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Sample Annotated Bibliography Paper on the Vaccination Debate: Should Vaccinations Be Mandatory

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Sample Annotated Bibliography Paper on the Vaccination Debate: Should Vaccinations Be Mandatory

Dr. Edward Jenner is credited with the inception of the first smallpox vaccine in the late 18th century. He successfully demonstrated that an inoculation material from a cowpox lesion was effective in protecting people against subsequent exposure to smallpox. His demonstration began the vaccine era that peaked in the 20th century when many vaccines would be developed. Since then, vaccines have been used, and they have had a spectacular impact on the incidence and occurrence of disease. However, opponents of vaccination have been reluctant in appreciating the effectiveness of vaccines. Despite vaccines being declared as one of the most significant medical advances, critics have always contended that parents are misled when it comes to the effectiveness of childhood vaccinations. Still, about 50 states have stepped up their legislation to ensure that all children attending public schools are vaccinated since the inception of inoculation(Orenstein and Hinman 1999). The recent ruling by the U.S. Supreme Court to uphold compulsory vaccination laws in 2014 have only intensified the controversy. Over 50 vaccine-related laws are being reviewed in state legislatures across the U.S. The debate on whether parents have a right to refrain from vaccinating their children has peaked in the past year when several states decided to make vaccinations mandatory. Although opponents of mandatory vaccinations view these laws as ignoring parental authority, the tremendous impact of vaccines on the occurrence of diseases cannot be ignored (Chemerinsk and Godwin, 2015). The freedom of choice cannot be misused to endanger the lives of people.  As such, state legislatures should enforce childhood vaccinations. The state has the exclusive rights of promoting better healthcare for populations and vaccinations, as one of the most critical public health achievements, should be used to further this mandate. Following example of Australia where vaccination is mandatory, the impact has been outrageous as it has significantly promoted health care (Isaacs, Kilham andMarshall,2014).The burden of disease being a huge expense to the U.S economy, mandatoryadministration of vaccines is a cornerstone for ensuring the US economy saves billions of health cost incurred annually.Moreso, protecting the society from any preventable diseases ensures good healthand well-being of the citizens. The opponents of vaccines claim composition of certain dangerous elements in vaccines like mercury but some of these claims have been proved as distorted and others scientifically proved to be safe. Other claims are based on the infringement of religious, psychological and parentalrights. However, vaccination has been highly effective inpreventingdisease, disability, death and in savingcosts. These benefits are more valuable as they concern lives of people, hence for the good of majority, childhood vaccination should be made mandatory.

A list of Diseases Prevented by Vaccination

Some of the diseases that CDC recommends for vaccination include:                                      


Congenital Rubella

Hepatitis A and B

Small pox






H. Influenza

Pneumococcal disease








Varying Opinions on Compulsory Vaccinations

Childhood vaccinations in the U.S.A. have been recorded to be the highest of all developed countries. By their first birthday, children in the U.S. will have received about 26 vaccinations. Children in Japan are estimated to receive just over ten within the same period. Opponents of vaccinations doubt the effectiveness of vaccinations in the U.S.A. given that it has the highest infant mortality worldwide. According to Isaacs et al. (2014), about six infant deaths are recorded for every 1000 births in the U.S.A. The fact is that this statistic could be worse without the intervention of vaccines. In the state of California, Gov. Brown signed a bill that made it compulsory for all children in public and private schools to be vaccinated. Earlier exemptions associated with religion were abolished in the wake of the measles outbreak in Disney in 2015. Those opposed to compulsory vaccinations view the legislation as oppressive and strict despite it being used in the aftermath of the measles outbreak in California that affected over 100 persons within a short time. It is such an outbreak that is forcing state legislations to demand mandatory childhood vaccinations for the sake of public healthcare. So far, only California, West Virginia, and Mississippi have come up with new legislation that does not consider previous nonmedical exceptions in administering childhood vaccinations. In a more general picture, only 46 states consider religion as an exemption while 17 include both religion and personal factors in their exemptions’ list. This is a strong argument being made for the case of mandatory childhood vaccinations across the U.S.A.

