Policy to Address Resurgence of Vaccine-Preventable Diseases

Introduction

Vaccinations are one of the innovative developments in human history. Indeed, the advent of vaccinations revolutionized the medical field in many ways, casting diseases that once devastated the population into the background of public consciousness. Unfortunately, due to the actions of misinformed parties, some of these diseases are beginning to make a comeback. Nations around the world have been shocked by the recent resurgence of vaccine-preventable diseases. To reduce the impact of this trend, one possible public policy options would be to mandate vaccinations on a federal level. While this policy would suffer some blowback from crowds who value favor liberties, the popularity of eliminating this problem, along with the clear goals of the policy, give it a good shot of getting on the agenda. 

Background

The resurgence of vaccine-preventable diseases around the world is one of the most unfortunate trends in the field of health care. Although modern vaccinations have rendered many formerly-devastating diseases benign, misinformation campaigns have caused scores of people to forego their vaccinations, allowing these ailments to re-emerge within society. According to the Centers for Disease Control and Prevention (CDC), illnesses such as the measles, mumps, and pertussis are re-emerging in increased numbers over the past several years. Specifically, between 1997 and 2010, most cases of measles in a given year was 140. However, between 2010 and 2016, there were 4 years with over 140 cases of measles, with the highest number of outbreaks (667) occurring in 2014. A similar trend can be seen with respect to mumps and pertussis, where the diseases have become more prevalent in recent years when compared to the last decade. What's more, this trend is also reflected in vaccination rates, where coverage (with respect to children who have received every major vaccination) has declined by nearly 6 percent since 2004 ("Appendix E: Data…," 2018).

As previously mentioned, this trend can largely be attributed to misinformation campaigns, which have been abetted by the internet and social media. Indeed, if one has paid any attention to the news over the past decade, she has likely heard of the Anti-Vaccine Movement at least in passing. The Anti-Vaccine Movement refers to a trend in which individuals choose to forego vaccinations for themselves and/or their children because they believe that vaccinations are fundamentally unhealthy. As one can guess, this trend has been heavily bolstered by social media, where pseudoscientists can share misleading information to the masses. What is more, the nature of social media empowers Anti-Vaxx communities to circulate this misinformation among themselves in heavily insular and self-reinforcing environments (Mavragani & Ochoa, 2018). 

Goals of Public Policy

In an attempt to solve this resurgence of vaccine-preventable diseases, public policy options need to be introduced. Additionally, these policy options need to be considered through the lens of the goals they are trying to accomplish. When formulating a policy goal, one must consider which of the following 3 outcomes she would like to achieve: Eliminating the problem completely, ameliorating the problem, or preventing it from spreading further. With respect to the issue of resurging vaccine-preventable diseases, it seems as though the first option (i.e., eliminating the problem completely) offers the most promising path forward. It must be noted that this option does not require legislators to get rid of these diseases entirely. Rather, an effective elimination of the problem would entail a return to the disease and vaccination rates of the early 2000s, as this would mean that vaccine-preventable diseases are no longer increasing from their former lows. 

The stakeholders with respect to these public policy options are widespread. Indeed, the population as a whole can be considered a stakeholder, as no individual will be immune to a vaccine-preventable disease if it mutates. On a smaller scale, the most relevant stakeholders are parents and children who are skeptical of modern vaccinations. Skeptical parents are stakeholders because public policy options that address declining vaccination rates will invariably affect their behavior. Meanwhile, their children are stakeholders because public policy options that increase vaccination rates will improve the likelihood that they do not contract a preventable a disease, thus empowering them to live healthier lives. Additional smaller-scale stakeholders include hospitals, schools, and local governments, who may be responsible for enacting the policies that are designed to tackle the issue. 

With these stakeholders in mind, the group that will need to be considered the most closely when formulating a policy option is likely the cohort of skeptical parents. This group needs to be considered the most directly because the policies that are introduced will almost certainly affect their behavior the most. As such, policymakers need to anticipate potential blowback on the part of this group and promote incentives that will outweigh their concerns. The biggest gripe that skeptical parents are likely to have with public policy options is that they reduce their freedom to decide what is best for their children. Many people from developed countries believe that the government should not infringe on their personal religious and philosophical beliefs, and some will claim that vaccination policies come into conflict with this basic right. As such, policymakers need to anticipate this concern and propose solutions that outweigh its argumentative strength. 

Policy Tools

Before a public policy option can be suggested, policymakers need to first identify the type of policy that will be introduced. Political scientists use typologies to categorize policy options to predict the types of conflict that may prevent certain policies from being enacted. One method of typology holds that there are three different categories of public policy options: Distributive, redistributive, and regulatory (Birkland, 2016, p. 210). When considering a policy that is designed to eliminate the resurgence of vaccine-preventable diseases, it seems as though this option would fall in the regulatory type of policy proposals. Regulatory policies are those that are designed to keep order and restrain harmful activities (p. 211). Homeland Security is also addressing this issue. Because the decision not to vaccinate one's self or her children can be classified as a harmful activity, potential solutions will need to be of the regulatory nature. 

