Editing Vaccination (section)

==Vaccination policy==
{{Main|Vaccination policy}}
[[File:DTP-Vaccination-rate-by-US-State-and-exemption-status-1.png|thumb|upright=1.2|Vaccination rate by US state, including exemptions allowed by state in 2017]]
To eliminate the risk of [[Disease outbreak|outbreaks]] of some diseases, at various times governments and other institutions have employed policies requiring vaccination for all people. For example, an 1853 law required universal vaccination against smallpox in England and Wales, with fines levied on people who did not comply.<ref>{{cite book | vauthors = Brunton D |title=The Politics of Vaccination: Practice and Policy in England, Wales, Ireland, and Scotland, 1800–1874 |date=2008 |publisher=University of Rochester Press |page=39}}</ref> Common contemporary U.S. vaccination policies require that children receive recommended vaccinations before entering public school.<ref>{{cite web |title=State Vaccination Requirements |url=https://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=7 December 2019 |date=11 March 2019 |archive-date=2 April 2020 |archive-url=https://web.archive.org/web/20200402194736/https://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html |url-status=live }}</ref>

Beginning with early vaccination in the nineteenth century, these policies were resisted by a variety of groups, collectively called [[antivaccinationist]]s, who object on scientific, ethical, political, medical safety, [[vaccination and religion|religious]], and other grounds.<ref>{{cite journal | vauthors = Tolley K |title=School Vaccination Wars |journal=History of Education Quarterly |date=May 2019 |volume=59 |issue=2 |pages=161–194 |doi=10.1017/heq.2019.3|doi-access=free }}</ref> Common objections are that vaccinations do not work, that compulsory vaccination constitutes excessive government intervention in personal matters, or that the proposed vaccinations are not sufficiently safe.<ref name="wolfesharp">{{cite journal | vauthors = Wolfe RM, Sharp LK | title = Anti-vaccinationists past and present | journal = BMJ | volume = 325 | issue = 7361 | pages = 430–2 | date = August 2002 | pmid = 12193361 | pmc = 1123944 | doi = 10.1136/bmj.325.7361.430 }}</ref> Many modern vaccination policies allow exemptions for people who have compromised immune systems, allergies to the components used in vaccinations or strongly held objections.<ref>{{cite journal | vauthors = Salmon DA, Teret SP, MacIntyre CR, Salisbury D, Burgess MA, Halsey NA | s2cid = 19344405 | title = Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future | journal = Lancet | volume = 367 | issue = 9508 | pages = 436–42 | date = February 2006 | pmid = 16458770 | doi = 10.1016/S0140-6736(06)68144-0 }}</ref>

In countries with limited financial resources, limited vaccination coverage results in greater morbidity and mortality due to infectious disease.<ref>{{cite journal | vauthors = Mhatre SL, Schryer-Roy AM | title = The fallacy of coverage: uncovering disparities to improve immunization rates through evidence. Results from the Canadian International Immunization Initiative Phase 2 – Operational Research Grants | journal = BMC International Health and Human Rights | volume = 9 | issue = S1 | pages = S1 | date = October 2009 | pmid = 19828053 | pmc = 3226229 | doi = 10.1186/1472-698X-9-S1-S1 | doi-access = free }}</ref> More affluent countries are able to subsidize vaccinations for at-risk groups, resulting in more comprehensive and effective coverage. In Australia, for example, the Government subsidizes vaccinations for seniors and indigenous Australians.<ref>{{Cite web|url=http://www.nps.org.au/consumers/publications/medicines_talk/medicinestalk_no._32_summer_2009/time_to_think_about_vaccinations_again |title=Time to think about vaccinations again? |archive-url=https://web.archive.org/web/20110727175547/http://www.nps.org.au/consumers/publications/medicines_talk/medicinestalk_no._32_summer_2009/time_to_think_about_vaccinations_again |archive-date=27 July 2011 |url-status=dead |work=Medicines Talk (No. 32 Summer 2009)|publisher=[[NPS MedicineWise]] |location=Sydney, Australia |date=1 February 2010}}</ref>

