Running head: IMMUNIZATIONS 1

Immunizations

Their Impact on Global Health

Delaware Technical Community College

NUR 310 Global Health

Reneé S. Smallwood

December 3, 2017
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Abstract

This paper explores immunizations and their impact on global health. Vaccinations are available

in different countries around the world from newborns to the elderly. According to the CDC,

there are 16 vaccine preventable diseases currently including Measles, Mumps, Rubella,

Varicella, Influenza, Rotavirus, Polio, Hep A, Diphtheria, and Tetanus (DTaP). In addition to

Hep A, Hep B, Haemophilus influenza, Pneumococcal, Meningococcal, Whooping cough

(pertussis) and HPV (Roper, 2014). Vaccine administrations have kept communicable diseases

under control and prevented epidemics that risk fatal outcomes. As developing countries try to

improve their health care system many people are not able to get vaccines and are at a higher risk

of contracting a disease like meningitis, measles, or hepatitis. This paper will reference Frieden

Health Impact Pyramid from most significant impact to the smallest effect and later examine the

impact healthcare providers can have on global health.

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Immunizations

There are multiple vaccines available around the world that protect from infectious

pathogens and diseases. Many are designated as part of a routine childhood vaccination schedule

(Glatman-Freedman & Nichols, 2012). When given in childhood, vaccines have many benefits

with the most critical being saving a child’s life (HHS, n.d.). According to UNICEF (n.d.),

bacteria, viruses, and parasites are responsible for significant childhood diseases like tetanus,

diphtheria, TB, and pertussis. Children are known not to have the most healthy immune systems

leaving them vulnerable to infections and diseases. Children with diseases may become

extremely ill and infect those around them. Immunizations protect people and others, are safe

and effective, save time and money, and protect future generations (HHS, n.d.). A significant

portion of childhood mortalities has been found in low-income countries (Glatman-Freedman &

Nichols, 2012).

Global Health Impact

Low- income countries have a higher burden of disease that is vaccine preventable. Low-

income countries face a high burden of diseases as a result of low vaccine supplies or shortages

and poor funding (Glatman-Freedman & Nichols, 2012). As underdeveloped countries work to

improve their health care system people are dying every day from preventable diseases (HHS,

n.d). Though non-vaccinations are killing the population due to the inadequate healthcare

system, there are also many people who refuse to vaccinate because of religious beliefs, lack of

education, and personal choice.

Educated parents are associated with higher childhood immunizations (WHO, 2016). A

few studies completed on the effect of education on men and women concluded higher education

allows for healthy behavior including childhood immunizations (WHO, 2016). Many parents in
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underdeveloped countries lack the knowledge to weigh out the risk and benefits of vaccines and

long-term health. In addition to education, religious belief interferes with controlling and

preventing the spread of vaccine prevented diseases as with the Muslim culture, one of the most

general populations in the world (DeSilver & Masci, 2017). “Certain religious leaders have cited

vaccines as a sin against God” (Glatman-Freedman & Nichols, 2012). The Muslim culture often

does not vaccinate because of their restriction to eat pork and their commitment to their holy

bible known as the Quran. The Quran states, “God allows us to enjoy all the good, lawful things

and forbids us to partake of those things that are harmful to our beliefs, health, well-being, or

morals” (Stacey, 2011). The intake of pork and pork containing products is considered unhealthy

and a sin if consumed by a Muslim (Stacey, 2011). Vaccines like influenza, measles, MMR,

varicella, and DTaP contain gelatin, a product made from pork (Johnson, 2013), deterring these

individuals away from the vaccine. Many religious groups “respect” their leader's opinion, but

in the end, they are putting themselves, their family and loved ones at risk by not being

immunized. Muslim have lower immunization rates because of alienation from society (WHO,

2016). Islam makes up the second largest religious group in the world with an estimated 1.6

billion as of 2010 (DeSilver & Masci, 2017). As a group often seen around the world, Muslims

impact global health as they continue to isolate and deny vaccines. Defined as, “behavior and

beliefs that are learned and shared” (Skolnik, 2016), culture plays a significant part in

immunizations worldwide.