Since 20th century, vaccines have been proved to be among the most successful and cost-effective methods for preventing diseases, disability and death. Giving an example of  the Polio case, the vaccine for Polio was licensed in 1955 and by 1991,polio resulting from wild-type viruses had been eliminated as compared  to 16,316 paralytic cases and 1,879 deaths from polio reported annually between 1951 1nd 1954(CA, 2014).A large proportion of the American population appreciates the safety and effectiveness of vaccinations. As revealed byZhou et al   (2014), an estimated 83% approve the effectiveness of vaccines for measles, rubella, and mumps. At the same time, only 68% of the American adults support compulsory childhood vaccinations while an estimated 30% view vaccinations as requiring parental guidance. These statistics have not changed much since 2009. The support for compulsory childhood vaccinations seems to be modestly distributed across the political scene. While the Democrats, Republicans and the Independents approve that vaccinations are safe for the children, varying divisions begin to appear when the question of compulsory vaccination is raised. According to Brennan (2016), the Republicans and the Independents share a common 33% approval rate for parental choice compared to the Democrats who are 22% more likely to support it.

The Case for Mandatory Childhood Vaccinations

The controversy surrounding childhood vaccinations has been around for several centuries now. Critics cannot comprehend the idea that a child can get immunity from a disease through a deliberate exposure. Apart from viewing that situation as counter-intuitive, the proponents also question the role of vaccination when the children can suffer from allergic reactions. However, what they ignore is that vaccines have reduced the heavy burden of infectious ailments in the U.S.A. How a powerful anti-vaccine lobby still contends up to today is a wonder for many people given the evident success that vaccines have garnered against formerly dangerous diseases that have now become rare. Scientific data has been issued to suppress the anti-vaccine movement to no avail. This is because those who do not support compulsory childhood vaccinations do not rely on science to make their strong conclusions.

Disease Eradication and Elimination

Compulsory childhood vaccinations are an important aspect in disease eradication. Vaccines are modern medical advances that have a huge potential of saving lives through eradicating diseases. One of the most fearsome diseases that have been eradicated is smallpox. This would not have possible without the persistence of vaccination carried out worldwide. It is, therefore, not understandable that some parents would make a decision to refuse to vaccinate their children. For example, about 9% of parents in the U.S.A. have consistently denied their children a chance to be vaccinated. The outbreak of measles in 2014 has brought the debate on mandatory into the limelight once again. Advocates have come out strongly to indicate that the governments should take up mandatory vaccine policies to ensure there is a consistent coverage and, ultimately, further disease outbreaks are stemmed and completely eradicated.

As an intervention, vaccination eradicates pathogen in the long run that will not re-emerge once the process is complete. As stated earlier, the world is free of smallpox and it has effectively discontinued the routine vaccination globally. In fact, the last record of smallpox in the U.S. was in 1948. There is a huge chance that other infectious diseases could also be wiped out of the face of the earth if effective vaccinations are carried out. According to Brennan (2016), an effective eradication of a pathogen is only possible if there is a high level of “herd immunity” in all areas of the world over a long duration. This cannot be achieved if the freedom of choice is left to the public. As such, the government and other healthcare stakeholders should promote mandatory vaccinations for this progress to be experienced. The targeted disease across the world today is polio. It is still a global challenge, and the U.S. healthcare industry and the government should take up the responsibility of supporting the world in eradicating it. There has been significant progress made in the U.S. concerning polio because studies reveal that it has virtually disappeared. This process can only be completed through enforced childhood vaccinations right from birth. The Center for Disease Control (CDC) reports that it is because of the consistent vaccinations that the U.S. is close to winning the war of eradicating diseases. The country should not relent on its expanding stand of making childhood vaccinations compulsory.

Disease Elimination

Scientific studies reveal that eliminating diseases on the local scene is possible even without eradicating the causative microorganism from a global perspective. For example, the case of measles has been contained because transmission does not occur indigenously. At the same time, importation does not lead to a prolonged spread of its virus. An example of this case is the one that occurred in the U.S.A. recently. The spread of the measles virus was not rapid because the U.S. had reached 95% population immunity. It is predicted that MMR vaccine has the potential to eliminate mumps around the world. It is still under record that measles has been completely eliminated in the U.S. due to the previously formulated vaccination programs. The only hindrance preventing the U.S. from eliminating certain diseases is the reluctance of opponents to accept mandatory vaccination programs.