Public Health Law Research, an independent US based organization, reported in 2009 that there is insufficient evidence to assess the effectiveness of requiring vaccinations as a condition for specified jobs as a means of reducing incidence of specific diseases among particularly vulnerable populations;<ref>{{cite web |url=http://publichealthlawresearch.org/product/laws-and-policies-requiring-specified-vaccinations-among-high-risk-populations |title=Laws and Policies Requiring Specified Vaccinations among High Risk Populations |publisher=Public Health Law Research |date=7 December 2009 |access-date=19 November 2014 |archive-date=18 November 2017 |archive-url=https://web.archive.org/web/20171118222128/http://publichealthlawresearch.org/product/laws-and-policies-requiring-specified-vaccinations-among-high-risk-populations |url-status=live }}</ref> that there is sufficient evidence supporting the effectiveness of requiring vaccinations as a condition for attending child care facilities and schools;<ref>{{cite web |url=http://publichealthlawresearch.org/product/vaccination-requirements-child-care-school-and-college-attendance |title=Vaccination Requirements for Child Care, School and College Attendance |publisher=Public Health Law Research |date=12 July 2009 |access-date=19 November 2014 |archive-date=18 November 2017 |archive-url=https://web.archive.org/web/20171118222300/http://publichealthlawresearch.org/product/vaccination-requirements-child-care-school-and-college-attendance |url-status=live }}</ref> and that there is strong evidence supporting the effectiveness of standing orders, which allow healthcare workers without prescription authority to administer vaccine as a public health intervention.<ref>{{cite web |url=http://publichealthlawresearch.org/product/standing-orders-vaccination |title=Standing Orders for Vaccination |publisher=Public Health Law Research |date=12 July 2009 |access-date=8 January 2014 |archive-date=18 November 2017 |archive-url=https://web.archive.org/web/20171118222356/http://publichealthlawresearch.org/product/standing-orders-vaccination |url-status=live }}</ref>

=== Fractional dose vaccination ===
[[Fractional dose vaccination]] reduces the dose of a vaccine to allow more individuals to be vaccinated with a given vaccine stock, trading societal benefit for individual protection. Based on the [[Nonlinear system|nonlinearity]] properties of many vaccines, it is effective in poverty diseases<ref>{{Cite journal|date=5 January 2012|title=Intradermal fractional dose inactivated polio vaccine: A review of the literature|url=https://www.sciencedirect.com/science/article/pii/S0264410X11017853|journal=Vaccine|volume=30|issue=2|pages=121–125|doi=10.1016/j.vaccine.2011.11.018|issn=0264-410X|last1=Nelson|first1=Katherine S.|last2=Janssen|first2=Julia M.|last3=Troy|first3=Stephanie B.|last4=Maldonado|first4=Yvonne|pmid=22100886|access-date=18 August 2021|archive-date=26 January 2022|archive-url=https://web.archive.org/web/20220126062155/https://www.sciencedirect.com/science/article/pii/S0264410X11017853|url-status=live}}</ref> and promises benefits in pandemic waves, e.g. in [[COVID-19]],<ref>{{Cite journal|vauthors=Hunziker P|date=24 July 2021|title=Personalized-dose Covid-19 vaccination in a wave of virus Variants of Concern: Trading individual efficacy for societal benefit|url=https://precisionnanomedicine.com/article/26101-personalized-dose-covid-19-vaccination-in-a-wave-of-virus-variants-of-concern-trading-individual-efficacy-for-societal-benefit|journal=Precision Nanomedicine|volume=4|issue=3|pages=805–820|doi=10.33218/001c.26101|doi-access=free|access-date=18 August 2021|archive-date=9 October 2021|archive-url=https://web.archive.org/web/20211009194402/https://precisionnanomedicine.com/article/26101-personalized-dose-covid-19-vaccination-in-a-wave-of-virus-variants-of-concern-trading-individual-efficacy-for-societal-benefit|url-status=live}}</ref> when vaccine supply is limited.

=== Litigation ===
Allegations of vaccine injuries in recent decades have appeared in litigation in the U.S. Some families have won substantial awards from sympathetic juries, even though most [[public health]] officials have said that the claims of injuries were unfounded.<ref name="Sugarman">{{cite journal | vauthors = Sugarman SD | title = Cases in vaccine court—legal battles over vaccines and autism | journal = The New England Journal of Medicine | volume = 357 | issue = 13 | pages = 1275–7 | date = September 2007 | pmid = 17898095 | doi = 10.1056/NEJMp078168 | doi-access = free }}</ref> In response, several vaccine makers stopped production, which the US government believed could be a threat to [[public health]], so laws were passed to shield manufacturers from [[Legal liability|liabilities]] stemming from vaccine injury claims.<ref name="Sugarman" /> The safety and side effects of multiple vaccines have been tested to uphold the viability of vaccines as a barrier against disease. The [[influenza vaccine]] was tested in controlled trials and proven to have negligible side effects equal to that of a [[placebo]].<ref>{{cite journal | vauthors = Nichol KL, Margolis KL, Lind A, Murdoch M, McFadden R, Hauge M, Magnan S, Drake M | title = Side effects associated with influenza vaccination in healthy working adults. A randomized, placebo-controlled trial | journal = Archives of Internal Medicine | volume = 156 | issue = 14 | pages = 1546–50 | date = July 1996 | pmid = 8687262 | doi = 10.1001/archinte.1996.00440130090009 }}</ref> Some concerns from families might have arisen from social beliefs and norms that cause them to [[Vaccine hesitancy|mistrust or refuse vaccinations]], contributing to this discrepancy in side effects that were unfounded.<ref>{{cite journal | vauthors = Oraby T, Thampi V, Bauch CT | title = The influence of social norms on the dynamics of vaccinating behaviour for paediatric infectious diseases | journal = Proceedings. Biological Sciences | volume = 281 | issue = 1780 | pages = 20133172 | date = April 2014 | pmid = 24523276 | pmc = 4078885 | doi = 10.1098/rspb.2013.3172 }}</ref>

