User:Mcguigan.m/sandbox

 Project 1: Literature Review 

'''research question: How are socioeconomic status and opinions on mandatory vaccination related? // Currently in the US, what kinds of populations are most likely to opt out of vaccinating their children, and why?'''

article 1: Anti-Vaccination Movement and Parent Refusals of Immunization of Children in USA


 * author: Marian Olpinski
 * link: https://www.sciencedirect.com/science/article/pii/S0031393912000042
 * pediatricians see increase in parents who opt out of vaccinating their children
 * VPD: vaccine-preventable diseases
 * fear of side effects > fear of disease
 * importance of public education and respectful persuasion
 * VPD incidence rates are at record low because of vaccine implementation, largely forgotten by public
 * measles, mumps, pertussis
 * "US is on verge of becoming victim of this success" --> people think that this incidence decline is enough to not vaccinate their kids
 * cycle of perception
 * pre-vaccine: public feels threatened by the disease
 * vaccine becomes available and widely accepted
 * vaccine results in decrease of VPD cases/deaths, people begin to forget threat
 * increased usage correlates with increased focus on side effects
 * develops false perception of cause-and-effect relationship
 * public now becomes fearful of government and public health institutions
 * causes increased in morbidity/mortality
 * people eventually begin to vaccinate again, disease can become eradicated
 * 1982: birth of anti-vax movement
 * WRC-TV airs program: "DPT: Vaccine Roulette" that claimed the pertussis component of the vaccine cause brain damage, seizures, and delayed mental/motor development
 * nationwide decrease in vaccination coverage
 * 1986: National Childhood Vaccine Injury Act allows kids to be compensated for "damages" while simultaneously protecting pharmaceutical companies
 * 1998: Dr. Andrew Wakefield publishes study in "Lancet" suggesting connection between MMR vaccine and autism
 * effect of thimerosal
 * 2004: Institution of Medicine panel determines that there is no relationship between thimerosal/MMR vaccine and autism
 * public generally refuses to alter viewpoints, politicians as well
 * Wakefield's research is later completely discredited, Lancet retracts study
 * celebrity influence
 * Robert F. Kennedy publishes "Deadly Immunity" in Rolling Stone Magazine, in which he accused gov of concealing evidence of mercury in vaccines causing autism in kids to protect drug companies
 * article was retracted
 * John Kerry, Chris Dodd, Joseph Lieberman
 * actors Jenny McCarthy and Jim Carrey
 * both endorsed by Oprah Winfrey and Larry King
 * National Immunization Survey (2009)
 * 25.8% delayed vaccines, 8.2% refused, 5.8% delayed and refused
 * "Pediatrics" journal study: in 2000, only 14% believed parents had right to send unvaccinated kids to school --> jumped to 31% in 2010
 * 25% of parents believe vaccines cause autism
 * 50% of responders expressed concerns regarding adverse side effects
 * most influential medium: internet
 * 52% of internet users believe "almost all" info on so-called health sites is credible
 * major perception: vaccines contain poisons, cause new diseases, erode "natural" immunity
 * suburban physicians caring for upper-middle class families experience more refusals
 * article ran in chronological order
 * no distinct tone, but seemed slightly in biased towards pro-vaccination, based on the compilation of evidence presented that collectively and consistently proved the anti-vaxxer argument wrong
 * emphasis on the role of fear in anti-vaxxer ideology
 * fear mongering by media

article 2: Shaming Vaccine Refusal


 * author: Ross D. Silverman and Lindsay F. Wiley
 * link: https://journals.sagepub.com/doi/pdf/10.1177/1073110517750597
 * once prevalence has drastically declined, many parents start to question if vaccination is truly necessary and still in the child's best interests
 * community immunity is designed to protect those who are allergic to vaccine ingredients or immunocompromised
 * for measles: 5% of an average school's population can be unvaccinated safely
 * question of who can reap the benefits of immunity without vaccination
 * rise of desire for a "natural" lifestyle
 * recent campaigns have started to associate vaccine refusal with negative traits, like greed or denial of medical evidence
 * question of how acceptable it is for private employers and physicians to discriminate against those who are opposed to vaccination
 * some legislators suggest imposing taxes or fines on parents who opt out of vaccinating their children for non-medical reasons
 * efforts to shame vaccine-refusing parents from the perspective of the institution will likely be unsuccessful
 * however, attaching a social shame from the public sector would be more effective
 * association of abusing privilege
 * 2015: CDC implements #TeamVax
 * media largely portrays anti-vaxxers as a group of selfish and misinformed parents
 * Los Angeles Times: "Rich, educated, and stupid parents are driving the vaccination crisis"
 * Huffington Post: "Anti-vaxxers are stupid and contagious"
 * within the anti-vaxxer community, solidarity is intensely valued to the point that challenges from an outside perspective only strengthen the group's beliefs
 * many pediatricians will turn parents away from their practice for not having their children vaccinated on time
 * shaming anti-vaxxers is a directly confrontation of beliefs, which can potentially counteract the fragile efforts already made by public health campaigns to promote vaccination
 * article takes on a cautious tone
 * authors are distinctly against the anti-vax movement, but question how to best inform the public
 * utilizes 95 reputable sources
 * takes on a similar tone as an op-ed
 * pushes for a public health approach that focuses on preserving efforts that have already been made to protect progress made for vaccinations while gently dismantling the ideology that having the privilege to not vaccinate is not harming others
 * anti-vaxxers use vaccines as an easy scapegoat

