After being yelled at by both Brendan and several of my peers, I finally included multi-modal sources. Although they are not as particularly informative as the ones in my HCP, a bulk of my proposed solution included an emotional appeal, and so I relied on pictures of sick children and the protesters in order to mimic the same emotional appeal used in the psychology study I depended on to carry my solution. I also made several minor changes, such as grammar, word choice, and citation corrections, as well as a few formatting errors that needed to be remedied. I was very proud to see how far my Advocacy Project had come since submitting that first prospectus; the difference was immense. 

                                                                         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 the right to make important health decisions for school-aged children, whether it’s for familial sakes, or for the greater good. On June 30^th California Governor Jerry Brown signed S0enate Bill 277 into law; a newly mandated and remarkably strict vaccine regimen for children starting daycare, public, and 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 the American Academy of Pediatrics’ recommended 40 doses of 10 different vaccines, and a new, rigorous system to administer them through. 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

I: 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. Andrew 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 (CNN 2011). 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 (CNN 2011). Despite multiple studies from the CDC and other health organizations 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. Although not all parents are convinced that their child is at risk for a developmental disorder, they are now fearing the risks of negative side effects from vaccinating their children.

            Just this year, as SB 277 was proposed, an alternative health website, Health Impact News, published an article with a statistic that alarmed parents across the nation; it stated that since 2004, there have been no deaths from measles in the United States, but there have been 108 deaths due to vaccine-related injury (Health Impact News). As with any medical procedure, there is some element of risk involved, however, this article’s statistic has been completely debunked by Snopes, citing credibility and clarity issues. First, 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. Second, the source that provided the vaccine-related death statistic, Vaccine Adverse Event Reporting System (VAERS) gives a disclaimer on the front page 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). This implies that any of the negative reactions to the vaccine that are reported, may be directly caused by the vaccine, or otherwise coincidental and not related, because this database is user-reported and therefore not as reliable. 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 solution. This bill came about after a measles outbreak in January of 2015 centered in Disneyland, California, affected nearly 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 for their kids. Any child that is not fully vaccinated will not be allowed to attend school until they can prove that they are completely immunized. This is not limited to children that are completely unvaccinated, as even children that only have 15 of the 16 shots required before starting kindergarten, will not be allowed to go to school unless their pediatrician has given a legitimate medical reason for exempting the child. (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, 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, and arguably a right to freedom of speech and belief, and to many, is 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.

II: Disputed Solution:

It’s difficult to find a solution that either 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 proposal that gets a high rating of approval among some physicians and lots of parents who 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 California, who wrote The Vaccine Book in which he suggests allowing skeptical parents to opt for an “alternative vaccination schedule.” Dr. Sears created 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 overall study were completely unvaccinated goes to show that the prevailing beliefs surrounding 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’ alternative schedule 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.” (Cornish). 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.

            Yet, 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. Although 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 inherent risk of an outbreak of a preventable disease. Yet the issue here is still only a matter of lack of research around the delayed vaccines that Dr. Sears proposes; something like an alternative or delayed schedule for parents that are hesitant for any number of reasons, could potentially save thousands of lives if such a thing existed, but we cannot take this potential solution to such a widespread problem seriously until there is hard evidence that can be used to advocate in favor of this option for parents.

III: 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). This is a dangerous state of mind for parents to be in, because they fear the thing that is least likely to harm their child, and yet many are insistent that the side effects of the vaccines are more likely to injure kids than the diseases they are meant to protect them from. So it seems the solution to vaccine non-compliance is through education, awareness, and outreach to the hesitant parents, to try and change ideas and beliefs towards the “dangers” of vaccines.

 This is where current psychology research may be helpful: 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 can be done in a number of ways, but because this issue has a lot to do with where and when the child is able to attend school, perhaps outreach through the school would be most effective. One way of doing this is to mimic the state’s most prominent pieces of legislation regarding sexual health education to students. AB 517 gave schools the authorization to teach sexual health and HIV/AIDS prevention, requiring schools to hire outside counselors to come to the school and teach; this curriculum is required for every school by the California state government as of October 2015, so that no school will be exempt from teaching everything from abstinence to abortion in middle and high schools (NCSL, Tucker). What if the state government were to materialize a similar program for parents on the topic of vaccinations? Theoretically, this would require parents with children starting kindergarten to attend an informational meeting (or two), in which an outside specialist uses some of the techniques used in Horne’s study, in order to justify the strict laws in place regarding school children and vaccines. This kind of outreach allows for parents to be confronted head-on with all the necessary information, and gives them the chance to speak with an expert on the subject and ask questions about what is considered best for their child. The school would be given the same liberty with the Vaccine Consultation as they have with the Sex-Ed program, which is to choose the circumstances of this informational meeting, whether it takes place with several consultants in smaller groups within classrooms, or with one consultant and one large general assembly of parents (NCSL). If the findings from Horne’s study is utilized in this way, it could mean an increase in vaccine-compliance (as SB 277 had originally intended), and result in keeping more kids in school.

            With the health of thousands of California children at stake, SB 277 effectively adapts and regulates a vaccination program that could minimize the risk of contracting a preventable disease. This widely debated piece of legislation was very well-intentioned, but there was little thought put into how the parents 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. While ideally this might include an alternative schedule for parents to opt for instead of the intensive AAP-recommended vaccination schedule, it is more likely that this transition will include outreach and awareness education to parents that are vaccine-hesitant. Through this outreach, we can only hope that the opposition to SB 277 will dwindle, and more vaccine-hesitant parents become compliant as they realize this law protects their individual children, as well as public health overall in California.