===Opposition===
[[File:Global trend in believing vaccines are not safe.png|thumb|upright=1.75|Global survey across 67 countries responding to the question: "Overall I think vaccines are safe". This image depicts the distribution of responses that replied "Strongly disagree" or "Tend to disagree" with the previous statement.<ref>{{cite journal | vauthors = Larson HJ, de Figueiredo A, Xiahong Z, Schulz WS, Verger P, Johnston IG, Cook AR, Jones NS | title = The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey | journal = eBioMedicine | volume = 12 | pages = 295–301 | date = October 2016 | pmid = 27658738 | pmc = 5078590 | doi = 10.1016/j.ebiom.2016.08.042 }}</ref>]]
{{main|Vaccine hesitancy}}
Opposition to vaccination, from a wide array of vaccine critics, has existed since the earliest vaccination campaigns.<ref name=wolfesharp/> It is widely accepted that the benefits of preventing serious illness and death from [[infectious disease]]s greatly outweigh the risks of rare serious [[adverse effect (medicine)|adverse effects]] following [[immunization]].<ref name="BH">{{cite journal | vauthors = Bonhoeffer J, Heininger U | s2cid = 40669829 | title = Adverse events following immunization: perception and evidence | journal = Current Opinion in Infectious Diseases | volume = 20 | issue = 3 | pages = 237–46 | date = June 2007 | pmid = 17471032 | doi = 10.1097/QCO.0b013e32811ebfb0 }}</ref> Some studies have claimed to show that current vaccine schedules increase infant mortality and hospitalization rates;<ref>{{cite journal | vauthors = Miller NZ, Goldman GS | title = Infant mortality rates regressed against number of vaccine doses routinely given: is there a biochemical or synergistic toxicity? | journal = Human & Experimental Toxicology | volume = 30 | issue = 9 | pages = 1420–8 | date = September 2011 | pmid = 21543527 | pmc = 3170075 | doi = 10.1177/0960327111407644 | bibcode = 2011HETox..30.1420M }}</ref><ref>{{cite journal | vauthors = Goldman GS, Miller NZ | title = Relative trends in hospitalizations and mortality among infants by the number of vaccine doses and age, based on the Vaccine Adverse Event Reporting System (VAERS), 1990–2010 | journal = Human & Experimental Toxicology | volume = 31 | issue = 10 | pages = 1012–21 | date = October 2012 | pmid = 22531966 | pmc = 3547435 | doi = 10.1177/0960327112440111 | bibcode = 2012HETox..31.1012G }}</ref> those studies, however, are correlational in nature and therefore cannot demonstrate causal effects, and the studies have also been criticized for [[cherry picking]] the comparisons they report, for ignoring historical trends that support an opposing conclusion, and for counting vaccines in a manner that is "completely arbitrary and riddled with mistakes".<ref name="Science Mom">{{cite web |last1=Science Mom |first1=Catherina |title=Infant mortality and vaccines |url=http://justthevax.blogspot.com/2011/05/oh-goodness-here-i-wanted-to-go-to-bed.html |website=Just The Vax |publisher=Blogspot.com |access-date=10 October 2019 |date=9 May 2011 |archive-date=10 October 2019 |archive-url=https://web.archive.org/web/20191010150149/http://justthevax.blogspot.com/2011/05/oh-goodness-here-i-wanted-to-go-to-bed.html |url-status=live }}</ref><ref name="Gorski">{{Cite journal |last1=Miller |first1=N. |last2=Goldman |first2=G. |date=2011 |title=Infant mortality rates regressed against number of vaccine doses routinely given: Is there a biochemical or synergistic toxicity? |url=https://scienceblogs.com/insolence/2011/05/16/vaccines-and-infant-mortality-rates |journal=Human & Experimental Toxicology |volume=30 |issue=9 |pages=1420–1428 |doi=10.1177/0960327111407644 |issn=0960-3271 |access-date=10 October 2019 |archive-date=26 January 2022 |archive-url=https://web.archive.org/web/20220126065905/https://scienceblogs.com/insolence/2011/05/16/vaccines-and-infant-mortality-rates |url-status=live |doi-access=free |pmid=21543527 |pmc=3170075 |bibcode=2011HETox..30.1420M }}</ref>

Various disputes have arisen over the morality, ethics, [[Efficacy|effectiveness]], and safety of vaccination. Some vaccination critics say that vaccines are ineffective against disease<ref name="Halvorsen">{{cite book | vauthors = Halvorsen R |title=The Truth about Vaccines |publisher=Gibson Square |year=2007 |isbn=978-1-903933-92-3}}</ref> or that vaccine safety studies are inadequate.<ref name="Halvorsen" /> Some religious groups do not allow vaccination,<ref>{{cite journal | vauthors = Sinal SH, Cabinum-Foeller E, Socolar R | s2cid = 29738930 | title = Religion and medical neglect | journal = Southern Medical Journal | volume = 101 | issue = 7 | pages = 703–6 | date = July 2008 | pmid = 18580731 | doi = 10.1097/SMJ.0b013e31817997c9 }}</ref> and some political groups oppose mandatory vaccination on the grounds of [[Liberty|individual liberty]].<ref name=wolfesharp/> In response, concern has been raised that spreading [[Disinformation|unfounded information]] about the medical risks of vaccines increases rates of life-threatening infections, not only in the children whose parents refused vaccinations, but also in those who cannot be vaccinated due to age or immunodeficiency, who could contract infections from unvaccinated carriers (see [[herd immunity]]).<ref>{{cite journal | vauthors = Omer SB, Salmon DA, Orenstein WA, deHart MP, Halsey N | title = Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases | journal = [[The New England Journal of Medicine]] | volume = 360 | issue = 19 | pages = 1981–8 | date = May 2009 | pmid = 19420367 | doi = 10.1056/NEJMsa0806477 | s2cid = 5353949 | doi-access = free }}</ref> Some parents believe vaccinations cause [[autism]], although there is no scientific evidence to support this idea.<ref>{{cite journal | vauthors = Gross L | title = A broken trust: lessons from the vaccine--autism wars | journal = PLOS Biology | volume = 7 | issue = 5 | pages = e1000114 | date = May 2009 | pmid = 19478850 | pmc = 2682483 | doi = 10.1371/journal.pbio.1000114 | doi-access = free }}</ref> In 2011, [[Andrew Wakefield]], a leading proponent of the [[MMR-autism myth|theory that MMR vaccine causes autism]], was found to have been financially motivated to falsify research data and was subsequently stripped of his [[medical license]].<ref>{{cite news |url=http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/index.html |title=Retracted autism study an 'elaborate fraud,' British journal finds |publisher=CNN.com |date=6 January 2011 |access-date=26 April 2013 |archive-date=4 January 2018 |archive-url=https://web.archive.org/web/20180104085313/http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/index.html |url-status=live }}</ref> In the United States people who refuse vaccines for non-medical reasons have made up a large percentage of the cases of [[measles]], and subsequent cases of permanent hearing loss and death caused by the disease.<ref>{{cite journal | vauthors = Phadke VK, Bednarczyk RA, Salmon DA, Omer SB | title = Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States: A Review of Measles and Pertussis | journal = [[JAMA (journal)|JAMA]] | volume = 315 | issue = 11 | pages = 1149–58 | date = March 2016 | pmid = 26978210 | pmc = 5007135 | doi = 10.1001/jama.2016.1353 }}</ref>

