Immunization Barriers, Safety and the Nurses Role

Immunization Barriers, Safety and the Nurses Role

For decades, vaccinations were seen as a preventive action that protected its participants against various diseases. However, in recent years the number of vaccinations has dropped, causing diseases that were almost eradicated to resurface. For example, measles was eliminated from the United States in the year 2000, thanks to a highly vigorous vaccination program, however, according to the CDC 1250 individual cases have been confirmed in 31 states in the year 2019. This is an increase in cases from 2018 where only 372 cases were reported (Measles, 2019). Evidence has shown that the cause of the outbreak was due to a sum of the population not receiving their MMR vaccinations. Now, the question to investigate is why the sudden decline in vaccination rate if the majority of the population knows the benefits of the vaccine. This paper aims to recognize the barriers to immunizations such as lack of reliable information and personal beliefs. It also addressed the role of the nurse, which is to have a higher knowledge of vaccination and be able to relay the information in a manner the public can understand.

Provider Barrier

The majority of vaccinations are done within either a hospital or a clinical setting. Therefore, the relationship between the family and the provider is an important factor. In the journal written by Mckee & Bohannon (2016), mentioned a study conducted by Gust et. al., concluded one-third of parents felt that they needed more information about the vaccines and wanted their provider to address the fact about vaccines in a format that is unbiased (Mckee, 2016). According to the article written by Chung et. al., (2017), their research was aimed to assess what external factors help parents decide whether to vaccinate their child. The results were that parents who were prone to delay their child’s vaccination would choose who their provider based on willingness to allow them to delay or refuse vaccinations (Chung et. al., 2017). Another study mentioned by Mckee & Bohannon, noted that 81.7% of parents stated that providers were the most important source of information (Mckee, 2016). It also discussed how among top-three trusted sources of information, a healthcare provider came in on top (Chang et. al., 2017). Parents who were initially hesitant of vaccines cited that the advice of their healthcare provider was a common reason they changed their mind and accepted the vaccine (Chang et. al, 2017). This information, shows the importance of the provider spending time with the patients and answering any questions they may have in an unbiased or judgmental fashion. All these factors will allow a trustful relationship to develop over time, and allow an open conversation between the provider and the patient, resulting in both parties feeling hear. 

Nursing Role in Provider Barrier

A critical role for a nurse is to present information in an unbiased format, along with factual information related to each individual vaccine, by providing the parents with an accredited website such as Centers for Disease Control and Prevention or American Academy of Pediatric website (Mckee, 2016). By providing additional resources, besides the nurses’ word, parents can do their own research and double-check that information presented to them in the hospital setting is correct. Furthermore, providing websites that are trusted allows the nurse and the provider to know that the information the parents are gathering is scientifically based. Also, having the nurse go and sit down with the family and explain the process in layman terms will help resolve any uncertainty. In order to create more trust nurses, need to break the negative opinion concerning vaccines and be able to build trust.

Parent Barrier

Personal and philosophical beliefs have a major effect on vaccine hesitancy. Vaccine hesitancy is a term used to describe “anyone who is doubtful about vaccinations or who chooses to delay or refuse immunization even when they are readily available” (Mckee, 2016). Vaccine hesitancy can be affected by multiple factors, which causes a parent to choose not to vaccinate.

 When researchers asked parents why they hesitate to vaccinate their children the most common answer is safety concerns. Safety concerns are mostly derived from misinformation from the media, public opinion and close family and friends. According to Doctor Goldstein et. al (2019), “a vocal minority has permeated social media with anti-vaccination rhetoric and has eroded trust in the vaccine industry”. This minority group, claims that certain vaccines lead or are linked to medical issues such as autism, brain damage and behavioral problems (Mckee, 2016). Additionally, the publication of the Wakefield Study, which links the MMR vaccine to autism, continues to create doubt and mistrust against the manufacturer, despite the fact that the study and its results were deemed false (Gerber, 2009).

  Chephra McKee, PharmD, and Kristin Bohannon, BS go more in-depth on additional reasons why there is vaccine hesitancy among parents. The reasons include fear of overloading the child's immune system and following the vaccine schedule will cause a higher risk for the child to experience adverse side effects. The parent wants to avoid putting any extra chemical in their child's body. Along with that, there is a small population of parents who believe that there is a benefit to their child contracting the disease. They believe that having their children exposed to the disease will strengthen their immune system for the future. It is also believed that if their child were to be exposed to the pathogen of the disease it would be easily treatable (Mckee, 2016). To reassure the parents of the safety of the vaccine, we need to address the misinformation about safety in order to regain trust with parents within the community.

Nursing Role in Parent Barriers

How can a nurse fix vaccine hesitancy? Well, the first form of action is to view vaccination with a positive attitude. Research has shown that “if an individual does not believe in the effectiveness of a vaccine, results showed a lower vaccine uptake” (Schmid et al., 2017). Furthermore, a lack of trust in authorities or healthcare providers was stated to decrease the likelihood of the individual getting vaccinated (Schmid et al., 2017).

 Another nursing role in parent barriers, is to have a trusting relationship with the parents by having an open-mind to their reasoning and help calm their fears. The nurse can give the parent options. For example, if a parent feels like the current vaccine schedule is too much for their children, offering them the option of a delayed vaccine schedule that limits the number of vaccines their child would receive each visit. This is a better option than having the child not vaccinated at all (Mckee, 2016). In addition, nurses should educate the importance of herd immunity. Herd immunity is defined as when the majority of the community is immune to a disease through vaccination. This creates a safeguard for individuals who are not able to get vaccinated, such as those who are immunocompromised (“Vaccines”, 2017).  

