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.

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).

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.

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).

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.