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The Importance of Vaccination Essay

Type of paper: Essay

Topic: Health , Disease , Vaccination , Medicine , Children , Security , Society , Family

Words: 1000

Published: 03/16/2021

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Works Cited

Alls, Cassandra. Vaccine Information Resource Guide: A Parent's Discovery. New York: Lulu.com, 2009. Centers for Disease Control and Prevention. State Vaccination Requirements. 30 September 2011. 4 May 2012 . Holk, Bonnie C. Minsky and Lisa. Our Children's Health: America's Kids in Nutritional Crisis and What We Can Do to Help Them. California: Vital Health Publishing, 2002. Neustaedter, Randall. The Vaccine Guide: Risks and Benefits for Children and Adults. Canada: North Atlantic Books, 2002. Romm, Aviva Jill. Vaccinations: A Thoughtful Parent's Guide: How to Make Safe, Sensible Decisions about the Risks, Benefits, and Alternatives. New York: Inner Traditions / Bear & Co, 2001. Salmon, Daniel A. "Disease Prevention and Control." Mandatory Immunization Laws and the Role ofMedical, Religious and Philosophical Exemptions (2002): 1-4. Sears, Robert W. The Vaccine Book: Making the Right Decision for Your Child. Chicago: Little, Brown and Company, 2011. Sherman, Jill. The Vaccination Debate. Canada: ABDO, 2012.

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Essay on Coronavirus Vaccine

500+ Words Essay on Coronavirus Vaccine

The Coronavirus has infected millions of people so far all over the world. In addition to that, millions of people have lost their lives to it. Ever since the outbreak, researchers all over the world have been working constantly to develop vaccines that will work effectively against the virus. We will take a look at the Coronavirus vaccine that is present today. Vaccines have the ability to save people’s lives. Developing the vaccine for Coronavirus was a huge step to end the pandemic.

Working of Coronavirus Vaccine

As Coronavirus caused a lot of confusion and fear amongst people, it is natural people were not aware of how the vaccine works. To begin with, a vaccine will work by mimicking an infectious agent.

The agent can be viruses, bacteria or any other microorganisms. They carry the potential of causing disease. When it mimics that, our immune system learns how to respond against it rapidly and efficiently.

As per the traditional methods, vaccines have managed to do this as they introduce a weakened form of an infectious agent. It enables our immune system to basically build its memory.

As a result, our immune system can then identify it quickly and fight against it before it gets the chance to harm us or make us ill. Similarly, some of the coronavirus vaccines have been made like that.

On the other hand, there are other coronavirus vaccines that researchers have developed by making use of new approaches. We refer to them as messenger RNA or mRNA vaccines.

Over here, they do not introduce antigens in our bodies. Instead, mRNA vaccines give the genetic code our body needs to enable our immune system for producing the antigen itself.

For several years, researchers have been studying mRNA vaccine technology. Thus, they do not contain any live virus and also do not interfere with the human DNA .

Get the huge list of more than 500 Essay Topics and Ideas

Safety of Coronavirus Vaccine

While the vaccines are being developed at a fast pace, they also require rigorous testing. The tests are done in clinical trials to ensure that they meet the benchmarks for the safety and efficiency of international standards.

When they meet the standards, then only can they get the go-ahead from WHO and national regulatory agencies. UNICEF has said that it will attain and supply only those vaccines that meet the WHO guidelines and have met the regulatory approval.

As of now, the vaccine doses are limited in number. Thus, the healthcare workers, first responders, people over the age of 75 and residents of long-term care facilities will receive the first doses.

After that, everyone will be able to get it once more of them are available. To get the vaccine, a person may require to pay a fee. However, some government institutions are providing it free of cost.

In order to get the vaccine, one must check with their local and state health departments on a regular basis. When they get the chance, they must get the dose right away.

The Coronavirus outbreak has challenged the whole world. Constantly, the experts and authorities are working to develop the vaccines. Therefore, we can also do our bit and adopt preventive measures to limit the spread of this disease. The major goal is to get the vaccine to everyone so that we can go on and about with our normal lives.

FAQ on Essay on Coronavirus Vaccine

Question 1: What are some common side effects of the Coronavirus vaccine?

Answer 1: The most common side effect includes a sore arm, fever , headache, and fatigue. However, not to worry, side effects are good in this case. They indicate that your vaccine is starting to work as it triggers your immune system.

Question 2: When do Coronavirus vaccine side effects kick in?

Answer 2: Usually, most of the side effects start to kick in within the first 3 days after you get your vaccine. Moreover, they will last up to 1 to 2 days only.

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Vaccine - Free Essay Examples And Topic Ideas

Vaccines are biological preparations that provide immunity against particular diseases by stimulating the body’s immune response. Essays on vaccines could explore their development, efficacy, and the public health implications of vaccination programs. Discussions might also delve into the historical milestones in vaccine development, the controversies surrounding vaccinations, and the challenges in global vaccine distribution. Moreover, analyzing the ethical considerations, the economic impact, and the future advancements in vaccine technology can provide a comprehensive understanding of the vital role vaccines play in global health and wellbeing. A vast selection of complimentary essay illustrations pertaining to Vaccine you can find in Papersowl database. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Vaccine Development

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Vaccines should be Mandatory

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Should Vaccinations be Required for Students to Attend Public School?

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A Discussion of the Importance of Flu and Pneumonia Vaccine for the Elderly

Lesson Description: Pneumococcal infection in the elderly is a primary consideration, emphasizing the need for prevention. The flu or influenza vaccine is a proven and effective method for maintaining health, preventing diseases, and even saving lives. As individuals age, there can be a higher risk associated with influenza. For this reason, elderly individuals, aged 60 years and above, are advised to receive a flu vaccine annually. The influenza vaccine is offered free, especially to the elderly. Contact your local public […]

Animal Testing: is it Ethical?

Animals being sacred gifts given to us, they are the best part of our lives and provide us with a special way of love. They do nothing but bring joy and happiness to us. My whole life I've grown up with all different kinds of animals. I've had a dog named Shelby, two cats Ruby and Smokey, a bird named Cheeks, two hamsters Bernard and Sandy, and I currently have a dog named Rocky and a rabbit named Daisy. I […]

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Review of Zika Virus Vaccine Market Place

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Children Vaccination

Introduction What are vaccines? Whenever germs enter into the body of a human being, the immune system distinguishes them as external substances to the body known as antigens. The immune system then fights against the antigens through the production of the correct and rightful antibodies. Vaccines then are a weakened version of a specific antigen or virus that causes a certain disease and are weakened to the point that they cannot produce any symptom of the specific disease. However, since […]

The Progress of Childhood Diseases

This research paper is about the progress of medicine in childhood diseases. The purpose of this paper will go over the childhood diseases and illness that control of human lives and morality rate. It on focus on childhood disease improvement of medicines and vaccinations that associate with certain illness and diseases. The discoveries in vaccination plays a role in treatments in different illness and diseases in childhood diseases. “Strategic vaccination campaigns have virtually eliminated diseases that previously were common in […]

Childhood Immunization

Introduction Nothing concerns a health care provider more than walking into a patient’s room to take a history and realizing that the child or adult you are attempting to treat never received vaccinations. Unfortunately, this situation and the number of “anti-vaxxers” in the United States are becoming a prevailing trend. This is regrettably proven by the increase in certain preventable yet deadly diseases like measles. In fact, “The largest measles outbreak in the United States in more than 20 years […]

The Precaution Adoption Process Model

If someone was faced with a health problem, how prepared would they be to resolve it? Would they have the knowledge to act in times of a crisis? The Precaution Adoption Process Model (PAPM) was developed to explain how a person makes decisions to take action and how he or she relates that decision into action (Sandman, Weinstein, & Blalock, 2001); it can be utilized to help people take part in health protective behaviors and move through its seven stages: […]

Pros and Cons of Animal Testing

Aside from what anyone thinks animal testing does has positives, although some might argue that they don't outweigh the negatives. Testing on a living organism could be more accurate than a small percentage of alternatives. It also gave us a much better understanding of our own anatomy considering before we tested on animals we thought our lungs pumped our blood throughout our body(Animal Experimentation). Also animal testing has given us an insight on the effectiveness of medications developed to combat […]

Animal Testing in Medical and Cosmetic Research

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The Controversy of Animal Testing

Imagine a cute white little bunny. You couldn't even fathom harming this creature, could you? However, every day bunnies, like the one you imagined, are used in trials where they are harmed. I'm sure you've heard of companies claiming that they are cruelty free or don't support animal testing , but are you aware of what animal testing really is and what the animals endure during their trials? Companies every day torture animals in tests that don't always prove to […]

Medical Animal Testing should be Banned

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Animal Testing and its Importance

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Progress against AIDS

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Homeostasis is a Communicable Infection

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Problems with Animal Testing: Inhumane Practices and Neglected Interests

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New and Safe Treatments for Humanity

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Getting vaccinated is a very controversial topic right now; some people are against it, and some people are for it. This is a very important topic because it can either harm a child or save them from a disease that is going around or is super contagious. According to omicsonline.org, A vaccine is a biological preparation that provides active acquired immunity to a particular disease. When disease germs enter your body, they start to reproduce. Your immune system recognizes these […]

How to Write a Persuasive Essay About Covid19 | Examples & Tips

11 min read

Published on: Feb 22, 2023

Last updated on: Oct 16, 2023

Steps to Write a Persuasive Essay About Covid-19

Here are the steps to help you write a persuasive essay on this topic, along with an example essay:

Step 1: Choose a Specific Thesis Statement

Your thesis statement should clearly state your position on a specific aspect of COVID-19. It should be debatable and clear. For example:

Step 2: Research and Gather Information

Collect reliable and up-to-date information from reputable sources to support your thesis statement. This may include statistics, expert opinions, and scientific studies. For instance:

COVID-19 vaccination effectiveness data
Information on vaccine mandates in different countries
Expert statements from health organizations like the WHO or CDC

Step 3: Outline Your Essay

Create a clear and organized outline to structure your essay. A persuasive essay typically follows this structure:

Introduction
Background Information
Body Paragraphs (with supporting evidence)
Counterarguments (addressing opposing views)

Step 4: Write the Introduction

In the introduction, grab your reader's attention and present your thesis statement. For example:

Step 5: Provide Background Information

Offer context and background information to help your readers understand the issue better. For instance:

Step 6: Develop Body Paragraphs

Each body paragraph should present a single point or piece of evidence that supports your thesis statement. Use clear topic sentences, evidence, and analysis. Here's an example:

Step 7: Address Counterarguments

Acknowledge opposing viewpoints and refute them with strong counterarguments. This demonstrates that you've considered different perspectives. For example:

Step 8: Write the Conclusion

Summarize your main points and restate your thesis statement in the conclusion. End with a strong call to action or thought-provoking statement. For instance:

Step 9: Revise and Proofread

Edit your essay for clarity, coherence, grammar, and spelling errors. Ensure that your argument flows logically.

