Category: Vaccination

Controversial issues regarding collective security during the COVID-19 pandemic often include discussions of if a sanitary mask fulfills the functions assigned to it or not. In particular, one of the ambiguous topics is the question of whether it is necessary to wear a mask after vaccination. Human resource managers should understand that after employees are vaccinated, wearing a mask is unnecessary and an overprotective measure. Forcing subordinates to resort to additional personal protective steps is pointless, and any liability for the non-observance of the mask regime should be removed at the organizational level.

After full vaccination, a person does not need to wear a mask when in contact with other people. According to Shriver (2021), antibodies build up in the body in sufficient quantity to fight off the disease, which is the essence of vaccination. In addition, Adjodah et al. (2021) argue that today, the rate of vaccination has improved, which indicates the imminent acquisition of herd immunity and a decrease in the incidence of the coronavirus infection. The main argument that West (2021) also makes is that vaccination protects vulnerable citizens and provides an opportunity to curb the growth of disease cases. Therefore, wearing a mask is an optional measure that is perceived rather as a habit than a real protection tool.

This information is relevant not only to employees but also to managers working with personnel. The current policies to monitor employee health compliance should be reviewed because vaccination is a step towards overcoming the pandemic, and collective safety principles need to be transformed. Therefore, the problem concerns the heads of structural divisions primarily. At the same time, despite the arguments presented, challenges may arise with the delivery of this information to supervisors and team leaders. People who do not understand the principles of vaccination can resist change, which, in turn, will make it difficult to optimize the workflow. For many of them, masks have become an essential attribute, and it may seem to them wrong to abandon these protection tools, despite the illogicality of such behavior.

The key goal is to convey to the target audience that vaccination is an objective driver to reduce the level of existing sanitary standards due to the principles of impact on public health. The gradual transition to mass vaccination and the abandonment of personal protective equipment as useless tools are important tasks to be implemented in the near future. To achieve this, an appropriate evidence base is needed, which includes not only general reasoning but also accurate scientific justification. Communicating the necessary data to team leaders and human resource managers can help convince them that they should not follow outdated health safety practices.

As a rationale for the proposed argument for avoiding masks for vaccinated employees, relevant resources can be utilized. For instance, the article by Adjodah et al. (2021) considers how avoiding mask mandate could affect COVID-19 outcomes. The authors note that tightening vaccination controls rather than personal protective equipment may be a better practice to address the pandemic (Adjodah et al., 2021). The research by Shriver (2021) cites similar theses, and the author draws attention to the fact that gradual vaccination of a large part of the population is inevitable, which can reduce new disease cases significantly.

As a result, the need for masks is eliminated because people acquire the necessary antibodies and immunity to the coronavirus infection. Finally, West (2021) argues that most policymakers and health managers agree on the benefits of masks but, at the same time, confirm that vaccination is a reliable means of protecting the population. Thus, authoritative sources confirm the relevance of the thesis about the safety of mask-free social contacts in the context of mass vaccination.

As a result of the proposed evidence, the argument about the uselessness of using masks in interactions between vaccinated employees can be supported by specific arguments. Firstly, human resource managers have information on the number of vaccinated employees, and this is not difficult for them to identify who has the right not to wear a mask in the workplace. Secondly, social distance becomes irrelevant since, as Shriver (2021) states, for a vaccinated person, even an unvaccinated interlocutor does not pose a threat. Thirdly, vaccination control is a sufficient measure to do by human resource managers because, according to Adjodah et al. (2021), vaccination is progressing rapidly. Therefore, the original argument has ample reasons to propose for consideration.

While taking into account the evidence presented, the safety of mask-free social contacts for vaccinated employees is easy to prove. The aforementioned research shows that wearing a mask is meaningless if a person is immune to the disease. In addition, based on vaccination statistics, the number of vaccinated citizens is growing rapidly. Since human resource managers are aware of the vaccination status, avoiding mask mandate can be an objective and reasonable solution in organizations with a sufficient number of vaccinated employees. As a result, given such explanations, one can justify the position about the possibility of abandoning masks.

References

Adjodah, D., Dinakar, K., Chinazzi, M., Fraiberger, S. P., Pentland, A., & Bates, S. (2021). Association between COVID-19 outcomes and mask mandates, adherence, and attitudes. PLOS ONE, 16(6), e0252315. Web.

Shriver, L. (2021). Its time to face the truth about masks. The Spectator, 346(10056), 23.

West, M. G. (2021). Covid-19 mask mandates are again at center of political battles. The Wall Street Journal. Web.

Description of the Issues

Vaccination is one of the most important procedures for a person, especially at a young age. With many serious diseases threatening the populations health, society must take preemptive action to prevent any further harm. Many contagious illnesses from the past were almost completely eradicated by vaccination and the development of herd immunity. Although nowadays, some people are starting to doubt the vaccines effectiveness, putting the community at a large risk. The solution to this problem is to mandate child immunization on the government level. In the face of many past diseases being brought back by negligence, the need to regulate vaccine application is becoming apparent. The process does have some problems, including the increased costs and the absence of a standardized framework for implementation.

There are many types of vaccines according to the type of illness and the affected age demographic of children. Some vaccines are administered right after birth and need to be re-applied to have the intended effect, and some are effective permanently. Though mandatory vaccination may not increase vaccine uptake significantly, it is still worth trying for the sake of public health (Macdonald et al., 2018 pp. 5811). It can be difficult to afford and keep track of all the various shots a child needs, so a government-mandatory system may help the people protect their children better. The regulations should preferably extend until the age of 3 since young children do not have a well-developed immune system and are susceptible to disease.

When the vaccines were first introduced, one of the apparent immediate effects was the reduced contraction of many diseases, and some of them became completely harmless to the human population. With the recent developments, however, a vocal minority of people are starting to raise their doubts against the practice of immunization. Brought largely by misinformation, fearmongering and the lack of available information, theories about the potential harm the vaccines bring are actively surfacing on the internet. Quickly spreading through the web, this movement becomes a serious detriment to the efforts of disease control and containment and needs to be combatted by government regulation.

Who are the Stakeholders?

Three parties play a major role in the question of mandatory immunization: the healthcare providers, the parents, and the whole community. Healthcare professionals and organizations are the ones responsible for informing the public and administering vaccines. The parents, on their part, weigh the pros and cons of immunization and are concerned with the well-being of their children. Lastly, the community at large operates in the interests of development and self-preservation, influencing the judgment of individuals. These three stakeholders have their positions on the topic that need to be addressed.

Parents and the Community

When speaking about the population, research has shown that most people understand why vaccines are important for the well-being of individuals and the community. Parents naturally want the best for their children, meaning they will take the opportunity to protect them from disease given they know vaccines work. The informed individuals are usually shown to be in favor of mandated vaccine practices. One of the caveats that should be mentioned though, is that many people feel like the information available to the public about the effects of vaccination is not sufficient (Ames et al., 2017 pp.1). The key to making vaccines more popular with the people is spreading awareness and teaching people through appropriate channels.

Many people feel the need for clearer communication between healthcare providers and the public.

Healthcare Providers

Healthcare professionals, as the people most informed about the benefits of vaccination, are largely in favor of mandatory immunization. The experts say that the hesitancy to vaccinate children is one of the biggest threats to public health and the most dangerous mistakes a person can make (Drew, 2019 pp. 575). Healthcare providers say that imposing restrictions and regulation immunization is one of the most effective ways of combating public negligence.

References

Ames, H. et al. (2017) Stakeholder perceptions of communication about vaccination in two regions of Cameroon: A qualitative case study, Plos One, 12(8).

Drew, L. (2019) The case for mandatory vaccination. pp.575. Web.

Macdonald, N.E. et al. (2018) Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps, Vaccine, 36(39), pp.58115818.

Introduction

The use of vaccines is generally seen as one of the biggest breakthroughs in medical science and public health, providing an effective, non-invasive, and relatively cheap method of protecting the public from deadly viral diseases. Since the first vaccinations by Edward Jenner in 1796, the method and technology of vaccines have developed into a complex science, leading to virtual eradication of diseases such as smallpox and polio that once ravaged through the population through a simple principle of herd immunity (Lemons 177). Vaccines are universally recognized by all international, national, and local health organizations and experts as the most effective and safest means of building the herd immunity and highly reducing the risk of infection in individuals.

To increase vaccine uptake, governments around the world have created regulations at various levels to mandate immunizations. However, throughout history, the issue of mandatory vaccinations has been controversial with various arguments ranging from religious beliefs to severe side effects to conspiracies surrounding pharmaceutical companies  all part of the group known as anti-vaxxers or, in official terms, vaccine hesitancy. This paper argues in support of government-mandated vaccinations as the benefit to society far outweighs the risk of individual complications (for which there are safeguards) and any personal beliefs that one may hold in order to reduce the risk of infection spread and increase public health protections.

Vaccination Policy

Currently, the United States does not have federal mandates for vaccinations, but there are laws at the state level which establish vaccination requirements. The vaccination requirements typically apply to children as well as certain professions such as healthcare and frontline workers or other specialized circumstances. Furthermore, organizations and employers, both public and private, may require immunizations. Essentially, although no one is physically forcing individuals to receive a vaccine, the laws and regulations make it so as to function normally in society (education, work), one most often needs to be vaccinated. These restrictions are in place to achieve vaccination uptake and maintain the most optimal levels of herd immunity.

