Argument Analysis
Midwestern State University
COUN-2143-DX1
March 31, 2019
References
Johnson, S. R. (2020). Healthcare workers get top priority for COVID vaccine, but hospitals may not mandate it. Modern Healthcare, 50(44), 16.
Abstract
The increased hesitancy, delay, or refusal for measles vaccinations and the recent increase in this disease, is a growing concern that has reached a global level. The following two articles in this analysis demonstrate the effects that this anti-vaccine movement has had, by first documenting a measles outbreak that occurred in Brooklyn, New York, in the summer of 2013. Second, by a presenting a modeling study that simulates the substantial health and economics consequences that a potential outbreak would have on the country. Both studies have been summarized, acknowledging both successes and limitations in each. I have expressed my view about each article and give a summarization of how I feel this issue can be addressed in the future.
Argument Analysis
Fallout from parental hesitancy, delay, or refusal of vaccinations, is the leading factor resulting in the resurrection of previously eliminated diseases. This crusade is commonly known as the Anti-Vaccine or “Anti-Vaxx” Movement. One study focuses on the “real-life” consequences and economic burdens caused by this movement and the effects that one imported case of measles had on Brooklyn, a populous borough of New York City in the summer of 2013 (Rosen, Arciuolo, Khawja, Giancotti and Zucker, 2018). Lo and Hotez (2017) set out to answer the growing concerns of the anti-vaxx movement and how infectious diseases, specifically measles, could have a detrimental impact on not only public health systems, but on economics resources in the United States. Measles is a highly contagious viral infection which typically includes high fever with a rash which presents itself as flat red spots located on the upper torso. Transmission occurs both by airborne and respiratory droplets, with an infectious period of 4 days prior to the appearance of a rash and 4 days post (Rosen et al., 2018). Due to the mode of transmission for measles, a large outbreak can occur from a single case (Rosen et al., 2018). In 2000, the United States declared measles eradicated (Rosen et al., 1028), however there has been a recent decline in vaccinations due to celebrity advocacy and the spread of pseudo-science regarding the perceived dangers of vaccines (Lo and Hotez, 2017). The authors pose that the hesitancy of vaccinations has caused the emergence of preventable childhood diseases. The reader will consider the documented cases and mathematical models to evaluate and substantiate their claims.
On March 13, 2013, a teenager returned to New York City following a trip aboard to London, England. This trip coincided with an outbreak of the measles virus genotype D8, which had spread throughout the United Kingdom (Rosen et al., 2018). This importation of the virus from a single individual resulted in a total of 58 confirmed cases of measles, with six generations of transmission, within two Orthodox Jewish neighborhoods in Brooklyn, New York (Rosen et al., 2018). The authors painstakingly list conclusive statistical data from the New York City Department of Health and Mental Hygiene (DOHMH) regarding the investigation of case patients, laboratory confirmation of the measles, IgM results or RT-PCR analyses and the age and vaccination status of the 58 case patients (Rosen et al., 2018). They concluded that the transmission of the virus occurred between eight extended families and presumed the other sources of transmission included occupants in their apartment dwelling, friends, community gathering areas and heath care facilities (Rosen et al., 2018). In addition to the 58 case patients, 3,351 people were also discovered to be exposed contacts; 66% had received the required double dose of the measles vaccination and 11% had received a single dose (Rosen et al., 2018). The exposure contact immunity status of the remaining 23% was listed as either susceptible or unknown (Rosen et al., 2018). DOHMH set up an extensive community outreach program where local health care providers, as well as schools and day-care facilities, were on heightened alert for new cases. Public notices were distributed through the media along with a telephone “hotline” for citizens to call with questions or concerns. Twelve different bureaus and 87 employees of the DOHMH were enlisted to Help in the outbreak between March 13, 2013, and June 9, 2013 (Rosen et al., 2018). The price tag for this preventable outbreak of measles, cost the City of Brooklyn roughly $400,000.00 (Rosen et al., 2018). Rosen et al., (2018) stated the confinement of the virus was “resource intensive,” requiring “the redirection of resources away from other public health activities” (p. 815). It was one of the largest post-eradicated outbreaks in the United States (Rosen et al., 2018).
As a reader I was impressed with the credibility and detail of the data provided in this study. As a health care professional I am acutely aware of the dangers of the measles virus. However, the manner in which the authors presented the information based on a verifiable outbreak was astounding. One case infected 58 people and exposed over 3,351 more at the cost of approximately $400,000.00 (Rosen et al., 2018). The authors sought to shed light on how a single measles outbreak placed an undue burden on a city’s allocation of resources, both used to discover and contain the virus. I feel they were successful in their endeavor and their findings could be used as a tool to educate and disseminate the anti-vaccine movement.