Evidence of Vaccine Safety

Before a vaccine is given to the public, it must go through a series of tests in order to be considered safe. According to the CDC vaccines must show potential in the lab before any animal testing, after which there are three phases of clinical trials. The first phase focuses on safety and determine the correlation of the dose to the side effects. The second phase, includes a larger population of volunteers, who are monitored for adverse side effects. The last phase compared vaccinated volunteers with volunteers who received the placebo in order to determine the effectiveness of the vaccine (“Ensuring Safety”, 2013).  Once all three phases are examined, the FDA has the final decision in determining whether the benefits outweigh the risk. Once the vaccine is introduced to the public, it remains monitored by the FDA through the Vaccine Adverse Event Reporting System (VAERS). Manufacturing is also monitored by the FDA. Ways they monitor manufacturing is inspecting the facilities the vaccine will be produced, making sure the facility is up-to-code and ensuring that each lot/batch of the vaccine are “potent, pure and sterile” (“Vaccine Safety, 2017). 

 After vaccines are given the public, continuous monitoring is to ensure side effects that may not have shown up in testing phase because the sample group was limited or not all demographic might have been included (“Ensuring Safety”, 2013). The public is encouraged to report any adverse side effects they experience to VAERS. The reports will then be studied further in order to determine if the vaccine was the reason for the side effects. One way of determining the side effects is by using the CDC’s Vaccine Datalink (VSD), which is a network that links side effects of all licensed vaccine in the United States (“Ensuring Safety”, 2013). In addition, to the use of VAERS and VSD, other systems of vaccine monitoring are available such as Post-licensure Rapid Immunization Safety Monitoring System (PRISM) and Clinical Immunization Safety Assessment Project (CISA) (“Vaccine Safety, 2017). The datalink can help determine whether certain side effects are linked with a certain racial group or whether a particular side effect is common with a vaccine.  By bundling vaccines into lots, the FDA can specify what lot was considered unsafe and needs to be recalled. According to an article written by Parasidis (2016), a reason associated with vaccine hesitancy is the belief that “regulators do not have appropriate systems in place to monitor the safety and efficacy of FDA- approved vaccines” (Parasidis, 2016). Currently, the FDA has a comprehensive hand on pre-marketing screening, but has a passive post-market monitoring. Once active post-market monitoring is addressed by the FDA, the individuals concerns of vaccine hesitancy can be resolved (Parasidis, 2016).

Conclusion

As nurses we are advocates for our patients, they place their trust in us and our ability to educate them on keeping them healthy. As advocates we should not be limiting ourselves to only the hospital setting but should be willing to speak out against injustices we see in our daily lives. Vaccine teaching can be improved by individualizing the teaching of vaccines and the signs and symptoms that should be expected. Likewise, answering all the questions the patient may have and informing them of techniques they can do to prevent getting sick, such as handwashing. It is only when nurses begin to speak up for our patients, gain trust, and understand the patients reasoning for their decisions, will we begin to decrease the number of outbreaks.

References

• Chung, Y., Schamel, J., Fisher, A., & Frew, P. (2017). Influences on Immunization Decision Making among US Parents of Young Children. Maternal & Child Health Journal, 21(12),2178–2187. https://doi.org/10.1007/s10995-017-2336-6
• Ensuring Safety of Vaccines in the United States . (2013, February). Retrieved October 31, 2019, from https://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe              ensuring-bw-office.pdf.
• Gerber, J. S., & Offit, P. A. (2009). Vaccines and autism: a tale of shifting hypotheses. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 48(4), 456–461. doi:10.1086/596476
• Goldstein, N. D., Suder, J. S., & Purtle, J. (2019). Trends and Characteristics of Proposed and Enacted State Legislation on Childhood Vaccination Exemption, 2011–2017. American Journal of Public Health, 109(1), 102–107. https://doiorg.ezproxy.plu.edu/10.2105/AJPH.2018.304765
• McKee, C., & Bohannon, K. (2016). Exploring the Reasons Behind Parental Refusal of Vaccines. The journal of pediatric pharmacology and therapeutics: JPPT : the official journal of PPAG, 21(2), 104–109. doi:10.5863/1551-6776-21.2.104
• Measles Cases and Outbreaks. CDC (2019, October 11). Retrieved October 30, 2019, from https://www.cdc.gov/measles/cases-outbreaks.html.
• Parasidis, E. (2016). Public Health Law and Institutional Vaccine Skepticism. Journal of HealthPolitics, Policy & Law, 41(6), 1137–1149. https://doi              org.ezproxy.plu.edu/10.1215/03616878-3666204
• Schmid, P., Rauber, D., Betsch, C., Lidolt, G., & Denker, M. L. (2017). Barriers of Influenza Vaccination Intention and Behavior - A Systematic Review of Influenza Vaccine Hesitancy, 2005 - 2016. PloS one, 12(1), e0170550. doi:10.1371/journal.pone.0170550
• Vaccine Protect Your Community (2017, December). Retrieved October 30, 2019, from http://www.vaccines.gov/basics/work/protection
• Vaccine Safety. (2017, December.). Retrieved November 1, 2019, from https://www.vaccines.gov/basics/safety.