With this idea in mind, one can begin thinking about specific policy options to tackle the problem of resurging vaccine-preventable diseases. One promising public policy option would be to mandate vaccinations for some of these resurgent diseases on a federal level. Although all 50 states currently mandate vaccinations, the standards from state to state are inconsistent. For example, some states allow people to forego vaccinations on religious/ philosophical grounds, while other states only allow people to abstain for medical reasons (Ciolli, 2008). To resolve these disparities, the federal government could introduce legislation that mandates vaccinations for every citizen in the United States if s/he wants to enjoy public services. Such federal regulations would provide consistent guidelines with which people would become qualified for vaccinations exemptions. Hopefully, these rules would remove the philosophical/ religious exemptions and make medical exemptions the only reasonable excuse for foregoing one's vaccinations. 

This system of mandating vaccinations on a federal level would primarily rely on coercion as opposed to persuasion. Specifically, individuals who do not want vaccinations for themselves or their children would be forced to obtain them before they can enroll in public schools or receive state-sponsored benefits such as health care or social security. There would no attempt to persuade these individuals on the benefits of vaccinating themselves and their children. Rather, they would be required to vaccinate if they want any chance at participating in the modern school system or workplace. While this 'coercive' approach may increase the blowback by skeptical parents, the benefits of reducing the spread of preventable diseases can be used to justify any counter-arguments. 

Implementation

If this proposal is passed, the responsibilities of implementation will be shared by state, local, and national governments – in addition to other institutions such as local schools. The first step of bringing this policy into reality could involve the introduction of a bill that mandates vaccinations on a federal level. Once this law has passed both through both chambers of Congress and been signed by the President, the next step will likely be turning over responsibilities to the Department of Health and Human Services. The Department of Health and Human Services is a component of the federal government that is responsible for monitoring the health care needs of U.S. citizens. The responsibilities of carrying out this law would likely fall with either the Assistant Secretary for Planning and Evaluation's Office, the Office of Inspector General, or the CDC, each of which are subsidiaries of the Department of Health and Human Services ("HHS Agency and…," 2019). 

Specifically, these branches would be tasked with collecting and evaluating vaccination data from local and state governments, ensuring that local parties are adhering to the new legislation. Consequently, they will also need to facilitate communication channels between the federal office, regional offices, and local governments so that they can collect this data. On the ground level, the law would be enforced primarily through local institutions such as public schools, hospitals, and welfare offices. Specifically, these institutions would be responsible for administering vaccinations, keeping records, and prohibiting non-vaccinated parties from enrolling in school and other public services. These local parties would also need to turn their records over to local and state governments, who will submit the information to the Department of Health and Human Services, where the policy's effectiveness can be evaluated on a nationwide level. 

Assessment

This policy proposal is likely to get on the agenda for a couple of reasons. First, there is the fact that the population at large are stakeholders in this problem. Since everyone has an interest in preventing the rise of vaccine-preventable diseases, there should be broad popular support for policy options that combat the anti-vaxx movement. Second, the policy proposal is based on a clear goal. One of the most common causes of policy failure occurs when policymakers fail to provide a coherent goal around which the policy is oriented. Specifically, the failure to arrange policies around a specific goal causes the people in charge of putting them in place to pursue many different goals at once (Birkland, 2016, p. 266). Luckily, this policy proposal is designed around a very clear goal – i.e., eliminating the resurgence of vaccine-preventable diseases. As such, the people responsible for carrying out this policy will have a clear objective, increasing the likelihood that it can be successfully implemented. 

On the other hand, there are also reasons to believe that getting this policy on the agenda could prove to be difficult. Perhaps the most significant concern stems from the fact that this policy would remove religious and philosophical exemptions for vaccinations. This component of the law may come with serious objections from certain individuals who believe that the federal government should not impose on individual rights. Indeed, this idea serves as one of the leading foundations for the Republican party's platform. As such, there could be significant ideological barriers that prevent Republicans from providing support for the bill, reducing the likelihood that it ever gets to the floor for a vote. Overcoming these barriers will require supporters of the Bill to convince skeptics about the dangers of resurging vaccine-preventable diseases such as chicken-pox. Namely, they need to prove that the hazards of allowing eradicated diseases back into society outweigh the limitations to personal freedoms that this law would impose. 

Conclusion

To combat the resurgence of vaccine-preventable diseases, it seems as though mandating vaccinations on a federal level would offer the most effective public policy option. While this legislation may not be popular among groups who value individual liberties over public welfare, the specific goals and popularity of eradicating these diseases make it a good candidate for getting on the agenda. Of course, this suggestion does not address the issue of misinformation about vaccinations being spread over social media. Instead, this policy attempts to solve the problem by regulating the behavior of misinformed parties. While it would be ideal to propose a policy that does not need to rely on coercion to achieve its aims, unfortunately, it seems unlikely that an alternative policy would alter the perspectives of the anti-vaccination community. Rather, a more prudent approach would be to curve the harmful activities of this small subsection of the population in favor of the general public's interest.

References

Appendix E: Data and statistics. (2018). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/vaccines/pubs/pinkbook/appendix/appdx-e.html

Birkland, T.A. (2016). Policies and policy types. In An Introduction to the Policy Process. New York, NY: Routledge. 

Ciolli, A. (2008). Mandatory school vaccinations. Yale Journal of Biology and Medicine, 81(3). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553651/

HHS agency and offices. (2019). HHS.gov. Retrieved from https://www.hhs.gov/about/agencies/hhs-agencies-and-offices/index.html

Mavragani, A., & Ochoa, G. (2018). The internet and the anti-vaccine movement: Tracking the 2017 EU measles outbreak. Big Data and Cognitive Computing, 2(1). Retrieved from https://www.mdpi.com/2504-2289/2/1/2