Control of Mortality and Morbidity

The impact of vaccination on the reduced mortality and morbidity rates among children in the past has been impressive. Efficacious vaccines have a general impact of protecting persons before and after exposure. Pre-exposure immunization for infants has been the most influential program in managing some childhood diseases. However, its impact is increasingly being eroded by the controversy surrounding its universality and effectiveness. It is estimated that childhood vaccinations prevent over 5 million deaths in the world. In the U.S.A., for the nine diseases that the healthcare departments have encouraged immunization, a noted decrease in their incidence and mortality has been recorded(CA, 2014).  Within the past century, numerous cases of fearsome diseases have been effectively reduced. Based on health reports, rubella killed 47,740, people every year, mumps caused 162,340 fatalities; diphtheria caused 21,000, and measles, 530,200. These figures have, however, decreased by 99% due to the intervention of vaccines. Despite the progress, several cases have been noted of children who have been lost their lives in schools while others have had to leave with physical scars as a result of vaccine-preventable diseases. For example, up to 45% of children who live through meningitis from Hib end up suffering neurological defects. This happens even when their parents understand that vaccines would have protected them. The authorities have always been clear in claiming that vaccines will not work to their optimum if a large number of the population, among them school children, do not take them. Therefore, if the government ensures that vaccines are mandated then the larger population will act as protective barrier against the likelihood of disease transmission, morbidity, and mortality in the society, thus indirectly protecting the small population that will not be legible for immunization due to medical conditions. Previous cases of vaccine-preventable diseases have hit communities hard where most of the children were not vaccinated. Given that there are slightly over 11,000 infant births per day in the U.S.A, the damage that not vaccinating would cause is huge for the society.

The mortality rates for about 14 diseases that are preventable through childhood vaccinations were recorded to have hit an all-time low in 2010(CA, 2014). For infections such as small pox, polio, and diphtheria, the rates of morbidity and death had been reduced by more than 90% since the beginning of the 20th century. Advocates of childhood vaccinations initiated a campaign to increase awareness in the U.S. after the resurgence of measles, and whooping cough threatened to cause havoc over the past five years. There is a new report that estimates about 10,000 and 30,000 incidences of whooping cough every year in the U.S.A. If the choice is left to the parents, there might be more cases of other vaccine-preventable diseases that will expose children to serious complications such as paralysis, brain damage, and limbs’ amputation. The proponents claim that vaccines should not be mandated because they contain harmful elements such as mercury which are used for preservation. Others claim that vaccinations have increasingly been linked with the development of autism among children (Taylor,Swerdfeger and Eslick, 2014). However, these claims are distorted. The complications and mortality rates that result from natural infection are more serious. Also, the fraudulent studies that the opponents cited have come to be discredited and even retracted. One of these studies is the relationship between autism and the MMR vaccines. These revelations should inform the campaign of embracing childhood vaccinations so that the mortality and morbidity rates are minimized.

Economic Benefits

The cost of healthcare in the developed world has risen in the last two decades due to the burden of diseases. This has prompted various governments to turn to vaccines in an attempt to reduce the burden. Opponents of mandatory vaccinations claim that physicians and other health agencies use scare tactics to intimidate parents towards considering vaccines. Apart from the usual “death” threats that they often cite, there are other major concerns on the national scale. According to Leichter  (2014),the yearly economic burden of whooping coughs, herpes, influenza, and pneumococcal is over $30 billion for adults in the U.S.A. This is a considerably high amount given that the healthcare costs form a large part of the budgetary allocation. It is confirmed that the low uptake of vaccines is one of the major reasons that pneumococcal and influenza accounts for over 70% of the total costs. The burden is estimated to be even higher if the affected adults were not immunized during their childhood years.

The timely use of vaccines curbs the high rates of morbidity and mortality to save the healthcare system of billions of dollar (Zhou, Shefer, Wenger, Messonnier, Wang, Lopez,  … & Rodewald,2014). It is estimated that for every $1 that the government spends on childhood vaccinations, about $10 is saved in treatment costs of such diseases. An outbreak of a vaccine-preventable disease is not only detrimental to the population’s health, but it is also very costly. Stopping such an outbreak costs the state over $10,000 per case. If those who are affected at any one time in an outbreak had been vaccinated, the resulting expenses of curing the diseases would be avoided(Hawke et al., 2014). On the global level, vaccinations save economies billions of dollars in expenses. Therefore, mandatory vaccination programs are great investments as they are cost effective. This is the reality that the opponents should consider while making decisions not to vaccinate their children.


