Healthcare

Unbiased Review of H.R. 2527: Vaccinate All Children Act of 2019

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H.R. 2527: Vaccinate All Children Act of 2019
Briefly describe the issue:

Reinhart (2020) stated that only 84% of people in U.S. say childhood vaccinations are important, down from 94% in 2001. According to GovTrack (2019), the recent trend of decreasing vaccination rates caused the 2019 measles rate to be higher than it had been in decades and creates the opportunity for other preventable outbreaks. All 50 states currently require vaccinations for children to attend school; however, 45 states allow religious or personal exemptions (GovTrack, 2019). Only five states currently allow no exemptions except for medical reasons. The issue is whether or not the federal government should require all states to remove the religious and personal exemption options from vaccination requirements, or should it be left to the state as is the status quo.

1.     Identify the Pros Identify the Cons
Proponents of federal intervention on state vaccination requirements argue that with surging rates of diseases easily prevented by vaccines, a public health crisis is being caused by the lack of strong public policy requirements (GovTrack, 2019). Pierik (2017) discussed how public questioning of vaccines leads to a decline in vaccination rates and ultimately culminates infectious disease outbreaks such as the measles outbreak in 2015, which was the first major measles outbreak in over a decade and spread throughout the US and Mexico. Shrivastava, Shrivastava and Ramasamy (2016) wrote how the outbreak had reiterated the importance of sustaining a high level of immunization coverage for vaccine-preventable disease. Infectious diseases were once the leading cause of death, but, since the creation and implementation of vaccines, they currently rank eighth (Anderson, 2015).

Childhood vaccination rates are lower in states with more permissive exemption policies (Garnier, Nedell, Omer, & Bansal, 2020). Garnier, Nedell, Omer, and Bansal’s study (2020) shows that non-medical exemption (NME) rates are negatively associated with vaccination rates for major childhood vaccinations for which mandates exist. Also, their study shows that eliminating NMEs is an effective way to reduce exemption rates overall.

Proponents insist the federal government can protect society against the threat of preventable, infectious disease by removing the state’s ability to allow religious and personal exemptions from immunization regulations (Pierik, 2017).

 

 

 

 

Opponents of federal intervention on state vaccine requirements argue that such federal mandates are an infringement on personal liberty, and the removal of a religious exemption violates the First Amendment’s freedom of religion (GovTrack, 2019). Opponents are often members of religious groups who argue that vaccinations interfere with divine providence (Pierik, 2017). Pierik (2017) described a growing anti-vaccination movement which argues that the dangers of vaccinations outweigh the benefits.

According to Dredze & Broniatowski (2015), common reasons parents give for refusing vaccinations are: fear that vaccines cause autism, concerns over toxins, beliefs about the benefits of measles to the immune system, distrust of government, distrust of pharmaceutical companies, and preference for a natural lifestyle. According to Anderson (2015), some believe vaccinating children denies that child free choice, and that the risks of infection are minimal due to advances in medicine. Another ethical concern for some is the fact that certain vaccines are grown in cell strains derived from an aborted fetus (McKenna, 2017).

Centers for Disease Control and Prevention (CDC) (2020) lists several incidences where vaccinations have caused harm such as the 1955 polio vaccine given to the public containing live virus and caused 250 cases of polio, the 1955-1963 simian virus 40 (SV40) contaminated polio vaccines, vaccine induced Guillain-Barré Syndrome associated with several vaccines, the 2009 H1N1 influenza vaccine that was associated with a high incidence of narcolepsy. According to the CDC (2020), there is a concern that vaccinations may have the ability to cause cancer and, although studies are reassuring, this idea has not been disproven.