Despite the U.S. vaccination policy reflecting that of other developed nations to a large extent, based on scientific knowledge and recommendations for best practices, it remains a controversial issue. While vaccinations have been in use for close to two centuries and their effectiveness, safety, and cost-benefit have been proven for the large majority of the population, whenever a policy of mandatory vaccines arises  it becomes controversial, largely due to a vocal opposition that are vaccine hesitant.

Evidence Supporting Mandatory Vaccination

In general, medical research supports the vitality and efficacy of compulsory vaccinations. Vaccines are developed, tested, and implemented for the specific purpose of protecting individuals from transmissible diseases, and by doing so achieving the herd immunity necessary to protect communities (Newman 2). Herd immunity is a concept which suggests that society is protected against a disease when the majority of individuals (95% is the optimal number) are immune to it, either from getting sick and recovering or through vaccinations. Theoretically, even if a disease does enter a community through a host, if herd immunity is present, it will not be able to afflict new hosts since immunized individuals cannot contract the disease, nor usually carry it as the immune system kills the virus upon entering the system. Therefore, it limits the potential of transmission, particularly to susceptible individuals such as children or immunocompromised. The transmission chain can be broken with a high herd immunity rate, even slightly below 100% (Vaccines).

The efficacy of immunization has historically led to the significant decline or eradication of highly viral diseases in the United States such as smallpox, diphtheria, and polio (Newman 2). Other diseases associated with high morbidity and mortality rates such as measles, mumps, and pertussis also strongly declined with the use of mandatory vaccinations in children (Yoo 2). Herd immunity is built in a community based on the vaccine coverage rate. However, due to vaccine hesitancy, herd immunity is declining stably. The Centers for Disease Control reported recently 1,282 cases of measles which is a record high for almost three decades. Meanwhile, 2015 and 2019 outbreaks at California Disneyland theme parks which then spread throughout the California region had been linked to non-vaccinated children of vaccine hesitant families and tourists that came to the state (Vaccines). As a result, California implemented stricter mandatory vaccination policies and sought to restrict religious exemptions that had been fraudulently manipulated by anti-vaxxers to legally avoid immunization. Nevertheless, these incidents and statistics demonstrate the working efficacy of vaccines and what can occur to communities and population disease spread when herd immunity declines due to vaccine hesitancy.

Common Counterarguments

One of the most prevalent concerns cited by opponents of mandatory vaccination is safety and effectiveness. These safety concerns range from acute complications such as anaphylactic shock and clotting to long-term effects. There are a number of vaccine safety concerns such as risk of autism in children, negative impact on the immune system from increased number of immunizations, and life-long neurological development impairment. Newman suggests that the U.S. Supreme Court states that no government should administer treatment or medication that is arbitrary or unreasonable or cruel or inhuman or one that can seriously impair health or possibly cause death (Newman 3). It is the legal defense that has been used by those that are vaccine-hesitant, indicating that there is a risk of complications, even acknowledged by the CDC.

These safety concerns have been supported by studies conducted over the years. The connection to autism was established by a 1998 study on MMR vaccines, which at the time and currently is compulsory for all children. The study suggested that the preservative containing ethyl mercury in the vaccine produce was responsible for causing autism. Another case, the Health Protection Agency in the UK identified that the swine flu vaccine could cause a life-threatening neurological disease Guillain-Barre. A vaccine expert, Dr. Sherri argues, vaccines efficacy leaves much to be desired, yet they expose recipients to a wide array of risks (Newman 3). Indeed, evidence has shown that some vaccines are at high-risk for complications while providing limited protection (either in time or in actual defense against the illness). As stated, the presence of antibodies does not guarantee that you will not get sick (Newman 3). These factors of proven vaccine ineffectiveness and risks are driving forces behind concerns of safety for those opposing mandatory vaccinations, indicating that it should be a matter of personal or family choice on whether to take on these risks.

Another aspect proposed to counter mandatory vaccinations is to present it as a violation of ethical and human individual rights. Legal and social scholars have challenged any such mandates in regarding to health as the infringement of individual liberties. The argument suggests since adults have the right to reject health treatment, including immunization, there should be no mandate forcing either adults or children to participate in immunization if they are able to make an autonomous decision. Patient autonomy is a key medical ethic, so even if there is a government mandate, medically, there should be an option to decline vaccine. Most states have policies which require immunization for entry to schools, but such mandates may cause ethical dilemmas such as the HPV vaccine which many rejected on religious grounds as they believed it promoted a sense of false safety in sexual relations among adolescents.

Nevertheless, the ethics debate goes beyond assumed personal interests and values. Mandatory vaccinations in itself are coercive rather than persuasive, and from an ethical perspective there is no good reason to use any form of coercion for risks they are not willing to take. Furthermore, bringing in the concept of distributive justice, it can be argued that it is unfair to force individuals to assume certain risks so that others benefit. Regardless of the situation at hand, the person getting immunized will carry the full risk to their health (both if there are complications from the vaccine or if they choose not to vaccinate, the risk of procuring the disease), so as long as there is even the slightest possibility of risk  it is unethical to force someone to input a substance into their body, even under the guise of the greater good.

Addressing the Counterarguments

The fact that vaccine efficacy and safety are being debated 20 years into the 21st century is astonishing, considering the long history of vaccine use and research which has proven to be the opposite. Unfortunately, due to the availability of technology and the Internet, the role of misinformation on such sensitive and controversial topics as vaccines have increased and is becoming extremely difficult to counteract. The 1998 study published which linked MMR vaccines to autism has been retracted and the lead author has lost their medical license due to proven fraud as it became evident that the studys results were falsified heavily. All national health agencies have stated that there is no associated risk between vaccines and any long-term disorders of any kind (Lemons 173). The concern of the immune system overload was addressed by a multi-agency case control study in the United States, identifying no immunological differences between vaccinated and non-vaccinated children (Yoo 3), while a ten-year study of over 800,000 children showed no immunological deterioration (Newman 3). Meanwhile, all ingredients located in the vaccines are safe, and the ethyl mercury present in MMR vaccines is a completely different substance from the toxic methylmercury. Ethyl mercury is quickly removed from the body as waste, does not accumulate, nor does it cause harm (Vaccines 2).

Overall, all vaccines are carefully developed and undergo a rigorous testing process on animals and eventually human volunteer studies which in most cases takes years (for the mandatory vaccines). The vaccine is then examined independently by other researchers as well as health agencies. In the United States, all vaccines must receive approval from the Food and Drug Administration (FDA). Most vaccines (other than in cases of public health emergency) undergo a licensure process where they are also closely studied and all their effects both positive and negative are noted. Only after a tedious process are the vaccines approved for medical use, with the FDA licensure process viewed as the gold standard in the world (Lemons 174).

All medical processes and procedures carry a risk of side effects, as it is impossible to full predict how a human body will react. Each human organism is extremely complex and inherently different, each with their own past medical history and complications. While trials attempt to consider most possibilities, just like with taking medication, there are risks of side effects or adverse reactions (Lemons 191). Just as antiretroviral drugs are used despite several potential effects, their benefits outweigh the risks in the large majority of humans. All involved stakeholders including the pharmaceutical company, the CDC, and the healthcare providers administering the vaccines are always transparent and clear regarding potential risks, and constantly update guidelines if new data emerges regarding which groups, when, and how to administer the vaccine. The safety precautions are overwhelming and warrant the potential risk, as the adverse effects from a vaccine are most likely going to be inconsequential, but the protection is significant and safer than naturally encountering the disease.

While the ethical issues are justifiable more than potentially other reasons for non-mandatory vaccinations, the reasoning can be disproved. In the context of health immunity, vaccination is used for the common greater good. The well-being of the majority of individuals is linked to the stability and health of their community (Yoo 3). This was clearly seen in the context of the Covid-19 pandemic when safety measures and lockdowns had to be implemented due to the virality of the disease, and as more people were infected, services such as basic healthcare provision was overwhelmed. From an ethics perspective, philosophers Hobbes and Locke proposed the well-known social contract theory which indicates that if one is to live in a society, certain agreements and rules have to be established for social benefits, one of which is to sacrifice individual freedoms for state protection. Therefore, each person has a social responsibility to act accordingly as to safeguard the well-being of the community. When vaccines have been proven safe and effective for centuries and there are multiple safeguards in place to ensure that everything is being done to avoid potential risks to the population from the immunizations  it is both logical and ethically correct to ensure vaccination for the substantial protection it can offer.

Public Opinion (Survey)

A 2017 widespread survey by the Pew Research Center found that there is overwhelming support for mandatory vaccinations, particularly for childhood immunization requirements. Approximately 82% of respondents suggest that healthy children should be required to vaccinate, while 88% suggest that benefits outweigh potential risks. While the overwhelming majority does support the mandatory vaccination, certain groups have greater vaccine hesitancy than others. For examples, among conservatives and White evangelical Christians there is one of the highest rates suggesting that decision should be up to families and individuals hovering around 22-25% (Funk et al.). As well known, political and religious beliefs are some of the primary influences driving perceptions and attitudes toward vaccinations, particularly in regard to public institutions and governments mandating it. Conventional and alternative practices also align with perceptions of risks and benefits of vaccination, with those which use alternative medicine more likely to oppose vaccination.

As noted by the survey, the large majority of Americans see the long-term preventive health benefits from mandatory vaccines, but there are a few subgroups demonstrating concern about vaccine-associated risks. Most noted concerns on the issue are vaccine safety/adverse events, both in short- and long-term, as well as the concept of personal freedom that parents and individuals should have the right to choose. Another important aspect is the public trust in medical scientists and research on vaccines. Here, there are significant differences, with only 55% of U.S. adults suggesting that practically the whole scientific community supports vaccines and understands its risks, while 28% suggest more than half of the scientific community. Meanwhile, 15% argue that less than 50% of the scientific community supports vaccinations (Funk et al.). While there are evident divisions among Americans regarding mandatory vaccinations, the large majority generally supports policy for them when it comes to the well-established childhood immunizations required to attend educational institutions.

