This first draft, although not perfect, is a vast improvement compared to my Prospectus. For this draft and the second draft, I didn't include any multi-modal sources, which was probably a mistake, because I feel like the pictures and graphs in the final draft really contribute to the argument. However, there was little for me to go off of with regards to my actual argument. I knew that the "alternative schedule" that I was referring to was a great ideal, but it was not practical enough to implement it into the new vaccine program. From the very beginning, I knew I would have to concede on this idea, but Brendan wanted something more, so it was back to researching for a practical solution to my vaccine issue. 

                                                                              Vaccinating California’s Kids:

                                                                 Issues and Compromises for Senate Bill 277

            Over the past several months, California lawmakers and parents have been debating who has more of a right to personal healthcare for school-aged children, whether it’s for familial sakes, or for the greater good. On June 30^th California Governor Jerry Brown signed into law Senate Bill 277, a newly mandated and remarkably strict vaccine regimen for children starting daycare, public, or private school after July of 2016. Parents across the state are outraged at this bill, seeing it as an unnecessary and invasive precaution that could seriously affect the lives of their children. The bill is comprised of a list of 10 federally recommended vaccines, given to all children in the state attending school, averaging about 40 doses per child before they graduate high school; 16 of these are administered before even starting kindergarten (California Coalition for Vaccine Choice). Although there are some parents that do not want to vaccinate at all, the issue is not deciding whether children should or should not be vaccinated, instead the problem with SB 277 is that parents are losing the right to consent to a medical procedure for their children, and thereby losing their right to freedom of speech. California lawmakers argue that parental consent does not outweigh the need for a strong public health system, and despite petitions and protests from angry parents, SB 277 is going through as planned.

The Problem: One of the biggest obstacles that the government faces when trying to regulate and enforce the vaccine regimen, is the misinformation circulating around vaccines, and the general mistrust from parents, as they fear for the health and safety of their children. This apprehension really became a problem in 1998 when the Lancet medical journal published a paper by Dr. Wakefield, who had been studying the effects of vaccines on children. He caused an international uproar when he released data that seemed to link the administration of vaccines to the development of autism. Understandably, that made parents around the world wary of these life-saving medicines, and vaccination rates began to drop. However, it was later discovered that the data that Dr. Wakefield used was inaccurate and falsified, and that there was in fact no connection between autism and vaccines; the Lancet retracted his paper, and he lost his medical license. Despite multiple studies that prove there is no causal relationship between vaccines and autism, many parents are still skeptical of the effectiveness and safety of the vaccine schedule, fearing the risks of vaccinating their children.

            Just this year, as SB 277 was being proposed, an alternative health website, Health Impact News, published an article with a statistic that scared parents across the nation; it stated that since 2003, there have been no deaths from measles in the United States, but there have been 108 deaths due to vaccine-related injury. As with any medical procedure, there is some element of risk involved, however, this article’s statistic has been completely debunked by Snopes, with credibility and clarity issues. Firstly, the CDC reports 5 measles-related deaths in the United States during the 12 year time span the article referenced, and most of these deaths occurred due to lack of knowledge about symptoms and warning signs, because measles is just not that common of a disease anymore. Secondly, the source that provided the vaccine-related death statistic, Vaccine Adverse Event Reporting System (VAERS) gives a disclaimer at the beginning of their website: “When evaluating data from VAERS, it is important to note that for any reported event, no cause-and-effect relationship has been established. Therefore, VAERS collects data on any adverse event following vaccination, be it coincidental or truly caused by a vaccine.” (Snopes). Not only are there issues in credibility, but the article failed to point out that the reason that there were so few deaths caused by measles, is because the MMR (Measles, Mumps, Rubella) vaccine is so powerful and effective, and because the US public health system is incredibly good at detecting and managing potential outbreaks. However, many citizens are unaware of this, and don’t see the benefit in putting their children and themselves at risk by getting a vaccine. It is this kind of misinformation that contributes to vaccine non-compliance and hesitancy, putting the greater public at risk of an outbreak.

            While widespread misinformation regarding vaccines is a serious problem, California legislators passing SB 277 was not the answer. This bill came about after a measles outbreak centered in Disneyland, California, affected over 150 people and spread into six states, with several additional cases popping up in Mexico and Canada (NBC News). While it may have seemed like a good idea at the time to regulate and enforce stricter vaccine schedules, for many, this measure was too extreme. Under this new law, parents may be forced to vaccinate their children, or face the consequence of the revoked privilege of public education. Any child that is not fully vaccinated will not be allowed to attend school until they can prove that they are completely immunized (California Coalition for Vaccine Choice). Not only were parents opposed to this approach for vaccine-compliance, but several lawmakers, including California State Assemblyman Mike Gatto, spoke out against the bill being passed for its slippery slope tendencies and the loopholes in logic. Assemblyman Gatto is quoted in opposition stating, “Here those same unvaccinated kids that are forced to be homeschooled, are still free to play football with other kids, to mingle with them at church, at parks, to go to Disneyland.” (Youtube). Unless there is some way for lawmakers to control interactions with unvaccinated children and adults outside of school, then restricting the child’s constitutional right to a free and public education is inconsistent with the intentions of the law, thus making it “constitutionally unworkable” (Gatto, Youtube). Considering that California’s vaccination rates are above average in the US, with less than 3% of children partially or completely unvaccinated for religious or personal beliefs, this law which takes away a parent’s right to exemption, is arguably a step too far in the name of public health (California Coalition for Vaccine Choice). SB 277 was well-intentioned, but in execution, the law may end up doing more harm than good trying to force parents into compliance.

