Running head: THE CASE FOR MANDATED CHILD FLU VACCINATIONS

The Perceived Risks of and the Case for

Mandated Child Influenza Vaccinations
Lauren T. Nguyen
Liberty High School

THE CASE FOR MANDATED CHILD FLU VACCINATIONS

Every year, an estimated quarter to half a million people die from the flu (Immunization
Seasonal, 2014). During years of flu pandemics, this number is even higher. Throughout the
last century, several severe influenza pandemics have occurred with devastating consequences
for the human population. These include the 1918 Spanish flu claiming 40-50 million lives, the
1957/1958 bird flu causing over 2 million deaths, the 1968 Hong Kong flu, resulting in 1 million
casualties, and the more recent 2009 H1N1 swine flu pandemic accounting for over a quarter
million deaths. However, could these losses of human lives have been averted with mandated flu
vaccinations, particularly for one of the most immunologically vulnerable groups, children?
Though there is a perception of risk involved with influenza vaccinations, research and history
supports the notion of implementing mandated flu vaccinations for children in order to minimize
the spread of the flu.
The exact definition of immunization is the process whereby a person is made immune
or resistant to an infectious disease, typically by the administration of a vaccine while the
purpose of vaccines can be described as to stimulate the bodys own immune system to protect
the person against subsequent infection or disease (Immunization, n.d.). Vaccines work by
triggering the response of the bodys immune system so that the body can recognize the virus
and produce antibodies against it. Thus, when a person is hit with the actual flu virus, the bodys
immune system will respond quicker to attack and kill the virus. However, each year the flu
virus strain alters (either minimally or, as the history of flu epidemics has shown, drastically).
This results in the need to vaccinate each flu season.
Each year, scientists from around the world predict which flu strains they believe to
transpire in the upcoming flu season, and choose three to put into the flu vaccinations of that
year. This decision is decided upon by observing which strains seem to be circulating the most

THE CASE FOR MANDATED CHILD FLU VACCINATIONS

throughout the year, as well as how those strains are spreading, gathered from national influenza
centers from around the world (Selecting, 2014). There are two ways to get a flu vaccination:
by a shot in the arm or through a nasal spray (known as LAIV, or live attenuated influenza
vaccine). Shots consist of inactivated viruses, while the LAIV contains a weakened version of
the flu virus. While for most seasons these strains of the flu virus chosen by scientists are
relatively close to the actual one for that year, what happens when the actual major flu strain for
the season differs drastically from the three prognosticated by scientists? This results in an
influenza pandemic, or an epidemic of an influenza virus that spreads on a worldwide scale and
infects a large proportion of the human population (Cinatl, Doerr, & Michaelis, 2009, p. 381),
with the three most significant flu pandemics having been the Spanish, bird, and Hong Kong
flus, respectively. Besides the drastic difference between predicted and actual flu viruses, these
epidemics were also due to the fact that the flu is so easily transmissible. One of the major
factors with influenza that makes it so widespread is its ability to be easily transferred from
person-to-person through sneezing, coughing, saliva, feces, and blood. The high-risk groups
most severely affected by the flu (with more cases of a contraction of the virus resulting in
hospitalization or death) are young children, the elderly, and the chronically ill.
One major argument for mandating vaccinations in children is that they are at a higher
risk of hospitalization or death if they acquire the flu virus. As published by the American
Journal of Bioethics (a journal specific to the field of bioethics, including the fields of public
health, scientific research, and clinical medicine), A naive immune system responds less
effectively to viral infection, meaning children are more likely to become sick and remain sick
for longer periods of time compared to adults (Bambery, Selgelid, Maslen, Pollard, &
Savulescu, 2013, p. 38). Due to childrens weaker and less developed immune systems (children

