“Immunization is one of the most cost-effective means of public health promotion and disease prevention. Vaccines prevent disease, disability, and death in children and adults. Sustaining high vaccine coverage levels in children and adolescents, increasing coverage rates in adults, effectively communicating the safety and value of vaccines, and incorporating new vaccines into the routinely recommended immunization schedule requires vigilance and adequate resources” (“ASTHO”, 2018). Immunization is a popular topic in today’s society. Many parents face the debate of whether or not they should vaccinate their children. “From the time they are born, babies face numerous immunizations- up to 28 shots by age 2. The Advisory Committee on Immunization Practices (ACIP) recommends vaccine schedules for children, adolescents and adults based on scientific evidence and the benefits of preventing infectious diseases” (“NCSL”, 2015). “School and daycare immunization requirements serve as a "safety net" for children who do not receive their recommended immunizations as an infant or small child. All school requirement laws are state-based and usually reflect the recommendations of the ACIP” (“NCSL”, 2015). Daycare and school are the two main reasons why vaccinations are pushed at parents. If a child does not get vaccinated, they may not be able to attend that daycare or school. They risk falling back, or other educational complications. For families who do decide to get their child vaccinated, they pay a large sum of money for daycare. “While your child is in the baby and toddler stages, you'll pay more. That's because kids this age need more hands-on care and so the center must hire more caregivers. The average cost of center-based daycare in the United States is $11,666 per year ($972 a month), but prices range from $3,582 to $18,773 a year ($300 to $1,564 monthly), according to the National Association of Child Care Resource & Referral Agencies. Parents report higher costs – up to $2,000 a month for infant care – in cities like Boston and San Francisco” (“Babycenter”, 2016). Costs for vaccinations are also very costly. “According to the Association of State and Territorial Health Officials, every $1 spent on immunizations saves $16 in avoided costs, but vaccines are not cheap. The federal contract price for all vaccines recommended to age 18 increased from $45 in 1985 to $1,105 for males and $1,407 for females in 2008 for programs that receive immunization grants. Factors pushing up costs include new vaccines and inflation” (“NCSL”, 2015). Luckily, there are Federal and State programs to help with the cost of vaccinations. Federal programs include: Vaccines for Children Program and Section 317 of the Public Health Services Act. “Vaccines for Children Program provides free vaccines for children who are uninsured, Medicaid-eligible, underinsured (if receiving immunizations in a federally qualified health center or rural health clinic), Native American or Alaska Native. In 2007, the National Immunization Program at the CDC awarded over $2.5 billion in VFC funds to state, local and territorial public health agencies for program operations and vaccine purchase. Section 317 of the Public Health Services Act is a federal program administered by the CDC and provides grants to states and territories, commonwealth trusts, and several cities for vaccine purchase and programs such as outreach and disease surveillance. The Affordable Care Act (ACA) reauthorizes the Section 317 grant program. Under section 317, prior to enactment of the ACA, states could purchase only recommended childhood immunizations; however, the ACA authorizes states to purchase recommended vaccines for adults as well. The U.S. Department of Health and Human Services secretary can negotiate and contract with vaccine manufacturers, allowing states to receive adult vaccines at a negotiated price and provide these vaccines to adults in their immunization programs” (“NCSL, 2015). Surprisingly, according to NCSL “federal programs do not cover all children, so many states supplement these funds” (“NCSL”, 2015). State programs include: Universal Purchase and Insurance Requirements. “Universal Purchase as of 2014, 7 states (Indiana, Maine, New Hampshire, New Mexico, Rhode Island, Vermont, and Washington) have universal purchase policies where the states or territory purchase all recommended vaccines for all children, including those who are fully insured. Two other states (Florida and North Dakota) and American Samoa have universal purchase polices for public providers. Five other states (Alaska, Connecticut, Massachusetts, South Dakota, Wyoming) have universal select programs that purchase all recommended vaccines for all children with the exception of one or more vaccines. Ohio has a universal select program for public providers. Once purchased, these vaccines are distributed to all public and private providers, who may charge an administration fee. Insurance Requirements the ACA requires new health plans and insurance policies to provide coverage without cost sharing, such as copayments or coinsurance, for certain preventive services. Preventive services in the law specifically include immunizations recommended by the national Advisory Committee on Immunization Practices (ACIP)–15 health experts appointed by the U.S. Secretary of Health and Human Services, who recommend vaccine schedules for children, adolescents and adults. According to regulations from the secretary issued in July 2010, new insurance plans or policies as of September 23, 2010 are required to provide preventive services, including ACIP-recommended vaccines without imposing out of pocket costs on the policy holder. Provisions allow for up to a one year delay for coverage of a newly recommended ACIP vaccine” (“NCSL”, 2015). According to the American Academy of Pediatrics “at least 29 states require insurance companies to cover childhood immunizations. States vary on which immunizations are covered. Some require those vaccines recommended by the American Academy of Pediatrics or the Advisory Committee on Immunization Practices (ACIP). Some of these states choose to include an immunization mandate as part of their "well-child" coverage. In this case, the requirement covers a wide variety of preventive services for children, which includes the recommended immunizations” (“AAP”, n.d.).
