Analysis of Stakeholder Needs and Interests

Analysis of Stakeholder Needs and Interests 

The stakeholders in the Town of Evergreen include parents, nurses, school administrators, health care providers, the public health department, the government, religious congregations, the Tourism Bureau, the business community, and elected representatives from Cedar and Fir County.  The new legislation to remove the exemption for firmly held religious beliefs from the current immunization requirements affects each stakeholder in different ways.  Each of these stakeholders have their own needs and interests related to the immunization requirements and they will need to come together to find out which legislation is the best for the whole entire community.

• The Tourism Bureau and the business community were negatively impacted by the outbreaks so they support the new legislation because it will increase the revenue for their businesses.
• Elected representatives from Cedar and Fir County and large congregations oppose the bill of removing religious beliefs and have proposed a new bill that adds a third exemption of “personal objection” to the current legislation.
• School nurses are worried about the public backlash of removing the religious beliefs while school administrators are worried about not having enough funds and the staff power to enforce the more restrictive immunization requirements and both do not support the new legislation. 
• Primary Care Providers are choosing not to administer the vaccinations due to the cost of keeping them on hand and instead are sending the children to the public health department to get the vaccinations.  The public health department does not get paid from commercial insurance companies for giving these immunizations and both stakeholders do not support the new legislation.
• All parents have their own beliefs and some of them may be in favor of the new legislation if they think that the recent outbreaks were caused from children that never got vaccinated.  Other parents may not support the new legislation and instead would like a third immunization exemption added to the policy of “personal objection” because they believe that they should what is in the best interest of their child. 

Current Laws, Policies, and Financing Practices

The State of Evergreen would need to look at current healthcare laws and policies that are relevant to the immunization issue in order to reach the best possible outcome and appease all of the stakeholders.  The U. S. Constitution reserves the primary power to regulate the public health and safety for the common good, often known as police power and can include laws authorizing community vaccinations if deemed necessary for the safety of the public (Hoke, n.d.).  States can require all children (except those with medical contraindications) to be vaccinated before going to school or day care and in 1944 the court proclaimed that religious freedom “does not include the liberty to expose the community or the child to communicable disease (Parmet, 2019).  Therefore, states do not have to have allow exemptions for religious reasons if it is in the best interest of the public health of the community.  Although, all 50 states grant exemptions to children for medical reasons, 45 states and Washington D.C. grant religious exemptions, and 15 states allow philosophical exemptions for those who object to immunizations because of personal, moral, or other beliefs (Skinner & Garcia, 2019).  Understanding community public health needs in the State of Evergreen requires implementation and coordination of a wide range of public-policy, health systems, and community-based interventions (Groom, Hopkins, & Pabst, 2014)

It is also important to consider the financial ramifications of the childhood immunization policy considering the financial constraints of the public-school system and primary care physicians.  Two sources of federal funds pay for approximately 95 percent of all publicly funded vaccinations and include the Vaccines for Children Program (VFC) and Section 317 of the Public Health Services Act (Johnson & Garcia, 2019).  The VFC provides free vaccines for children 19 years of age and younger who are uninsured, Medicaid-eligible, underinsured, Native American or Alaska Native while Section 317 is a federal program administered by the CDC and provides grants to states and territories, commonwealth trusts, and several cities for vaccine purchase and programs such as outreach and disease surveillance (Johnson & Garcia, 2019).  The Affordable Care Act also requires new health plans to cover preventative services (which includes immunizations) with no cost share to individuals of all ages.

Explain Potential Value Conflicts

Stakeholder value conflicts exist because there is insufficient communication with different needs and interests among all of the stakeholders.  Health care organizations, doctors, and scientists agree that vaccines are safe and effective; however, despite this, there are a growing number of parents choosing not to vaccinate their children due to myths, misconceptions, and misinformation that they receive (Burgess, 2019). Some myths and misconceptions include vaccines weaken a child’s immune system, cause autism, and contain unsafe toxins (Burgess, 2019).  In regards to weakening a child’s immune system the opposite is actually true as vaccines expose the body to a small, weakened version of a disease and it prompts the body to produce antibodies to fight off the infection, teaching the immune system how to fight off the disease (Burgess, 2019).  According to research by the Centers for Disease Control and Prevention (CDC), there is no valid scientific evidence linking the MMR vaccine to autism (Burgess, 2019).  It is true that some vaccines contain substances that are harmful to the body in high amounts—such as mercury, formaldehyde, and aluminum, but the quantities of these substances in vaccines is so low that they cause no harm to the body (Burgess, 2019).  Since there are so many articles out there based on very limited evidence and not enough research parents are receiving incorrect and inaccurate information and choosing not to vaccinate their child based on these findings. 

Another value conflict includes the freedom of religion and thoughts among individuals.  Dutch Protestant-Christian congregations refuse vaccinations because they consider it contrary to their religious conviction (Pierik, 2017).  They believe that God has predestined the fate of all human beings, including the health and the prevalence of diseases, and conclude that vaccinations are an inappropriate meddling in the work of God (Pierik, 2017).  Some Christian Scientists argue that disease is a spiritual phenomenon that should be healed through prayer instead of medication and refuse vaccines because they believe that physical illness is an illusion of the material world and that prayer can help correct the false beliefs that give rise to illness (Pierik, 2017). Taking away the religious mandate in the State of Evergreen would create a lot of backlash from parents, religious leaders, and other state officials because they believe in the freedom of religion amendment and hold very strict beliefs regarding their religions.