 

2.     Summarize the bill:

H.R. 2527: Vaccinate All Children Act of 2019 is a bill currently under consideration (GovTrack, 2019). Its passage would prohibit the Department of Health and Human Services from awarding grants to public entities of a state for preventive health service programs unless the state institutes vaccination requirements on all its public schools. The bill would force all states to require each student in public elementary or secondary school to be vaccinated in accordance with the recommendations of the Advisory Committee on Immunization Practices. According to GovTrack (2020), the only exception to this bill would be for students whose health would be endangered by vaccination in the opinion of a physician conforming to the accepted standard of medical care. The purpose of this bill is to prevent future outbreaks of contagious diseases, and it addresses the issue of whether or not federal government should remove the religious and personal exemption options from vaccination requirements (GovTrack, 2019). Variations in state vaccination regulations would be eliminated and all states would be forced to uphold the same set of federal regulations.

An example of this is in the state of Indiana which currently allows vaccine exemptions for religious reasons. The state will no longer be permitted to allow these exemptions if the bill passes. (National Conference of State Legislators, 2020). According to GovTrack (2019), the bill is in the first stage of the legislative process and is expected to be considered by committee before being sent on to the House or Senate. It is possible that even if this legislation does not pass Congress, a federal agency could enact a similar change on a national level. The Food and Drug Administration’s commissioner recently suggested that his agency might step in to introduce a federal requirement if states do not enact stricter guidelines (GovTrack, 2019).

3.     Discuss how the issue and the bill affects healthcare providers, specifically ARNPs:

H.R. 2527: Vaccinate All Children Act of 2019 is an important bill to ARNPs because they are on the front lines of promoting and administering immunizations. Whether or not the federal government should force states to eliminate vaccination exemptions is an ongoing, controversial issue, and ARNPs will encounter parents and patients with strong opposing and proposing opinions. According to William (2019), an increasing number of children in the United States are not receiving some or any vaccinations. The CDC reported that the percentage of unvaccinated children younger than 2 years has quadrupled since 2001 (William, 2019).

Balestra (2016) discusses that ARNPs, especially those working in the pediatric and family specialties, should ensure all parents are informed about both the risks of vaccine-preventable diseases and the risks and benefits of immunizations. ARNPs are required by law to discuss vaccine-associated adverse reactions and the provision of Vaccine Information Statements (VISs). The National Childhood Vaccine Injury Act requires that all healthcare providers give parents a copy of VISs before administering any dose of a vaccine (Balestra, 2016).

To deal with the issue of vaccination, the APRN should first know where they stand on the issue and look to professional organizations for guidance. According to Anderson (2015), many healthcare providers also are hesitant on the topic of vaccination. Second, APRNs should decide how they will approach parents who are opposed to vaccines. Understanding the fear some parents have as they contemplate vaccinating their child and addressing specific concerns for their child with scientific data is one approach to improve immunization rates (Anderson, 2015). Third, APRNs should understand current research regarding relevant perspectives and practices regarding immunizations and be equipped to answer questions or concerns parents have about vaccinations. According to Anderson (2015), an effective intervention is to build a trustworthy relationship with the patient and parent and be transparent with information, allowing parents the opportunity to verbalize their specific concerns in a nonjudgmental environment. Fourth, the ARNP should support long-term efforts to monitor vaccine safety by reporting to the Vaccine Adverse Event Reporting System of the CDC as indicated (Anderson, 2015). Some practices are handling the issue by not treating patients who are not immunized. However, this approach is controversial as it leaves children without well-child or sick care (Kaplan, 2019).

The American Nurses Association’s (ANA) (2020) current stance is that all individuals should be immunized against vaccine-preventable diseases according to the best and most current evidence outlined by the CDC and the Advisory Committee on Immunization Practices (ACIP). However, the ANA (2020) supports exemption from immunizations for religious beliefs and medical contraindications. Therefore, ARNPs can support patients and honor requests for exemption due to religious beliefs with support from the ANA.