Framework

If addressed appropriately, critical health issues could reduce the leading cause of

preventable deaths and illnesses drastically (Roper, 2014). The availability of clean water and a

rapid decline in infectious diseases has increased the life expectancy by an average of 20 years in
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the United States and parts of Europe (Frieden, 2010). Many health impact modules have been

proposed but only focus on health infrastructure and service and delivery of clinical health

(Frieden, 2010). “Although these are critical importance, public health involves far more than

health care” (Frieden, 2010). The operation, fundamentals composition, organization of society

are often unnoticed. Current health impact frameworks fail to define the essential elements or the

role of public health (Frieden, 2010).

The Health Impact Pyramid

The public health pyramid explores the impact of the variety of public health

interventions that provide an outline for improving health. These impacts range from

socioeconomic factors to clinical responses to recommendations that may allow more people to

get vaccinated (Frieden, 2010). Frieden’s 5 tier health impact pyramid was established to

implement interventions that discuss long-term protection, ongoing direct clinical care,

counseling and education and overall to improve health (Frieden, 2010). These 5- tiers will be

referenced as they apply to immunizations and the global health impact.

Socioeconomic factors. When vaccines and healthcare are not available, social

determinants appear to play a significant role (Belardo, 2015). The environment, safety,

education, nutritional status, religion, and socioeconomic status are a few that play a role in

health determinants about immunizations (Skolnik, 2016). Immigrant groups are currently living

in middle and high-income countries and if under-immunized may contribute to disease

outbreaks (Belardo, 2015). Many people in underdeveloped countries do not have the resources

or access to health care to pay for vaccines for themselves or their family. Household living

conditions and vaccine rates were found to be limited in low-income countries (Glatman-

Freedman & Nichols, 2012). Families with better housing are more likely to have their child(ren)
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vaccinated. Income is a vital part of health care. Indirect cost and transportation to clinics are

bearable in households with higher income (Glatman-Freedman & Nichols, 2012). Health and

culture are often linked together, and what is often perceived as an unacceptable cultural practice

for some, it is considered an adaption to others (Skolnik, 2016). Immunizations are highly

significant in countries like the United States to prevent the spread of diseases, but on the other

hand in Africa, a child with measles is considered healthy because of the high incidences of the

disease (Skolnik, 2016). A household in Uganda, Africa is often led by the father who makes

decisions about family participation in government programs even though the mothers are

considered the primary caregivers of children (Glatman-Freedman & Nichols, 2012). The father's

choices and objections are a barrier identified in partaking in immunization programs (Glatman-

Freedman & Nichols, 2012). Compared to women in high-income countries women in low-

income countries depend on men “socially, economically, and culturally, and are at a

disadvantage…” (Glatman-Freedman & Nichols, 2012). Women’s role and power affect child

vaccines because of social support and education, and social support mold attitudes toward the

care of children and their health (Glatman-Freedman & Nichols, 2012).

Changing the context to encourage health decisions. New laws in Germany make it

mandatory for all children to receive their immunizations before entering kindergarten (Scutti,

2017). Germany is trying to keep their children safe and prevent the spread of diseases or viruses

like measles that have seen a recent increase in outbreaks since May 2017 (Scutti, 2017). The

United States and Australia mandate immunization before starting school, but in the U.S., there

is an exception for medical, religious, and ethical beliefs (Scutti, 2017). Most insurance

companies cover vaccines. The state of Delaware offers free vaccines to children between the

ages of 0-18 years who are uninsured, have Medicaid, underinsured, and Native American or
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Alaskan Native (DHSS, 2017). Free vaccines for all children between the ages of 0-18 and the

vulnerable like the elderly is an alternative to fighting infectious diseases and epidemics. As

previously mentioned, due to the Muslim culture belief of not intaking pork or pork containing

products, a possible organic vaccine can be researched and trialed for effectiveness. Clinical

trials are currently being done on natural alternatives for vaccines for parents against vaccines

due to their additives (Carmen, n.d.). Vaccine avoidance can lead to inadequate immunization

rates in addition to the increased occurrence “of vaccine-preventable diseases, resulting in

significant and potentially tragic consequences to the societies in which these children

live”(Belardo, 2015).