article 3: Correlates of high vaccination exemption rates among kindergartens


 * author: MS Birnbaum, et al
 * link: https://www.sciencedirect.com/science/article/pii/S0264410X12017434?via%3Dihub
 * study of AZ schools with high PBE (personal belief exemptions) rates among populations of kindergarteners
 * 2010-2011 Immunization Data Report for kindergarten
 * direct correlation of increased proportion of white students with increased PBE rates
 * correlation of higher income with higher PBE rates
 * high PBE rates serve as potential outbreak hotspots
 * study results are different from the historical perception that unvaccinated children were part of an underserved and/or lower class population
 * parent beliefs for not vaccinating
 * kids get too many vaccines
 * parents question legitimacy and importance of vaccines
 * VPDs are easily prevented with "natural" living
 * highest PBE: 68%
 * study worked by finding groups of exemption clusters and characterizing their populations
 * 2010-2011 AZ Immunization Data Report
 * analysis of 1018 schools (strong sample size)
 * focus on race: schools with largest proportion of white students were more than 14 times likely than those with the lowest proportion to have permanent PBEs

article 4: Attitudes toward vaccination and the H1N1 vaccine: Poor people's unfounded fears or legitimate concerns of the elite?


 * author: Patrick Peretti-Watel, et al
 * link: https://www.sciencedirect.com/science/article/pii/S0277953614001397
 * H1N1 outbreak generally decreased public confidence in vaccination
 * vaccine opposition is often described as the product of "misinformation and ignorance"
 * instead, most parents opposing H1N1 vaccination were hesitant, yet well-informed
 * lower SES people are generally associated with greater risk perceptions
 * higher sense of vulnerability
 * people with higher SES are more inclined to exert autonomy over their own health
 * wealthy, educated people are most receptive to the concept of "manufactured risk"
 * in the case of H1N1, the risk is the H1N1 outbreak being constructed by the government to promote the pharmaceutical industry
 * identification of "risk society": skepticism surrounding scientific knowledge and opposition to scientific evidence, generally embraced by the middle class
 * culture of "being against the establishment"
 * focus on the educated middle class
 * large sample size: 9480 people age 15-79
 * focus on "healthism" of the middle class: idea that health is the responsibility of the individual and not a concern of the population
 * opposition has to do with more than just ignorance
 * study conducted via survey with questions about vaccines, for which responses were merged into a binary outcome
 * during the H1N1 outbreak, more people opposed the H1N1 vaccine than vaccination itself

article 5: Pediatricians' Experience with and Response to Parental Vaccine Safety Concerns and Vaccine Refusals: A Survey of Connecticut Pediatricians


 * author: Susan Leib, et al
 * link: https://journals.sagepub.com/doi/pdf/10.1177/00333549111260S203
 * 2008 study of 133 pediatricians in CT
 * pediatricians observe increased vaccination refusal rates among parents
 * 30% of surveyed pediatricians have dismissed families based on their refusal to immunize their children
 * increased concern among physicians in upper-middle class suburban areas
 * pediatricians caring for wealthy educated families are more likely to decline care for families who refuse to vaccinate their children on time
 * potential adverse impact on childhood vaccination rates
 * higher parental SES positively correlated with both increased vaccine concerns and refusal
 * correlation has grown stronger over time
 * patients in urban areas report less concern, lower refusal rates
 * potentially due to lack of information, resulting in a general trust in physician
 * physicians report that children who are unvaccinated because parents opted out usually come from higher SES families and have parents with college degrees
 * study is severely limited by small sample size