If the bill were to be passed, it would significantly impact ARNP practice in the 45 states that currently allow religious and personal exemptions. Standards of care in those states would need to change immediately and healthcare providers would no longer be able to provide exemptions for any other reason than medical. A concern is that APRNs would be faced with more requests for medical exemption. In California, after the removal of all exemptions except medical reasons, the number of medical exemptions increased from 0.2% to .07% (Kaplan, 2019). APRNs would need to fully understand qualifications for medical exemption and be prepared to face backlash from families continuing to refuse vaccination.

 

References

William, L., (2019). Role of the pediatric nurse practitioner in enhancing vaccination rates. AACN: Adv Critical Care, 30, 278–28. doi:10.4037/aacnacc2019992

American Nurses Association. (2020). Immunizations – ANA position statement. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/immunizations/

Anderson, V., (2015). Promoting childhood immunizations. JNP: The Journal for Nurse Practitioners, 1, 1-10. doi:10.1016/j.nurpra.2014.10.016

Balestra, M. (2016). The antivaccine movement: Legal implication for nurse practitioners. The Nurse Practitioner, 41, 12-14. Retrieved from https://www.nursingcenter.com/journalarticle?Article_ID=3835347&Journal_ID=54012&Issue_ID=3835331

Centers for Disease Control and Prevention (CDC). (2020). Historical vaccine safety concerns. Retrieved from https://www.cdc.gov/vaccinesafety/concerns/concerns-history.html

Center for Disease Control and Prevention (CDC). (2019). U.S. measles cases in first five months of 2019 surpass total cases per year for past 25 years. Retrieved from https://www.cdc.gov/media/releases/2019/p0530-us-measles-2019.html

Dredze, M., & Broniatowski, D. (2015). Understanding vaccine refusal. Pediatrics for Parents, 31, 18-19. doi:10.1016/j.amepre.2015.10.002

Garnier, R., Nedell, E., Omer, S., & Bansal, S. (2020). Getting personal: How childhood vaccination policies shape the landscape of vaccine exemptions. Open Forum Infectious Diseases, 17, ofaa088, doi:10.1093/ofid/ofaa088

GovTrack. (2019). H.R. 2527: Vaccinate all children act of 2019. Retrieved from https://www.govtrack.us/congress/bills/116/hr2527/summary

Kaplan, L., (2019). Preventable diseases. The Nurse Practitioner, 44, 15-16. doi:10.1097/01.NPR.0000574660.34486.a5

McKenna, K. (2017). Use of aborted fetal tissue in vaccines and medical research obscures the value of all human life. The Linacre Quarterly. doi:10.1080/00243639.2017.1375065

National Conference of State Legislators (NCSL). (2020). States with religious and philosophical exemptions from school immunization requirements. Retrieved from https://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx

Pierik R. (2017). On religious and secular exemptions: A case study of childhood vaccination waivers. Ethnicities17, 220–241. doi:10.1177/1468796817692629

Reinhart, R. (2020). Fewer in U.S. continue to see vaccines as important. Retrieved from https://news.gallup.com/poll/276929/fewer-continue-vaccines-important.aspx

Shrivastava, S, Shrivastava, P., & Ramasamy, J. (2016). The 2015 measles outbreak in America: Identified shortcomings and recommendations to the health authorities. Annals of African medicine15, 42–43. doi:10.4103/1596-3519.153986

 

 

 

 

Healthcare

Biden on Healthcare: Who’s Got the Right Idea on U.S. Healthcare Delivery?

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Democratic presidential candidate, Joe Biden, is promoting a healthcare outline that is similar to the Affordable Care Act (ACA) but attempts to improve upon several of its aspects (Laszewski, 2019). Although the ACA created some improvements in healthcare delivery, such as the expansion of care (more people received access to healthcare) and promotion of public health (global health issues), there were unsuccessful components represented by the skyrocketing premiums and deductibles. Biden outlines expanding Medicaid coverage further by making Medicaid available to all low-income consumers in every state (Laszewski, 2019). A substantial part of the expansion is the plan to remove the cap on individuals and families receiving federal subsidies, so no one pays more than 8.5% of their income on premiums. More people could actually afford their healthcare. Consistent with the ACA, Biden wants to increase budgeting for community health center development, improving upon public health initiatives.