Discussion

In the context of mandatory vaccines, for those that oppose them, the issue typically boils down to safety. Whether it is the risk of side effects, the potential connection to autism, the presence of harmful materials inside the vaccines, or the simple presence of too many shots  the reasoning offered by those demonstrating vaccine hesitancy seems rational but is in fact based on fear. One can argue that it is a normal occurrence, but each one of those reasons has been debunked as discussed previously. Immunizations are some of the strongly tested, planned, and effective medications, reviewed by everyone ranging from the pharmaceutical companies to independent researchers to medical professionals, and finally, government agencies. Each vaccine has a purpose as to how it is developed and implemented, including the recommended schedule and dosages (Lemons 174).

Notably, the case for mandatory vaccines is one of the few instances where government authority takes a hard stance (supported by the medical community as well as the Supreme court) in Western Democracy. The issue of balancing individual rights with the public good is inherently complex in public health. However, the governments right to require immunization has been supported time and time again because in the context of the existence of vaccines, not immunizing is dangerous. The issue involved goes beyond individual choice and personal health but affects the overall social good (Lemons 174). As presented in the article by Lemons, immunization is comparable to child car-seats and seatbelts. These are mandatory and required to be used for childrens protection. However, no one complains about the use of seatbelts because they are proven to be safe. While yes, mandatory vaccines are communitarian and potentially restrictive oppressive, but they are done so for the clearly (both anecdotally and mathematically) defined social good (Lemons 174).

Those that oppose mandatory vaccinations, even if they agree with the science, attempt to make the argument about individual rights and the ability of parents to make informed medical decisions for themselves and their children. Many conservatives argue that the oppressive policies, such as in California that ignores religious and philosophical examinations, turn the concept into a civil rights issue. They argue the oppression will generate resistance since people believe that their health is on the line (Lemons 175). In defense of this, libertarians cite the utilitarian philosopher John Stuart Mill, The only

purpose for which power can rightfully be exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant (El Amin et al. 3) Furthermore, most national governments implement the so-called precautionary principle which was partially the foundation of the 1905 Supreme Court decision, which suggests that in public health the government has the role to protect populations against reasonably foreseeable threats even under conditions of uncertainty. If the costs of inaction are considered, the failure to implement preventive measures must be justified (El Amin et al. 4).

While these are potentially purely ethical discussions, they are the foundation of the legal policy for governments when the vaccine mandates are implemented. Governments and public health officials do not and ultimately should not think about the individual, but about the population as a whole. When examining data and evidence over the course of decades on public health, vaccination uptakes, and other relevant elements  it oftentimes becomes clear that mandatory vaccinations lead to higher immunization rates, and in turn, lower infection rates of these preventable communicable diseases.

In the modern world, choice is understandably an essential value, particularly when there is inherently more choice than ever before in virtually all areas of life, including healthcare. Any mandate is seen as a violation of that key freedom. The debate and evidence sides with the pro-vaccination supporters, but to achieve optimal outcomes it may be necessary to listen to the opposition as well. Social and political experts agree that regulation is useful but absolute mandates may have a detrimental effect. Instead, the focus should be aimed at public health media campaigns, combating disinformation, education, and transparency. Arguably, some vaccines for deadly diseases should remain mandatory such as measles and polio but for vaccines such as the COVID-19 immunization, there are no mandates yet due to its newness and unique circumstances of rapid development. Yet, with the government actively campaigning for it and offering education, there is significant voluntary update. This goes to show that other tools exist to encourage vaccine uptake and mandatory policies should be put in place only as a last resort.

Conclusion

Vaccines are a critical public health tool in preventing disease transmission, reducing morbidity and mortality, and building herd immunity. They are a relatively safe, highly effective, easily utilized, and accessible, as well as ah ethical medical procedure which has been implemented for more than two centuries. This paper offers extensive evidence on the benefits and reasons for mandatory vaccination and disproves the several counter arguments offered by the vaccine hesitant community based on fear and misinformation. Overall, mandatory vaccinations are legal, ethical, and increase vaccine uptake, but in the modern world of individual rights and choice, it should be used carefully and in combination with other tools which can potentially increase the trust of the population in this method of protection for public health.

Works Cited

El Amin, Alvin N., et al. Ethical Issues Concerning Vaccination Requirements. Public Health Reviews, vol. 34, no. 1, 2012, pp. 1-20. Web.

Funk, Cary, et al. Vast Majority of Americans Say Benefits of Childhood Vaccines Outweigh Risks. Pew Research Center, Web.

Lemons, Jane F. Vaccine Controversies. CQ Researcher, vol. 26, no. 8, 2016, pp. 169-192.

Newman, Alex. There Is Evidence That Vaccines Promote, Rather than Eradicate Disease. Edited by Noël Merino, Gale, 2012.

Vaccines. Gale, 2020. Gale in Context: Opposing Viewpoints, Web.

Yoo, Jung Kim. The Anti-Vaccine Movement Disregards the Great Success of Vaccines. Edited by Roman Espejo, Gale, 2014.

Among the numerous recent healthcare advancements, vaccines occupy a specific place for their unique benefits for individuals and society in general. They constitute a relatively cheap measure which has allowed to prevent the outbreaks of many life-threatening diseases throughout the world. Moreover, they play a critical role in achieving herd immunity protecting the most vulnerable people who cannot be vaccinated for safety reasons. Still, the increasing popularity of the anti-vaccination campaign is an evident trend nowadays, posing significant risks for society. Finding the right ways to treat patients fears and explain the benefits of vaccines is critical for any health care professional.

The presentation of arguments for the need for vaccination is a comprehensive process, which needs to account for various psychological and medical facts. First, it is reasonable to emphasize the overall advantages of this approach. The development of vaccines has resulted in a 68 to 100% reduction in preventable infectious diseases (Michel, 2020, p. 1402). In addition, it is worth mentioning that although any medical procedure involves some risk, vaccines are subject to rigorous trials and monitoring during their development and application (Di Pasquale et al., 2016). Finally, emotional aspects need to be considered, as the fear of rear but severe complication can often outweigh the benefits (Zikmund-Fisher et al., 2016). Providing all this information to patients and emphasizing the advantages of disease prevention is a good practice for a health care professional.

The recommendations mentioned above demonstrate the complexity of the vaccination issue and the immense benefits they can bring. However, opponents also provide some argumentation which needs to be taken into account. For example, some published research may indicate the occurrence of severe diseases, as in the case of Wakefields study dedicated to the connection between measles vaccine and autism. Still, the relative publication was found biased and led to a dramatic increase in the cases of this infection (Di Pasquale et al., 2016). Other opinions, such as an introduction of a microchip in a coronavirus vaccine, are simply conspiracy theories without any scientific grounds (Goodman & Carmichael, 2020). Therefore, the communication of the true benefits of vaccines is incredibly valuable with todays abundance of false information and a critical need to use them to stop the on-going health crisis.

References

Di Pasquale, A., Bonanni, P., Garçon, N., Stanberry, L. R., El-Hodhod, M., & Tavares Da Silva, F. (2016). Vaccine safety evaluation: Practical aspects in assessing benefits and risks. Vaccine, 34(52), 6672-6680.

Goodman, J., & Carmichael, F. (2020). Coronavirus: Bill Gates microchip conspiracy theory and other vaccine claims fact-checked. BBC News.

Michel, J. P. (2020). The wellknown and less wellknown benefits of vaccines. Aging Clinical and Experimental Research, 32, 1401-1404.

Zikmund-Fisher, B. J., Wittenberg, E., & Lieu, T. A. (2016). Parental weighting of seizure risks vs. fever risks in vaccination tradeoff decisions. Vaccine, 34(50), 6123-6125. Web.

Disease and illness have plagued the human race for as long as we have walked the earth. Similarly, to disease, the spread of misinformation also has dreadful effects. The anti-vaccination movement has become a health crisis and is fueled by the distortion of facts that have been passed down through the internet. You can think of the internet as a game of telephone, the more the information is circulated the more incorrect it becomes. As more parents buy into the fallacious reasoning of the group known as the “anti-vaxxers” (a group against vaccinations especially for children due to the fear that vaccines cause autism or other side effects) the more children are left without the protection of vaccines to shelter them from a horrible illness. The most prominent illness to flare up in recent years has been Measles. The anti-vaccination movement has led to many rejecting vaccinations for their children, the rise of serious and preventable illness seeping into schools, and even mortality of the innocent.

As a little bit of background, vaccinations have been around for centuries, the first implementation of vaccination was in the 1700s. As stated by, Dr. Stanley A. Plotkin, Emeritus Professor of the University of Pennsylvania, American physician and consultant to vaccine manufacturers, “As the development of vaccines continues in the twenty-first century, and as it is now over 215 years since vaccinology was launched by Edward Jenner’s observations of the powers of cowpox to prevent smallpox, it is useful to contemplate the past” Since their implementation, vaccines have only become safer and more effective as modern medicine has developed. In this “modern era” of vaccines the child mortality rate is as low as it has ever been, but with the enactment of the modern anti-vaccination movement, those rates have been put into jeopardy. Countless parents believe their children will be fine without being vaccinated, however, history tells a different story. Just think about a time before vaccinations, the Black Plague, for instance, millions of individuals perished. If there was a way to prevent the ailment, millions of lives could have been spared. It seems senseless in today’s day and age to reject protection from disease for a child in fear of trivial side effects.