The controversy surrounding the issue of mandatory vaccinations has existed for centuries. A rich debate has ensued among scientists, health specialists, parents, and politicians. There may never be a united front concerning mandatory childhood vaccinations. Therefore, the government has to become involved and introduce mandatory immunization policies. Other governments should also implement changes to policies in their countries so that there is a consistent coverage. New legislation is the way to go to encourage vaccination(Thompson, Compare & Smith, 2014). States such as Mississippi have led the way in adopting new laws eliminating exemptions on the grounds of religion, politics, and personal issues. The recent outbreak of measles should drive the states to involve new policies in curbing the damage caused by diseases among the population. Secondly, there should be campaigns to create awareness and dispel false truths associated with vaccinations. Some parents still quote the unfounded claims of autism as being caused by vaccines. Such fraudulent claims traced back to the late 1980s have been discredited by recent scientific research. The advocates of mandatory vaccinations should inform the parents so that they can make informed decisions.  It is after this intervention that the government could think of turning towards other ways to enforce the directive. One key strategy used to enforce the directive of mandatory vaccinations is to demand home-schooling for those children who are not vaccinated. California has used this strategy, but it is recommended that those against vaccinations should be informed rather than punish the innocent children. Ultimately, all stakeholders should collaborate for the sake of public health.


The development of modern vaccine technology should not be curtailed by inadequate information on the part of proponents. Public health is beyond the freedom of choice, and it should not be left to the individuals to make the final decisions on a matter of this magnitude. It is evident that vaccines have reduced rates of morbidity and mortality related to infectious diseases. Numerous reports indicate that there have been up to 99% reductions in various life-threatening and infectious diseases in the U.S. and around the world. Given that children are the most vulnerable to contracting diseases, the states should enforce mandatory vaccination programs. There are too many infants at the risk of dying if they do not receive vaccinations against certain diseases. The anti-vaccine movement should not be allowed to quote unfounded data on the ineffectiveness of vaccines.Whether in a libertarian political framework or not, the government must intervene to find ways that encourage and make vaccination possible acceptable as expected.(Brennan, 2016) . Moreover, vaccinations are meant to benefit the entire population remains free of preventable diseases.


















Brennan, J. (2016). A libertarian case for mandatory vaccination. Journal of Medical
      Ethics, medethics-2016.                                            

The paper outlines facts that strongly support the case for mandatory vaccination. It argues that vaccination can be justified even with the existence of a libertarian political framework. The paper weighs the benefits of vaccination against disadvantages. It further suggests ideas of how a nation can encourage people to accept vaccination. According to the study, those people that refuse vaccinations deny other people a chance to participate in upholding the moral principle of preventing unjust harm or risk. The findings of the research state that, there are many reasons why people in a libertarian framework may be forced to accept certain vaccines. Some of these reasons include the requirement by the law to serve the common, and recommendations made by an analysis of cost verses benefits of using a vaccine. The most crucial reason however would be the strong need to prevent harm from the society, which is caused by wrongful impositions made by the anti-vaccination campaigns. This source is helpful in my essay as it analyses and criticizes the reasons for refusing immunization and provides a way forward on how opponents can be lured into accepting immunization.



Morbidity and Mortality Weekly Report, 63(16), 352-355.

The authors of this book explore the benefits accrued from childhood vaccination in the United States since the implementation of Children Program in 1994.The study explains the reduction of child mortality rate since the emergence of the programme.It explains the prevention of measles disease and health costs saved. The paper gives a description of the outbreak of Measles disease in 1980 and its effects on the children as they were the ones affected to a large extend. The benefits of the program are used to encourage vaccination to prevent other diseases to save lives and reduce health costs. The authors of this paper design a cost-benefit model analysis for the U.S children born during the program and the results reveal that vaccines are a highly significant mode for preventing infectious diseases. The analysis demonstrates the impact of vaccination on healthcare by the large amounts of diseases prevented, deaths prevented and reduced hospitalization rates. This source is very informative about the effectiveness of vaccines as it gives data on the success of previously administered vaccines. This sourcebuilds my contentin my case for reduced mortality, eradication and elimination of diseases.