In contrast to the ACA, Biden plans to improve upon the individual health insurance market. According to Laszewski (2019), Biden proposes the development of a public option to be marketed alongside private insurance options, giving Americans three options: Medicaid, private insurance, and public health insurance. Biden’s outline partly builds upon the ACA, making healthcare expansion even broader and further reducing the number of uninsured people. Fan, Yan, Coyte, & Yu (2019) found that public health insurance leads to better health outcomes and long life expectancies. A public health insurance option may level the playing field. Private insurance companies will be forced to compete with public prices, reducing the imbalance of coverage and provider options between people with different socioeconomic statuses (Laszewski, 2019).

Another benefit of Biden’s plan, according to Laszewski (2019), is increasing community health budgeting, which is more consistent with a population health model of care delivery rather than a medical model. Population health focuses on preventative concepts such as nutrition and lifestyle. The medical model is the traditional American way which focuses on treating disease in each individual, rather than preventing it.

HOWEVER, with all of this said, I still have a problem with Joe Biden. I will not vote for him as president of the U.S. because of his views on Planned Parenthood. But, does it not make sense that we work together on healthcare, democrats and republicans, and find a middle ground on changing our healthcare delivery system? I do not think that Biden having a bad concept in his outline (funding Planned Parenthood) means that all his ideas are bad. There are some great ideas here! We are at a standstill in our country. Although some concepts, such as abortion laws, are improving, other aspects of healthcare delivery in the U.S. have stalled. Oh, how I wish our appointed officials could sit down and find a way to move forward.

Margie Huff, RN

ARNP/FNP Student at University of Southern Indiana

References:
Ebel, B., Cassidy, E., Trujillo, M., & Orleans, T. (2019). Organization of care. In J. Knickerman,& B. Elbel (Eds.), Health Care Delivery in the United States (pp. 170-171). Springer Publishing Company
Fan, H., Yan, Q., Coyte, P. C., & Yu, W. (2019). Does public health insurance coverage lead to better health outcomes? Evidence from Chinese adults. Inquiry56. doi:10.1177/0046958019842000
Landry, A., & Erwin, C. (2019). Organization of care. In J. Knickerman, & B. Elbel (Eds.),
Health Care Delivery in the United States (pp. 36-38). Springer Publishing Company
Laszewski, R. (2019). Joe Biden’s health care plan would fix the individual health insurance
system. Retrieved from https://www.forbes.com/sites/robertlaszewski2/2019/12/22/joe-bidens-health-care-plan-would-fix-the-individual-health-insurance-system/#211d74d51f93
McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS Medicine16. doi:10.1371/journal.pmed.1002752
National Academies of Sciences (NAS). (2016). Removing barriers to practice and care. In S.H. Altman, A.S. Butler, L. Shern (Eds.), Assessing Progress on the Institute of Medicine
Report the Future of Nursing (pp. 39-56). Washington, DC: National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK350160/
Office of Disease Prevention and Health Promotion (ODPHP). (2020). Access to health services. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services
Office of Disease Prevention and Health Promotion (ODPHP). (2020). Health related quality of  life and well-being. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/health-related-quality-of-life-well-being
Pennsylvania Coalition of Nurse Practitioners (PCNP). (2016). Five new studies: Nurse practitioners expand access to health care, lower Costs, improve outcomes. (2016). Retrieved from https://www.pacnp.org/news/277542/Five-New-Studies-Nurse-Practitioners-Expand-Access-to-Health-Care-Lower-Costs-Improve-Outcomes.htm
Russo, P., & Gourevitch, M. (2019). Organization of care. In J. Knickerman, & B. Elbel (Eds.), Health Care Delivery in the United States (pp. 103-107). Springer Publishing Company