The excruciating process in which parents must decide on whether or not to vaccinate their children is fraught with a labyrinth of information on which they are left to decipher. For some it is easy, it a strong moral belief based on religion or culture, but for others it is established in the spread of false information regarding the dangers of vaccinations and the ill-perceived notion that the disease itself is extinct. Lo and Hotez, (2017) developed a stochastic mathematical model which focused strictly on children from the ages of 2 to 11 years old. They used data from the US Centers for Disease Control and Prevention (CDC) to simulate measles, mumps and rubella (MMR), vaccination coverage. The data gathered from the CDC ChildVaxView, 2013-2015 replicates vaccine coverage for children between the ages 2 to 5 years old (Lo and Hotez, 2017). For children between the ages of 5 to 11 years old, it was gathered from CDC SchoolVaxView, 2010-2015 (Lo and Hotez, 2017). Lo and Hotez (2017) also used the CDC SchoolVaxView data for “state-level prevalence of vaccine hesitancy, defined as nonmedical (e.g., personal belief) exemptions of childhood vaccination” (p.888). They predicted a 1% to 8% per state reduction in vaccine coverage, which also represented the increase in widespread non-medical exemptions (Lo and Hotez, 2017). Based on literature from various state and local health institutions, the estimated cost of a single measles case is approximately $20,000 for state and local expenses only; no estimated financial burden for the family was included (Lo and Hotez, 2017). Regarding statistical analysis, the model was based on a measles outbreak ensuing two chance events, both simulated imported cases in U.S. counties, one by way of contact with a child, and one by way of multiple contacts (Lo and Hotez, 2017). The results of this model concluded that a 5% decline in MMR vaccinations in children residing in the U.S. “would result in a three-fold increase in national measles cases” (p.890) in the 2 to 11 years age group, for a total of 150 new cases of measles, costing the public $2.1 million dollars (Lo and Hotez, 2017).
Although this article does not document the events of an actual outbreak as the previous one does, it does focus more on cause and effect of the anti-vaccine movement. Lo and Hotez (2017) document limitations of their study such as the narrow focus on the age group (2 to 11 years old) and the data from CDC containing “variation(s) in reporting standards from individual states” (p. 891). Even with these noted limitations and conservative estimates, the authors successfully address the effect that even a minute decline in vaccination coverage, had a substantial increase in the number of cases of measles. In order to improve the credibility of this study I would attempt to include all age groups; this study scarcely touches on the fact that infants from 0 to 1 years old are more vulnerable to this virus and not eligible to receive the vaccine until after 12 months of age. In an attempt to gather more information regarding the status of vaccine coverage and exemption, I believe I would encounter the same issue as the authors did, with the discrepancy of how states report standards. I would attempt to push for not only more education regarding anti-vaccination, but would also focus on the process in which it is conveyed.
I feel both articles presented different approaches to the anti-vaccine movement. Rosen et al., (2017) documented the effects from a health and economic stand point; how one imported case of measles from an unvaccinated teen impacted a populous city such as Brooklyn, New York. Lo and Hotez (2018) approached the subject by the use of a stochastic mathematical model, demonstrating how just a small sample of the population (children ages 2 to 11 years old), could be effected by an imported case of measles and a steady decline in vaccine refusals.
Throughout my years as a health care provider, I have had extensive training regarding the administration and containment of infectious diseases. I am aware that the majority of these diseases can be contained or even eradicated through a vaccine program. As a parent, I too have agonized over the decision on whether or not to vaccinate my children and risk the “fact” that they could become autistic through my decisions as their parent. The authors made their focus of this argument on the disease process, rather than the vaccine itself. Rosen et al., (2017) had a greater impact on me due to the fact that this study was based on an actual event. According to recent reports in the news, the majority of States offer some form of vaccine exemption for either medical or non-medical personal belief. I believe the findings in the above studies can have an impact on passing laws to first eliminate the non-medical exemption and secondly, deny public access to any government funded schools, parks, buildings, and facilities for those who refuse to abide by said laws. With implementation of such measures, we could once again eradicate measles and other vaccine preventable diseases. I recognize the extremity of these proposed laws and the outcry of the violation of personal rights that would ensue. However, a violation of the rights of personal safety for the health and well-being of the majority of Americans, has already been violated by those who refuse vaccinations; evidence of this would be the 3,351 residents of the boroughs of Brooklyn in New York City.
References
Lo, N. C., & Hotez, P. J. (2017). Public health and economic consequences of vaccine hesitancy for measles in the United States. JAMA Pediatrics, 171(9), 887-892. doi:10.1001/jamapediatrics.2017.11695
Rosen, J. B., Arciuolo, R. J., Khawja, A. M., Fu, J., Giancotti, F R., & Zucker, J. R. (2018). Public health consequences of a 2013 measles outbreak in New York City. JAMA Pediatrics, 172(9), 811-817. doi:10.1001./jamapediatrics.2018.1024
