Controversies of Vaccination in Public Health

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There have been several public concerns from various segments regarding the entire issue of vaccination. No wonder the point is heavily politised in the world (de Cellés et al., 2014). The claims on the basis of its economic and ethnic outlook for and against vaccines can be investigated. In some instances, mandatory administrations of vaccines like Human Papillomavirus (HPV) by public health workers for all girls in the United States of America has raised concerns based on the aspects of ethics and the morality of administration, morality and issues of parental accord regarding mandatory vaccination.

There is need for vaccination to be looked at as a basic human right for an individual’s wellbeing and health. As a matter of fact, it is the responsibility of every person, the state, health systems and the community to ensure that the public has access to the desired vaccines. Despite the positive gains of administration, vaccination has been met with great controversies which range from religious and ethical concerns, economical issues and concerns of equal protection for gender sensitive vaccines (Basharat and Shaikh, 2017). This paper attempts to scaffold the controversies surrounding the administration of vaccines based on ethical, economical, religious and equality concerns. For affectivity, the paper will look into these issues based on the controversies surrounding the administration of HPV vaccine in the United States of America as well as the administration of polio vaccines in Pakistan.

Background

Vaccination goes to record as one of the most cost effective intervention in public health based on the overwhelming positive effects it has shown in reducing morbidity and mortality of children under the age of five years. The levels of effectiveness of vaccines in cutting down the burden of different diseases have been analyzed in research. However, there are serious issues hindering the achievement of 100% vaccination coverage; an issue that requires the development of a deeper understanding (Angioli et al., 2016).

Vaccination goes a long way in reducing disabilities, diseases and deaths. Developing countries like Pakistan have not achieved 100% vaccination against critical diseases for its population (Basharat and Shaikh, 2017). Polio is a paralytic disease which needs to be eradicated. However, the world is faced with challenges on this issue. Religion and religiosity act as key sources of guidelines for n numerous practices all over the world. This includes health related issues and choices of life that have an influence on health. Public health workers and researchers have continuously attempted to consider the issues of cultural and religious sensitivity in their efforts of providing services and interventions.

Arguments against and for vaccines can be looked at based on the issues of economics and ethics. The United States of America has seen an increase in controversies about administering the HPV vaccine because of issues of morality and the criticalities surrounding parental rights based on mandatory vaccination (Nicol et al., 2016). Further, there are controversies of equality over whether male students should also be vaccinated as a way of reducing the rates of transmission of HPCV to their female counterparts who later risk contracting cervical cancer.

Main Content

Religious controversies surrounding polio vaccination in Pakistan

The Pakistani health system’s challenges are compounded by a difficult terrain ranging from the glaciers of the Himalayas to the impassable roads of the southern region of Baluchistan which contribute to its public health difficulties. Vaccination aimed at eradicating polio has raised hot debaters in Pakistani newsrooms. Basharat and Shaikh (2016) note that the global efforts for eradication of polio are highly dependent on the capacity of Pakistan to tackle a wide range of issues acting as obstacles to vaccination which range from socioeconomic to political and religious inconsistencies in the extents of vaccine coverage, health infrastructure revealing massive loopholes and conflicts in areas considered to be polio-endemic.

Studies conducted by de Cellès et al. (2014) demonstrate a strong relationship between religious factors and the decisions made by parents on immunizing their children. In their research, Bashrat and Sheikh (2017) explain that parents in Pakistan are faced with great religious oppositions in their efforts to immunize children against polio. This has had a great negative effect on the side of public health workers. According to de Cellès et al. (2017), the most prominent religious objection to the administration of vaccines is underpinned in “divine providence and deliberate introduction of ‘diseases’ inside the God’s created human body” through immunization. Such levels of resistance to polio and other vaccines are highly multifaceted. As a result, the lives of more than 0.25 million Pakistani children are in danger of contracting polio (Bashrat and Shaikh, 2016).

There is need for public health workers to tackle this issue through engaging in multi-sectorial approaches. Public health stakeholders need to take maternal education in a positive way to ensure that the Pakistani population achieves the desired positive health outcomes through availing the necessary education on the importance of vaccination. According to a study conducted by de Cellès et al. (2014), women can play a significant role in shaping their families’ behavior of seeking healthcare services based on their positions as primary caregivers and their levels of concern about the health wellbeing of their children. The force of female public health workers acting as vaccinators needs to be inclined towards communicating the importance of vaccinations to their fellows. Bashrat and Shaikh (2017) note that vaccination rates tend to depreciate in instances where women are not empowered to take decisions about the health statuses of their children.

Ethical, Economic and Inequality Controversies Surrounding the Administration of HPV Vaccines in America

There are more than 100 kinds of HPV’s with type 16 and 18 accounting for 70% of cervical cancer cases in the United States of America (Angioli et al., 2016). According to Nicole et al. (2016), 90% of genital warts cases are caused by types 11 and 16 of HPV. Despite the fact that vaccines have been developed to prevent infections caused by selected strains of HPV, the United States of America is still faced with controversies regarding the issues of ethics, gender equality and economics of administration.

Ethical controversies

Ethical issues surrounding the administration of HPV vaccines are multi-faceted with arguments touching either sides of the line. Such controversies emanate from the fact that HPV vaccination has been made mandatory by the United States of America’s government; an issue that has raised eyebrows on the involvement of parents in their children’s affairs. According to Angioli et al. (2016), mandatory administration of this vaccine infringes the parental role and autonomy in raising their young ones particularly in regard to issues touching their sexual development and behavior. Some parents have argued that administering vaccines for sexually transmitted diseases like HPV at a tender age of 11 gives them the implicit allowance of being involved in sexual behaviors which are not only risky but also threatening. However, there is no evidence supporting these worries. Researches conducted by different public health stakeholders have shown that the greatest percentage of adolescents tend to be unaware of HPV. Therefore, the fear of STIs like HPV poses little effects on the decisions they make concerning their sexual behaviors.