Many parents do not vaccinate their children because they feel that diseases are no longer present due to vaccination.<ref>{{cite press release |url=https://www.who.int/immunization/newsroom/events/immunization_week/2012/further_information/en/|archive-url=https://web.archive.org/web/20130921020026/http://www.who.int/immunization/newsroom/events/immunization_week/2012/further_information/en/|url-status=dead|archive-date=21 September 2013|title=WHO – World Immunization Week 2012|website=[[World Health Organization]] (WHO) }}</ref> This is a false assumption, since diseases held in check by immunization programs can and do still return if immunization is dropped. These pathogens could possibly infect vaccinated people, due to the pathogen's ability to mutate when it is able to live in unvaccinated hosts.<ref>{{Cite web |url=https://io9.gizmodo.com/how-poor-vaccination-rates-can-help-viruses-beat-the-va-1492482862 |title=Why anti-vaxxers might be creating a world of more dangerous viruses |vauthors=Inglis-Arkell E |website=io9 |date=January 2014 |access-date=10 June 2019 |archive-date=13 July 2019 |archive-url=https://web.archive.org/web/20190713192201/https://io9.gizmodo.com/how-poor-vaccination-rates-can-help-viruses-beat-the-va-1492482862 |url-status=live }}</ref><ref>{{Cite web|url=https://www.contagionlive.com/news/pertussis-and-other-diseases-could-return-if-vaccination-rates-lag|title=Pertussis and Other Diseases Could Return If Vaccination Rates Lag|website=ContagionLive|date=26 March 2019 |access-date=10 June 2019|archive-date=26 March 2019|archive-url=https://web.archive.org/web/20190326195203/https://www.contagionlive.com/news/pertussis-and-other-diseases-could-return-if-vaccination-rates-lag|url-status=live}}</ref>