Step 10: Cite Your Sources

Include proper citations and a bibliography page to give credit to your sources.

Remember to adjust your approach and arguments based on your target audience and the specific angle you want to take in your persuasive essay about COVID-19.

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Examples of Persuasive Essay About Covid19

When writing a persuasive essay about the Covid-19 pandemic, it’s important to consider how you want to present your argument. To help you get started, here are some example essays for you to read:

Check out some more PDF examples below:

Persuasive Essay About Covid-19 Pandemic

Sample Of Persuasive Essay About Covid-19

Persuasive Essay About Covid-19 In The Philippines - Example

If you're in search of a compelling persuasive essay on business, don't miss out on our “ persuasive essay about business ” blog!

Examples of Persuasive Essay About Covid-19 Vaccine

Covid19 vaccines are one of the ways to prevent the spread of Covid-19, but they have been a source of controversy. Different sides argue about the benefits or dangers of the new vaccines. Whatever your point of view is, writing a persuasive essay about it is a good way of organizing your thoughts and persuading others.

A persuasive essay about the Covid-19 vaccine could consider the benefits of getting vaccinated as well as the potential side effects.

Below are some examples of persuasive essays on getting vaccinated for Covid-19.

Covid19 Vaccine Persuasive Essay

Persuasive Essay on Covid Vaccines

Interested in thought-provoking discussions on abortion? Read our persuasive essay about abortion blog to eplore arguments!

Examples of Persuasive Essay About Covid-19 Integration

Covid19 has drastically changed the way people interact in schools, markets, and workplaces. In short, it has affected all aspects of life. However, people have started to learn to live with Covid19.

Writing a persuasive essay about it shouldn't be stressful. Read the sample essay below to get idea for your own essay about Covid19 integration.

Persuasive Essay About Working From Home During Covid19

Searching for the topic of Online Education? Our persuasive essay about online education is a must-read.

Examples of Argumentative Essay About Covid 19

Covid-19 has been an ever-evolving issue, with new developments and discoveries being made on a daily basis.

Writing an argumentative essay about such an issue is both interesting and challenging. It allows you to evaluate different aspects of the pandemic, as well as consider potential solutions.

Here are some examples of argumentative essays on Covid19.

Argumentative Essay About Covid19 Sample

Argumentative Essay About Covid19 With Introduction Body and Conclusion

Looking for a persuasive take on the topic of smoking? You'll find it all related arguments in out Persuasive Essay About Smoking blog!

Examples of Persuasive Speeches About Covid-19

Do you need to prepare a speech about Covid19 and need examples? We have them for you!

Persuasive speeches about Covid-19 can provide the audience with valuable insights on how to best handle the pandemic. They can be used to advocate for specific changes in policies or simply raise awareness about the virus.

Check out some examples of persuasive speeches on Covid-19:

Persuasive Speech About Covid-19 Example

Persuasive Speech About Vaccine For Covid-19

You can also read persuasive essay examples on other topics to master your persuasive techniques!

Tips to Write a Persuasive Essay About Covid-19

Writing a persuasive essay about COVID-19 requires a thoughtful approach to present your arguments effectively.

Here are some tips to help you craft a compelling persuasive essay on this topic:

Choose a Specific Angle

Start by narrowing down your focus. COVID-19 is a broad topic, so selecting a specific aspect or issue related to it will make your essay more persuasive and manageable. For example, you could focus on vaccination, public health measures, the economic impact, or misinformation.

Provide Credible Sources

Support your arguments with credible sources such as scientific studies, government reports, and reputable news outlets. Reliable sources enhance the credibility of your essay.

Use Persuasive Language

Employ persuasive techniques, such as ethos (establishing credibility), pathos (appealing to emotions), and logos (using logic and evidence). Use vivid examples and anecdotes to make your points relatable.

Organize Your Essay

Structure your essay involves creating a persuasive essay outline and establishing a logical flow from one point to the next. Each paragraph should focus on a single point, and transitions between paragraphs should be smooth and logical.

Emphasize Benefits

Highlight the benefits of your proposed actions or viewpoints. Explain how your suggestions can improve public health, safety, or well-being. Make it clear why your audience should support your position.

Use Visuals -H3

Incorporate graphs, charts, and statistics when applicable. Visual aids can reinforce your arguments and make complex data more accessible to your readers.

Call to Action

End your essay with a strong call to action. Encourage your readers to take a specific step or consider your viewpoint. Make it clear what you want them to do or think after reading your essay.

Revise and Edit

Proofread your essay for grammar, spelling, and clarity. Make sure your arguments are well-structured and that your writing flows smoothly.

Seek Feedback

Have someone else read your essay to get feedback. They may offer valuable insights and help you identify areas where your persuasive techniques can be improved.

Tough Essay Due? Hire Tough Writers!

Common Topics for a Persuasive Essay on COVID-19

Here are some persuasive essay topics on COVID-19:

The Importance of Vaccination Mandates for COVID-19 Control
Balancing Public Health and Personal Freedom During a Pandemic
The Economic Impact of Lockdowns vs. Public Health Benefits
The Role of Misinformation in Fueling Vaccine Hesitancy
Remote Learning vs. In-Person Education: What's Best for Students?
The Ethics of Vaccine Distribution: Prioritizing Vulnerable Populations
The Mental Health Crisis Amidst the COVID-19 Pandemic
The Long-Term Effects of COVID-19 on Healthcare Systems
Global Cooperation vs. Vaccine Nationalism in Fighting the Pandemic
The Future of Telemedicine: Expanding Healthcare Access Post-COVID-19

In search of more inspiring topics for your next persuasive essay? Our persuasive essay topics blog has plenty of ideas!

To sum it up,

You have read good sample essays and got some helpful tips. You now have the tools you needed to write a persuasive essay about Covid-19. So don't let the doubts stop you, start writing!

If you need professional writing help, don't worry! We've got that for you as well.

MyPerfectWords.com is a professional essay writing service that can help you craft an excellent persuasive essay on Covid-19. Our experienced essay writer will create a well-structured, insightful paper in no time!

So don't hesitate and get in touch with our persuasive essay writing service today!

Frequently Asked Questions

Are there any ethical considerations when writing a persuasive essay about covid-19.

Yes, there are ethical considerations when writing a persuasive essay about COVID-19. It's essential to ensure the information is accurate, not contribute to misinformation, and be sensitive to the pandemic's impact on individuals and communities. Additionally, respecting diverse viewpoints and emphasizing public health benefits can promote ethical communication.

What impact does COVID-19 have on society?

The impact of COVID-19 on society is far-reaching. It has led to job and economic losses, an increase in stress and mental health disorders, and changes in education systems. It has also had a negative effect on social interactions, as people have been asked to limit their contact with others.

Caleb S. (Persuasive Essay, Literature)

Caleb S. has been providing writing services for over five years and has a Masters degree from Oxford University. He is an expert in his craft and takes great pride in helping students achieve their academic goals. Caleb is a dedicated professional who always puts his clients first.

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Open access
Published: 20 July 2023

Advances in vaccines: revolutionizing disease prevention

Timir Tripathi ORCID: orcid.org/0000-0001-5559-289X 1

Scientific Reports volume 13 , Article number: 11748 ( 2023 ) Cite this article

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Biochemistry
Drug discovery

Vaccines have revolutionized modern medicine by preventing infectious diseases and safeguarding public health. This Collection showcases cutting-edge research on advancements in vaccine development and their impact on disease prevention. The papers presented here report various facets of vaccine efficacy, immunological responses, and design, providing insight into future immunization strategies. I believe this Collection will serve as a catalyst for further advancements in the field of vaccine research.

Vaccines have long been credited as the most effective tool in preventing and managing infectious diseases. They have drastically reduced the global disease burden 1 . Over the years, significant progress has been made in understanding the immune system and developing novel vaccine design and delivery platforms 2 , 3 . From developing mRNA vaccines 4 that offer rapid response to identifying novel antigenic targets for broader protection, we have been at the forefront of innovation. Furthermore, the exploration of advanced adjuvants and delivery systems is enhancing vaccine efficacy and accessibility 5 . These cutting-edge technologies and advancements in vaccine research hold immense potential for tackling infectious diseases and improving global public health. In this Collection, I am delighted to present research articles highlighting the latest advances in vaccine development, shedding light on innovative vaccine design and delivery strategies, novel targets, and promising candidates. These breakthrough articles have the potential to revolutionize the field of vaccines and move us one step closer to a world free from the grip of devastating infectious diseases and outbreaks 6 .