One of the most crucial ethical controversies emanates from the fact that the vaccine only prevents cervical cancer by 70%. This calls for continuity of surveillance using Pap smears. According to Nicole et al.(2016), some vaccinated women tend to develop false senses of security then forego the desired screening. In such instances, de Cellès et al. (2014) note that administration of the HPV vaccine among women may lead to a paradoxical rise in cases of cervical cancer; a fact that is supported by Nicole et al. (2016) in instances where not more than 70% of the population is screened. According to Angioli et al. (2016), there has been an increase in the number of young women skipping screening sessions in their own will. It is important to note that women must be educated on the need for screening as a way of eliminating the risks associated with cervical cancer particularly after the administration of the HPV vaccine. Such ethical arguments against the HPV vaccine call for active involvement of public health workers to educate the population on its importance. This could be achieved through a continuous campaign on the risks associated with cervical cancer. Despite this, it is also important for public health workers to put into consideration the fact that the requirement for a booster does not give sufficient evidence for lack of administration of a primary vaccine.

Economical controversies

The economics of mandatory administration of the HPV vaccine are centered on the issue of cost effectiveness. De Cellès et al (2014) explain that the three recommended dosses of his vaccine cost $360. While there are concerns that the price for this vaccine may see an increment, it is highly prohibitive putting into consideration the living standards of some families in the United States of America. Such issues call for the need of the central government to include the HPV vaccine in the Federal Vaccine for Children Program as well as mandated insurance coverage for the vaccine. This is despite the fact that there are families which lack the ability to afford the vaccine or lack the desired qualifications for inclusion into the federal vaccine program. Public health workers in the United States of America need to fight for the inclusion of an exclusion clause in all legislations mandating the administration and use of the HPV vaccine as a way of taking care of girl livings in economic hardships. This will allow girls who may not be able to get the vaccine due to monetary reasons have the permission to attend school.

Controversies of equality

Another critical controversy surrounding the administration of HPV vaccines is whether the boys should also receive it. The debate in this controversy is fostered by two different thoughts. First, there is the issue on the need to protect males against HPV and other diseases related to this virus. Second, there are gaps on the extents to which the females would be protected against cervical cancer through vaccinating the boys. Nicole et al. (2016) explain that males face the risk of contracting anal, oral, penile and other neck and head cancers which are caused by HPV. This is with disregard of the risk of genital warts. Angioli et al. (2016) note that males have an interestingly higher burden of oral HPV related diseases and de Cellès et al. (2014) explain that this rate is actually three time in comparison to that of women. The greatest reason why this matters emanates from the fact that most oral HPV infections in which type 16 is considered to be the most common puts the person at a 50-fold heightened risk for oropharyngeal squamous cell carcinoma (Angioli et al., 2016). According to de Cellès et al. (2016), this kind of cancer has seen a 225% increase in the past few years. Unfortunately, there is no proof that the vaccine can be used to prevent oral HPV infections. Public health stakeholders need to undertake researches to confirm whether the vaccine can be used to prevent these oral cancers.

Discussion

The question of vaccination and the important of vaccines raise multiple controversies based on regional, cultural and social differences of the stakeholders. It is clear that these controversies tend to vary with geographical locations, levels of education of a populace and issues of gender disparity. Pakistan is a developing economy faced with multiple infrastructural challenges which limit the extents to which public health workers can administer vital vaccines as way of ensuring that the world is polio free (Basharat and Shaikh, 2017). On the other hand, the Pakistani population upholds strong religious beliefs which ac as hindrances to effective administration of the polio vaccine among children. It is the role of public health workers to move with the required speed in sensitizing women on the need for vaccinating their children against critical conditions like polio.

While America is a developed economy, a better part of its population is still faced with the risk of HPV. While the administration of the HPV vaccine is meant to ensure that the populace is kept safe from oral and cervical cancers, it is faced with multiple controversies. Despite the cost implications, ethical and equality issues, it is important for public health workers to sensitize Americans on the importance of this vaccine.

Conclusion

Based on the reviews made on the controversies surrounding the administration of vaccines, it is clear that every nation has its own difficulties. These controversies emanate from the social, religious and economic setup of a nation. The controversies in Pakistan are clearly of infrastructural and social origin. The public health workers in this economy must move with the required haste to educate its populace on the need for polio vaccines. On the other hand, the United States of America’s controversies are surrounded by issues of ethics, equality and economics. Bearing in mind the health hazards of HPV, it is only fair that the public health workers engage in interdisciplinary approaches to ensure that every American child from the age of 11 accesses this vaccine.

References

Angioli, R., Lopez, S., Aloisi, A., Terranova, C., De Cicco, C., Scaletta, G., … & Montera, R. (2016). Ten years of HPV vaccines: state of art and controversies. Critical reviews in oncology/hematology, 102, 65-72.

Basharat, S., & Shaikh, B. T. (2017). Polio immunization in Pakistan: ethical issues and challenges. Public Health Reviews, 38(1), 6.

de Cellès, M. D., Riolo, M. A., Magpantay, F. M., Rohani, P., & King, A. A. (2014). Epidemiological evidence for herd immunity induced by acellular pertussis vaccines. Proceedings of the National Academy of Sciences, 111(7), E716-E717.

Nicol, A. F., Andrade, C. V., Russomano, F. B., Rodrigues, L. L. S., Oliveira, N. S., & Provance Jr, D. W. (2016). HPV vaccines: a controversial issue?. Brazilian Journal of Medical and Biological Research, 49(5).

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