====Vaccination and autism====
{{Main|Vaccines and autism}}

The notion of a connection between vaccines and autism originated in a 1998 paper whose lead author was the physician [[Andrew Wakefield]]. His study concluded that eight of the twelve patients, aged three years of age to 10 years of age, developed behavioral symptoms consistent with autism following the administration of the [[MMR vaccine]] (an immunization against [[measles]], [[mumps]], and [[rubella]]).<ref name="Wakefield">{{cite journal | vauthors = Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA | s2cid = 439791 | title = Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children | journal = Lancet | volume = 351 | issue = 9103 | pages = 637–41 | date = February 1998 | pmid = 9500320 | doi = 10.1016/S0140-6736(97)11096-0 | url = http://briandeer.com/mmr/lancet-paper.htm | author-link1 = Andrew Wakefield | access-date = 5 February 2012 | archive-date = 27 September 2007 | archive-url = https://web.archive.org/web/20070927010149/http://briandeer.com/mmr/lancet-paper.htm | url-status = live }}{{Retracted|doi=10.1016/S0140-6736(10)60175-4|pmid=20137807|http://retractionwatch.com/the-retraction-watch-leaderboard/top-10-most-highly-cited-retracted-papers/ ''Retraction Watch''|http://retractionwatch.com/2015/02/03/frauds-long-tail-measles-outbreak-shows-important-look-downstream-retractions/ ''Retraction Watch''|intentional=yes}}</ref> The article was widely criticized for lack of scientific rigor and it was proven that Wakefield falsified data in the article.<ref name="Wakefield" /> In 2004, 10 of the original 12 co-authors (not including Wakefield) published a [[Retraction in academic publishing|retraction]] of the article and stated the following: "We wish to make it clear that in this paper no causal link was established between MMR vaccine and autism as the data were insufficient."<ref>{{cite journal | vauthors = Murch SH, Anthony A, Casson DH, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Valentine A, Davies SE, Walker-Smith JA | s2cid = 5128036 | title = Retraction of an interpretation | journal = Lancet | volume = 363 | issue = 9411 | pages = 750 | date = March 2004 | pmid = 15016483 | doi = 10.1016/S0140-6736(04)15715-2 }}</ref> In 2010, ''[[The Lancet]]'' officially retracted the article, stating that several elements of the article were incorrect, including falsified data and protocols. The article has sparked a much greater anti-vaccination movement, particularly in the United States, and even though the article was shown to be fraudulent and was heavily retracted, one in four parents still believe that vaccines can cause autism.<ref>{{cite journal | vauthors = Daley MF, Glanz JM | title = Straight talk about vaccination | journal = Scientific American | volume = 305 | issue = 3 | pages = 32–34 | date = September 2011 | pmid = 21870438 | doi = 10.1038/scientificamerican0911-32 | bibcode = 2011SciAm.305b..32D }}</ref>

All validated and definitive studies have shown that there is no correlation between vaccines and autism.<ref>{{Cite web|url=https://www.cdc.gov/vaccinesafety/concerns/autism.html|title=Vaccines Do Not Cause Autism Concerns Vaccine Safety CDC|date=6 February 2019|website=U.S. [[Centers for Disease Control and Prevention]] (CDC)|access-date=22 March 2019|archive-date=16 March 2017|archive-url=https://web.archive.org/web/20170316105455/https://www.cdc.gov/vaccinesafety/concerns/autism.html|url-status=live}}</ref> One of the studies published in 2015 confirms there is no link between [[MMR vaccine and autism|autism and the MMR vaccine]]. Infants were given a health plan, that included an MMR vaccine, and were continuously studied until they reached five years old. There was no link between the vaccine and children who had a normally developed sibling or a sibling that had autism making them a higher risk for developing autism themselves.<ref>{{cite journal | vauthors = Jain A, Marshall J, Buikema A, Bancroft T, Kelly JP, Newschaffer CJ | title = Autism occurrence by MMR vaccine status among US children with older siblings with and without autism | journal = JAMA | volume = 313 | issue = 15 | pages = 1534–40 | date = April 2015 | pmid = 25898051 | doi = 10.1001/jama.2015.3077 | doi-access = free }}</ref>

It can be difficult to correct the memory of humans when wrong information is received prior to correct information. Even though there is much evidence to go against the Wakefield study and retractions were published by most of the co-authors, many people continue to believe and base decisions on the study as it still lingers in their memory. Studies and research are being conducted to determine effective ways to correct [[misinformation]] in the [[public memory]].<ref>{{cite journal | vauthors = Pluviano S, Watt C, Della Sala S | title = Misinformation lingers in memory: Failure of three pro-vaccination strategies | journal = PLOS ONE | volume = 12 | issue = 7 | pages = e0181640 | date = 27 July 2017 | pmid = 28749996 | pmc = 5547702 | doi = 10.1371/journal.pone.0181640 | bibcode = 2017PLoSO..1281640P | doi-access = free }}</ref>