Initially, the modern anti-vaccination movement arose through the spread of misinformation and it is still, to this day, fueled by it. In the age of social media many look to google for medical advice and diagnosis. After all, looking at Google is much easier than venturing out into the world to visit a physician. Naturally, searching the web is the first thing many will do when in need of advice. Markye S. Steffens is a Ph.D. candidate at the Centre for Health Informatics at Macquarie University’s Australian Institute of Health Innovation. Steffens has a background in science communication and the media. Steffens describes the term misinformation as follows, “The term misinformation refers to false information shared without the intention of har. Vaccination misinformation is any claim that has been investigated and rejected with reasonable confidence in the peer-reviewed literature”. To further her claim Steffens also states that, “Misinformation is associated with serious public health consequences, such as increased public fear and loss in vaccine confidence. Misinformation may lower vaccine acceptability and vaccination rates, and clusters of refusal are associated with disease outbreaks”. The majority of anti-vax parents refuse advice and recommendations of doctors and instead get their information from others within the group. They then take to sites like Google or Facebook to share their newfound data as to why vaccinations are wicked. This leads to more and more parents reading and buying into the unreliable resources provided online. These parents choose to either not vaccinate or at least hesitate to vaccinate due to the misinformation they have received. Hesitation opens a window for illness in children which can be just as detrimental as no vaccines at all. The spread of misinformation is very much a deadly cycle as the information spreads like a wildfire creating more opportunities for individuals to become persuaded to refuse the advice of physicians in favor of the latest Facebook research.

Nevertheless, it is undeniable that there is valuable information to be found on the internet even regarding medical help. There is an abundance of data to be found from many different sources online. Anna Kirkland, the Director of the Institute for Research on Women and Gender (IRWG), and Director of the Science, Technology, and Society Program at the University of Michigan states that “The most important current media sources (based on their validation in survey and interview research about where parents get vaccine-critical information, Internet prominence, and their prominence according to speakers at the NVIC conference) are Peggy O’Mara’s Mothering Magazine and Arianna Huffington’s Huffington Post blog.” There can be interesting data and stories provided in blog posts and magazines, the information can also be very persuasive at times. Though, the point to be made here is not that there is no interesting or reliable information to be found online. The problem is in the reliability of the sources the information is found in. As Dr. Steffens states, “While these online spaces are useful for promoting health, there are few safeguards preventing the promotion of misinformation. Misinformation can be popular, persuasive, and spread with relative ease”. The leading resources for anti-vax data prove to be unreliable. It can be difficult for people searching the web to sort between reliable and unreliable information furthering the misinformation. The facts found online may not come from credible sources and many people are unable to realize that they are reading statements that are not backed up by professionals. When in search of medical guidance, the most trustworthy source would be from physicians themselves or at least articles written or approved by educated professionals in the medical field.

Consequently, anti-vax parents have much to say about vaccinations, especially regarding information being given regarding the side effects involved with vaccines, they believe we are not being told the entire truth. Ron Whitmont, MD is the president of the American Institute of Homeopathy, he delves into the fears of anti-vaxxers and supports such ideas. Dr. Whitmont states that “There is a tremendous amount of media coverage being devoted to the measles vaccination and extremely limited information regarding potential risks and side effects” The fear is that there are truths being hidden from the public eye. Among the anti-vaxx community, there is an anxiety of deception. This is a common fear that comes with anything that includes possible side effects. People often fear that there is something they are not being told. There have been cases of illness being linked to vaccinations, but we seldom hear about them in the media. This is a legitimate concern especially when it comes to the safety of a child. Media tends to cover the most impactful stories that come up. Rarely will the news or other media sources cover stories that impact small groups of people? The cases involving illness regarding vaccinations are affecting much less of the population than outbreaks of illness such as measles. News media may not be covering these stories since they are not “groundbreaking” enough, but there is a lot of information and research to be found incredible journals and writings from physicians themselves. Of course, there is some degree of illness related to vaccinations, not everyone reacts similarly to the ingredients. Components found within vaccinations will have adverse effects on certain people, the same as anything else. Some people can eat peanuts, and some are highly allergic. This is not deemed newsworthy as it is not a threat to all. Dr. Andrew W. Campbell is the medical director of the Medical Center for Immune and Toxic Disorders in Houston Texas. Dr. Campbell states “When it comes to adverse events from vaccines, keeping in mind that there is nothing that is 100% safe, since 1989, pharmaceutical companies have paid out only $2.3 billion for vaccine injuries” This may seem like a high number, but over the span of 30 years and with the sizeable amount of vaccinations being given every year this is not as many cases as one might think. Yes, there are cases regarding vaccination injury, but this does not mean all cases are life-threatening or lifelong. According to the Health Resources & Services Administration, “The United States has the safest, most effective vaccine supply in history. In the majority of cases, vaccines cause no side effects, however, they can occur, as with any medication—but most are mild. Very rarely, people experience more serious side effects, like allergic reactions.” Many cases of injury or illness linked to vaccinations are mild. Nothing is foolproof, there are risks with anything in life. The chance of mild effects should not be enough to deter people from vaccinating children. The risks of illnesses such as measles are more costly than the risks of possible adverse vaccination reactions.

Moreover, as a result of the fear and rejection of vaccinations, comes the gloomy matter of mortality. When children are not vaccinated, they are put at high risk for death. A child’s immune system is not as strong as an adult’s, they are much more likely to be infected and the effects can be much more detrimental to a child. Dr. Jeremy Goldhaber-Fiebert is an assistant professor of medicine at Stanford University. He has done extensive research on measles and other childhood infectious diseases. According to Dr. Fiebert, “Historically, measles infections have been a major cause of morbidity and mortality in children, even though effective measles-containing vaccines (MCV) were first developed more than 40 years ago.” Fiebert also states that “Thus far, substantial progress has been made. In 2008, there were an estimated 164,000 measles deaths, a 78% reduction compared to mortality in 2000”. Measles is a vicious disease that can only be prevented with vaccination. As the quality of vaccines improves, they become more effective at keeping the killer infectious disease at bay. When you remove the vaccine from the equation, children begin to lose their lives.

Although, there are always two sides to the coin. Many parents are willing to take the chance of their children contracting the disease. This seems to be the thinking of many anti-vaxx parents, that contracting the disease will create immunity. Such as children contracting chickenpox, if one is infected early on then it can be avoided later in life. This is also the thinking of Dr. Whitmont who was mentioned above. Dr. Whitmont claims that “with measles, by allowing children to contract this illness and develop permanent immunity, very few adults will get the disease, and the rate of more serious complications will be much lower since adults get more complications from this illness than children”. This is a major claim in the reasoning in many anti-vaxx parents’ logic. They believe that contracting the Measles virus will be beneficial later in life. Maybe contracting the illness will grant immunity, but by allowing a child to contract the illness there comes a chance that they will spread the disease. Yes, there may be a chance of survival. This is not true for all children, there have been many cases of children perishing from the virus. With vaccination, the chances of anyone dying from Measles can be reduced greatly, even to zero with eradication. Eradication of the illness seems like a much more logical route than risking infection and gambling with a child’s health.

Furthermore, one thing that needs to be more closely examined is the statement that Measles does not affect children as adversely as it does adults. This statement is not necessarily true, especially in children who have other health complications. Dr. Johan C. Bester is a bioethicist with much experience as an assistant professor in medical school education as well as clinical ethics practice at the University of Nevada. Dr. Bester wrote an article on the obligation parents has to vaccinate their children against Measles. In his article, Dr. Bester writes, “children with measles who are malnourished or have vitamin A deficiency may have death rates as high as 25%. Furthermore, children in highly vaccinated societies who remain unvaccinated and then get measles are estimated to be at 4.5 times higher risk for measles complications”. Children who are unvaccinated create a cycle; they contract the disease then spread it to other unvaccinated children. Therefore, measles has been able to spread rapidly in recent years. The no vaccination trend is deathlier than many anti-vaxx parents want to believe. The facts are there, measles has killed many children. Children who are sickly, to begin with, having a higher death rate. Also, unvaccinated children that are around children who are vaccinated are more likely to suffer complications with the disease. Which in many areas, the majority of children are vaccinated, this puts unvaccinated children at an even higher risk of death. Measles is not only life-threatening, but it also has lingering effects. Another statement from Dr. Bester’s article is, “Measles also leads to immune suppression that can linger for years after measles infection. Previously this immune suppression was thought to last only a few weeks or months after infection, but recent analysis has shown it to last much longer, up to 3 years.” So, after a child contracts measles, they are immune, great. Now the child must deal with a severely lowered immunity to other illnesses. They were not only at risk of dying from Measles but now they are also at risk of dying from numerous other illnesses as well. Again, the best way to keep a child safe from these awful consequences is to vaccinate them. There is an understanding that not all children can be vaccinated, there are complications that come up. According to the Centers for Disease Control and Prevention, “Because of age, health conditions, or other factors, some people should not get certain vaccines or should wait before getting them”. From CDC’s website, an example of something that restricts a person from getting the measles vaccine is: “Has had an allergic reaction after a previous dose of MMR or MMRV vaccine, or has any severe, life-threatening allergies.” This is out of a parent’s hands. When a child is allergic to a vaccine there is no choice but to not get that vaccine. This is a reason more kids should be vaccinated, for the sake of those that can’t get the vaccination. When denying vaccination for personal beliefs or the fear of side effects they are putting their own children and those that can’t receive vaccinations at risk. Parents of children who are unable to get vaccinated must be very careful about who their children come in contact with. Most of these parents would love to give their children protection, but that is not always an option. Even for the sake of others, vaccinations are security.