Long-lasting protective interventions. According to Healthy People 2020, “health starts

in our homes, schools, workplaces, neighborhoods, and communities” (Healthy People, 2017).

Many diseases have been reduced or eliminated that at one point killed or disabled people a few

years ago (HHS, n.d.). Because of parents against vaccines, measles and pertussis have been on

the rise in children in the U.S. (HHS, n.d.). Vaccinating on the immunization schedule is

recommended (HHS, n.d.). Vaccine boosters are available for lifelong immunity because of the

weakened immunes system memory (Vaccine Center, 2017). Titers are available to check how

much antibodies are in the blood and an individual’s immunity to the disease (Vaccine Center,

2017). Also, titers are an alternative if there is a concern about too many vaccines and if they are

useful.

Clinical Interventions. Vaccine hesitancy requires ongoing monitoring due to its global

difficulty and the rapid global problem (WHO, 2016). The World Health Organization defines

vaccine hesitancy as the,“… delay in acceptance or refusal of vaccines despite the availability of

vaccination services. Vaccine hesitancy is complex and context-specific varying across time,
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place and vaccines. It includes factors such as complacency, convenience, and confidence”

(WHO, 2016). Survey questionnaires have been utilized to determine the risk and uncertainty

amongst those who are not vaccinated (WHO, 2016). Questionnaires will decide if the child is at

risk of contracting or spreading a highly contagious disease like meningitis. Many Latin

countries offer incentives for vaccines and well-visit checkups (Skolnik, 2016). Money can make

people agree to participate in programs like vaccine programs and the participant and society

benefits as a result.

Counseling and Education. Vaccine programs have been a success at the global level

and in public health (Miller & Sentz, 2006). Though a significant amount of effort has been

made in vaccination development and administrations throughout the world, many countries,

mainly developing countries, struggle with immunizing their children (Miller & Sentz, 2006).

Education appears to take priority in decreasing the occurrence of widespread diseases from

happening. Although the spread of some diseases like polio, measles, and mumps have declined

due to the development of vaccines, family and education of an individual also impact

immunizations. The growing anti-vaccine movement has hurt individual and population-level

health (Belardo, 2015). The decade's old measles vaccine is associated with autism leading to a

decrease in the measles vaccine (Belardo, 2015). Anti-vaccine movements have become

“weapons of mass distraction” regarding education on the risk and benefits of the vaccine

(Berlardo, 2015). No causes about the MMR vaccine and autism have yet to be confirmed, yet

parents remain concerned about the safety of vaccines (Berlardo, 2015). Adopting a plan that

figures out why parents are opposed to vaccines besides becoming autistic will assist in tackling

this determinant in global health.

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Immunizations are vital to overall health now and in the future. Many determinants

impact whether a child receives a vaccine or not. It is recommended to communicate with

parents to maintain trust because vaccine safety is a concern for most parents (Roper, 2014).

Communication allows for matters to be expressed and to establish a rapport. Personal accounts

from peers or healthcare professionals could be persuasive too. Reinforcing the social norm

around vaccinations can be beneficial (Roper, 2014). If vaccines were considered a “social

norm” it may encourage people to want to be vaccinated (Scutti, 2017). Childhood

immunizations rely on multiple factors with social determinants affecting immunizations

programs around the world (Glatman-Freedman & Nichols, 2012). Globalization and

communication ease these effects resulting in a reduction and stopping the spread of diseases

leading to lower death rates (Glatman-Freedman & Nichols, 2012). Healthcare can assist to

impact and improve health worldwide.

Training of healthcare workers can be initiated to empower them to address vaccine

hesitancy. Educating younger individuals about vaccines can alter future beliefs about vaccines

and behavior (WHO, 2016). Involving nontraditional/trusted providers like fire department

medics or pharmacist will help sustain the system (Roper, 2014). The pharmacist can be utilized

as immunizers as part of medical home neighborhoods and fire department medics in

underserved communities. The nontraditional staff will be available on weekends and after hours

and prove to be a safe place for a lot of families (Roper, 2014). With full involvement of the

community, a fight can be made to decrease the burden of disease and determinates impacting

immunization and global health.

