government or grants. This would be
considered to be a non-profit organization willing to work with families in need of help.
Throughout this agreements, laws, and policies will need to be formed.

Summary

Parents who are not given enough information about vaccinations feel lost. By promoting
universal vaccinations, parents might begin to ask more questions and be interested in
vaccinations if they are covered under the program. Because there are many benefits to children
being vaccinated from a young age, remembering that the health of the future will outweigh the
cost. Future health of these young individuals will provide an improved, growing economy.
With vaccinations, parents need healthcare providers to be pure and understanding. Be pure.
P- Pursue a better life for your child

U- Understand the importance of immunizations
R- Responsibility of your child’s health

E- Educate yourself and others

PURE is described by giving every parent equal access to these vaccinations and providing
advocacy and education on each main one through national laws and polices. This can be done
by advocating for the removal of financial obstacles, such as low-income, lack of insurance,
transportation cost to health centers, and informal payments for health services. By mobilizing
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and empowering communities to demand and claim their right to vaccinations and health through
advocating universal approaches that guarantee high-quality vaccines for the entire population.
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References

Armoni, J., Baron-Papillon, F., Coudeville, L., Debbag, R., & Lopez, E. (2007, February). The
cost-effectiveness of universal vaccination of children against hepatitis A din Argentina: results
of dynamic health-economic analysis. US National Library of Medicine, National Institutes of
Health. DOI: 10.1007/s00535-006-1984-x

Bohannon, K. & McKee, C. (2016, March/April). Exploring the reason behind parental refusal of
vaccines. The Journal of Pediatric Pharmacology and Therapeutics: JPPT, 21(2), 104-1-9. DOI:
10.5863/1551-6776-21.2.104

CDC (Center for Disease Control and Prevention). (2018, November 1). Vaccines for children
program (VFC). Retrieved from https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-
management/price-list/

Gavi. (2017). Supply and procurement. The Vaccine Alliance: GAVI. Retrieved from http://
www.gavi.org/library/gavi-documents/supply-procurement/.

Lopalco, P. L., de Carvalho, H. G., Kreidl ,P, Leitmeyer, K, Giesecke, J. (2009). Childhood
vaccination schedules in Europe vary widely. Is this a problem. Bundesgesundheitsblatt
Gesundheitsforschung Gesundheitsschutz 52(11):1095–1098.

National Vaccine Information Center. (2018, July 19). Iowa State Vaccine Requirements.
Retrieved from https://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/iowa.aspx

Offit P. A., Quarles, J., Gerber, M. A., Hackett, C. J., Marcuse E. K., Kollman T. R., Gellin B. G.,
& Landry S. (2002). Addressing parents' concerns: Do multiple vaccines overwhelm or weaken
the infant's immune system. Pediatrics. 109(1):124–129

Public Health Leadership Society. (2002). Principle of the Ethnical Practice of Public Health.
American Public Health Association. Retrieved from https://www.apha.org/-/media/files/pdf/
membergroups/ethics/ethics_brochure.ashx

WHO (World Health Organization). (2012, September) Immunization, vaccines and biologicals.
Geneva, Switzerland: World Health Organization. Retrieved from http://www .who.int/
immunization /policy/immunization_tables /en/index.html.

WHO (World Health Organization) (n.d). Behavioral factors in immunizations. World Health
Organization. Retrieved from http://www.who.int/mental_health/media/en/28.pdf?ua=1