All things considered, vaccinations offer protection for children. A parent’s main goal should be to shield their child from illness and injury. Denying vaccines opens the door for illness to enter a child’s life. Children are innocent, they do not make choices for themselves. Children rely on the guidance of their parents. If a parent chooses the wrong path for their little ones, they risk tragedy. For all parents, it is crucial to understand the costs of denying a child vaccination. Weigh the risks, is it worth it? Think of the lives already lost to infectious diseases. Don’t let another child suffer the consequences of the decision to not vaccinate. These children are the future, they are the doctors, presidents, and scientists of the time to come. They are needed here on earth to make it a better place, they were not meant to just be another statistic of the dangers of anti-vaccination. Defend the children, they can’t do it on their own.

As we age and get older we typically think that these changes manifest physically in our appearance, but the change also affects us genetically and on a cellular level specifically the immune system. As we age the immune system is progressively deteriorating which cause normal functions such as metabolism and immune defense to not function as they did at a younger age, this is known as Immunosenescence. Oh SJ, Lee JK, Shin OS (2019) stated that “Immunosenescence is characterized by a progressive deterioration of the immune system associated with aging” (pp. 1). It is also pretty interesting that our bodies also begin to process vaccines and medication differently as we get older; become less and less receptive to them essentially immune in a sense. We will be discussing a possible reason this is accurate and the changes our bodies undergo play a role in its ability to process vaccines.

The older we get the more vulnerable our immune system becomes at fighting off infectious diseases. The primary cause of this is the decrease in the amount of T cells we have as we get older. According to the study by Fukushima Y, Minato N, Hattori M (2018) “the TCR responsiveness of the overall CD4+ T-cell population, in terms of proliferation and regular cytokine production, diminished gradually with age”. The reason why T-cells are important as it relates to the immune system is because their main role is to fight of and kill virus infected cells. I think that it would be very important to begin exploring the effectiveness of vaccines tailored to elder patients. Life expectancy is begin extended that means that the elder population is also being pushed further, so it would be important to start developing treatments that would be able to support that demographic of the population. In the study performed by Haralambieva IH, Painter SD, Kennedy RB (2015) the observed the effects of age and immunosenescence markers post influenza vaccination and the results indicate that there is an indicator that tie the effects of age to the effectiveness of vaccine effectiveness.

One major cause in how effective vaccines are in elderly patients is because of Immunosenescence. I think it is important for to observe the effectiveness of vaccinations as it relates to the elderly population, we know that the demographic of the population is susceptible to infections due to the decline in T-cells. In conclusion understanding the immunosenescence functions will also help us understand the aging and how vaccines work in elderly patients.

References

1. Oh SJ, Lee JK, Shin OS. Aging and the Immune System: The Impact of Immunosenescence on Viral Infection, Immunity and Vaccine Immunogenicity. Immune Netw. 2019;19(6):e37. Published 2019 Nov 14. doi:10.4110/in.2019.19.e37
2. Fukushima Y, Minato N, Hattori M. The impact of senescence-associated T cells on immunosenescence and age-related disorders. Inflamm Regen. 2018;38:24. Published 2018 Dec 24. doi:10.1186/s41232-018-0082-9
3. Haralambieva IH, Painter SD, Kennedy RB, et al. The impact of immunosenescence on humoral immune response variation after influenza A/H1N1 vaccination in older subjects. PLoS One. 2015;10(3):e0122282. Published 2015 Mar 27. doi:10.1371/journal.pone.0122282

Introduction

The two public health interventions that have had greatest impact on the world’s health are clean water and vaccines. (childhood immunization, 2011)

We are shielded from infectious diseases by our system, which destroys diseases causing germs once they enter into our body. If our system is not quick or strong enough to stop those germs, we get sick. We use vaccines to prevent this from happening. Therefore immunization and vaccination are important to safeguard our self and other people around.

Edward Janner is taken into account the founder of vaccinology within the west in 1976, after he inoculated a 13 years old boy with vaccine virus (cow pox) and demonstrated immunity to small pox. In 1978, the primary smallpox vaccine was developed. (Riedel, 2005)

Vaccination is defined as a term used for getting vaccines but immunization is defined as the process of receiving both the vaccines and becoming resistant to the diseases following vaccination. With safety, immunization or vaccines effectively use low amount of a weakened or killed virus or bacteria that imitate the virus so as to stop infection by that same virus or bacteria. (Levinson, 2018)

Immunization is the most profitable public heath intervention. Each year millions of people were prevented from illness and death by vaccines. “Annually, about two million children still die from diseases that are accessible at low cost. Over 90,000 fall victim to paralytic polio, this could also have been prevented by immunization.” (Riedel, 2005)

What is immunity?

The ability of a body to resist infection or diseases.

Our immune system is essential for our survival because without an immune system, our bodies would be attacked by bacteria, virus, parasites and etc. (Deepa & G, 2015)

Two ways to develop immunity;

1. Natural infection
2. Vaccination.

Vaccines: are unnatural ways of activating the system to safeguard against infectious diseases.

It stimulates production of protective antibody and other immune mechanisms.

Vaccination: is defined as the term used to get vaccine.

Purpose of vaccination

• To protect the individual from diseases.
• To reduce the severity of diseases.
• To protect the community.
• To eradicate the diseases.

Route of immunization;

• Intradermal: BCG
• Subcutaneous: Measles, MMR, Meningococcal, Varcilla.
• Intramuscular: DTP, Hep A, Hep B, Hib. (Anand, 2015)

Site of administration;

• Deltoid: BCG
• Triceps (posterior skin fold): Measles, MMR, Meningococcal, Varcilla.
• Vastus lateralis: Anterolateral aspect of thigh in infants. (Anand, 2015)

Types of vaccines

1. Live vaccines/ live attenuated

• Contains weakened type of wild virus or bacteria.
• Produce local immunity.
• Usually single dose is enough.
• More suitable for mass immunization.
• Unstable and severe reactions are possible.
• May get inhibited by circulating antibodies.

Example: Bacterial-BCG (Bacillus Calmette Guerin), Oral typhoid.

Viral- OPV (oral polio vaccine), MMR (Measles-Mumps- Rubella), Varicella.

2. Killed vaccines/ inactivation vaccines

• Organisms are killed or inactivated by heat or chemicals but remains antigenic.
• Vaccines are stable.
• Immunity induced is not permanent.
• Multiple doses are required.

Example: Bacterial- DTP (Diphtheria-Tetanus-Pertusis vaccine).

Viral- IPV (inactivated polio vaccines), Rabies, Hep A.

3. Toxoids Vaccines

• Toxoids are modified toxins.
• Primary immunization is in the form of multiple divided doses in order to decrease the side effects.
• To sustain the protection, booster doses are required.

Example: TT (Tetanus Toxoids), diphtheria

4. Subunit, conjugate and recombinant vaccines;

• Contains bacterial capsular polysaccharide.
• Eg: Hib (Haemophilus influenza B vaccine), meningococcal, pneumococcal.
• Or contains viral surface antigens. Eg- Hep B
• Produce only IgM antibodies.
• To introduce microbial DNA to cells of the body, weakened virus is used.

Eg-HPV (Human papillomavirus)

How are vaccines administered?

There are many ways of administering vaccine and most are administered through vaccines. But with the development in medical field, here are some ways of administering vaccines aside from injection such as;

• Nasal spray: through nose. Eg-flu injection.
• Inhalant: inhale through mouth. Eg-measles vaccine.
• Orally: certain vaccines can be given in the form of tablet.
• Micro needle: certain flu vaccine can shoot the substances into the body without making use of needles. (Riedel, 2005)
• Economics of vaccination: health determines the economic prosperity of the country. This can be because healthier individuals are better at contributing to the economic development of a county than a sick.
• If someone gets vaccinated, diseases won’t infect him and also he will be able to protect those around him. This results in healthier society, which allows individuals to be more economically productive.

IMMUNIZATION

Definition: According to World Health Organization, “immunization is defined as the process of making a person resistant to infectious diseases after getting vaccines.”

How does immunization works?

When you get an immunization, you are injected with a weakened form of diseases. This triggers our body’s reaction, causing it to either produce antibodies to that particular disease or induce other processes that enhance immunity. (childhood immunization, 2011)

In future, again if we are exposed to that particular diseases causing organism, our immune system is ready to fight the infection. A vaccine will usually prevent the onset of diseases or reduce its severity.

Goal of immunization

• To generate B and T memory cells.
• To increase immune response to pathogens.
• To minimize adverse effects.
• To prevent/reduce severity of infectious diseases.

Types of immunization;

1. Passive
2. Active.

Conclusion

In conclusion, it is important to get vaccinated and immunized because the goal of public health is to prevent diseases. It is easier and more cost effective to prevent diseases than to treat it.

Immunization protects us from serious disease and also prevents the spread of these diseases to others. Over the years, some infectious diseases like measles, mumps and respiratory diseases were prevented from spreading by immunization. Some vaccines must be one time. Other requires updates or boosters to make immunization successful and continued protection against diseases (Riedel, 2005).

As we all know that “Prevention is better than cure”, immunization and vaccination are the important factors to protect our self and people around us from infectious diseases.