THE CASE FOR MANDATED CHILD FLU VACCINATIONS

dont fully develop their immune system until 7-8 years of age), they should be afforded extra
protection against the flu. This could be done by being given a flu vaccination every year,
especially earlier in the flu season since it takes two weeks for the immune system to produce
antibodies for the flu viruses. Not only would consistent, annual flu vaccinations benefit the
childs body to respond to the flu for that year, but it will also serve to develop the childs
immune system to be better prepared for future encounters with flu viruses.
Another significant reason for the case of mandatory flu vaccinations for children is the
fact that they greatly add to the transmission of the flu to other significant groups. This is
acknowledged by Bambery et al. (2013) in the American Journal of Bioethics:
Studies have shown that children are frequent introducers of influenza into the household
and that schools, in particular, act as a conduit for disease transmission throughout the
communityModels have shown that vaccinating 20% of school-aged children can more
profoundly decrease adult mortality than vaccinating 90% of those aged greater than 65.
With vaccination coverage of 40%, serious morbidity and mortality could reduce by 70%
in the elderly70% coverage among children could prevent 100 million cases of
influenza in the United States every year. (p. 38-39)
Children are a major contributing factor in the spread of influenza, starting with the germinfested schools where most catch the flu virus. This then spreads to other members of the
family, including siblings, parents, and, more dangerously, grandparents, which also affects the
amount of lost school and work days for the whole family. Thus, it would be more beneficial to
target vaccinations for children rather than other high-risk groups, namely seniors, due to the
greater influence they hold in decreasing adult mortality. This decrease in flu-related deaths and
infections in the communal population is supported with Japans implementation of a widespread

THE CASE FOR MANDATED CHILD FLU VACCINATIONS

mandatory influenza vaccination program for all schoolchildren from 1977 to 1987, which saw
decreases in mortality of at least 37,000 deaths each year (Bambery et al., 2013, p. 39). Japans
implementation of mandatory vaccinations demonstrates the benefits of a similar program
elsewhere in the world, such as in the U.S., to decrease influenza death rates each year.
An additional factor favoring vaccinations that might not be readily thought of is that
forcing vaccinations for children could actually save the country a significant amount of money
in the long-run, compared to not vaccinating. According to an article from PharmacoEconomics
& Outcomes News:
Early vaccination for a human influenza A (H7N9) pandemic has substantial health and
economic benefitsThe model predicted that without vaccination, 1.92 million persons
would become symptomatically infected and 48,254 would die. Vaccinating at 9 months
would avert 2,365 deaths. Vaccinating at 6 months, rather than at 9 months, would avert
5,775 additional deaths, and would save $US51 million in treatment costs (2012 values);
vaccinating at 4 months, rather than at 6 months, would avert 5,633 additional deaths, and
would save $50 million. (Substantial benefits, 2014, p. 15)
This source and model is relatively credible, coming from a journal that gets its research
specifically from pharmacoeconomics meetings and symposia by the world leaders in the field.
The model demonstrates the value of vaccination, and, particularly, early vaccination, in terms of
both decreasing mortalities and saving the country money in the long-run. If early vaccinations
were actually mandated, flu pandemics could be averted, and their consequences, both
monetarily and fatally, would not be as devastating.
Also, the cost of immunizing a high-risk group would not be as high as many assume.
Such was the case in 1976 with the implementation of the National Influenza Immunization

THE CASE FOR MANDATED CHILD FLU VACCINATIONS

Program where the estimated budgeted cost of the program was $137 million (Sencer & Millar,
2006, p. 30). Furthermore, Sencer and Millar (2006) wrote:
When Congress passed the appropriation, newspapers mischaracterized the cost as $1.9
billion because the $137 million was included as part of a $1.9 billion supplemental
appropriation for the Department of Labor. In the minds of the public, this
misconception

prevailed. The risk of potentially unnecessary costs in a mass vaccination

campaign is

minimal. (p. 30)

This source and program was headed by David J. Sencer, who has a thorough background in
public health with having been in charge of the 1976 immunization program, the Health
Commission of New York City for four years, and the director of the CDC for 11 years. This
budget of $137 million (in todays time about $575 million) is rather minimal compared to the
federal governments projected spending amount this year of $3.9 trillion (Federal Spending,
n.d.). With the budget of a similar immunization program for a highly susceptible group so low
compared to overall spending, implementing an immunization program today seems relatively
manageable, economically speaking.
Those against mandated vaccinations, however, may argue that there is a significant
increased risk in contracting other diseases and disorders, such as Guillain-Barr s syndrome
(GBS) and autism. This was the argument in 1976 regarding the National Influenza
Immunization Program, What NIIP did not and could not survive [was]finding cases of
-

syndrome (GBS) among persons receiving swine flu immunizations (Sencer &

Millar, 2006, p. 31). Interestingly enough, for the 1976 year, the predicted swine flu pandemic
never became full-fleshed. Instead, there were 504 cases of GBS among vaccine recipients, of
which at least 211 of them were attributed to the vaccine and 32 vaccine recipients died

