Government Mandated Vaccination: A Social Construct
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Example of a perspective essay based on research
Government Mandated Vaccination: A Social Construct
The controversy surrounding the prospect of government mandated vaccination programs is fueled by idiomatic misconceptions that continue to trivialize vaccine efficacy and the concept of herd immunity. According to The Vaccine Uptake Continuum: Applying Social Science Theory to Shift Vaccine Hesitancy, attitudes towards vaccinations are described as a continuum: oscillating between absolute acceptance to complete refusal (Dubé et al., 2014; Piltch-Loeb and DiClemente, 2020). From a social science perspective, vaccines protect the vaccinated individuals in order to also protect society as a whole. In this respect, vaccination is considered a prosocial action where success is contingent on a large number of contributing individuals (Korn et al., 2020). Despite credible recommendations, safety remains the main concern driving vaccine reluctance and decreased rates of vaccine uptake (Larson et al., 2014). Vaccine Safety: Myths and Misinformation argues this concern is deceitfully propagated by misinformation through organized groups positioned against vaccines, amplified by social media, and further sensationalized as celebrity endorsements (Geoghegan et al., 2020).
Though many reasons influence the decision to vaccinate, research has attributed vaccine hesitancy to four overarching categories including “religious reasons, personal beliefs or philosophical reasons, safety concerns, and a desire for more information from healthcare providers.” (McKee and Bohannon, 2016). However, cultural and perceived value of capital also play a significant role in the decision (Atwell et al., 2018). Although many diseases have been controlled in many parts of the world, ideologies on vaccine uptake and one’s social obligation are not invariably universal. A collective agreement to implement government mandated vaccinations remains controversial as a portion of people continue to be vaccine reluctant. Differences in vaccination opinions are simultaneously influenced by various social constructs and religious assertions which induces various forms of discrimination.
Differences in vaccine opinions are byproducts of social constructs. Colloquially, vaccination behaviors of a person’s immediate social network are used as a predictor of behavior (Atwell, 2018; Brunson, 2013). Childhood immunization refusal: provider and parent perceptions argue that the most commonly reported reason for refusing one or more vaccines was due to other people or media reports (Fredrickson et al., 2004). Rather than delivering an objectively unbiased view, often the information filtered through social media and large-scale news outlets is sensationalized to elicit increased ratings. In this sense, popular media sources are socially manufactured by subjectively biased assertions. Information is systematically framed to appeal to the viewer. This is exemplified in the fact that news reports do not provide all details or cover all events that occur. Although rare incidents are not representative of an entire population, news reports may highlight uncommon incidents to achieve more newsworthy ratings, for example, the rare, unintended side effects that may occur in response to a vaccine. This ambiguity further preserves the spread of misinformation.
In addition, popular media sources relay information through journalists who may or may not be credible. Advertising can also affect the news agenda, therefore there is potential to be influenced by economic motivators. One recurring argument concentrates on the fabricated claim that vaccines cause illnesses such as autism or are more dangerous than the disease itself (Geoghegan et al., 2020). Media outlets have previously cited problems with components of vaccines and reported that vaccines can cause autism, brain damage, or behavioral problems which causes concerns regarding the safety of vaccines (McKee and Bohannon, 2016). Though all research claiming that the measles, mumps, and rubella (MMR) vaccine causes autism were subsequently retracted on the basis of scientific misconduct, a portion of the population continues to validate reasons to not vaccinate on the basis that it causes autism (Geoghegan et al., 2020).
In contrast, some people see some benefit in having their child(ren) contract certain preventable diseases (Fredrickson et al., 2004; McKee and Bohannon, 2016). More interestingly, some are under the impression that natural immunity is better for their children than immunity acquired through vaccinations (Fredrickson et al., 2004; McKee and Bohannon, 2016). Others may express the belief that the diseases for which we vaccinate are not very prevalent in their location. By this logic, they believe their children are at minimal risk of contracting these diseases. For this reason, they may also believe that the possible negative side effects of vaccine administration outweigh the benefits of the vaccines (McKee and Bohannon, 2016; Saada et al., 2015). Since information can be overwhelming for some parents to sift through, there is difficulty in making well-informed decisions (Fredrickson et al., 2004; Harmsen et at., 2013; McKee and Bohannon, 2016).
Most of the safety concerns influence the decision to remain un-vaccinated and are based on information revealed in popular media sources or translated by someone in their social circle. However, influences from other social constructs with varying opinions may be able to intervene. Additional research has shown that the unvaccinated populations may still be influenced by other social constructs within the larger culture. For example, “Research studies have found that the probability of becoming vaccinated is associated with the frequency of walking by or in a vaccinating clinic”(Tak, 2020). Studies suggest pharmacists have become more widely accepted as reliable administrators; when pharmacists are involved as educators, facilitators, or administrators, research studies have repeatedly shown improvement in vaccination uptake (Tak, 2020).
At the core, all opinions on vaccines are socially constructed, and hesitancy is a socio-behavioral and cultural phenomenon (Piltch-Loeb and DiClemente, 2020). Social constructs inherently develop within smaller sub-cultural populations and cultivate unique social norms. Previous studies have explored attributes within unvaccinated populations, citing parallels in particular forms of cultural capital, racial and economic privilege (Atwell et al. 2018). Consequently, the vaccine behaviors of a person’s immediate social network are often used as a predictor of behavior (Atwell, 2018; Brunson, 2013). For those who absolutely refuse vaccinations or admit hesitancy, these commonalities often transpire as dismissive generalizations such as “conspiracy theorist” or “misinformed skeptic” which leads to various forms of discrimination towards these individuals. Despite a documented history of systemic bias and unethical experimentation, mistrust in the government or vaccine development is often trivialized as “anti-science.”
One of the most compelling reasonings to refrain from vaccinations entirely, stems from religious beliefs which are distinct from “personal” or philosophical reasons (McKee and Bohannon, 2016). Prior research has investigated links between individuals who are driven by religious assertions and the complete refusal of all vaccines (Dubé, 2014; McKee and Bohannon, 2016). Although colloquial assumptions may consider these choices a by-product of ignorance, the decision to not vaccinate is calculated, intentional and adopted over many years (McKee and Bohannon, 2016). Religious barriers to measles vaccination evaluated different organized religions and reasons that vaccines may violate their religious freedoms (Wombwell et al., 2015). The most common explanation involves specific components of the vaccines. The two largest concerns are with animal-derived gelatin that is used to synthesize certain vaccines as well as the human fetal tissue used in the rubella (Wombwell et al., 2015). For example, “in Judaism there is a supreme value placed on human life and preserving it at all costs; the physician and the patient both have an obligation to provide and seek health so that one can further the practice of the religion and live the life God intended” (Rosner, 1990; Wombwell et al., 2015). Hindu’s medical ethics also stem from a principle of nonviolence and respect for animal life forms; often vegetarianism is an extension of this belief (Wombwell et al., 2015). Additionally, there are several Jewish dietary laws which restrict what can be consumed. These restrictions could be applied to vaccines that contain gelatins, such as both measles vaccine formulations (Wombwell et al., 2015). Furthermore, practicing Catholics believe abortion is immoral (Furton, 2004; Wombwell et al., 2015). Therefore, any involvement with vaccines derived from aborted fetal tissue carries a conflicting moral burden for consumers, marketers, and vaccine producers (The National Catholic Bioethics Quarterly 2006; Wombwell et al., 2015). Social constructs are embedded within each practicing religion and reasons to remain unvaccinated are generally linked to the core beliefs of the parents. Therefore, it is very difficult to dissuade these individuals from views against immunization (McKee and Bohannon, 2016).
In the United States, the laws surrounding school vaccination play a significant role in the control of vaccine preventable diseases. Research compiled from Religious exemptions for immunization and risk of pertussis in New York State found that the increase in school vaccination exemptions were due to religious reasons between 2000 and 2011 (Imdad and Tserenpuntsag, 2000-2011). Although, religious and other exemptions to mandatory vaccination laws are not required by the U.S. Constitution, from a political perspective, requiring all individuals to participate in government mandated vaccination programs infringes on the ethical standards behind informed consent (Ciolli, 2008). In addition, since 100 percent immunization rates are not needed to achieve herd immunity, most state governments make exemptions on mandatory vaccination requirements, believing that communities can successfully obtain herd immunity without the exempt individuals (Ciolli, 2008). Exemptions began to increase in attempts to bypass mandates with religious freedoms as a loophole (McKee and Bohannon, 2016). In response, lawmakers placed guidelines that introduced specific requirements in order for schools to grant religious exemptions (Imdad and Tserenpuntsag, 2000-2011; McKee and Bohannon, 2016). History documents numerous examples of vaccine-preventable outbreaks among religious schools, congregations, and communities further illustrating how clusters of vulnerable people can enable epidemics (Grabenstein, 2013). Therefore, widespread use of these exemptions undermines many of the benefits of mandatory vaccinations, such as preserving herd immunity (Calandrillo , 2004; Ciolli, 2008).
A number of studies have continued to look into the reasons that parents refuse, delay, or are hesitant to vaccinate their child(ren). Research indicates that religious reasons tend to account for the majority of total vaccine refusal, while parents with personal beliefs against immunization tend to be more willing to compromise and at least partially vaccinate their children (McKee and Bohannon, 2016). Conversely, those with genuine religious objections to vaccination do not represent the entire threat to society. Many individuals have sought out exemptions that are not due to genuine beliefs; some are simply too lazy to vaccinate. These individuals may assume that they do not bear the negative costs or harms of losing herd immunity directly (Ciolli, 2008). However, shame, guilt and ‘fitting in’ should not be overlooked. These perceived feelings may also contribute to the decision to vaccinate or not. In my opinion, social stigmas within religious communities have a strong influence on the decision to vaccinate. The adoption of certain religious beliefs, misuse of exemptions, and unregulated misinformation perpetuates vaccine hesitancy. It is unlikely that state governments will eliminate such exemptions entirely since government mandates evoke emotional public debates that oppose freedom of choice against concerns for social welfare (Korn et al., 2020).
Despite the overwhelming evidence of vaccine efficacy, refusal of vaccines is a growing concern for vaccine preventable diseases and in my opinion, educational interventions should be taken (McKee and Bohannon, 2016). However, translating the benefits of herd immunity through mandated vaccination will likely lead to noncompliance in a portion of the population if exemptions are unequally governed and information continues to be unregulated. There are many influences that dictate the decision to vaccinate other than religious assertions. Many individuals distrust the current systems which design and deliver vaccines and may regard vaccines as an unwelcome and unnatural incursion into a ‘natural body’. However, to reduce the likelihood of infectious diseases, individuals must also reflect on obligations to social welfare that go beyond mere self-interest and consider the prospect of getting vaccines (Atwell et al., 2017; Atwell et al., 2018 Dube et al., 2016, Reich, 2016 ).
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