Humans have used vaccines for hundreds of years to prevent diseases even before the advent technology and civilization. This paper focuses on the historical background of vaccines as a method for preventing diseases. It also highlights some of the laws governing the provision of vaccines. Vaccines work in tandem with natural immune system. Therefore, understanding how the immune system works will be highlighted in order to further understand the functional relationship between vaccines and the natural immune system. Such interrelationship can only be effectively highlighted with proper knowledge of how the vaccines work. The mechanisms through which vaccines help in preventing diseases will be discussed. Since different individuals have different guidelines for vaccine administration and regime, this paper will discuss the various groups that require vaccines and why they need to be vaccinated. Specifically, it will focus on why it is important to vaccinate children entering school. Before vaccination, there are important factors to be considered. These factors determine who needs to be vaccinated or excluded from the process. Such individuals and factors will also be highlighted. Some of these factors include manifestation of side effects. Knowledge on these side effects of vaccines is vital in vaccine administration, manufacture and clinical trials. It also helps in developing safety measures and approval standards and processes to ensure the safety of those being immunized. This paper will highlight such safety and approval process and standards for vaccines. The paper will also carry out a comparative analysis of mortalities for specific demographics with and without administration of vaccines. Finally, the will discuss some of viewpoints held by proponents and opponents of vaccines including religious beliefs.
History of Vaccines
The recorded cases of live or inoculated microbes being used to prevent diseases can be traced to the 10th century in China where villagers used smallpox virus to prevent smallpox infection. While not strictly defined as vaccination, the Chinese inoculated themselves using the smallpox virus; their bodies later developed immunity against the disease. The “vaccines” were administered in powder form through the nose. This practice was also common in English farms where Edward Jenner observed that many of the farmers suffering from the mild-effect cowpox were rarely affected by the devastating smallpox. Jenner later experimented on some of the children by inoculating them with cowpox virus. The inoculated individuals were not infected by smallpox. This marked the first generation of vaccines which were later improved by Louis Pasteur who expanded the field of vaccines in 1880s and developed vaccines for cholera which plagued many communities at the time. He also developed a vaccine for anthrax.
With scientific development and spread of knowledge scientists especially medical practitioners and biologists increased the knowledge pool on various diseases and pathogens. The identification of pathophysiology of diseases such as rubella, cholera and measles, new ideas for developing vaccines emerged. In the 1800s, microbes such as Vibrio cholerae, Mycobacterium tuberculosis, Influenza bacillus and Pneumococcus among others were discovered across the globe by various scientists. This new movement to understand these diseases and microbes was also driven by the outbreak of pandemics across the globe which led to the led to the death of thousands of people.
The 1900s opened a new chapter in the search for vaccines for various diseases. In the early 1900s, mosquitoes were identified as the causative agent for Yellow Fever which had killed thousands of people in the United States and Panama. Bacille Calmette-Guerin (BCG) came up with the yellow fever virus in 1924 while a live attenuated version of the vaccine was introduced in 1935 by Max Theiler. A decade later, a vaccine for influenza was also introduced. Between 1955 and 2014, technological and scientific developments propelled the development of new vaccines and discovery of new diseases and pathogens. Within this period, live attenuated vaccines for mumps, polio, rubella, measles, Hepatitis B, meningitis, leishmaniasis and Human Papillomavirus (HPV) among others were developed and licensed. This allowed the World Health Organization (WHO) to declare such diseases as smallpox, polio and cholera eradicated in various regions including India, Europe and the Americas.
Laws Governing Vaccines
Vaccination is a contentious issue in the United States with many opposed to the practice based on philosophical or religious beliefs. Therefore, most the laws governing vaccines and vaccination in the country exist at state level. Some states give vaccination exemption based on medical, religious or philosophical grounds. For example, in states such as Arizona, Utah, Oklahoma, North Dakota, Idaho, Oregon and Minnesota among others, individuals can be exempted from vaccination due to strongly held religious and philosophical beliefs as well as on medical grounds. However, Wyoming, New Mexico, Kansas and South and North Carolina among others only exempt individuals on religious and medical grounds.
The first recorded laws governing vaccination in the U.S was passed in Massachusetts in 1809. This law primarily legislated vaccination against smallpox for all residents of the state. Currently, the state and local level laws governing vaccines are passed based on the guidelines provided by the Advisory Committee on Immunization Practices. The committee is tasked with giving research-based recommendations on vaccination practices and guidelines for all levels of government. These guidelines act as template for developing federal and state level vaccination policies.