Early strategies for investigating new vaccine targets or developing formulations increasingly rely on sophisticated computational approaches. These approaches help save resources and refine in vitro and in vivo studies. For example, in one of the papers in this Collection, Goodswen et al. 7 present a state-of-the-art methodology for high-throughput in silico vaccine discovery against protozoan parasites, exemplified by discovered candidates for Toxoplasma gondii . Vaccine discovery against protozoan parasites is challenging due to the limited number of current appropriate vaccines compared to the number of protozoal diseases that need one. The group generated a ranked list of T. gondii vaccine candidates and proposed a workflow integrating parasite biology, host immune system defences, and bioinformatics programs to predict vaccine candidates. Although testing in animal models is required to validate these predictions, most of the top-ranked candidates are supported by publications reinforcing the confidence in the approach.

In another paper showcasing the benefits of an in silico approach, Palatnik‐de‐Sousa et al. 8 report the design and development of a multiepitope multivariant vaccine based on highly conserved epitopes of multiple proteins of all SARS-CoV-2 variants. The authors propose that this could offer more long-lasting protection against different strains of SARS-CoV-2 compared with current vaccines. The vaccine was developed based on highly promiscuous and robust HLA binding CD4 + and CD8 + T cell epitopes of the S, M, N, E, ORF1ab, ORF 6 and ORF8 proteins of SARS-CoV-2 variants Alpha to Omicron. The study found that the selected epitopes were 100% conserved among all 10 studied variants, supporting the potential efficacy of the multivariant multiepitope vaccine in generating cross-protection against infections by viruses of different human SARS-CoV-2 clades. The use of immunoinformatics and in silico approaches to design the vaccines in these articles could be a cost-effective and time-efficient method for developing vaccines for other infectious diseases in the future.

The translation of scientific discoveries into practical applications ensures the successful development and evaluation of effective vaccines, such as those reported by Quach et al. 9 and Uddin et al. 10 . Quach et al. 9 report the development of a peptide-based smallpox vaccine by identifying and evaluating immunogenic peptides from vaccinia-derived peptides. They assessed the immunogenicity of these T-cell peptides in both transgenic mouse models and human peripheral blood mononuclear cells. The vaccine, based on four selected peptides, provided 100% protection against a lethal viral challenge and induced a long-term memory T-cell response, highlighting the potential of peptide-based vaccines for infectious diseases. Uddin et al. 10 developed and evaluated a mucosal vaccine against the bovine respiratory pathogen Mannheimia haemolytica using Bacillus subtilis spores as an adjuvant. They found that intranasal immunization of spore-bound antigens generated the best secretory IgA-specific response against both PlpE and LktA in all bronchoalveolar lavage, saliva, and faeces samples. The spore-based vaccine may offer protection in cattle by limiting colonization and subsequent infection, and Spore-MhCP warrants further evaluation in cattle as a mucosal vaccine against M. haemolytica . This technology has potential commercial benefits as production of B. subtilis is well established and has low-cost inputs, and B. subtilis is recognized as a probiotic that has generally regarded as safe status, used commercially in food/feed products for human beings, poultry, cattle, swine, and fish. The use of oral administration of the vaccine would allow for large-scale administration, which is especially important as livestock management strategies, including vaccination, are cost- and ease-of-use dependent. The work highlights innovative approaches to address pressing challenges in vaccine development.

Understanding cellular responses following the administration of vaccines is crucial in assessing their efficacy and safety and in the development of improved vaccine strategies. Gmyrek et al. 11 characterize the B cell response in mice vaccinated with a live-attenuated HSV-1 mutant, 0ΔNLS, and compare it to the parental virus, GFP105. The study found that 0ΔNLS vaccination resulted in a more robust B cell response, including an increase in CD4 + follicular helper T cells, germinal B cells, and class-switched B cells, as well as an elevated titer of HSV-1-specific antibody. The study reports that HSV-1 thymidine kinase and glycoprotein M are likely expendable components in the efficacy of a humoral response to ocular HSV-1 infection. Lunardelli et al. 12 provide a detailed assessment of the immune responses induced after immunization with different regions of the ZIKV envelope protein. The study found that immunization with E ZIKV, EDI/II ZIKV, and EDIII ZIKV proteins induced specific IFNγ-producing cells and polyfunctional CD4 + and CD8 + T cells. The study also identified four peptides present in the envelope protein capable of inducing a cellular immune response to the H-2Kd and H-2Kb haplotypes. The results suggest that the ZIKV envelope glycoprotein is highly immunogenic and could be a potential target for developing a vaccine against ZIKV. A paper by Suryadevara et al. 13 contributes to understanding the molecular signature of CD8 + Trm cells elicited by subunit vaccination and their potential to protect against respiratory infectious diseases. The molecular signature of subunit vaccine-elicited CD8 + Trm cells resembles those elicited by virus infection or vaccination, with distinct molecular signatures distinguishing lung interstitial CD8 + Trm cells from effector memory and splenic memory counterparts. The transcriptome signature of the elicited CD8 + Trm cells provided clues to the basis of their tissue residence and function. Insights into cellular responses, such as those provided by the studies mentioned above, can not only help us understand tissue-specific responses to diseases but also how to harness them to promote resistance or treatment.

The advancements in vaccine research are transforming the landscape of disease prevention. From mRNA vaccines to novel antigenic targets, adjuvants, and delivery systems, these breakthroughs offer new avenues for combating infectious diseases and improving global public health 2 , 3 , 5 , 6 , 14 , 15 . Addressing vaccine hesitancy 16 , 17 and ensuring equitable access to vaccines are also top priorities 18 . Continued investment in research, collaboration, and development is essential to drive innovation and overcome challenges. The Collection highlights the innovative strategies, novel technologies, and cutting-edge research in vaccine technology, formulation, and delivery systems that have revolutionized vaccine development. With these advancements, we are inching closer to a future where the burden of preventable diseases is significantly reduced, paving the way for healthier communities and a safer world.

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Acknowledgements

On behalf of all the editors of this Collection, I extend my deepest appreciation to the authors for their invaluable contributions. I appreciate the peer reviewers who generously dedicated their time to evaluate and help improve these articles. I am also grateful to Nature Research and the editorial team at Scientific Reports for extending me an invitation to organize and edit this Collection.

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What you need to know about covid-19 vaccines, answers to the most common questions about coronavirus vaccines..

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Vaccines save millions of lives each year. The development of safe and effective COVID-19 vaccines are a crucial step in helping us get back to doing more of the things we enjoy with the people we love.

We’ve gathered the latest expert information to answer some of the most common questions about COVID-19 vaccines. Keep checking back as we will update this article as more information becomes available.

What are the benefits of getting vaccinated?

Vaccines save millions of lives each year and a COVID-19 vaccine could save yours. The COVID-19 vaccines are safe and effective, providing strong protection against serious illness and death. WHO reports that unvaccinated people have at least 10 times higher risk of death from COVID-19 than someone who has been vaccinated.

It is important to be vaccinated as soon as it’s your turn, even if you already had COVID-19. Getting vaccinated is a safer way for you to develop immunity from COVID-19 than getting infected.

The COVID-19 vaccines are highly effective, but no vaccine provides 100 per cent protection. Some people will still get ill from COVID-19 after vaccination or pass the virus onto someone else.

Therefore, it is important to continue practicing safety precautions to protect yourself and others, including avoiding crowded spaces, physical distancing, hand washing and wearing a mask.

Who should be vaccinated first?

Each country must identify priority populations, which WHO recommends are frontline health workers (to protect health systems) and those at highest risk of death due to COVID-19, such as older adults and people with certain medical conditions. Other essential workers, such as teachers and social workers, should then be prioritized, followed by additional groups as more vaccine doses become available.

The risk of severe illness from COVID-19 is very low amongst healthy children and adolescents, so unless they are part of a group at higher risk of severe COVID-19, it is less urgent to vaccinate them than these priority groups.

Children and adolescents who are at higher risk of developing severe illness from COVID-19, such as those with underlying illnesses, should be prioritized for COVID-19 vaccines.

When shouldn’t you be vaccinated against COVID-19?

If you have any questions about whether you should receive a COVID-19 vaccine, speak to your healthcare provider. At present, people with the following health conditions should not receive a COVID-19 vaccine to avoid any possible adverse effects:

If you have a history of severe allergic reactions to any ingredients of a COVID-19 vaccine.
If you are currently sick or experiencing symptoms of COVID-19 (although you can get vaccinated once you have recovered and your doctor has approved).

Should I get vaccinated if I already had COVID-19?

Yes, you should get vaccinated even if you’ve previously had COVID-19. While people who recover from COVID-19 may develop natural immunity to the virus, it is still not certain how long that immunity lasts or how well it protects you against COVID-19 reinfection. Vaccines offer more reliable protection, especially against severe illness and death. Vaccination policies after COVID-19 infection vary by country. Check with your health care provider on the recommendation where you live.

Which COVID-19 vaccine is best for me?

All WHO-approved vaccines have been shown to be highly effective at protecting you against severe illness and death from COVID-19. The best vaccine to get is the one most readily available to you.

You can find a list of those approved vaccines on WHO’s site . 

Remember, if your vaccination involves two doses, it’s important to receive both to have the maximum protection.

How do COVID-19 vaccines work?

Vaccines work by mimicking an infectious agent – viruses, bacteria or other microorganisms that can cause a disease. This ‘teaches’ our immune system to rapidly and effectively respond against it.