article 6: Addressing the vaccine confidence gap


 * author: Heidi J Larson, et al
 * link: https://www.sciencedirect.com/science/article/pii/S0140673611606788
 * public decision making regarding vaccines driven largely by psychosocial factors that impact ability to trust
 * H1N1 epidemic: adverse events associated with vaccine that occurred by chance easily become linked to the vaccine itself (false correlation)
 * public skepticism also concerns vaccine research and funding
 * communication alone isn't enough to break down resounding distrust
 * general distrust in today's society has a lot to do with the fact that most new parents making the decision to not vaccinate are too young to have witnessed the actual detrimental effects of VPDs on a population
 * difference between those who cannot afford to be vaccinated and those who opt out of vaccination
 * social media and internet give outlier perspectives more attention and value than they deserve
 * Jim Carrey and Jenny McCarthy
 * residual effect of Dr. Wakefield's research, even though it has been proven incorrect
 * as long as anti-vaxxers have financial means, they can continue to support their cause
 * conflict of interest present in article: funding from Novartis
 * similar to Olpinski, shoots down logic of anti-vaxxers consistently

article 7: What are the factors that contribute to parental vaccine-hesitancy and what can we do about it?


 * author: Sarah E. Williams
 * link: https://www.tandfonline.com/doi/full/10.4161/hv.28596?src=recsys
 * main barrier: vaccine safety
 * VHP: vaccine-hesitant parent
 * vaccine-accepting parents have stronger relationships with their children's PCP than VHPs
 * communicating with VHPs is often difficult because they themselves are usually highly educated and see those who try to push for vaccination as condescending
 * because the anti-vax movement is highly emotionally charged, some VHPs may respond better to emotional pro-vax messages because it levels the educational playing field and removes education level as a factor
 * lack of evidence about strategies for pushing VHPs to vaccinate
 * article takes on a positive and encouraging tone
 * emphasis on using effective communication models to prevent sounding condescending
 * used HPV vaccine as running example, which is helpful for contextualizing the issue, but it's important to note that responses could change depending on the given vaccine
 * charged responses because HPV is a sexually transmitted disease

Wikipedia Article Edit (2/10/19): 2018/2019 US Measles Outbreaks
I want to edit the existing Wikipedia article "Vaccine hesitancy" by adding a section about the various outbreaks of measles that have occurred in the United States over the past year. Within the past two weeks, a new outbreak of measles has emerged on the west coast, and I think it would be really interesting to study public and political reactions to the outbreak in real time.

Add Section: 2019 Washington State Measles Outbreak
ROUGH OUTLINE

-when and where did it start

-how many cases; how was it spreading

-how did people react

-public health emergency → state of emergency

-mid February: Facebook bans anti-vax posts

-this week (week of 2/18): incidence has started to decline

In late December 2018, the Public Health Department of Clark County, Washington identified a patient with a high fever and rash, which are symptoms characteristic of measles. This was Clark County’s first confirmed case of measles (1). The case sparked immediate concern, as measles is a highly contagious disease: the virus can spread through coughing or sneezing, and it is infectious enough that 90% of people within close proximity to the patient, if unvaccinated, will contract measles (2).

Through the end of December and into January, measles cases in Clark County continued to increase, even after placing patients in quarantine (3). Public health officials identified that one of the measles patients from Oregon had been traveling through the Portland International Airport on January 7th (4), which may have been related to measles cases in California, Colorado, Connecticut, Georgia, Illinois, New Jersey, New York, Oregon, Texas, and Washington that emerged throughout January 2019 (3).

As of February 16th, 2019, Clark County has identified 59 confirmed cases of measles (5). 56 of the cases were among children ages 18 and under (6). None of these 59 patients had received the complete set of MMR (measles, mumps, rubella) vaccinations (6). According to the Center for Disease Control, 91.9% of children aged 19 to 35 months had received at least one dose of the MMR vaccine in the year 2017 (9). For the 2017-2018 academic year, personal belief exemptions were filed on behalf of 7.9% children enrolled in school (kindergarten through grade 12). Personal belief exemptions (PBE) are forms that can be filled out by parents that excuse children from school-wide immunization requirements on the premise of moral, philosophical, or religious opposition (cite wiki article on PBE). Only three of the 50 United States prohibit the utilization of PBEs entirely: Mississippi, West Virginia, and California (8).

SOURCES

1. https://www.clark.wa.gov/public-health/measles-investigation

2. https://www.cdc.gov/measles/about/transmission.html

3. https://www.cdc.gov/measles/cases-outbreaks.html

4. https://www.washingtonpost.com/nation/2019/01/23/an-anti-vaccination-hotspot-near-portland-suffers-public-health-emergency-over-measles/?noredirect=on&utm_term=.c81ab5a06d50

5. https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/Measles/MeaslesOutbreak

6. https://www.clark.wa.gov/public-health/measles-investigation

7. https://www.clark.wa.gov/public-health/immunizations

8. https://www.vox.com/2019/1/27/18199514/measles-outbreak-2018-clark-county-washington

9. https://www.cdc.gov/nchs/fastats/immunize.htm

10.