Currently, the Center for Disease Control and Prevention (CDC) is mandated with running the National Immunization Program. There are no regulations making it mandatory for adults to be vaccinated. However, the CDC usually recommends that adults to be vaccinated against various vaccine-preventable diseases (VPDs). Children, teenagers and foreign nationals seeking residency in the country on the other hand must be vaccinated against these diseases. Many learning institutions require applicants to undergo vaccination for various VDPs. School-age children must be vaccinated before joining school event thought the diseases vary from one state to another. However, they are commonly given shots for diseases such as hepatitis B, meningitis, diphtheria, polio, measles, tetanus and rubella. Such vaccinations usually require parental or guardian consent. These activities are guided by the Public Health Law Program. To reduce the outbreak and spread of VPDs, most healthcare facilities and organizations currently requires employees to get vaccinated.
The Science of the Natural/Immune System
Normally, the body has a network of cells connected to tissues and organs whose primary function is to prevent pathogens and foreign particles from invading the body. The primary cells involved in the immune system are the leucocytes or white blood cells. This network operates through an intricate communication system which initiates an immune response. After production in various organs including the bone marrow and spleen, the leucocytes are stored in lymph tissues but circulate throughout the body through the blood and lymph vessels. Leucocytes are divided into two. The phagocytes seek out the invading foreign bodies and destroy them while lymphocytes copy a copy or memory of the pathogen which helps with future invasion. Phagocytes are further divided into neutrophils which primarily target and destroy bacteria. B and T lymphocytes work synergistically as the former identifies foreign bodies and lock them down before they are destroyed by the latter.
The primary defense system for the body is the skin which prevents entry of pathogens. However, when a pathogen or foreign body invades the body, the immune system identifies it as an antigen. It is recognized the immune cells which trigger the production of antibodies by the B lymphocytes which lock down the antigens and ready for destruction by other immune cells. Immune cells such as T cells or killer cells and phagocytes may destroy body through lysis and phagocytosis. Sometimes, the toxins in the antigens are neutralized. Body cells which have been infected by the antigens are also destroyed. To offer future immunity, a memory of the antigen is kept in case of future attacks.
How Vaccines Work
Vaccines, whether dead, live attenuated or inactivated organisms or in some cases purified materials extracted from these organisms primarily target the immune system. Inactivated vaccines are produced by destroying the virulent chemicals of pathogens while live attenuated vaccines are comprised of pathogens whose virulent chemicals have been disabled but still capable of eliciting an immune response. In some cases, they are comprised of pathogens wghich are biologically related but whose virulence are comparatively lower than the disease causing microorganism. Attenuation is achieved through tissue culturing. Other vaccines such as those for diphtheria are made of inactivated toxic compounds extracted from the disease causing microorganisms. Known as toxoids, such vaccines do not use organisms but rather the toxins that they inject into the cells during infection. In some, vaccines can be developed by introducing only a portion of the pathogens’ proteins into the body.
When introduced into the body, they are recognized as foreign bodies by the immune system. This is achieved by the T cells which identify the surface proteins of the vaccine. This triggers an immune response where antibodies and immune cells are produced to attack, destroy and/or neutralize the foreign body: the vaccine. However, the keeps a memory of the antigens and produces antibodies against the inactivated or attenuated virulent compounds identified in the vaccine. Future inversion by the virulent form of the microorganisms will then be responded to by the already existing antibodies within a shorter timeframe.
Groups to be Vaccinated
Vaccination is carried based on various factors including age, strength/vulnerability of immune system and probability or disease outbreak or exposure among others. The following are groups to be vaccinated:
- Children: They are vaccinated against a wide array of diseases from birth. This is because their immune system is underdeveloped as such important primary immune response, the skin, is still too delicate to effectively prevent entry of pathogens.
- Pre-teens, Teens and adults: They are vaccinated because they are prone to exposure to pathogens as a result of activities they engage in including work, schooling, visiting overcrowded areas and sexual activities among others.
- Employees in specialized work environments such as hospitals, farms, industries and mines are vaccinated due to their susceptibility to exposure to various disease causing microorganisms some of which may be communicable.