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Conclusion

Immunizations have been around for decades and are administrated to protect us from

deadly diseases. Developing countries suffer from a weak and inadequate health care system

making them more susceptible to vaccine-preventable diseases. Vaccine shortages in these

countries also prevent proper protection in these underdeveloped countries. Many anti-vaccine

groups are developing in middle and higher income countries putting children and societies at

risk. A health pyramid framework was designed by Thomas Friedan as an outline to improve

health and supply an appropriate variety of public health interventions. With this health outline,

the help of the community, and support of health care providers will get the world close to

sustaining health for ourselves and future generations.

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References

2020, H. P. (2017, October 30). Social Determinants of Health. Retrieved from Healthy People

2020: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-

of-health

Belardo, R. A. (2015). Mother & Child Health Coalition. Retrieved from Social Determinants of

Health: https://mchc.net/programs/

Carmen. (n.d.). Natural Vaccination Alternatives For You And Your Kids. Retrieved from Off

The Grid News: http://www.offthegridnews.com/alternative-health/natural-vaccination-

alternatives-for-you-and-your-kids/

Center, V. (2017). The Vaccine Center Offers Blood Titers. Retrieved from Vaccine Center:

https://www.vaccinecenter.com/blood-titers/

DeSilver, D., & Masci, D. (2017, January 31). World’s Muslim population more widespread than

you might think. Retrieved from Pew Research Center: http://www.pewresearch.org/fact-

tank/2017/01/31/worlds-muslim-population-more-widespread-than-you-might-think/

Frieden, T. R. (2010, April). A Framework for Public Health Action: The Health Impact

Pyramid. American Journal of Public Health, 100(4), 590-596. Retrieved from American

Journal of Public Health.

Glatman-Freedman, A., & Nichols, K. A. (2012, February 13). Taylor & Francis Online.

Retrieved from The effect of social determinants on immunization programs:

http://www.tandfonline.com/doi/full/10.4161/hv.19003
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Johnson, K. (2013, November 21). Flu Vaccine Allergy May Be Attributed to Gelatin, Not Egg.

Retrieved from Medscape: https://www.medscape.com/viewarticle/814826

Miller, M. A., & Sentz., J. T. (2006). Vaccine-Preventable Diseases. Retrieved from National

Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/books/NBK2284/

Organization, W. H. (2016, June 7). Addressing Vaccine Hesitancy. Retrieved from World

Health Organization:

http://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/

Orginazation, W. H. (2016, November 11). Immunization, Vaccines, and Biologicals. Retrieved

from Estimates of disease burden and cost-effectiveness:

http://www.who.int/immunization/monitoring_surveillance/burden/estimates/en/

Roper, A. (2014). Healthy People 2020: Who's Leading the Leading Health Indicators?

Retrieved from Healthy People 2020:

https://www.healthypeople.gov/sites/default/files/HP2020_LeadingHealthIndicators_CPS

_2.pdf

Scutti, S. (2017, June 6). How countries around the world try to encourage vaccination.

Retrieved from CNN: http://www.cnn.com/2017/06/06/health/vaccine-uptake-

incentives/index.html

Services, D. O. (2017). Vaccines for Children Program (VFC). Retrieved from Delaware.gov:

http://www.dhss.delaware.gov/dph/dpc/immunize-vfc.html
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Services, U. D. (n.d.). Five Important Reasons to Vaccinate Your Child. Retrieved from

Vaccines.gov: https://www.vaccines.gov/more_info/features/five-important-reasons-to-

vaccinate-your-child.html

Skolnik, R. (2016). Global Health 101 (3rd ed.). Burlington, MA, United States of America:

Jones & Bartlett Learning, LLC.

Stacey, A. (2011, October 16). Why Pork is Forbidden in Islam (part 1 of 2): Obeying the laws

of God. Retrieved from Islam Religion:

https://www.islamreligion.com/articles/2513/viewall/why-pork-is-forbidden-in-islam/

UNICEF. (n.d.). Immunization. Retrieved from UNICEF:

https://www.unicef.org/immunization/index_why.html