Traditionally, vaccines have done this by introducing a weakened form of an infectious agent that allows our immune system to build a memory of it. This way, our immune system can quickly recognize and fight it before it makes us ill. That’s how some of the COVID-19 vaccines have been designed.

Other COVID-19 vaccines have been developed using new approaches, which are called messenger RNA, or mRNA, vaccines. Instead of introducing antigens (a substance that causes your immune system to produce antibodies), mRNA vaccines give our body the genetic code it needs to allow our immune system to produce the antigen itself. mRNA vaccine technology has been studied for several decades. They contain no live virus and do not interfere with human DNA.

For more information on how vaccines work, please visit WHO .

Are COVID-19 vaccines safe?

Yes, COVID-19 vaccines have been safely used to vaccinate billions of people. The COVID-19 vaccines were developed as rapidly as possible, but they had to go through rigorous testing in clinical trials to prove that they meet internationally agreed benchmarks for safety and effectiveness. Only if they meet these standards can a vaccine receive validation from WHO and national regulatory agencies.

UNICEF only procures and supplies COVID-19 vaccines that meet WHO’s established safety and efficacy criteria and that have received the required regulatory approval.

How were COVID-19 vaccines developed so quickly?

Scientists were able to develop safe effective vaccines in a relatively short amount of time due to a combination of factors that allowed them to scale up research and production without compromising safety:

Because of the global pandemic, there was a larger sample size to study and tens of thousands of volunteers stepped forward
Advancements in technology (like mRNA vaccines) that were years in the making
Governments and other bodies came together to remove the obstacle of funding research and development
Manufacturing of the vaccines occurred in parallel to the clinical trials to speed up production

Though they were developed quickly, all COVID-19 vaccines approved for use by the WHO are safe and effective.

What are the side effects of COVID-19 vaccines?

Vaccines are designed to give you immunity without the dangers of getting the disease. Not everyone does, but it’s common to experience some mild-to-moderate side effects that go away within a few days on their own.

Some of the mild-to-moderate side effects you may experience after vaccination include:

Arm soreness at the injection site
Muscle or joint aches

You can manage any side effects with rest, staying hydrated and taking medication to manage pain and fever, if needed.

If any symptoms continue for more than a few days then contact your healthcare provider for advice. More serious side effects are extremely rare, but if you experience a more severe reaction, then contact your healthcare provider immediately.

>> Read: What you need to know before, during and after receiving a COVID-19 vaccine

How do I find out more about a particular COVID-19 vaccine?

You can find out more about COVID-19 vaccines on WHO’s website .

Can I stop taking precautions after being vaccinated?

Keep taking precautions to protect yourself, family and friends if there is still COVID-19 in your area, even after getting vaccinated. The COVID-19 vaccines are highly effective against serious illness and death, but no vaccine is 100% effective.  

The vaccines offer less protection against infection from the Omicron variant, which is now the dominant variant globally, but remain highly effective in preventing hospitalization, severe disease, and death. In addition to vaccination, it remains important to continue practicing safety precautions to protect yourself and others. These precautions include avoiding crowded spaces, physical distancing, hand washing, and wearing a mask (as per local policies). 

Can I still get COVID-19 after I have been vaccinated? What are ‘breakthrough cases’?

A number of vaccinated people may get infected with COVID-19, which is called a breakthrough infection. In such cases, people are much more likely to only have milder symptoms. Vaccine protection against serious illness and death remains strong.

With more infectious virus variants such as Omicron, there have been more breakthrough infections. That’s why it's recommended to continue taking precautions such as avoiding crowded spaces, wearing a mask and washing your hands regularly, even if you are vaccinated.

And remember, it’s important to receive all of the recommended doses of vaccines to have the maximum protection.

How long does protection from COVID-19 vaccines last?

According to WHO, the effectiveness of COVID-19 vaccines wanes around 4-6 months after the primary series of vaccination has been completed. Taking a booster to strengthen your protection against serious disease is recommended if it is available to you.

Do the COVID-19 vaccines protect against variants?

The WHO-approved COVID-19 vaccines continue to be highly effective at preventing severe illness and death.

However, the vaccines offer less protection against infection from Omicron, which is the dominant variant globally. That's why it's important to get vaccinated and continue measures to reduce the spread of the virus – which helps to reduce the chances for the virus to mutate – including physical distancing, mask wearing, good ventilation, regular handwashing and seeking care early if you have symptoms.

Do I need to get a booster shot?  

Booster doses play an important role in protecting against severe disease, hospitalization and death.

WHO recommends that you take all COVID-19 vaccine doses recommended to you by your health authority as soon as it is your turn, including a booster dose if recommended.

Booster shots should be given first to high priority groups. Data shows that a booster shot plays a significant role in boosting waning immunity and protecting against severe disease from highly transmissible variants like Omicron.

If available, an additional second booster shot is also recommended for some groups of people, 4-6 months after the first booster. That includes older people, those who have weakened immune systems, pregnant women and healthcare workers.

Check with your local health authorities for guidance and the availability of booster shots where you live. 

What do we know about the bivalent COVID-19 booster doses that have been developed to target Omicron?

Bivalent COVID-19 booster shots have now been developed with both the original strain of the coronavirus and a strain of Omicron. These have been designed to better match the Omicron subvariants that have proven to be particularly transmissible. Lab studies have shown that these doses help you to mount a higher antibody response against Omicron. Both Moderna and Pfizer have developed these bivalent vaccines, and some countries have now approved their use.

Check with your local health authorities for information about the availability of these doses and who can get them where you live. And it’s important to note that the original COVID-19 vaccines continue to work very well and provide strong protection against severe illness from Omicron.

Can I receive different types of COVID-19 vaccines?  

Yes, however, policies on mixing vaccines vary by country. Some countries have used different vaccines for the primary vaccine series and the booster. Check with your local health authorities for guidance where you live and speak with your healthcare provider if you have any questions on what is best for you.

I’m pregnant. Can I get vaccinated against COVID-19?

Yes, you can get vaccinated if you are pregnant. COVID-19 during pregnancy puts you at higher risk of becoming severely ill and of giving birth prematurely.

Many people around the world have been vaccinated against COVID-19 while pregnant or breastfeeding. No safety concerns have been identified for them or their babies. Getting vaccinated while pregnant helps to protect your baby. For more information about receiving a COVID-19 vaccination while pregnant, speak to your healthcare provider.

>> Read: Navigating pregnancy during the COVID-19 pandemic

I’m breastfeeding. Should I get vaccinated against COVID-19?

Yes, if you are breastfeeding you should take the vaccine as soon as it is available to you. It is very safe and there is no risk to the mother or baby. None of the current COVID-19 vaccines have live virus in them, so there is no risk of you transmitting COVID-19 to your baby through your breastmilk from the vaccine. In fact, the antibodies that you have after vaccination may go through the breast milk and help protect your baby. >> Read: Breastfeeding safely during the COVID-19 pandemic

Can COVID-19 vaccines affect fertility?

No, you may have seen false claims on social media, but there is no evidence that any vaccine, including COVID-19 vaccines, can affect fertility in women or men. You should get vaccinated if you are currently trying to become pregnant.

Could a COVID-19 vaccine disrupt my menstrual cycle?

Some people have reported experiencing a disruption to their menstrual cycle after getting vaccinated against COVID-19. Although data is still limited, research is ongoing into the impact of vaccines on menstrual cycles.

Speak to your healthcare provider if you have concerns or questions about your periods.

Should my child or teen get a COVID-19 vaccine?

An increasing number of vaccines have been approved for use in children. They’ve been made available after examining the data on the safety and efficacy of these vaccines, and millions of children have been safely vaccinated around the world. Some COVID-19 vaccines have been approved for children from the age of 6 months old. Check with your local health authorities on what vaccines are authorized and available for children and adolescents where you live.

Children and adolescents tend to have milder disease compared to adults, so unless they are part of a group at higher risk of severe COVID-19, it is less urgent to vaccinate them than older people, those with chronic health conditions and health workers.

Remind your children of the importance of us all taking precautions to protect each other, such as avoiding crowded spaces, physical distancing, hand washing and wearing a mask.

It is critical that children continue to receive the recommended childhood vaccines.

How do I talk to my kids about COVID-19 vaccines?

News about COVID-19 vaccines is flooding our daily lives and it is only natural that curious young minds will have questions – lots of them. Read our explainer article for help explaining what can be a complicated topic in simple and reassuring terms.

It’s important to note that from the millions of children that have so far been vaccinated against COVID-19 globally, we know that side effects are very rare. Just like adults, children and adolescents might experience mild symptoms after receiving a dose, such as a slight fever and body aches. But these symptoms typically last for just a day or two. The authorized vaccines for adolescents and children are very safe.

My friend or family member is against COVID-19 vaccines. How do I talk to them?

The development of safe and effective COVID-19 vaccines is a huge step forward in our global effort to end the pandemic. This is exciting news, but there are still some people who are skeptical or hesitant about COVID-19 vaccines. Chances are you know a person who falls into this category.

We spoke to Dr. Saad Omer, Director at the Yale Institute for Global Health, to get his tips on how to navigate these challenging conversations. >> Read the interview

How can I protect my family until we are all vaccinated?

Safe and effective vaccines are a game changer, but even once vaccinated we need to continue taking precautions for the time being to protect ourselves and others. Variants like Omicron have proven that although COVID-19 vaccines are very effective at preventing severe disease, they’re not enough to stop the spread of the virus alone. The most important thing you can do is reduce your risk of exposure to the virus. To protect yourself and your loved ones, make sure to:

Wear a mask where physical distancing from others is not possible.
Keep a physical distance from others in public places.
Avoid poorly ventilated or crowded spaces.
Open windows to improve ventilation indoors.
Try and focus on outdoor activities if possible.
Wash your hands regularly with soap and water or an alcohol-based hand rub.