References

1. Anand, A. (2015). slideshare. Retrieved from slide: http://www.slideshare.com
2. childhood immunization. (2011). Retrieved from world health organisation: http://www.who.int
3. Deepa, P. a., & G. (2015). Anatomy and Physiology for nurses. Jaypee Brothers Medial Publisher.
4. Levinson, W. (2018). Medical Microbiology and immunology. Medical publishing division.
5. Richard V Goering, M. Z., & Peter L Chiodini, C. M. (2008). Medical Microbiology. Elesevier Limited.
6. Riedel. (2005). Edward Jenner and the history of small pox and vaccination.

The first few years of our baby’s life are the most crucial ones, and so parents seek to provide the best for them especially during their developing years. The terms immunizations, vaccines, and vaccinations are used interchangeably by parents frequently and they have become normalized in Jamaica. Vaccination is the act of providing immunity by introducing a biological substance that protects the human immune system from contracting diseases or infections caused by bacteria and viruses. Immunization is getting individuals protected against a disease or virus. Vaccines are products that give you the ability to resist an infection or a specific disease and are mostly given by injection using a needle while some are given by mouth (orally) or sprayed in the nostril. The importance of vaccination for our children, is vaccination safe and the dangers of neglecting vaccination.

Getting our children vaccinated is very important to Jamaicans. Taking our children to the doctor’s office or clinics for their regular checkup to make sure they get their necessary shots are just a few things that parents do to ensure that their child or children is healthy. At these checkups the babies normally receive their first shot of vaccine which helps to fight against viruses. According to Acting Director of Family Health Services in the Ministry, Dr. Melody Ennis “acknowledged that Jamaicans have taken the safety and well-being of their children seriously, with a significant number of children from birth to six years being comprehensively immunized against the 10 targeted diseases.

Concerns may rise in parents about their babies being vaccinated as to whether it is safe, how often does the child have to receive them and what are the risks of being vaccinated. Vaccines are very safe and must be tested and licensed by the Food and Drug Administration (FDA) before it can be used on our children. In Jamaica immunisations are mandated by law for children prior to school entry. At birth they receive the BCG vaccine to protect against severe forms of tuberculosis; at six weeks, to six months old, polio; pentavalent vaccine to protect against diphtheria, pertussis otherwise called whooping cough, tetanus also known as locked jaw, haemophilus influenza type B, and hepatitis B. At 12 and 18 months old, the MMR to protect against measles, mumps and rubella.

The dangers of neglecting to get your child vaccinated can be very dangerous. It can lead to effects such as them losing one of their arm or leg, paralysis of limbs, hearing loss (deaf), convulsions, brain damage and even death. None of us would want their child colliding into a wall as heshe takes their first step, as a result of been losing their sight due to complications from a rubella infection at birth. Nor your child being unable to walk properly due to poliomyelitis also called polio or struggling to breathe as a result of complications from diphtheria have blocked the air passage.

Vaccination is a clinical application of immunization designed to artificially help the body to defend itself. It should be our number one priority as parents to ensure that our children are fully immunized to ensure that they are protected for the dreadful diseases or virus. Don’t worry vaccines are not harmful to our children as it has been tested and approved by the Food and Drug Administration. The vaccines will be administered at stages in our child’s life and not all at once. Our children can be visually impaired, deaf, and even brain damage if not immunized. As the Jamaican proverb says prevention is better than cure.

The first few years of our baby’s life are the most crucial ones, and so parents seek to provide the best for them especially during their developing years. The terms immunizations, vaccines, and vaccinations are used interchangeably by parents frequently and they have become normalized in Jamaica. Vaccination is the act of providing immunity by introducing a biological substance that protects the human immune system from contracting diseases or infections caused by bacteria and viruses. Immunization is getting individuals protected against a disease or virus. Vaccines are products that give you the ability to resist an infection or a specific disease and are mostly given by injection using a needle while some are given by mouth (orally) or sprayed in the nostril. What is the importance of vaccination for our children, is vaccination safe and what are the dangers of neglecting vaccination?

Getting our children vaccinated is very important to Jamaicans. Taking our children to the doctor’s office or clinics for their regular checkup to make sure they get their necessary shots are just a few things that parents do to ensure that their child or children is healthy. At these checkups the babies normally receive their first shot of vaccine which helps to fight against viruses. According to Acting Director of Family Health Services in the Ministry, Dr. Melody Ennis “acknowledged that Jamaicans have taken the safety and well-being of their children seriously, with a significant number of children from birth to six years being comprehensively immunized against the 10 targeted diseases.

Concerns may rise in parents about their babies being vaccinated as to whether it is safe, how often does the child have to receive them and what are the risks of being vaccinated. Vaccines are very safe and must be tested and licensed by the Food and Drug Administration (FDA) before it can be used on our children. In Jamaica immunisations are mandated by law for children prior to school entry. According to Chad Bryan “At birth they receive the BCG vaccine to protect against severe forms of tuberculosis; at six weeks, to six months old, polio; pentavalent vaccine to protect against diphtheria, pertussis otherwise called whooping cough, tetanus also known as locked jaw, haemophilus influenza type B, and hepatitis B. At 12 and 18 months old, the MMR to protect against measles, mumps and rubella”.

The dangers of neglecting to get your child vaccinated can be very dangerous. It can lead to effects such as them losing one of their arm or leg, paralysis of limbs, hearing loss (deaf), convulsions, brain damage and even death. None of us would want their child colliding into a wall as heshe takes their first step, as a result of been losing their sight due to complications from a rubella infection at birth. Nor your child being unable to walk properly due to poliomyelitis also called polio or struggling to breathe as a result of complications from diphtheria have blocked the air passage.

It should be our number one priority as parents to ensure that our children are fully immunized to ensure that they are protected for the dreadful diseases or virus. Don’t worry vaccines are not harmful to our children as it has been tested and approved by the Food and Drug Administration. The vaccines will be administered at stages in our child’s life and not all at once. Our children can be visually impaired, deaf, and even brain damage if not immunized. As the Jamaican proverb says prevention is better than cure.

Introduction

Vaccines are designed to help protect and prevent serious diseases and help build up our body’s immunity to the various harmful diseases and viruses that are in the world. However, in recent years there has been many controversial discussions surrounding vaccinating. There have been topics of discussion regarding if there is a link between autism and vaccinating and now more than ever, there is a large group of the world’s population who have become advocates for anti-vaccinating. Mainstream media has played a big influence on the rise of anti-vaccinators and all of the benefits and pros of vaccinating seem to have been forgotten. The beginning of the year 2020 started out with a serious virus that originated in China and has spread worldwide to become a pandemic from a strain of Coronavirus. It is a perfect example of why vaccinations are so important. We could also take a look at diseases such as the measles which was almost completely eradicated but came back with a vengeance because there was a large portion of people who were against vaccinating for the disease. Vaccinations are still a very important part of our health and are crucial to the health of our children as they grow up. Throughout this study, we will look at the advancements of vaccinations, the types of vaccines there are and explore more in depth the benefits of vaccinating and their importance in the health care field.

Body

It is well known that vaccinating is the most cost-effective public health intervention. In the USA and Europe (high-income countries, HICs), vaccines have saved millions of lives, as seen with an increase in life expectancy as found in a study by Barocchi and Rappuoli. Vaccinating has the potential to save a life and to help build up a person’s immunity from serious or deadly diseases. Take for instance preventable diseases such as the mumps, influenza, tetanus, measles, pertussis and more. These are all diseases that are still a threat in our world and can be prevented through the use of a single vaccination. These diseases still have a major effect in our world as they continue to contribute to the hospitalizations and deaths that occur every year from children and adults who are not vaccinated. In the same study by Barocchi and Rappuoli, it was concluded that vaccination over a period of 50 years prevented 40 million cases of diphtheria, 35 million cases of measles and a total of 103 million cases of childhood diseases, the final outcome being that over the past century life expectancy in the USA has risen from 43.7 to 78.7 years. Vaccinations have always been a concept that people, parents especially, tend to weigh their options and ask questions and one of the biggest concerns is that there is not a clear understanding of what these vaccinations do within our bodies.

Typically, there are four traditional vaccines that contain either killed microorganisms, live microorganisms, toxoid-based vaccine and subunit vaccines. In any vaccination that a person receives, there is a very low number of antigens which are going to be the contributing factor of the germs that help to build up a person’s immune system. Having this small exposure allows the body to identify the foreign disease and gives it the capability to fight it off. Within these vaccines, we are exposing ourselves and our children to germs that they already come in contact with throughout a normal day; they’re just receiving it in a smaller portion. Vaccines are just as important to adults as they are to children because there is always a potential to gain exposure to the same germs or diseases that children get. There are four major population groups that should get vaccinated including infants, adolescents, adults and the elderly. According to a study by Rappuoli, Pizza and De Gregorio (2014), until 4 or 6 mo. of age, infants are exposed to GBS, influenza, RSV, pertussis, meningococcus, and tetanus, among others. Recently, it has been found that vaccination of pregnant women during the third trimester against tetanus, pertussis, and influenza induces protective immunity in the mother and in the newborn baby through the transplacental transfer of the antibodies. There are still many diseases that can be life-threatening to infants even in well developed countries so the urgency to vaccinate is crucial to ensure the best possible health outcome for any infants. Infants are an important population to keep in mind when considering vaccinating, but another population that needs vaccinations just as much is the elderly. In the same study by Rappuoli, et al. (2014), it was found that aging immune systems expose the elderly to many diseases that occur in the young. In addition, the elderly are often exposed to antibiotic resistant bacteria, especially during hospitalization. Our technological advancements have drastically improved our vaccines, therefore in the elderly populations, having an aging immune system, they often need newer vaccines that are more powerful or have higher doses that will in turn increase the effectiveness in older populations. However, there are studies that demonstrate how populations such as the elderly are often left out of vaccination programs because they are not a target group. One study performed by Gualano, Olivero and Siliquini (2019) found that vaccination programs can concern the population in general (children, adolescents and adults in good health), but they are usually targeted towards specific groups such as pregnant women, travelers and individuals with specific diseases/conditions. The elderly population is missing from most vaccination programs when they are a part of the population that could benefit the most from them.

