Vaccination as a Public Health Policy Issue


Vaccination is an important health policy issue in Miami-Dade County in Florida. At the moment, the state’s laws on vaccination require children to receive certain vaccines, including diphtheria-tetanus-acellular pertussis (DTaP), IPV, varicella, MMR, and others, before entering daycare or family daycare (FDH, n.d.). The set number of doses of these vaccines is also required throughout kindergarten and school. For instance, to enter or transfer to a Florida school, children are expected to have four or five doses of DTaP and IPV, two doses of MMR, and two doses of varicella (FDH, n.d.). Nevertheless, each parent has a right to apply for a medical or religious exemption from immunization, thus leaving his or her child unvaccinated.

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Furthermore, no state regulations require schools to provide flu vaccines for students. These factors contributed to the decrease in vaccination rates in Miami-Dade County. In 2013, 8 percent of children entered public schools without the required vaccinations (Veiga, Alcantara, & Dapena, 2015) The key legislator that could be approached with regards to this issue is Frederica S. Wilson, who is a representative of the 24th congressional district. In 2015, she introduced the Vaccinate All Children Act, which requires public institutions to vaccinate all students to receive grants from the Department of Health and Human Services (“H.R.2232 – Vaccinate All Children Act of 2015,” 2015). Although the Act provides medical exemptions to students threatened by vaccination, it would still motivate public education institutions to promote immunization and achieve better student health outcomes.

Formulating a Healthcare Policy

Public Health Policy

The issue chosen for the assignment is the immunization of children in educational institutions, such as kindergartens and schools. This issue was chosen as the primary focus of the assignment as it affects the health of children who attend public education institutions. Health issues and infections can cause complications and result in long-term consequences; however, vaccinations can help to prevent the issue, which means that addressing the problem of low immunization through appropriate legislation can help to improve public health outcomes for children.

Background of the Issue

Vaccination is a controversial issue that is widely studied in research. According to empirical research, timely vaccination can prevent over a dozen diseases in children, including diphtheria, chickenpox, mumps, rotavirus, measles, hepatitis A and B, flu, and polio (CDC, 2016). However, some parents still believe that vaccinations are harmful to children and refuse to consent to it, thus applying for exemptions. As defined by Kahan (2013), the controversy originated due to a science communication problem, which means that empirical research evidence supporting the use of vaccines did not manage to dissolve public concerns over the health risks and consequences of vaccination. There is a significant divergence between the opinion of medical experts and the general public, which influences parents’ decisions with regards to vaccination of children and can thus affect public health outcomes.

Kahan (2013) outlines an important case with the HPV vaccine, which became the source of a major debate in 2006: “Experimental evidence showed that individuals tended to selectively credit information relating to the vaccine’s risks and benefits in patterns reflecting their cultural predispositions” (p. 53). Many parents search for information about vaccination risks online (Harmsen et al., 2013), which exposes them to unverified information and biased opinions that could also influence decision-making with regards to vaccination. Communication barriers between the scientific community and the general public are also evident in the case of Miami-Dade County, where over 8 percent of parents apply for exemption certificates to prevent their children from immunization. Miscommunication reduces the effectiveness of all educational interventions, thus impairing the efforts to promote immunization. It is thus crucial for the state to review the current legislation and impose stricter regulations on compulsory immunization procedures.

Thoughts About the Policy Issue

There are two primary sides to the controversy surrounding vaccinations of children. On the one hand, the scientific community believes that at least 95% of residents must be immunized to ensure a “herd community,” which prevents outbreaks of preventable diseases and infections (Song, 2014). On the other hand, many parents believe that vaccination of children is no longer necessary, as most of the diseases that require immunization were eliminated in the United States (2014). However, it is also important to understand the context and the demographic factors that influence the spreading of disease. In the U.S. there are relatively high rates of immigration and travel, which can promote the spreading of those diseases that rarely occur in America.

By exempting children from recommended immunization, parents expose them to these diseases. For instance, an outbreak of pertussis, or whooping cough, observed in 2010 could be prevented by appropriate immunization (Song, 2014). Outbreaks of measles are also relatively common, although they could have been prevented by vaccination: “In fact, during 2011 alone, a total of 222 measles cases and 17 measles outbreaks were reported to the CDC, compared with a median of 60 cases and four outbreaks reported annually from 2001 to 2010” (Song, 2014, p. 541). Therefore, exempting children from vaccination is not a viable alternative to age-appropriate immunization. To resolve the issue and improve immunization rates in Miami-Dade County, it is crucial to review the current legislation and to impose stricter controls on the exemption procedure.

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Florida Department of Health (FDH, n.d.) provides current information regarding vaccination requirements in the state. For instance, FDH (n.d.) lists the required immunizations by age and education level, including school, kindergarten, and university.

Targeted Level of Government

The issue involves the state government, as the legislation that applies to the health care sector is approved and imposed on a state level.


As mentioned in the introduction, the key legislator that should be contacted with regards to the issue is Frederica S. Wilson, who is a representative of the 24th congressional district.

Impact of the Policy-Priority Issue

In Miami-Dade County, the immunization rate is significantly lower than considered necessary for a herding community: “In 2013, 92 percent of Miami-Dade County kindergartners enrolled in school fully immunized. Florida wants to immunize 95 percent of kindergartners. About half of all counties, including Miami-Dade, don’t meet that goal” (Veiga et al., 2015, para. 3). With 8 percent of students lacking immunization for infections such as measles and chickenpox, and even more left unvaccinated for flu, there is a threat to the safety and well-being of many children. Thus, the chosen policy-priority issue has a significant impact on nursing practice, as it affects the health of entire communities. Parents’ refusal to vaccinate children can lead to disease outbreaks that will increase the need for and use of medical care. Moreover, disease outbreaks can increase the state’s health care expenditures and affect the quality of care, thus influencing community health outcomes.


Overall, the issue of low children’s immunization rate in Miami-Dade County poses a threat to the community due to the risk of outbreaks. The controversy surrounding vaccination of children is caused primarily by the miscommunication between the scientific community and the general public. To ensure that the residents of the county stay safe, it is crucial to achieving at least a 95% rate of immunization. However, due to the barriers in communication, achieving the goal requires a major legislative action that would impose stricter rules on exemptions, thus increasing vaccination rates among children.


Centers for Disease Control and Prevention (CDC). (2016). 14 diseases you almost forgot about (thanks to vaccines). Web.

Florida Department of Health (FDH). (n.d.). School immunization requirements. Web.

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Harmsen, I. A., Doorman, G. G., Mollema, L., Ruiter, R. A., Kok, G., & de Melker, H. E. (2013). Parental information-seeking behaviour in childhood vaccinations. BMC Public Health, 13(1), 1219-1228.

H.R.2232 – Vaccinate All Children Act of 2015. (2015). Web.

Kahan, D. M. (2013). A risky science communication environment for vaccines. Science, 342(6154), 53-54.

Song, G. (2014). Understanding public perceptions of benefits and risks of childhood vaccinations in the United States. Risk Analysis, 34(3), 541-555.

Veiga, C., Alcantara, C., & Dapena, K. (2015). Half of Florida counties meet state’s vaccination goal. Miami Herald. Web.

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