If you or a family member has a fever, cough or difficulty breathing, seek medical care early and avoid mixing with other children and adults.

Can COVID-19 vaccines affect your DNA?

No, none of the COVID-19 vaccines affect or interact with your DNA in any way. Messenger RNA, or mRNA, vaccines teach the cells how to make a protein that triggers an immune response inside the body. This response produces antibodies which keep you protected against the virus. mRNA is different from DNA and only stays inside the cell for about 72 hours before degrading. However, it never enters the nucleus of the cell, where DNA is kept.

Do the COVID-19 vaccines contain any animal products in them?

No, none of the WHO-approved COVID-19 vaccines contain animal products.

I’ve seen inaccurate information online about COVID-19 vaccines. What should I do?

Sadly, there is a lot of inaccurate information online about the COVID-19 virus and vaccines. A lot of what we’re experiencing is new to all of us, so there may be some occasions where information is shared, in a non-malicious way, that turns out to be inaccurate.

Misinformation in a health crisis can spread paranoia, fear and stigmatization. It can also result in people being left unprotected or more vulnerable to the virus. Get verified facts and advice from trusted sources like your local health authority, the UN, UNICEF, WHO.

If you see content online that you believe to be false or misleading, you can help stop it spreading by reporting it to the social media platform.

What is COVAX?

COVAX is a global effort committed to the development, production and equitable distribution of vaccines around the world. No country will be safe from COVID-19 until all countries are protected.

There are 190 countries and territories engaged in the COVAX Facility, which account for over 90 per cent of the world’s population. Working with CEPI, GAVI, WHO and other partners, UNICEF is leading efforts to procure and supply COVID-19 vaccines on behalf of COVAX.

Learn more about COVAX .

This article was last updated on 25 October 2022. It will continue to be updated to reflect the latest information.

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Institute of Medicine (US) Committee on the Evaluation of Vaccine Purchase Financing in the United States. Financing Vaccines in the 21st Century: Assuring Access and Availability. Washington (DC): National Academies Press (US); 2003.

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Financing Vaccines in the 21st Century: Assuring Access and Availability.

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6 Conclusions and Alternative Strategies

The preceding chapters of this report have highlighted key issues related to the history and organization of vaccine finance in the United States, as well as the many factors that influence vaccine access and availability. This chapter reviews those prior discussions and summarizes the committee's conclusions. It also describes the alternative strategies the committee considered in formulating the recommendations presented in Chapter 7 .

In developing its conclusions and recommendations, the committee sought to devise a set of financing strategies that could achieve the twin goals of (1) assuring access to recommended vaccines and (2) sustaining the availability of vaccines in the future. At present, these two goals are addressed through a fragmented system of separate programs: payments by some private health care insurance plans (which distribute the costs to consumers and employers through premiums), personal out-of-pocket payments, public vaccine purchase programs (such as Vaccines for Children [VFC] and state universal purchase programs), and public health care finance arrangements (such as Medicare). Government efforts to assure access to recommended vaccines have evolved incrementally and in separate policy arenas. The cumulative impact of these efforts is that federal purchases now exceed 50 percent of the childhood vaccine market through the VFC and Section 317 programs. The government pricing strategy has focused on obtaining deeply discounted vaccine prices.

These strategies have worked reasonably well in assuring access for children. Yet these same strategies have been blamed, in part, for reducing the financial incentives for private investment in the production and licensing of vaccines. 1 Firms have abandoned vaccine products or left the vaccine business completely, and unprecedented vaccine shortages occurred in 2001 and 2002. In addition, health care providers are increasingly concerned about the inability to recover payment for their costs of purchasing and administering vaccines to children and adults. Private-sector providers, who currently administer over 80 percent of childhood vaccines, continue to refer patients to public health clinics for vaccinations, creating missed opportunities that can delay or prevent immunization and reduce overall immunization rates for vulnerable populations. It is in this context that the committee presents the following conclusions, which in turn form the basis for the recommendations in Chapter 7 .

CONCLUSIONS

The introduction of new vaccines in the coming decades will impose additional and sometimes unexpected financial burdens on public and private health care plans, providers, and consumers. These burdens are offset by the value of these new vaccines, including financial savings that result from decreased medical expenditures, enhanced quality of life, reduced care-giving burdens, and gains in productivity associated with the prevention of infectious disease.

Vaccines for contagious diseases have strong spillover effects, given that immunization interrupts the disease transmission process and reduces the likelihood that an infection will harm others. Current and potential new vaccines that protect against contagious diseases are the strongest candidates for public investments in vaccine assurance efforts, since the spillover effects of these vaccines are substantial (Pauly and Cleff, 1995). But not all future vaccines will have the same level of spillover effects. Some future vaccines will prevent specific noncontagious diseases, such as certain forms of cancer and immune system disorders, rather than inhibiting the spread of contagious disease (see Box 2-1 in Chapter 2). The committee views vaccines that do and do not have these spillover effects quite differently. There is a more compelling rationale for strong federal intervention in the case of vaccines with spillover effects, since they are the ones most likely to be undervalued in the market and therefore to require subsidization.

This distinction is viewed as increasingly important since the proportion of vaccines in the pipeline that do not address highly contagious diseases is growing. Although all vaccines share certain public-good properties in terms of basic research and development, the spillover effects in consumption of vaccines provides the key rationale for broad public support of vaccine financing. The rationale is less compelling in the case of vaccines without these spillover effects, except in certain cases where the public benefits of the vaccine are exceptionally high. Burdening the national immunization system with the financing of a new generation of expensive vaccines without substantial spillover effects would divert resources away from vaccines that benefit the public more broadly.

The committee sought to design financing strategies that could resolve the tensions among growing public-sector demand for vaccines; higher vaccine expenditures; and the economic incentives that influence the development, production, and administration of vaccines.

Conclusion 1: Current public and private financing strategies for immunization have had substantial success, especially in improving immunization rates for young children. However, significant disparities remain in assuring access to recommended vaccines across geographic and demographic populations.

Current efforts have not achieved the Healthy People 2010 goal of immunizing 80 percent of all 2-year-old children. One in four young children is not up to date in receiving recommended immunizations. Sustaining current levels of immunization (about 74 percent) and achieving future immunization goals are threatened by predictable financial pressures in the coming decade as new and more expensive vaccines are added to the recommended schedule for children and adults.

Immunization rates for adults aged 65 and older have improved (66 percent for annual influenza and 50 percent for pneumococcal vaccine in 1999) since the inclusion of influenza and pneumococcal vaccines in Medicare benefits, and more than doubled in the period 1988–1995 (GAO, 1995). However, morbidity and morality rates for both diseases remain significant in this population. Immunization rates for high-risk adults aged 18–64 are especially poor. Most working-age adults with chronic illness (including such disorders as heart and lung disease and diabetes), who are at particular risk for vaccine-preventable disease, have not received the recommended immunizations. In 1999, only 31.9 percent received an annual influenza vaccination, while only 17.1 percent had ever received a pneumococcal vaccination (NCHS, 2000). The difficulties associated with risk-based strategies (i.e., based on health conditions) for adults have caused many providers within the health profession to shift to an age-based strategy. One example is the recent Advisory Committee on Immunization Practices (ACIP) guideline for influenza vaccine, which recommends immunization of all adults over age 50 (replacing the earlier guideline of 65 and older).

The relationships among cost barriers, access to recommended vaccines, and immunization status are uncertain. Immunization rates are highest among young children (aged 5 and under) and adults (aged 65 and older), who have the broadest access to vaccines through government-supported vaccine purchase programs. Immunization rates remain low among the high-risk adults aged 18–64 years, for whom no dedicated vaccine finance programs exist apart from those who are enrolled in Medicaid.

In addition to uneven immunization rates at the national level, substantial variation (almost 20 percent) in immunization rates currently exists within and across states. Some large urban centers, in particular, have difficulty achieving high immunization rates for children aged 19–36 months. The causes of these disparities are not well understood, but low levels of immunization are commonly associated with areas characterized by a concentration of poverty and groups that frequently move in and out of safety net programs. The disparities in vaccine-preventable disease burden between children and adults are especially troubling.

Conclusion 2: Substantial increases can be expected to occur in public and private health expenditures as new vaccine products become available. While these cost increases will be offset by the health and other social benefits associated with these advances in vaccine development, the growing costs of vaccines will be increasingly burdensome to all health sectors. Alternatives to current vaccine pricing and purchasing programs are required to sustain stable investment in the development of new vaccine products and attain their social benefits for all.

Although the costs associated with purchasing and delivering vaccines have historically been small, new vaccines will be priced at higher levels reflecting the scale of investment necessary to bring new products through the licensing and production processes. The addition of new vaccines to the recommended schedule and the higher costs associated with newer vaccine products have placed tremendous stress on safety net programs that are already straining to achieve public health goals. Higher vaccine prices can be expected to exacerbate such problems as uneven distribution patterns, delays in the vaccine price negotiation processes for federal and state contracts, and continued fragmentation in the scope of vaccine benefits included in public and private health plans. An increased burden on public health clinics also occurs when private health plans reduce reimbursements for recommended vaccines in the face of higher costs. This burden places substantial stress on public health budgets and interferes with the ability to provide vaccines to traditional safety net populations, as well as those who lack vaccine benefits within their health plans.

It should be noted that vaccines provide a net long-term savings in health care costs. Over time, vaccines should lead to a diminution in what would otherwise be spent on health care. But certain sectors (such as state and federal health agencies) will bear substantial short-term costs of acquiring and delivering vaccines.