- Travelers are usually vaccinated before and after travelling to areas which are prone to diseases such as malaria, measles and cholera prone areas. Destinations may also have humid conditions, high temperatures and poor accommodation and healthcare services. These are conditions which increase chances of falling sick. Vaccination will ensure that these individuals do not export or import diseases to other areas.
- Individuals suffering from certain diseases which affect the immune system should be vaccinated as they are vulnerable to infection by other diseases.
- Refugees and immigrants are usually vaccinated against diseases such as swine flu, hepatitis B and smallpox among others because of the possibility of having been infected. Vaccination will ensure that they do not import diseases to the destination country.
- Pregnant women are given vaccine jabs before, during and after pregnancy for various diseases such as rubella, whooping cough and measles. This protects the mother and child as well as helping in passing the immunity to the unborn baby.
Importance of Vaccination for Children Entering School
In most states and learning institutions it is mandatory to vaccinate children before admission. It is an admission requirement in most schools. This mandatory vaccination is very critical in reducing cases of communicable diseases such as diphtheria, rotavirus and hepatitis B among others. This is because school-age children come from different backgrounds and are exposed to different pathogens. In addition, learning and play times are primarily contact-based. This significantly increases chances of unvaccinated sick children infecting others including their teachers. Moreover, schools especially playgrounds are usually crowded. Children are usually hurdled around play objects which increases the frequency and likelihood of their coming into contact with others or disease-causing pathogens.
Individuals not to be Vaccinated
The National Vaccine Center notes that there are four primary grounds for exempting individuals from vaccination. First, individuals who are allergic to the vaccines may be exempted from vaccination. This also includes individuals suffering from specific diseases which may be exacerbated by administration of vaccines. Such exemption must however be written by a certified medical practitioner to ascertain that administration of such medication will be detrimental to an individual’s health. This exemption is provided in all the states in the country. Second, individuals with proof of immunity, acquired or natural, as a result of recovery from that particular illness should not be vaccinated or re-vaccinated. This is because these individuals already have antibodies against such infections. Individuals with strong religious beliefs which object to vaccination should not be vaccinated as this will violate their constitutional rights. However, such exemptions are subjective to state laws. Lastly, individuals with strong philosophical or conscientiously beliefs against vaccines and vaccination are exempted in some states in law with their constitutional rights.
Side Effects of Vaccines
Vaccines are relatively safe but may have mild or moderate, nonlife threatening side effects. Some of these mild side effects include fever, muscle pain, stuffy nose, diarrhea, swelling and reddening of the injected area, head ache and fatigue. Others may include allergic reactions. However, these side effects vary from one individual to another as well as different vaccines. Moreover, these side effects are primarily manifested in children. Some of the adverse side effects of vaccines include blood-stained stool or urine, pneumonia and digestive track inflammation. This is usually common for adenovirus vaccines. There are also rare causes of adverse allergic reactions to anthrax vaccines while cases of prolonged coma and permanent brain damage have also been recorded for tetanus and diphtheria even those they are extremely rare. These side effects and deafness have also been recorded, even though rare, for mumps, rubella, varicella (chickenpox) and measles vaccines. Rotavirus vaccines have also been associated with bowel blockage in infants. The mild and moderate side effects can be minimized with proper practice including lying still for a few minutes immediately after the injection. Moreover, the manifestation of these side effects may be exacerbated when such vaccines are administered as a combination such as MMR(V) vaccine for mumps, measles, rubella in addition to varicella (chickenpox) or Tdap vaccine for tetanus, diphtheria and pertussis.
Safety, Effectiveness and Approval of Vaccines
The safety of vaccines, like all products used in the United States, are vetted and approved by the United States Food and Drug Administration (FDA). The FDA work in cooperation with the CDC and other federal and state level agencies to verify manufactured vaccines. They also coordinated with other international bodies such as the WHO and research facilities and institutions. This ensures that the vaccines allowed into the healthcare system, whether locally or internationally, meet both local and international standards. Such monitoring includes verification of the process of manufacturing and clinical trials. This ensures that proper procedures, professional and ethical standards were followed during the manufacture and clinical trials for the vaccines. When properly followed, these verification procedures ensure that vaccines are effective.