Chemerinsky, E., & Goodwin, M. (2015). Compulsory Vaccination Laws

 are Constitutional. Northwestern University Law Review, 110, 16.

Chemerinsky and Goodwin explore the issues surrounding the mandatory vaccination laws being implemented in various states. The authors make a case for the compulsory vaccination of all children. The source claims that the government’s mandate to protect children and prevent the spread of illnesses justifies the compulsory childhood vaccinations. Before making this conclusion, the source tracks the history of mandatory vaccination laws in the U.S. and argues on the benefits of introducing such laws in every state. Despite the unrelenting pressure from anti-vaccination movements, the source provides a strong argument why the parents’ rights and the freedom of religion should not be a hindrance to the introduction of compulsory vaccination laws. Several cases are reviewed to denote the effectiveness of childhood vaccinations in the U.S. since the 20th century even in the presence of objections from the anti-vaccination movement. Reliable data on population health is used to support the argument for the adoption of stricter childhood vaccination laws across all states. This source is very relevant in supporting my first point in the case for mandatory vaccination. It lays benefits of government laws on vaccination and the opponent’s claims on parent’s rights and freedom of religion side by side. From the analysis it clearly explains the need for compulsory vaccination.

Hawkes, S., Kismödi, E., Larson, H., & Buse, K. (2014). Vaccines to promote and

        protect sexual health: Policy challenges and opportunities. Vaccine, 32(14), 1610-1615.

This article reviews vaccines that immunize people against sexually transmitted diseases and analyses ideas and institutions that are in support of vaccine policy. The paper investigates challenges and opportunities that might swipe out the STI vaccines and then explores lessons that can be learned if vaccination was rolled out. It further introduces a way forward for the introduction of vaccinations in future. From the review of policies and human rights, the paper highlights the needs and rights of adolescent to ensure health care is administered to them. The study describes the reasons why vaccination should not be mandatory and also why it should not, and then support its case for mandatory vaccination. It concludes by revealing policy opportunities that can be helpful to develop new STI vaccines. The paper is relevant to my thesis as it clearly outlines the needs of the society and the costs that might be incurred if vaccination was disqualified.


Isaacs, D., Kilham, H. A., & Marshall, H. (2014). Should routine childhood         

         immunizations be compulsory?Journal of pediatrics and child health, 40(7), 392-396.

This study emphasizes on the importance of childhood immunization. According to the study, routine childhood immunization is compulsory only in a few nations, and this is caused by the notion that it infringes the freedom of parents in making choices for their children. The paper outlines facts why children should be vaccinated. It points out that immunization in children saves lives. The authors weigh the benefits immunization brings to the society and its significance in limiting the freedom of people and eventually concludes immunization should be compulsory. Though the authors base their study referencing Australia, they successfully show the need for immunization by revealing how Australia has benefited from it.According to the article, Australia has achieved high rates of routine childhood immunization through over 90% by letting it be voluntary. They further suggest reasons why other nations should adopt the same scheme and conclude with claims in support of the case for voluntary immunization. This reference adds content to my essay still in support of mandatory vaccination by comparing achievements of vaccination by other countries and why USA should apply same strategy.

Leichter, H. M. (2014). Free to be foolish: politics and health promotion in the United

         States and Great Britain. Princeton University Press.

The authors of this book discuss the on-going debates in the United States on the role of government in promoting good health and supporting the rights of people in the society. It reveals the constant tension born by the debate. According to the study, the health promotion policies are significantly distinct from other public policies. This book examines the costs of healthcare when vaccination is limited the benefits of vaccination in terms of cost reduction. The details of this book argue that freedom cannot be replaced with good health therefore, conceiving anything basic to human dignity and happiness than good health would be difficult. The authors of this book support their argument by using the US statistics of billions of dollars spend on health each year. They then state the importance of sustaining good health by using tools like vaccination in order to cut these costs hence growing the economy of the nation. This source provides relevant statistics of health costs are useful in analyzing the economic benefits of vaccination in my essay.

Taylor, L. E., Swerdfeger, A. L., & Eslick, G. D. (2014). Vaccines are not associated

with autism: an evidence-based meta-analysis of case-control and cohort

studies. Vaccine, 32(29), 3623-3629.