Disputed Solution: It’s difficult to find a solution that wither side of this debate will be happy with. The pro-vaccination defenders are pushing for SB 277 to be enforced as planned, but the anti-vaccination advocates have been petitioning and protesting to have the law repealed. Neither “solution” is realistic, but there are some things that can potentially be done in order to reach a middle ground, and hopefully put this endless debate to rest.

There is one solution that gets a lot of traction among some physicians and lots of parents that are simply hesitant due to the number of vaccines and the amount of doses in such a short time frame. This solution was originally proposed by Dr. Bob Sears, from Dana Point, California, who wrote a book titled The Vaccine Book in which he suggests allowing skeptical parents to opt for an “alternative vaccination schedule.” Dr. Sears wrote a customized vaccination schedule that would accommodate most families that did not feel they should have to comply with the conventional vaccination schedule; this thoughtfully tailored schedule addressed the complaints that many parents were voicing, including the fear of starting to vaccinate too early, too much, and with too many at once. Dr. Sears’ alternative schedule does not begin administering immunizations until the child is at least two months old, as opposed to most children who are only hours old when they receive their first vaccinations. Dr. Sears believes that this gives the child’s immune system a chance to mature before bombarding it with several different diseases. Another important aspect of Dr. Sears’ schedule is that he will not conduct more than two vaccinations at a time, listing the reasons and benefits of this, he writes in his book, “By only giving two vaccines at a time (instead of as many as 6), I decrease the chance of chemical overload from grouping so many vaccines chemicals all together at once. This allows a baby's body to better detoxify the chemicals one or two at a time." (Loving-Attachment-Parenting). Dr. Sears’ book struck a chord with a lot of parents that were torn between vaccinating at the federally recommended schedule, but scared of all the horror stories they had heard in the media.

In recent years, Dr. Sears has started a trend of pediatricians and physicians across the nation coming up with their own alternative vaccination schedules, and the option is becoming increasingly popular among parents. Researchers at the American Academy of Pediatrics released a study in 2011, evaluating just how much pulling power this delayed schedule has among American parents, and what factors played a part in whether the parent opted for an alternative schedule. Amanda Dempsey, a professor of pediatrics and one of the leading researchers on this survey, found that amid the average American households with children ranging in age from 6 months to 6 years, nearly 13% reported following a different vaccination schedule than the one federally recommended (Dempsey). She found that most of these children (53%) were only exempt from certain vaccines, while others (55%) were vaccinated fully at a later time in their childhood (Dempsey). The fact that only 17% of the families surveyed were completely unvaccinated goes to show that the attitudes around vaccines is not that they are inherently dangerous, but that they are administered too many at a time in too short a time span (Dempsey). Many families are seeing Dr. Sears and other pediatrician’s alternative schedules as viable options to vaccinate their children at the parent’s own discretion and pace.

However there is significant opposition to Dr. Sears’ schedule, with many physicians, public health organizations, researchers, and lawmakers bringing up several valid points to counter the idea that a delayed schedule is the best option for hesitant parents. To begin with, there is no “alternative” vaccination schedule; Dr. Sears came up with this solution on his own, and promoted it in his book to counter the required, tested, and approved CDC recommended schedule. Tara Haelle, a freelance science reporter who has studied and written extensively on the topic, was interviewed on NPR’s health blog in September of this year. In this interview, Haelle states one of the main issues with Dr. Sears’ schedule is: “…that the schedule he proposes in his book is not tested by any medical authorities at all. No studies have been done to say that it's safe or it's effective. He's essentially promoting an untested schedule that gives people a false sense of security and can actually increase risks because when you delay vaccines, several different risks go up.” (NPR). The CDC and WHO also voice concerns about pediatricians promoting their untested, individualized schedules, reminding everyone that research is done for a reason, and while it might be enough for some parents to just listen to Dr. Sears, it is not enough to put this idea into action as law (Gardner). There is simply not enough support willing to forego the risks that delaying a child’s vaccine schedule can pose; “Research backs it up, based on clinical trials and decades of experience with patients. The schedule is very specific to keep children as safe as possible until they are fully protected” (Gardner). This idea of creating an official alternative, delayed schedule for parents to opt for instead of the conventional schedule sounds really good in theory, but unfortunately the reality of this idea is not feasible due to lack of support and ample evidence of higher risk associated with a delayed schedule.