Increases in the budgets of government vaccine programs should be seen as acceptable, indeed desirable, insofar as new vaccines can offer substantial public health benefits. What is missing in the array of current vaccine purchasing programs is a clear and deliberate strategy that the government can use to stabilize and assure adequate rates of return on future private investments in vaccine development. While the true costs of innovation remain unknown, government pricing systems and bulk purchases alone appear to provide insufficient incentives, according to industry sources, given the higher production costs and uncertainties associated with vaccine development and the tendency to push down prices in the public sector.

Conclusion 3: Many young children, adolescents, and high-risk adults have no or limited insurance for recommended vaccines. Gaps and fragmentation in insurance benefits create barriers for both vulnerable populations and clinicians that can contribute to lower immunization rates.

Many individuals (referred to as “underinsured”) have private health insurance that does not include coverage for vaccines. Estimates of underinsured children vary from 5 to 14 percent of all children. Others have insurance policies that require individuals to cover vaccine costs in the form of high deductibles and copayments. Still others, such as Medicare beneficiaries, are covered for certain vaccines but not others. Persons who face such financial barriers are less likely to receive routine immunizations in their medical homes and may fail to receive certain immunizations at all.

Although most large public and private health plans include vaccine benefits, signs of slippage are occurring within the scope of vaccine benefits offered by small businesses and other large subscribers, such as public employee health plans. The omission of or limitations on vaccine benefits in health plans, coupled with increasing deductibles and copayments, create gaps that existing safety net programs cannot easily fill. The result is increasing fragmentation and administrative barriers that interfere with the timely delivery of vaccines within routine health care services.

The multifaceted eligibility determinations associated with the current fragmented system of public and private vaccine benefits represent a serious barrier to immunization by imposing substantial burdens on physicians and other health care providers. Clinicians must determine whether the costs of purchasing and administering recommended vaccines are reimbursable under the terms of a wide variety of insurance plans and entitlements, including VFC, the State Children's Health Insurance Program (SCHIP), Section 317 , Medicare, and multiple private health insurance plans. These administrative barriers can result in missed opportunities for immunization and frequent referrals of underinsured patients to public health clinics for routine vaccines, which in turn ultimately contribute to shortfalls in immunization rates.

Conclusion 4: Current government strategies for purchasing and assuring access to recommended vaccines have not addressed the relationships between the financing of vaccine purchases and the stability of the U.S. vaccine supply. Financial incentives are necessary to protect the existing supply of vaccine products, as well as to encourage the development of new vaccine products.

Tensions exist in the vaccine supply system between the need to control the current costs of vaccine purchases and the need to spend more money for innovation and the production of present and future vaccines. The desire to maximize short-term savings in purchasing current vaccine products and to maintain price caps is directly opposed to the goal of creating financial incentives for commercial firms to develop new vaccine products. Policy efforts to resolve recurring tensions among escalating vaccine costs, tighter health budgets, and the desire for sustainable and competitive markets in the vaccine industry have been limited to a series of stopgap measures and policy proposals in recent years (Fairbrother and Haidery, 2002). Thus, federal and state governments currently lack a coherent policy that can assure an appropriate balance among these objectives. The result is uncertainty among both producers and purchasers, which in turn reduces incentives for future vaccine development and threatens to exacerbate current disparities in immunization rates among insured, underinsured, and uninsured populations.

Conclusion 5: The vaccine recommendation process does not adequately incorporate consideration of a vaccine's price and societal benefits.

The recommendations of ACIP and its counterpart groups within the American Academy of Pediatrics and the American Academy of Family Physicians have significant implications for public and private expenditures. For example, ACIP recommendations directly affect vaccine prices and supply, such as the addition of vaccine products to the recommended vaccine schedule, the inclusion of vaccines in the VFC entitlement program, the standard of care for the Medicaid vaccine schedule, and the universal purchase guidelines for many states. Yet the ACIP decision-making process requires the formulation of recommendations before the government purchase price of a vaccine product is known. In addition, ACIP has no mechanism for distinguishing vaccines with strong spillover effects, such as those that prevent highly contagious diseases, from vaccines that do not, such as tetanus and therapeutic vaccines (such as cancer vaccines) that are in development. The lack of a capacity to address these variables is a serious impediment to a coherent finance strategy for vaccine purchases in the national immunization system.

ALTERNATIVE STRATEGIES

In framing its recommendations, the committee focused its analysis on seven alternative approaches, which included market-oriented, government intervention, and incremental strategies. Each approach was considered in terms of its impact on both access to vaccines and incentives for the production and development of vaccines in the private sector. In addition, the committee sought to design a strategy that would maintain a reasonable budget for vaccine purchases for children and adults in the public and private health sectors. The committee evaluated dozens of proposals for changes to the immunization system that had been developed by congressional committees, professional and industry associations, government agencies, advocacy groups, and experts before focusing its efforts on seven alternative strategies (including the current system). 2 Each proposal was considered in light of the following goals:

Eliminate individual financial barriers to immunization.
Increase incentives to the industry to invest in R&D and production capacity.
Reduce provider burden and improve provider compensation.
Minimize fragmentation of financing and delivery.
Maintain existing community and provider relationships.
Control escalation of costs and increasing fiscal burden on state budgets.

There are several tensions among these objectives. For example, increasing incentives to industry, if achieved through higher prices, could conflict with controlling costs. Higher vaccine prices would also increase costs to providers, further fragmenting delivery, and to state budgets, thereby increasing fragmentation of financing. In addressing these conflicts, the question of increasing or decreasing government involvement emerges as a key factor. A universal government purchase program would address most of the above objectives. However, the committee views the growing share of government in vaccine purchasing as a discouragement to vaccine investment. Indeed, the committee determined that no single alternative can satisfy every objective; each involves trade-offs, assumptions, and perhaps ideological orientations. The following analysis of alternatives is meant to illuminate these trade-offs so they can be clearly understood. The final recommendation formulated by the committee combines elements of several different approaches to balance competing objectives.

The committee considered the following seven alternative approaches:

Maintain the current system.

Expand the VFC program to include additional eligibility categories.

Provide universal coverage through federal purchase and supply of all recommended vaccines.

Provide a federal block grant to the states for vaccine purchase.

Use public vouchers to purchase recommended vaccines for disadvantaged populations.

Create an insurance mandate that would require public and private health plans to cover all recommended vaccines.

Combine features of the insurance mandate and voucher alternatives into a new funded mandate system.

These approaches are described below, along with the merits and deficiencies of each. They are further summarized in Table 6-1 .

Summary of Alternative Strategies for Vaccine Purchases.

Alternative 1: The Current System

Description/design options.

The current system is based primarily on the VFC entitlement, which provides free vaccines to approximately 10 million safety net children through private office-based practices and community health centers. The program is supplemented by Section 317 grants to states and state-funded programs. Through VFC, the federal government assures access to the vaccines that prevent 11 diseases 3 for certain categories of children (aged 0–18): all uninsured and Medicaid-eligible children, Native Americans and Alaska Natives; and children who receive recommended vaccines in federally qualified health centers (FQHCs). 4 The federal government also assures access to vaccines against influenza and pneumonia for all adults over age 65 through the Medicare program. In addition, younger adults (aged 18–64) who receive Medicaid benefits have access to certain vaccines if recommended by their physician as part of a treatment plan.

Vaccines are purchased under a federal contact negotiated by CDC for the states on behalf of the eligible populations of children and adults. VFC does not include provider fees, which are typically paid with Section 317 or state funds. Program growth will result from the increasing numbers of the eligible population (mainly uninsured and Medicaid children), the addition of new vaccines that are likely to be recommended for children in the next two decades, and higher prices of new vaccines.

There are some advantages to maintaining the current system. In nearly a decade of experience, VFC has been successful in enhancing public insurance coverage among children and improving their immunization rates. Public health advocates have indicated that the presence of a federal entitlement has provided stable and certain funding not subject to the fiscal budgetary pressures faced by discretionary programs.

Disadvantages

The two principal disadvantages of the current VFC system are its reliance on government purchase of vaccines and its fragmentation of vaccine financing. As noted earlier, government purchase, which is growing as a share of the total vaccine market, tends to discourage industry investment in production capacity and new vaccine R&D. The government price negotiation process itself leads to delays, inefficiencies, and uncertainty about reimbursement among clinicians.

The eligibility limitations of VFC increase the burden on clinicians for eligibility determination; create funding inequities between entitlement and discretionary funding streams (e.g., VFC, Section 317 , and state general funds); and fragment the financing and delivery of services, resulting in missed opportunities, scattered records, and fewer children immunized than would otherwise be the case. Moreover, VFC does nothing to help high-risk adults who are either uninsured or underinsured. The separation of vaccine purchases and fees further fragments funding, and results in referrals even of covered children to public-sector clinics. Finally, the VFC financing structure encourages the erosion (“crowd-out”) of private coverage because of the existence of public financing.

Alternative 2: Expanded VFC

This approach maintains the central features of the current system, and does not change the structure of the VFC program, but expands VFC to include immunization of underinsured children within their medical home. As a result, children who previously could obtain free vaccines only in FQHCs—an estimated 2.7 million children nationwide—would be able to receive vaccines in their medical home. This approach also expands VFC to cover adults who are either under- or uninsured and who are at high risk as defined by CDC.

The advantages of the expanded VFC alternative are that it maintains VFC, a time-tested and well-funded program, while making improvements to strengthen coverage. The expanded coverage targets the two most critical coverage gaps: underinsured children and high-risk adults (both uninsured and underinsured). Implementing this alternative would somewhat, but not totally, alleviate eligibility problems that result in missed opportunities and reduce the number of referrals by private providers to the public sector. Among options for changing the current system, this approach would also be the easiest to implement.