THE CASE FOR MANDATED CHILD FLU VACCINATIONS

(Alcabes, 2010, p. 11). There is also a popular perception of children becoming autistic due to
vaccinations, as British gastroenterologist Andrew Wakefield (2009) argued in Lancet, [There
is] a link between the three-in-one shot for measles, mumps and rubella (MMR) and the
development of colitis and autism in a small group of previously normal children (Vaccines,
2009, p. 119). Wakefields paper provoked a lot of panic in the public, as the U.K. saw a major
drop in vaccination rates for MMR and an upsurge of the measles in children (Vaccines, 2009,
p. 119), showing how scare tactics unfortunately affected the U.K. population. Also of concern
during that time was the use of thimerosal in vaccines, which contained a mercury compound.
This resulted in a sharp decline of the use of preservatives containing mercury since 1999, due to
the fears usually associated with mercury exposure, including developing nervous disorders,
cancer, kidney damage, and respiratory failure.
However, the scientific community has repudiated the link between autism and
vaccination originally proposed by Wakefield in the Lancet paper. As reported in the article
Vaccines versus viruses published in Nature Medicine (2009):
Several large epidemiological studies have failed to find a connection between autism
and either the MMR vaccine or any vaccine containing thimerosal. The Lancet paper
was

subsequently deemed to be flawed and its conclusions were retracted by ten of its thirteen
authors. Furthermore, thimerosal has been eliminated from most childhood vaccines
since 2001 without a corresponding drop in autism ratesclearly contradictory to the
proposed causal effect of the preservative. (p. 119)

Thus, the concern of vaccinations causing autism is unwarranted and rescinded, both by its own
authors and the scientific community. With a decrease in the use of thimerosal in child vaccines,
and no corresponding drop in autism rates, a relationship between the two is not supported. With

THE CASE FOR MANDATED CHILD FLU VACCINATIONS

autism being a neurodevelopment disorder mainly thought to be genetic, environmental factors
(any factor influencing living organisms) such as vaccination would not be a very profound
cause. This false belief may be furthered by the fact that most children show signs of autism in
their early child years, around the same time vaccinations are required for children entering
school.
Though there may be a public discernment of a cause-and-effect relationship between
vaccinations and getting autism, scientific studies have proven this to simply not be true. Other
factors of decrease in deaths, transmission of the flu, and saving the country money all lead to
favoring mandated child flu vaccinations. With the implementation of a program as such, the
minimization of the spread of the flu will surely be seen. Along with that, decreases in
absenteeism in schools and workplaces, as well as decreases in infections and deaths among
high-risk groups will occur, while severe influenza pandemics can be deterred. Thus, mandating
flu vaccinations in children will save not only the country money, but also the human population
itself.

References
Alcabes, P. (2010). Flu Vaccination in Historical Perspective: Public Health for the Middle
Class. Social Alternatives, 29(2), 8-14.
Bambery, B., Selgelid, M., Maslen, H., Pollard, A. J., & Savulescu, J. (2013). The Case for
Mandatory Flu Vaccination of Children. American Journal Of Bioethics, 13(9), 38-40.
doi:10.1080/15265161.2013.813602

THE CASE FOR MANDATED CHILD FLU VACCINATIONS

Cinatl, J. Jr., Doerr, H. W., Michaelis, M. (2009). An Influenza A H1N1 Virus RevivalPandemic

H1N1/09 Virus. PubMed Health, 37(5), 381-389. doi: 10.1007/s15010-009-9181-

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Federal Spending: Where Does the Money Go. (n.d.) National Priorities Project. Retrieved
from https://www.nationalpriorities.org/budget-basics/federal-budget-101/spending/
Immunization. (n.d.). World History Organization. Retrieved from http://www.who.int/topics/
immunization/en/
Immunization Seasonal. (2014, March). World History Organization. Retrieved from http://
www.who.int/mediacentre/factsheets/fs211/en/
Selecting the Viruses in the Seasonal Influenza (Flu) Vaccine. (2014, September). Centers for
Disease Control and Prevention. Retrieved from http://www.cdc.gov/flu/professionals/
vaccination/virusqa.htm
Sencer, D. J., & Millar, J. D. (2006). Reflections on the 1976 Swine Flu Vaccination Program.
Emerging Infectious Diseases, 12(1), 29-33.
Substantial benefits from early vaccination for flu pandemic. (2014). PharmacoEconomics &
Outcomes News, 706(1), 15. doi:10.1007/s40274-014-1371-4
Vaccines versus viruses. (2009, February). Nature Medicine. p. 119. doi:10.1038/nm0209-119.