There many areas of the world that are experiencing an opposition to the use of vaccinations and a large portion of the population who are refusing the recommended treatment to get vaccinated. Opposition to vaccinations has been a highly talked about discussion within the last few years, not just people refraining from vaccinating their newborns and children but opposing vaccinations entirely. There are concerned parents and persons all over the world who fear the use of vaccinations for reasons such as mainstream news and media speculating about links to autism if a child is vaccinated. There are religious aspects that play a part in the opposition as well as sanitary objections too. Our economic state is also a crucial element to consider because there have been challenges that the healthcare field faces in regard to budgeting that also make vaccinating a tough choice for some if they are not able to access or afford the preventative care. No matter what the opposition is though, it is important to consider the long-term effects that vaccinating can provide on not only a personal level but a global scale. Gastanaduy, Banerjee and Durrheim (2018) did a study that showed in late September 2016, the Americas became the first region in the world to have eliminated endemic transmission of measles virus. Measles had been eradicated from the Americas and there were other parts of the world that were also in the process of fully eliminating this life-threatening disease. A few years after the news of the eradication of measles, it seemed to have made a comeback. Parents are afraid to take their children places and parents of newborns warn others of handling their child or showing acts of affection because of fear of diseases. Had the populations complied and continued to vaccinate, the measles virus could’ve stayed dormant for much longer as it was most prevalent in the 1960’s and then between the years of 1997 until 2001, there were record low reports of the measles virus, then came 2016 with the eradication and now a disease that was seemingly gone as made a return. Measles is a very highly contagious disease and in order to protect people from contracting the disease, there needs to be a high percentage of people who are vaccinated against it or else it will spread rapidly. There is a concept called “herd immunity” which means that there needs to be high populations or communities that are vaccinated in order to protect and prevent the spread of the disease. Measles happens to be a life-threatening disease in which you do need that herd immunity but unfortunately, with low numbers of infants, adults and elderly being vaccinated, it became a very prevalent disease again in recent years.

There are many people who worry about the chemicals and antigens in the vaccinations that are given but they undergo quite a broad process to get approval from the FDA. Vaccinations just like any other drug or prescription, undergo extensive trials of research before the vaccine can get licensed and even then, the vaccine is continuously studied before it is used routinely for preventative care. With newer vaccines there are three phases of clinical trials that showcase elements of safety and show their effectiveness. More recently, sophisticated technologies have improved the way we mimic microorganisms and induce protective immunity. Modern vaccines are made of components purified from the pathogen, recombinant antigens produced in yeast, Escherichia coli or baculovirus, as well as antigens modified with structure-based design or synthesized in the laboratory (Rappuoli, et al., 2015). There has not been any evidence of negative long-term effects and like most vaccines and prescriptions that we take, the most noticeable side-effects which vary per individual range from minor effects of soreness, redness, discomfort/pain or a very low-grade fever. As stated in a study by Griesenauer and Kinch (2017), products that predated the FDA or never received formal approval have been removed from the market and are no longer available. Due to changes in the structure of the Food and Drug Administration (FDA), the approval process for some products has changed over time. The health care field is ever evolving and changing along with our technological advancements, innovations in science and therefore, organizations such as the FDA comply to ensure the safety of the vaccines and the efficacy of their use.

Vaccinations are important no matter the age of a person but there have been substantially low reports of adults receiving vaccinations. Concerns regarding vaccination payments have been reported as major barriers to adult vaccination implementation by healthcare providers, including family physicians, internists and obstetricians and gynecologists (Leidner, Murthy and Bridges, 2019). Costs of vaccinations vary per family and individual, especially depending on if there is health care coverage or not. Payments for adults to receive vaccinations through services such as Medicaid vary by state, however, it is commonly known that for pregnant woman, the cost of vaccinating is significantly lower if covered through Medicaid versus a private insurance company. Services such as Medicare cover the costs of vaccines for the elderly depending on the type of coverage they have such as Medicare Part B and Part D. Efforts to improve healthcare providers and health systems’ awareness of the cost-effectiveness of adult vaccines may prompt more efforts to improve the implementation of vaccination recommendations and reduce missed opportunities for adult vaccinations (Leidner, et al. 2019). This is a very important step to provide the right coverage and to shed light on the benefits and cost-effectiveness of vaccinations to finally reach the adult population to boost the numbers of those who are vaccinating. As adults, we often forget about the usefulness of vaccinating for ourselves and focus on our children or our older family such as parents or grandparents. Even as adults, there is a much lower chance of contracting specific diseases when the choice to vaccinate is being made. The vaccines will essentially work with the person(s) body and its natural defenses to develop an immunity to diseases and viruses. In turn, this immunity will lower the chance of getting disease in the future and possibly suffering from complications as well. For instance, when vaccinating for the Influenza, there is a much lower risk of getting flu, suffering from a flu-related heart attack or complication that may arise from an underlying health condition. As adolescents and even adults, when vaccinating for the human papilloma virus (HPV), there is a lesser risk of contracting cervical cancer. Not to mention, as adults, it is important to vaccinate so you are protecting and preventing those around you from getting a disease and therefore, lessening the possible spread of a disease.

Infants and elderly people have weakened immune systems, so if you don’t want to vaccinate for yourself, it should be a consideration for those who are around you who may be vulnerable to getting a disease or virus. Vaccines allow for humans to have a chance to protect and prevent and create a safer healthy life. It is important that as patients in the health care world, that we continue to ask questions, to become proactive and knowledgeable. Vaccinations should be a high priority especially when there are other services that are offered that take precedence over getting a vaccine. Other preventive services, such as hypertension screening and breast/colorectal cancer screening, appear to have similar cost-effectiveness profiles as adult vaccinations, however these services appear to be given greater priority during clinical practice (Leidner, et al. 2019). If a preventable disease is contracted because a person chose not to get an immunization, there are long-term cost effects that are often overlooked such as the costs of a doctor’s visit, possible hospitalization, treatment and prescription bills and possibly premature death.

In conclusion, it is crucial that there is a global consensus on priority for emerging and neglected vaccine-preventable diseases; and a commitment to providing funds for research, development and delivery of these vaccines worldwide. The scientific community must make health prevention issues an important thematic discussion in the global health political agenda (Barocchi, et al. 2015).

Conclusion

Vaccines have proven to be effective tools for controlling and eliminating life-threatening infectious diseases and ae estimated to avoid between 2 and 3 million deaths each year (Gualano, et al. 2019). Vaccinations have proven to be a successful tool in our health in aspects of prolonging life and preventing deaths. Imagine if there was a larger number of the population that invested the time to research vaccines, ask their primary physician questions and vaccinated, the number of lives saved each year could go up substantially. There are no harmful chemicals or antigens in the vaccines provided and approved by the FDA. All vaccines are safe and offer only a small fraction of a killed virus/bacteria that is created to simply imitate the virus. If ever exposed to the injection received for said vaccination, a person’s immune system is already built up and ready to fight in infection or virus. With the help of vaccinations, common preventable diseases such as measles, mumps, influenza, etc. have all been diminished and there has even been the extinction of various other disease including smallpox and polio. It has always been said that it is more effective and cost-conscious to prevent a disease than to treat it. Getting an immunization will help to lessen the spread of infectious disease and will provide protection. When choosing to get immunized, it is a small step in the right direction on a global and public health scale.

Antibodies have been utilized to lessen the wellbeing effect of immunization preventable maladies among kids and grown-ups worldwide, with 2–3 million passing anticipated every year by fruitful vaccination. Vaccines against regular illnesses, for example, measles, mumps, rubella, chickenpox, and polio are incorporated into the inoculation plans for kids in most countries. In request to completely vaccinate a youngster at a proper age, synchronous inoculations against a few infections, or vaccination with consolidated immunizations, for example, the antibody against measles, mumps, and rubella (MMR), are routinely recommended. Combination antibodies have the upside of less infusions for the patient at each visit to the specialist and are commonly favoured over concurrent separate infusions. In my essay I will put light on several researches which are undertaken and going on from past many years, as well as tetravalent and combined vaccination and MMR accination.

Measles, mumps, rubella and chickenpox is one of the most spreadable diseases which is main root for death and disability among young children globally. Consolidating mix antibodies, for example, the measles-mumps-rubella-varicella (MMRV) antibody, into vaccination calendars ought to be assessed from an advantage chance viewpoint. Utilization of MMRV antibody stances challenges because of a perceived expanded danger of febrile seizures (FSs) when utilized as the principal portion in the second year of life. On the other hand, culmination by age 2 years of measles, mumps, rubella, and varicella inoculation may offer improved infection control. Varicella zoster virus (VZV) is an alpha herpesvirus that infects exclusively humans [Hambleton and Gershon, 2005]. Varicella (or chickenpox) is an exceptionally infectious ailment in youngsters with an expected family unit auxiliary assault pace of 90% [Arvin, 1996; Ross, 1962]. During the brooding time frame (10–21 days), the infection at first repeats in the upper respiratory tract and through an essential subclinical viremia, the infection spreads to the reticuloendothelial framework (liver, spleen) and different organs.