Legal Risks and Malpractice Issues

The State of Evergreen will have to be careful in accounting for the potential legal risks and malpractice issues that they may face depending on the outcome of the legislation.  The citizens of the State of Evergreen can hold the state accountable if there was an outbreak of a disease because some people were not vaccinated and caused other people to contract the disease.  These individuals can bring a civil lawsuit to the State of Evergreen demanding money for damages that were caused due to them contracting the disease.  If an unvaccinated person contracts a preventable disease and infects another person there may be cause for a possible tort lawsuit (Reiss & Naprawa, 2014).  Additional potential civil lawsuits include an unvaccinated child suing their parents for not vaccinated them and the child ends up contacting the disease (Reiss & Naprawa, 2014).  Infected individuals can also sue the anti-vaccine organization or doctor for negligence of misrepresentation caused by physical harm if they promoted anti-vaccine misinformation (Reiss & Naprawa, 2014).   Non-vaccinated individuals who cause an outbreak may be sued under public nuisance laws (Reiss & Naprawa, 2014).  Under state statue or local ordinances, the appropriate government entity can sue for the behavior of one person that can, be injurious and can cause harm to an entire community, which becomes a public nuisance and allows the state to be able to sue the individual (Reiss & Naprawa, 2014). 

Medical malpractice may occur when a child goes to their primary care physician and they refuse to administer the vaccine because they don’t have the vaccine in stock.  This is when they would refer the patient to the public health department to get vaccinated.  However, every doctor is supposed to act in the best interest of their patient and their own primary care physician should be able to administer the vaccinations. The current practices of primary care physicians and the public health department exposes them to medical malpractice litigation due to the primary care physicians not retaining an adequate supply of vaccines for public administration over costs and refusing to administer the vaccinations altogether and instead redirecting the patients to the public health department without a proper referral.  This delays the immunization as parents have to face an additional, unnecessary step by having to go to another facility after seeing their own child’s primary care physician.  The National Childhood Vaccine Injury Act of 1986 established the National Vaccine Injury Compensation Program (VICP) as a federal “no-fault” compensation system for individuals who may have been injured by specific covered vaccines (Evans, 1996).  Healthcare providers can also be involved in civil lawsuits and penalties if parents decide to pursue for more damages which can award both compensatory and punitive damages to parents and healthcare providers who can still be at risk for criminal punishments as well, including suspensions of their license to practice medicine (Freed, Kauf, & Freeman, 1998).

References

• Burgess, L. (2019, June 4). Anti-vaccination: Myths and facts. Retrieved November 26, 2019, from https://www.medicalnewstoday.com/articles/325371.php.
• Evans, G. (1996, December 1). National Childhood Vaccine Injury Act: Revision of the Vaccine Injury Table. Retrieved November 26, 2019, from https://pediatrics.aappublications.org/content/98/6/1179.
• Freed, G. L., Kauf, T., & Freeman, V. A. (1998). Vaccine-Associated Liability Risk and Provider Immunization Practices. JAMA Pediatrics, 285-289.
• Groom, H., Hopkins, D., & Pabst, L. (2014). Immunization Information Systems to Increase Vaccination Rates: A Community Guide Systematic Review. Retrieved November 27, 2019, from file:///C:/Users/cas25/AppData/Local/Microsoft/Windows/INetCache/IE/QAJWQLXW/vpd-jphpm-evrev-IIS1.pdf.
• Hoke, K. (n.d.). What is Public Health Law? Retrieved November 27, 2019, from file:///C:/Users/cas25/AppData/Local/Microsoft/Windows/INetCache/IE/BL6NQHYS/What_is_Public_Health_Law_factsheet.pdf.Johnson, T., & Garcia, A. (2019, May 22). Immunizations Policy Issues Overview . Retrieved November 26, 2019, from http://www.ncsl.org/research/health/immunizations-policy-issues-overview.aspx.
• Parmet, W. (2019, February 28). Gottlieb's federal vaccine mandates threat: iffy legality, poor policy. Retrieved November 26, 2019, from https://www.statnews.com/2019/02/28/gottlieb-federal-action-vaccine-mandates/.
• Pierik R. (2017). On religious and secular exemptions: A case study of childhood vaccination waivers. Ethnicities, 17(2), 220–241. doi:10.1177/1468796817692629
• Reiss , D., & Naprawa, A. (2014, September). Vaccines and the Law. Retrieved November 15, 2019, from https://www.voicesforvaccines.org/content/uploads/2014/10/Vaccines-and-the-Law-Toolkit.pdf.
• Skinner, E., & Garcia, A. (2019, June 14). States With Religious and Philosophical Exemptions From School Immunization Requirements. Retrieved November 27, 2019, from http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx.