The Outbreak or the Vaccine? Which (Should) Come First?

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By Rachel Hoffman

In 2000, the United States declared that measles had been eradicated within the country. Since that time, over 1,000 cases of measles have been reported domestically, with the majority occurring in 2014. In Pennsylvania alone there have been 11 reports of measles since 2009. Likewise, case reports of other vaccine-preventable illnesses such as mumps, pertussis (whooping cough), polio and rubella have been increasing at alarming rates in the United States. So why is it that despite available vaccines for these diseases, incidence rates are increasing? Are vaccines are too costly, unavailable or simply ineffective?

Currently, under the Affordable Care Act, insurance companies are required to cover the cost of preventative services such as vaccines. If a scheduled doctor’s appointment is solely for the purpose of administering vaccines, most insurance plans will cover the entire cost of the visit. Furthermore, if a child is not insured or is underinsured, the Vaccines for Children (VFC) program may cover the cost of recommended vaccines. For more information on qualifications and access, visit the VFC program website at https://www.cdc.gov/vaccines/programs/vfc/index.html.

Children and adults can receive vaccinations at doctors’ offices, hospitals, clinics and community pharmacies. As community pharmacies are often the most accessible and often do not require an appointment, they provide prime opportunity to get vaccinated. In the state of Pennsylvania, pharmacists can administer the influenza vaccine to children 9 years of age and older with parental consent, and all other immunizations to those 18 years of age and older. The Pennsylvania Pharmacists Association will be advocating for legislation later this year to allow pharmacists to be able to provide all immunizations to patients nine years and older. Most pharmacies in Pennsylvania offer the tetanus, diphtheria and pertussis (Tdap) and measles, mumps and rubella (MMR) vaccine without a prescription.

There are numerous credible scientific studies proving that vaccines available today are safe and effective at preventing infectious disease. Vaccine development typically endures 10-15 years of research before approval by the US Food and Drug Administration (FDA). The Centers for Disease Control and Prevention (CDC) recommends routine vaccination for 17 preventable diseases that can occur in adults and children. The Advisory Committee on Immunization Practices (ACIP; the group within the CDC that issues vaccine schedules and recommendations) states that approximately 90-95% of children develop protective antibodies against diseases such as measles and rubella within 14 days after a single dose of the live vaccine. A total of 80-85% of recipients are protected against varicella and mumps after a single dose of their respective vaccines.

With vaccines widely available, affordable and effective, there still remain outbreaks of these diseases. Failure to vaccinate stems from a variety of different reasons, including religious or personal beliefs. Vaccine hesitancy, or the delay/refusal of vaccination despite available services, significantly increases the risk of an outbreak. It is important for parents to know that not vaccinating their child puts them at a much higher risk of developing these preventable illnesses. Additionally, those who develop contagious illnesses may spread them to others who are unvaccinated or immunocompromised. The majority of people who contracted measles in the 2014 outbreak were unvaccinated, including largely unvaccinated Amish communities in Ohio.

A recent well-known example is the measles outbreak at Disneyland in California. In February 2015, a total of 125 cases of measles had been reported in relation to this outbreak. Those infected included residents from California, Arizona, Colorado, Nebraska, Oregon, Utah, Washington, Mexico, and Canada. Among the 110 California patients, 45% were not vaccinated, 5% had 1 dose of the vaccine, 6% had 2 doses, 1% had 3 doses, and 47% had unknown vaccination status. The source of the original exposure at Disneyland has not been identified, but the risk to the public is plainly evident. Research suggests that sharing news of disease outbreaks is one of the most effective ways to increase vaccination rates, compared to vaccine education or promotion. In a study by Emily Oster, a professor of economics at Brown University, it was found that children were more likely to get vaccinated after an outbreak. Specifically, after an outbreak of pertussis in one county the number of unvaccinated children decreased by about 28%.

Vaccines are available, affordable and proven to be safe and efficacious. The spread of preventable illnesses such as measles, mumps and pertussis presents a health risk to the entire public. The more people that are vaccinated, the less risk there is of an outbreak occurring and the greater the possibility of complete disease eradication. For more information, visit https://www.cdc.gov/vaccines/index.html.

References:

  1. Council on Foreign Relations. Vaccine preventable outbreaks. http://www.cfr.org/interactives/GH_Vaccine_Map/#map
  2. CDC. Vaccines and immunizations. https://www.cdc.gov/vaccines/index.html
  3. Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA. Vaccine hesitancy:  An overview. Human Vaccines & Immunotherapeutics. 2013;9(8):1763-1773.
  4. Phadke VK, Bednarczyk RA, Salmon DA, Omer SB. Association between vaccine refusal and vaccine-preventable diseases in the United States: a review of measles and pertussis. JAMA. 2016;315(11):1149-1158.
  5. Immunization Action Coalition. Vaccine information you need. http://www.vaccineinformation.org/health-coverage-vaccines/
  6. Pennsylvania Pharmacists Association. Toolkit: laws and regulations. http://www.papharmacists.com/?page=LawsandRegulations
  7. Jena AB, Khullar D. To increase vaccination rates, share information on disease outbreaks. Harvard Business Review. 2/22/2017. https://hbr.org/2017/02/to-increase-vaccination-rates-share-information-on-disease-outbreaks

This article was written by Rachel Hoffman, student pharmacist at Duquesne University School of Pharmacy, and reviewed by her faculty advisor, Dr. Jordan Covvey.

Rachel is a fifth-year pharmacy student. She is actively involved in several pharmacy organizations on campus and works as a pharmacy intern at a local hospital. After graduation, Rachel plans on pursuing a postgraduate pharmacy residency and possibly later specialization in infectious disease.

Dr. Covvey is an Assistant Professor in Pharmacy Administration at the Duquesne University School of Pharmacy. She earned her Doctor of Pharmacy from the University of Kentucky in 2010, and then completed residency training at Virginia Commonwealth University Health System in 2011. She subsequently passed her board certification in pharmacotherapy (BCPS) and was selected as a recipient of a Fulbright grant to complete a Doctor of Philosophy at the University of Strathclyde Institute of Pharmacy and Biomedical Sciences in Scotland. She currently teaches in the public and global health curriculum for pharmacy students at Duquesne, and her research area is in the utilization of healthcare data, such as electronic medical records, for quality improvement in prescribing.