One of the main debates of immunizations is that they are unsafe. You usually hear about how vaccinations cause autism. “S/THAs implement several different approaches to monitor vaccine safety and effectiveness. After a vaccine is licensed in the United States, public health experts review epidemiologic data to monitor for vaccine safety and efficacy. National systems have been developed to compensate individuals harmed by rare vaccine side effects. ASTHO supports the following measures to improve and monitor vaccine safety” (“ASTHO”, 2018).
“The Healthy People initiative, a program managed by Office of Disease Prevention and Health Promotion at the US Department of Health and Human Services HHS that aims to provide Americans with evidence-based, 10-year national objectives for improving their health defines a disparity in health care as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage” (Gregorian, 2017). “Disparities in vaccinations lead to disease outbreaks affecting certain groups more than others. For example, during the 1989-1991 measles outbreak in the US, American Indian, non-Hispanic black, and low-income children had a 3 to 16 times greater risk for measles than non-Hispanic white children. These same groups were also at that time recognized as being under-vaccinate” (Mead, 2017). The VFP program has addressed this issue with groups being under vaccinated, usually because of money. Adults in minority groups are also in trouble with sicknesses, because they are more unlikely to get vaccinated. “There are no universal vaccine mandates or vaccine programs tailored for adults as there are for children. Yet the disparities themselves have been well evaluated, and are clear: there are much lower influenza and pneumococcal vaccination rates among non-Hispanic blacks and Hispanics than non-Hispanic whites. Even after accounting for variations in age, sex, level of education achieved, economic status, region, frequency of physician visits, and the presence of high-risk conditions, elderly non-Hispanic blacks and Hispanics are still less likely to receive influenza and pneumococcal vaccinations.1,5 Overall, adults are well below national goals for adult vaccination, which are 70% influenza for those aged equal to or less than 18 years; 60% and 90% pneumococcal for those aged 18-64 years with comorbidities, and aged equal to or less than 65 years, respectively; 30% herpes zoster for those aged equal to or less than 60 years. For example, in those aged65 years, 64% of non-Hispanic whites get the pneumococcal vaccine, and only 41% of Asians get vaccinated” (Gregorian, 2017). “Attempts have been made (and are ongoing) to tackle language and literacy barriers to achieving elimination of vaccination disparities among minority groups, such as with the development of vaccine information sheets in multiple languages by organizations like the Immunization Action Coalition. Most recently, cultural groups are using language- and culture-specific media sites, including popular blogs and traditional media, for outreach. For example, in Flint, Michigan, the Universal Kidney Foundation co-sponsored a series of forums to raise awareness about the benefits of the flu vaccine. Local radio stations with large African American demographics covered these events. In 2013, Hispanic women who authored well-known blogs about motherhood, as well as popular Latino-centric health websites, worked with medical experts to address misconceptions and myths about the flu vaccine on their blogs, using personal vaccine success stories to highlight key points” (Mead, 2017