Risk of FSs Following MMRV and MMR Vaccines: During the investigation examination period, 1668 one of a `kind FS scene were distinguished in 1471 kids more youthful than 5 years. Of these kids, 1335 (90.8%) had just 1 scene and 136 (9.2%) had at least 2 scenes isolated by in any event 7 days. The middle age at the hour of the main FS was 21 months (interquartile extend [IQR], 14-31 months), like the middle age at receipt of MMRV antibody of year and a half (IQR, 18-19 months) and the pinnacle age at FSs indicated previously. After limitation to age 11 to 23 months and the prescribed immunization grouping, there were 465 FS scenes in 391 youngsters. Ten youngsters with 12 FSs (10 of 401 cases [2.4%]) were barred in light of the fact that the prescribed timetable was not pursued (just 4 had MMRV as portion 1, which was a deficient example to break down FS hazard). Of the 391 youngsters included, 278 (71.1%) had gotten MMR pursued by MMRV antibody, (24.8%) had gotten MMR immunization just, and 16 (4.1%) had gotten neither immunization. The consequences of the essential and affectability self-controlled case arrangement investigations. In the essential investigation, which balanced for age utilizing 3 age gatherings, there was no altogether expanded danger of FSs inside the 5-to 12-day chance period following MMRV, the prevaccination time frame, or the 13-to 30-day postvaccination period. The RI of FSs was brought up in the 5 to 12 days following MMR immunization (MCV portion 1) (RI, 2.71; 95% CI, 1.71-4.29), and there was an essentially lower hazard in the 2 weeks before inoculation. The aftereffects of the affectability examinations were like those of the essential investigations. Continuously from 2005: At least 95% of every single defenceless youngster, regardless of measles inoculation or horribleness status, get in any event one portion of measles antibody through supplemental vaccination program (Kenya Ministry of Health and Division of Planning and Development, 2000). In the United States there was a generous lessening in the rate of mumps even in the primary years subsequent to permitting of the immunization in 1967. All the more enthusiastically sought-after inoculation programs, still with a solitary portion of vaccination at the period of l3-year and a half, prompted a record low number of mumps cases, 1692, in this nation in 1993. It issignificant that general immunization inclusion be as viable as conceivable in light of the fact that in more seasoned youngsters there is a higher propensity to create orchitis (ANDERSSON et al. 1987). Likewise, with measles and mumps, rubella is a human advancement subordinate intense infection, yet it for the most part runs a preferably mellow course over the previous two.

WHO:As indicated by WHO and different suggestions, all youngsters ought to get a second open door for measles vaccination. Although most regularly given on school section (4-6 years), the second portion of measles or MMR antibody might be given as ahead of schedule as multi month after the main portion, contingent upon the nearby epidemiologic and automatic considerations. In 2004, the immunization timetables of every one of the 52 nations in the European district comprised of 2 dosages of measles-containing antibody, with 45 nations prescribing MMR immunization. Varicella inoculation is suggested in numerous European nations for high-hazard gatherings, however use is exceptionally restricted. A dish European proposal has been issued on the significance of varicella UMV in kids, by a gathering of specialists from Europe and the US (EuroVar). This accord paper suggested varicella UMV for every single sound tyke matured 12-year and a half, with the stipulation that high inclusion could be accomplished.

Tetravalent MMRV Vaccination: made by Merck and Co., Inc., has been accessible since 2005 in the US. It is right now a solidified immunization (put away at – 15[degrees]C) for organization to people from a year of age. Another tetravalent MMRV antibody made by GlaxoSmithKline Biologicals has been accessible in Germany since 2006 as a cooler stable antibody (to be put away somewhere in the range of +2[degrees]C and +8[degrees]C) for organization to kids from 9 months of age.

Combined MMRV Vaccination: Combined MMRV inoculation offers a potential new apparatus for control and possible end of every one of the 4 ailments with a solitary immunization. Like MMR, the 2-portion timetable is the best alternative for utilization of this immunization. A joined MMRV antibody would clearly encourage the presentation of varicella UMV.15 Reaching the high inclusion rates important to accomplish the full advantages of varicella immunization in any nation would be encouraged by the current framework for MMR 2-portion inoculation, and the far-reaching acknowledgment of the idea and requirement for varicella inoculation.

Conclusion

Measles can be avoided with MMR immunization because researches indicates that this antibody secures against three infections: measles, mumps, and rubella. CDC (centres for Disease Control) prescribes kids get two portions of MMR antibody, beginning with the primary portion at 12 through 15 months of age, and the second portion at 4 through 6 years old. The MMR antibody is sheltered and compelling. Two portions of MMR antibody are about 97% viable at anticipating measles; one portion is about 93% powerful.

References

1. Centre’s for Disease Control and Prevention. Vaccines timeline [online]. Available from URL: http://www.cdc.gov/nip/vaccine/vacc-timeline.htm [Accessed 2008 May 26]
2. World Health Organization. Immunization, vaccines and biologicals [online]. Available from URL: http://www.who.int/features/factfiles/immunization/en/index.html [Accessed 2008 May 26]
3. United Nations Children’s Fund. Immunization summary: the 2007 edition [online]. Available from URL: http://www.unicef.org/publications/files/Immunization_Summary_2007.pdf [Accessed 2008 Mar 18]
4. Ross, A. (1962) Modification of chicken pox in family contacts by administration of gamma globulin. N Engl J Med 267: 369–376.
5. Arvin, A. (1996) Varicella-zoster virus. Clin Microbiol Rev 9: 361–381.
6. Anderson RM, Crombie J A. Grenfell BT (1987) The epidemiology of mumps in the UK: a preliminary study of virus transmission, herd immunity and the potential impact of immunization. Epidemiol Infect 99:65-84
7. CDC. Recommended immunization schedules for persons aged 0-18 years-United States, 2007. MMWR. 2007;55(51/52): Q1-Q4.
8. WHO. Health 21-The Health for All Policy Framework for the WHO European Region. 1999. Available at : http://www.euro.who.int/document/health21/wa540ga199heeng.pdf. Accessed January 4, 2007.
9. Macartney, Kristine; Gidding, Heather F ; Trinh, Lieu ; Wang, Han ; Dey, Aditi ; Hull, Brynley ; Orr, Karen ; Mcrae, Jocelynne ; Richmond, Peter ; Gold, Michael ; Crawford, Nigel ; Kynaston, Jennifer A ; Mcintyre, Peter ; Wood, Nicholas JAMA Pediatrics, 01 October 2017, Vol.171(10), pp.992-998
10. RA. Wright PF, San ella EC, Hutcheson RH. Schaffner W (1994) Sustained transmission of mumps in a highly vaccinated popUlation: assessment of primary vaccine failure and waning vaccine-induced immunity. J Infect Dis 169:77-82
11. FDA. ProQuad: Product Approval Information-Licensing Action. Available at:http://www.fda.gov/cber/products/mmrvmer090605.htm. Accessed January 4, 2007.
12. Rentier B, Gershon AA. European Working Group on Varicella. Consensus: varicella vaccination of healthy children-a challenge for Europe. Pediatr Infect Dis J. 2004; 23:379-389.
13. Wutzler P, Neiss A, Banz K, et al. Can varicella be eliminated by vaccination? Potential clinical and economic effects of universal childhood varicella immunisation in Germany. Med Microbiol Immunol. 2002; 191:89-96
14. Paul Ehrlich Institute. Bundesanzeiger-Veroffentlichung 14. 10. 2006; Bundesanzeiger Nr. 194; S. 6714. Bekanntmachung Nr. 300 uber die Zulassung von Sera und Impfstoffen sowie andere Amtshandlungen vom 14. September 2006. Availableat:http://www.pei.de/cln_048/nn_154446/SharedDocs/Downloads/bekanntmachungen/2006/zul-banz-194-14-10-2006-s6714-bekannt-300,templateId=raw,property=publicationFile.pdf/zul-banz-194-14-10-2006-s6714-bekannt-300.pdf. Accessed 4 January, 2007.
15. Hambleton, S., Gershon, A. (2005) Preventing varicella-zoster disease. Clin Microbiol Rev18: 70–80.
16. http://www.fda.gov/cber/products/mmrvmer090605.htm
17. http://www.pei.de/cln_048/nn_154446/SharedDocs/Downloads/bekanntmachungen/2006/zul-banz-194-14-10-2006-s6714-bekannt-300,templateId=raw,property=publicationFile.pdf/zul-banz-194-14-10-2006-s6714-bekannt-300.pdf
18. http://www.pei.de/cln_048/nn_154446/SharedDocs/Downloads/bekanntmachungen/2006/zul-banz-194-14-10-2006-s6714-bekannt-300,templateId=raw,property=publicationFile.pdf/zul-banz-194-14-10-2006-s6714-bekannt-300.pdf
19. http://www.pei.de/cln_048/nn_154446/SharedDocs/Downloads/bekanntmachungen/2006/zul-banz-194-14-10-2006-s6714-bekannt-300,templateId=raw,property=publicationFile.pdf/zul-banz-194-14-10-2006-s6714-bekannt-300.pdf
20. http://www.pei.de/cln_048/nn_154446/SharedDocs/Downloads/bekanntmachungen/2006/zul-banz-194-14-10-2006-s6714-bekannt-300,templateId=raw,property=publicationFile.pdf/zul-banz-194-14-10-2006-s6714-bekannt-300.pdf