Comparative Analysis of Mortality Rates with and Without Vaccines
One of revolutionary vaccines that significantly reduced mortality rates was the measles vaccine introduced by Maurice Hilleman. Patricia Sullivan notes that the mortality rates for measles reduced by up to one million annually as a result of the vaccine. In many countries across the globe, diseases such as polio, smallpox and anthrax have been declared eradicated in some countries by the WHO as a result of vaccination thereby reducing the mortality rates from such diseases. It is estimated that over 500 individuals died as a result of measles in the U.S in 1958. However, the introduction of measles vaccine saw the death rates drop to less than 150. Currently, most of new cases of measles in the country are as a result of importation from other countries. The CDC reports that the 1988 introduction of vaccine has seen a 99% drop in infections such as meningitis and others caused by Haemophilus influenzae. Vaccines are estimated to save over 33,000 lives per year while over 14 millions new cases of infections have been prevented. Up to 64% cases of measles outbreak in 16 selected states by 2013 were children who had not been vaccinated as a result of exemption upon parental objection. A study conducted by Neil Miller and Gary Goldman (2011) established that infant mortality rates (IMRs) are significantly low in countries with proper sanitation, healthcare services, food and water.
Proponents and Opponents of Vaccinations
For many decades, vaccination has been marred in controversies with many religious groups opposing its administrations. Others have also questioned its rationality and validity of claim that vaccines reduce infection rate. One of the strong proponents of vaccination is the CDC which is also tasked with the administration and research into vaccines, diseases, pathogens and drugs. Other proponents are primarily medical practitioners including doctors while stakeholders in the field including pharmaceutical companies which manufacture these vaccines also support vaccination. Religion has played a significant role in the rejection of vaccines as many religious groups and individuals have held that vaccination goes against their religious beliefs. Others have held that mandatory vaccination denies their fundamental right to choose freely and conscientiously. However, others have used the Andrew Wakefield theory to argue that some vaccines are associated with autism in children. In Nigeria, many people have rejected vaccines on the grounds that they can lead to infertility.
Vaccines are relatively safe and offer significant immunity against various diseases. They play an important role disease prevention and eradication. With proper safety standards and practices, their side effects can be minimized and their efficacy increased. While there are no federal level laws governing administration of vaccines, various states have passed laws that govern vaccination especially among school-age children and other vulnerable and high-risk individuals. While these laws offer exemption on medical grounds, many states have excluded religious and philosophical exemption list.
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 Stern, A. M. and Markel, H. (2005). The history of vaccines and immunization: Familiar patterns, new challenges. Health Aff., 24(3): 611-621.
 NVIC. (2016). “State Law & Vaccine Requirements.” National Vaccine Information Center.
 CDC. (2016c). “Vaccination Laws.” Center for Diseases Control and Prevention.
 Alberts, B. et al. (2002). Molecular Biology of the Cell. New York and London: Garland Science.
 National Institute of Allergy and Infectious Diseases. “Vaccine Types”.
 WHO. (2016). “Travel and health.” World Health Organization
 CDC. (2016b). “Maternal Vaccines: Part of a Healthy Pregnancy.”
 NIVC. (2016b). “Frequently Asked Questions about Vaccine Exemption Information.” National Vaccine Information Center.
 CDC. (2016a). “Possible Side-effects from Vaccines.”
 Sullivan, P. (2005). “Maurice R. Hilleman dies; created vaccines”. Wash. Post.
 Sutter, R. W, and Maher, C. (2006). “Mass vaccination campaigns for polio eradication: an essential strategy for success”. Curr Top Microbiol Immunol, 304: 196
 Orenstein, W. A., Papania, M. J. and Wharton, M. E. (2004). “Measles elimination in the United States”. J Infect Dis. 189 (Suppl 1): S1–3.
 CDC. (2002). “Progress toward elimination of Haemophilus influenzae type b invasive disease among infants and children—United States, 1998–2000”. MMWR Morb Mortal Wkly Rep. 51 (11): pp. 235, 236.
 Park, A. (2008). “How safe are vaccines?” Time
 Miller, N. Z and Goldman, G. S. (2011). Infant mortality rates regressed against number of vaccine doses routinely given: Is there a biochemical or synergistic toxicity? Hum Exp Toxicol. 30(9): n.pag
 LeBlanc, S. (2007). “Parents use religion to avoid vaccines”. USA Today
 Bonhoeffer, J. and Heininger, U. (2007). “Adverse events following immunization: Perception and evidence”. Current Opinion in Infectious Diseases, 20 (3): 237–46.
 Goldacre, Ben Bad Science. London: Fourth Estate, 2009. pp. 292–294.