The principal disadvantage associated with the expanded VFC approach is that it maintains and even expands the government's role in purchasing vaccines, potentially discouraging industry investment in production capacity and the development of new vaccines.

Furthermore, while the expansion of coverage would reduce fragmentation, it would not eliminate it; and the burden of eligibility determination on clinicians would remain unaddressed. Crowd-out would be exacerbated, and the separation of vaccine purchases and fees would continue to encourage referrals even of covered children to public-sector clinics. Disparities between entitlement and discretionary program would continue if some states chose to supplement VFC categories with state-purchased vaccines.

The public costs of expanding coverage to include the 3.5 million underinsured children aged 0–5 would be substantial. A national entitlement program is obligated to meet funding levels once eligibility has been established. Hence, the VFC budget grows to meet demand. CDC's fiscal year 2000 budget for immunization was $1.6 billion. This figure includes $990 million for the VFC program and an additional $250 million for Section 317 vaccine purchases (the remaining portion consists of discretionary funds to support state immunization programs).

Immunization would increase among families that could not or would not pay the extra (uncovered) charge for obtaining the vaccine from their private practitioner and who did not have access to a public health clinic for free treatment. How large is this group? Freed et al. (1999) studied the effects of a new universal purchase vaccine program in North Carolina on immunization rates by insurance status. This program provided coverage to the underinsured in much the same way as would the payment plan proposed here. Freed found that the percentage of children who were up to date in immunizations did increase among both those with periods of underinsurance and those with partial coverage (from 80 percent to 86.5 percent for the former and from 85.3 percent to 90.9 percent for the latter, measured at the 24-month point), although his study probably understates the effect since his “preprogram” data were actually collected shortly after the program had begun. There was also some decline in the percentage receiving immunizations at public health clinics, although a significant proportion continued to use the latter facilities. 5 That is not surprising since private physicians would still charge for the visit, even if the vaccine were provided free of charge.

Freed et al. (1999) suggest that increased immunization rates can occur when health professionals and public officials make a big effort to move children into private care. Despite some success, however, it appears that coverage alone does not guarantee these outcomes. It is possible that other factors, such as parents' education, can help explain much of the differentially lower rates of vaccination and higher rates of use of public health clinics among subgroups with different types of coverage.

Alternative 3: Universal Federal Purchase

Under this approach, the federal government purchases all routinely recommended childhood vaccines. These vaccines are distributed by the states through existing VFC mechanisms. All children are vaccinated with publicly acquired vaccines, regardless of their health insurance status or care setting. All children from birth through 18 years of age are covered under this approach; adult vaccines could be covered as well.

CDC would continue negotiate a contract price for each vaccine. But in contrast to the current method, CDC would calculate a value for the societal benefit of each vaccine and set a price as some percentage of that amount. Provider administration fees could be mandated as an option, and states could use Section 317 funds to support payment of those fees.

This approach has many advantages. All children would be covered under all circumstances. Eligibility determination would be eliminated, and providers would no longer have to maintain multiple stocks of vaccines. No children would have to be referred from private to public clinics because of ineligibility to receive the vaccine on hand. Children could remain in their medical homes for immunization services. Because states would be expanding their childhood vaccine distribution system, the contact between public health departments and private providers could be enhanced, likely promoting improvements in immunization-related activities, such as participation in population-based immunization registries.

A price based on societal benefit might be higher than a price based on such factors as the market power of the purchaser. However, it would express the maximum amount that society would be willing to pay for the vaccine, and provide a more adequate incentive for R&D and assure a continuous supply of those vaccines that are developed and marketed.

The principal disadvantage of this approach is the continuation and expansion of the government purchase system. If government were to utilize its additional monopsony power to reduce prices, such action could lead to further shortages, exacerbate market exit, and choke off R&D. Even if the proposed pricing model yielded higher prices, the risk of future price reductions could make investment in R&D appear less attractive. The industry's uncertainty about future pricing is one of the key issues associated with any government-funded program. If the private market for vaccines were virtually eliminated, there would be no theoretical basis for determining appropriate prices; and industry would be at risk for a change in government procurement policy, for example, as part of a federal-deficit reduction initiative.

The public costs of this alternative would be quite substantial—possibly doubling the federal government's vaccine budget, even at current prices. Congress has consistently rejected universal, single-payor programs, although a single-payor approach for vaccines may be more palatable in this case given that these services have strong public-good properties and are a small component of overall health spending. Vaccine manufacturers are also likely to oppose a universal purchase proposal. Although manufacturers are used to universal government purchase programs through their western European operations, they rely on the U.S. market as a source of profits to support R&D.

Only indirect evidence exists in support of this approach. For example, many other countries that have universal government acquisition of vaccines have higher vaccination levels than those of the United States. In those states that have implemented their own versions of universal purchase arrangements, however, significantly higher childhood immunization rates have not been achieved as compared with states that rely exclusively on the current less-than-universal federal government purchase programs. 6

Other concerns include the erosion of long-standing community and health plan relationships that have evolved as a result of the mixed public–private system; the continued separation of vaccine purchases and fees; and the potential windfall to health plans, which might not adjust premiums immediately despite the elimination of vaccine costs.

Alternative 4: Federal Block Grant

Under this approach, states receive annual grants for immunization from the federal government. The government calculates the grant using a formula based on current VFC funding and other variables. States must meet certain immunization targets to avoid penalties, including loss of the grant. The states have broad discretion in how they allocate the funds among the various immunization-related activities, such as purchasing vaccines, investing in infrastructure, paying administrative fees, conducting targeted immunizations, enhancing registries, and providing education and outreach services. States also determine eligibility for public programs.

This approach has two principal advantages. First, it would encourage innovation by allowing states to try different approaches and combinations of inputs (e.g., vaccines, infrastructure, education) to optimize their program. Second, this approach would allow programs to be customized to the particular needs and environment of each state, which vary considerably. The focus on outcomes would reinforce the opportunities for experimentation.

This approach would also create a decentralized, nonfederal market for the purchase of vaccines, which would enable vaccine companies to compete across states and across a range of product and service configurations. The impact on prices cannot be predicted: the loss of federal monopsony power would result in increased prices, all else being equal; but this might be balanced by the development of large purchasing consortia and the higher degree of price sensitivity of states.

The principal concern with regard to block grants in general— whether maternal and child health, education, or other social service programs—is the possibility that states would find ways to divert the funds to other purposes, especially when faced with pressure to reduce their total budgets. Clearly designated outcomes and performance measures could help prevent such diversion of funds, but enforcement might be difficult and highly political. Moreover, the level of block grant funding, being discretionary, could be threatened from year to year and would be subject to jockeying for advantage among the states. Block grant formulas are widely perceived as being notoriously difficult to make truly equitable. For example, states could find a wide range of vaccine prices based on their size and negotiating clout, resulting in an inequitable cost burden across states and exacerbating disparities in immunization rates.

In addition, despite regional differences, infectious disease control may be better suited to management by regional or national authorities. Immunization 's public-good characteristics are national in scope—epidemics do not respect state borders—and states could become “free-riders,” particularly in times of fiscal stress. The elimination of programmatic funding through federal agencies could impair tracking and consistent enforcement, adversely impact federal–state collaboration, and make it difficult for the federal government to provide guidance or to intervene should a state program fail to meet minimum targets. By adopting very different approaches, states could lose the ability to draw useful comparisons or to coordinate effectively in case of regional outbreaks.

Alternative 5: Public Vouchers for Vaccine Purchase

As in alternative 4 , the voucher approach devolves vaccine purchasing from the government to insurers, states, and providers. Under this approach, a voucher is given to each eligible person (including both children and high-risk adults) to cover some percentage of the cost of each vaccine and the associated provider fee. The person can then spend the voucher at any provider of his or her choice. In their basic design, these vouchers are similar to food stamps. The amount of the voucher is set in advance and may cover all or part of the vaccine purchase price. Vaccines can be purchased directly by providers or purchased by states, clinics, hospitals, insurers, or other entities and supplied to providers. If the voucher is set at an amount below the total of the purchase price and administration fee, the provider can bill the patient for the difference. The voucher as envisioned by the committee covers all uninsured children and adults.

The committee considered many specific design alternatives:

Providing universal coverage versus means testing the voucher.
Setting the voucher amount to cover the full cost of vaccines or less than the full cost.
If less than the full cost, means testing the cost sharing, or not.
Using an electronic card system, paper vouchers, or simply physician billing for each vaccine administered.

There are trade-offs involved in all of these approaches. For example, covering all children would be expensive, but would be the easiest approach to administer. Means testing the voucher, on the other hand, would require a significant administrative apparatus to enroll children in the voucher program, establish eligibility, and monitor and pay claims. Preserving some consumer responsibility through the use of cost sharing, however, would reward families for seeking out low-cost providers, thereby helping to contain the costs of the system.

For those with insurance, the eligible person would receive a voucher or credit equal to the annual actuarial value of vaccinations provided; this credit could be used to cover any direct premium or to offset lower wages associated with employer-provided insurance or signed over to the employer or union that makes the payment for the family's insurance. The purpose of this provision is to avoid an incentive to employers and eligible employees to drop coverage in order to be eligible for a voucher (i.e., to avoid “crowd-out”), to permit administrative cost economies derived from having a single insurer administer all types of medical care for employment-group members at all income levels, and to achieve equitable treatment of those who obtain insurance coverage that substitutes for direct vouchers. If the administrative cost of instituting insurance vouchers for recommended immunizations were high in absolute terms and relative to the value of the voucher, the direct payment mechanism might be extended to those currently having coverage as well. Crowd-out would then be expected but would be tolerated in the interest of administrative simplicity.