The authors focus on the perceived relationship between childhood vaccinations and the subsequent development of disorders such as autism. Being one of the most cited arguments against childhood vaccinations, the source explores numerous medical studies, cohort studies, and case-control data to establish whether there is a possibility of autism spectrum disorder and childhood vaccinations. The authors use a hypothesis to approach the possibility of the link and draw upon extensive research to make conclusive remarks. One of the major statements made by the authors is that the childhood vaccinations have reduced the rates of morbidity and death by great margin since the beginning of the 20th century due to their impact of vaccine-preventable diseases. Secondly, the meta-analysis proves that childhood vaccinations are not linked to autism. This source is relevant in clearing the controversy because it uses several cohort studies of over a million children together with supporting control studies. All components of vaccines, such as mercury, are cleared by studies of their perceived link with autism.

Thompson, A., Compare, A., & Smith, M. J. (2014). Ethical considerations in

        post-market-approval monitoring and regulation of vaccines. Vaccine, 32(52),


The objective of the paper was to find out the ethical considerations that would assist regulators to make good decisions regarding vaccines post-licence. The four considerations that were needed to ensure vaccines are safe and effective were: making decision in advance of immunization, regularly warning the public about any imminent dangers of a vaccine, researching intensely about the vaccine to ensure any information related to it is quality and evidenced, and finally, appropriate monitoring of vaccination process. The study further adds ethical issues to these considerations and state them as transparency, stigma minimization, awareness and acceptance of both benefits and risks associated with a certain vaccine, public trust and finally setting obligatory measures to the vulnerable population. This study is very useful to my topic as it gives a comprehensive way forward for ensuring the mandatory vaccination policies continue to impact justifiable benefits in the society.More so, ethics considered gives hope to the regulators and researchers who have found themselves in the line of law due to post-market monitoring of vaccines. Upon these considerations, law makers will make a way for decision making and shape research.

Orenstein, W. A., & Hinman, A. R. (1999). The immunization system in the United States—

      the role of school immunization laws. Vaccine, 17, S19-S24.

Orenstein and Hinman explore the impact of school immunization laws on vaccine-preventable diseases, the parent’s differences in accepting the laws and the way forward to ensure the effectiveness of these laws. The authors describe benefits associated with these laws especially in public schools and the need to for the public to support their enforcement. One of the ways the study points out about enforcement of these laws is the elimination of unvaccinated children from school to ensure success. The study adds that these laws exempt persons on religious grounds and philosophical grounds. The paper also describes how the school laws are harnessed by resources like education to immunization effort.Moreso, a safety net is established to ensure a wide coverage of the program each year. From the analysis of the study, school immunization laws have contributed highly to the success of prevention of vaccine diseases. It gives examples of smallpox disease which has so far been eradicated and the likelihood of Polio following the suit soon enough. This source is very valuable in my essay as is enables me convince the readers  the impact school laws can make on healthcare hence supporting mandatory vaccination.

Zhou, F., Shafer, A., Wenger, J., Messonnier, M., Wang, L. Y., Lopez, A., … & Rodewald,

  1. (2014). Economic evaluation of the routine childhood immunization program in

the United States, 2009. Pediatrics, 133(4), 577-585.

The study evaluated the economic impact of vaccination in the US for diseases immunized including Influenza and measles. The methodology used analyzed the disease evidence before and after vaccination and evaluated a vaccine efficacy. Both direct and indirect costs were estimated and net benefit- cost ratios calculated. The analysis showed childhood immunization in the US prevented early deaths of approximately 42 000 and prevented about 20 million cases of diseases. According to the study, the extensive use of vaccines was among the most effective means for quality healthcare and has been very effective in eradicating the vaccine-preventable diseases. Routine immunization program remains to be the most effective aspect of controlling diseases among children and should be fully utilized as it is the only available and efficient resource to promote health among children. The conclusion was that both direct and indirect costs reduce by making vaccination mandatory and therefore the program not only promotes healthcare but results in substantial cost savings. This source supports cost effectiveness of vaccines mentioned on most parts of the essay especially in the section of economic benefits where previous data of children vaccination programs provides evidence for reduced health costs.

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