            However, the idea does beg the question, so what if some parents are delaying the vaccines for their children? If the initially small amount of vaccine hesitant parents that had no intention of vaccinating at all were allowed to instead vaccinate according to a delayed schedule, isn’t a delayed schedule better than no schedule at all? It doesn’t seem reasonable to enforce a one-size-fits-all model schedule on all families in California, because each family is different and may have different concerns or beliefs; while this is all true and seems like a very good policy to go by, the reality is necessitating the same schedule for every family in the region provides a well-rounded public health policy that keeps kids alive and healthy. The American Academy of Pediatrics says, “…there’s no sure way to adjust the schedule and know that your child will be safe from potentially life-threatening infections, since all kids are at risk. And it might actually mean more shots in the long run.” (Gardner). The potential risk from administering a vaccine does not outweigh the risk of an outbreak of a preventable disease.

Feasible Solutions: One of the biggest problems with trying to convince parents to fully vaccinate is due to the fact that these diseases are simply not prevalent anymore, and so people don’t see the risk of contracting one of them as a particularly big deal; Dr. Robert Frenck Jr., an expert who sits on the American Academy of Pediatrics Committee on infectious diseases, said in an interview with CNN, “Vaccines have been so effective that people now don't even know what the disease looks like or what problems the diseases can cause,” Frenck states, "[People] don't perceive risk from the disease. They don't perceive the benefits of the vaccine." (Park, CNN 2010). So it seems the solution to vaccine non-compliance is through education, awareness, and outreach to the hesitant parents.

 This is where Zachary Horne, a University of Illinois graduate student conducted a study with Psychology professors from University of Illinois and UCLA, John Hummel and Keith Holyoak to see if anti-vaccine attitudes could be altered. Studies had previously shown that arguing with a vaccine-hesitant parent, and telling them that their beliefs about vaccines are contradictory to everything science proves about vaccines, only makes the parent more defensive and less eager to listen to reason (Yates). However, Horne and his research partners took a different approach, by showing parents and unvaccinated people what could potentially happen if a preventable disease is contracted. Horne wanted to take the time to raise awareness of these illnesses before parents had the chance to make a decision on their own, and has said to parents, “You may be focused on the risk of getting the shot. But there’s also the risk of not getting the shot. You or your child could get measles.” (Yates). In this study, a group of 315 people with controversial views and fears towards vaccines were assigned randomly into one of three different study groups; the first group was given texts to read that spoke out against anti-vaccination opinions, similar to the studies previously mentioned, where the point of contestation is that the anti-vaccine attitude is not based on science, but irrational fear. Another group was given material that had nothing to do with vaccines, serving as a control group; and the last group was given information about the specific risks of the disease, Horne described the study: “Participants read a paragraph written by a mother about her child’s infection with measles; saw pictures of a child with measles, a child with mumps and an infant with rubella; and read three short warnings about the importance of vaccinating one’s children.” (Horne). This approach was more emotional, and more comprehensive than previous studies, thus enabling it to be more effective than any other study previously done on trying to change vaccine-hesitant attitudes. (Yates).

            After each participant was given their information, they were given another short evaluation regarding their views of vaccines, to see if their attitudes had changed. Unsurprisingly, there was little to no change among the group that was given pro-vaccination propaganda; but those that were in the “disease risk” group showed a significant change in attitude (Yates). Horne elaborated on the research team’s findings, stating, “We found that directing people’s attention to the risks posed by not getting vaccinated, like getting measles…and the complications associated with those diseases, changed people’s attitudes positively toward vaccination …Actually, the largest effect sizes were for people who were the most skeptical.” (Yates). This is a remarkable step forward; if one of the main solutions to parents not vaccinating their children is as simple as government outreach programs making an emotional appeal to these parents, and showing them pictures and first-hand accounts of just how dangerous contracting one of these diseases can be, then paired with a devaluation of some of the sources that spread misinformation regarding vaccine safety, attitudes in California and across the nation might start to change.

            This widely debated piece of legislation was very well-intentioned, but there was little thought put into how the parents of the state of California would react to the government taking away the parental rights to informed consent for their children. Although there is a legitimate free speech issue here, the legislation is going through as planned for the sake of public health, and all parents, hesitant or not, must comply with this new law. In order to make this transition to an incredibly strict vaccination regimen, the state government needs to do all that it can to make complete vaccine consent an easy thing for parents. There is, unfortunately little to no support for the idea of having an “alternative schedule” written up, and so vaccine safety and effectiveness, as well as the risks of not vaccinating children, and education on the topic must be made readily available to parents that are skeptical of immunizations, or considering not vaccinating at all.