A principal advantage of the voucher approach is that eligibility is determined at the time the voucher is issued, not at the point of service, thus relieving providers of this onerous and difficult administrative task. Vouchers would also eliminate the clinician's uncertainty about eventual reimbursement (aside from government reimbursement delays). Since providers would themselves decide where and how to purchase vaccines, there would be no need to segregate vaccine supplies for different categories of patients. The voucher approach would probably result in fewer lost opportunities for vaccination by reducing referrals away from the patient's medical home.

The voucher approach would also promote efficiency by putting purchasing power directly in the hands of the needy population, giving the recipient free choice of a provider. The federal government would no longer purchase vaccines or negotiate vaccine prices, except perhaps for vaccines with only a single seller. State governments could elect to purchase vaccine supplies for resale to physicians in the state, especially if the state believed it could negotiate a favorable price.

The electronic voucher card option would facilitate the development of a central registry. Having such a registry would assist in surveillance, reduce missed opportunities, and prevent duplicate vaccinations that can occur when charts are not available at the point of service.

There is also considerable flexibility in the way a voucher system can be designed, and its payment structure can be manipulated easily from a central point. For example, to provide extra incentives for vaccination in special circumstances, such as outbreak control or difficult-to-reach categories of children, the value of the voucher could be set higher than the outlay cost; for example, a family in a rural area could receive an additional payment to reflect greater travel costs.

Vaccine companies would likely support a program that reduced federal purchasing and enabled them to compete. There has also been experience with successful government voucher programs—such as food stamps and college loans through the GI bill and other federal programs—that could provide guidance in setting up a vaccine voucher system.

The principal disadvantage of the voucher approach is its administrative complexity and cost of implementation, particularly with regard to investments in information technology and the workforce required to establish eligibility for the vouchers. Tying the program to existing programs, such as Medicaid, would simplify its implementation. Also, some of these problems would be considerably reduced with a universal voucher.

A voucher system would be a new program, with attendant costs of set-up and education. Many design details would have to be addressed, including eligibility; enrollment systems; and computer linkages for cards, doctors' offices, and reimbursement centers. Particularly challenging would be determining a voucher price that would balance providing sufficient return on investment to the vaccine industry to encourage continued supply and investment in R&D; protecting taxpayers from exorbitant increases in vaccine prices; and avoiding significant increases in patient cost sharing, which can present a barrier to immunization.

The administrative disadvantages of the voucher system could be minimized, however, through alternative approaches. A magnetic card or paper voucher, like a food stamp, would give the consumer full control of the purchase decision and the ability to shop for the best quality and price. At the same time, it would ensure that the provider would accept the voucher by making it simple to use and redeem. The provider would not need to assess eligibility—possession of the voucher would be sufficient.

An essential difference exists, however, between food stamps and vaccines. Because medical providers have established procedures for submitting claims for services rendered, they could easily integrate a paper voucher into their billing system. Thus, a physical voucher might not be necessary in the case of vaccines. For example, providers could immunize a patient and submit a bill to the federal vaccine authority, which would reimburse the provider for all vaccine claims on a regular basis, allocating the payment to the appropriate program based on the patient's eligibility. While there are certain advantages to the paper or electronic card version of the voucher approach, its administrative complexity would be enormous.

A substantial disadvantage of a voucher system that excluded adults not at high risk is that many adults with high-risk indications would go unrecognized and, as a consequence, would remain unvaccinated. The voucher approach would require that high-risk adults be identified as such in advance for the purpose of obtaining the voucher, so that the voucher would be available when needed. But physicians could have a difficult time identifying patients with high-risk indications for immunization.

Alternative 6: Insurance Mandate

This approach requires that all insurers, both public and private, provide coverage to all enrollees, with limits on the deductibles, copayments, and coinsurance they can require. While 28 states have already imposed mandates on state-regulated insurers, this approach involves a federal requirement that applies to both state- and federally - regulated insurers and employer plans (AAP, 2003). Insurers would be required to report on vaccine coverage and cost sharing to the government. The mandate would apply to any vaccine that has low insurance coverage rates (i.e., more than 5 percent of the target population remains uninsured for the vaccine) 5 years after the introduction of the vaccine or after the initiation of the program.

This approach is contingent on a redesign of the ACIP recommendation process. ACIP's decisions have enormous private- and public-sector financial implications. Given the rising costs of vaccines, combined with the less-favorable cost–benefit profiles of some current and pipeline vaccines, ACIP has a responsibility to make economic considerations central to its recommendation function. Under this approach, ACIP would establish multiple tiers for vaccine recommendations. One tier would include vaccines with strong spillover effects because of the highly infectious nature of the diseases they prevent. The mandate would apply principally to these vaccines. The committee's proposed approach with respect to ACIP is described fully in Chapter 7 .

The mandate approach targets the most important coverage gaps— underinsured children and high-risk adults (both underinsured and uninsured). In addition, by eliminating crowd-out and reducing referrals from private to public providers, the approach would add stability to the immunization system and enhance the ability of federal and state governments to estimate needs and plan accordingly. Reduced referrals would result in less fragmentation of care and thus fewer missed opportunities and duplicate immunizations. The mandate approach would also alleviate the provider burden by greatly reducing the problem of eligibility determination.

The emphasis on tier-one vaccines would foster a more stable and predictable growth in vaccine costs over time and send clear signals to the industry about the societal priorities for vaccine development. The reduced public market share would appeal to producers because it would enable them to compete in a larger private market.

The principal disadvantage of an insurance mandate is that the costs of increased coverage are likely to be passed on to either consumers, in the form of higher copayments and deductibles, or their employers, in the form of higher premiums. Although vaccines represent a relatively small share of insurer costs, that share is expected to increase substantially with the addition of new vaccines to the schedule. Mandating coverage could drive companies to drop coverage altogether, particularly in a weak economy, thereby increasing the number of uninsured. Moreover, while the burden on providers for determining eligibility would be alleviated by the elimination of the distinction between those who are fully insured and those who are underinsured within the insured population, determination of eligibility within public programs would remain burdensome.

Furthermore, while the mandate would technically eliminate insurance crowd-out, referrals of privately insured patients to the public sector for immunizations could increase nonetheless. Past experience with both VFC maintenance-of-effort laws and state mandates suggests that substantial investments in regulatory infrastructure could be required to ensure compliance with the mandate and to control the rate of referrals from the private to the public sector.

The government's market share in vaccine purchases would decrease under this alternative, reducing the monopsony power of the government and its ability to negotiate steep discounts. The committee views this lifting of pressure on prices positively in terms of investment in production capacity and R&D; however, it could have adverse short-term impacts on states, programs, and providers.

Alternative 7: Funded Mandate

The funded mandate alternative combines elements of the voucher approach and the insurance mandate. The mandate requires that both public and private insurers provide coverage for all insured children, all adults over age 65, and certain designated populations, such as adults aged 18–64 who are at particular risk for the consequences of vaccine-preventable disease because of certain health disorders. The insurers' costs of providing this mandated coverage are reimbursed in full by the federal government. Insurers purchase vaccines directly and receive reimbursement at the subsidy rate. Health plans are required to reimburse their providers the full replacement cost of the vaccine up to the subsidy amount, plus the full administration fee. If the health plan or provider can obtain vaccines at a price below the federal subsidy amount, they can keep the difference. Patients who are uninsured receive a voucher for immunization as described under alternative 5 above.

The amount of the federal subsidy is some percentage of a vaccine's calculated social benefit, announced in advance of the release of the vaccine to stimulate the pace of development. A method for determining a price in advance based on the calculated societal benefit is described by McGuire (2003) (see Box 6-1 ). Societal benefit , as defined by the committee, is a measure of the total benefits provided by a vaccine, including both private benefits to those who receive the vaccine and public benefits that accrue to the rest of society. These benefits include direct medical costs saved because the disease was prevented, as well as such benefits as increased length of life and improved quality of life. Under this alternative, prices of current vaccines are determined based on some combination of calculated social benefit and past prices.

Setting Prices for New Vaccines in Advance. The economic return to vaccine development appears to be low. The number of firms producing vaccines for the United States has declined (Rappouli et al., 2002), and research and development (R&D) on (more...)

This approach shares many of the advantages of the voucher and mandate alternatives. It would increase incentives for the development of new vaccines by providing manufacturers with assurance of adequate pricing and returns. Furthermore, the assurance of a price subsidy based on societal benefit would steer innovation toward the most socially beneficial vaccines. An additional advantage of this approach to setting a price subsidy is that it would require no reference to industry cost data.

Funding the insurance mandate would maintain the insurer's role in immunization, avoid disruption of existing infrastructure, preserve established community networks, and prevent referrals from physicians to public-sector providers. It would create market mechanisms by allowing insurers and physicians to keep savings they might obtain, and thereby stimulate efficiency and competition among vaccine producers, who would enjoy competition in multiple markets—physicians, institutions, states, and purchasing cooperatives. This approach would eliminate government purchasing and the concomitant delays and uncertainties in reimbursement.

A key difference between the subsidy approach and a universal purchase approach is in the way prices are determined. Currently, the price of a vaccine is determined in two ways. In the private sector, it is based on “what the market will bear.” In the public sector, it is based on a negotiation between CDC and the manufacturers, usually resulting in a substantial discount. To stimulate additional investment in R&D, each of the alternative approaches considered by the committee seeks to increase the rate of return on vaccine products within reasonable limits. The approaches pursue this goal in different ways. Under a universal purchase approach ( alternative 3 ), the government would purchase all vaccines. It could raise prices to stimulate investment, or it could drop prices if they were too high. The fact is, however, that government would have no basis for raising or lowering prices because there would no longer be any market reference price for comparison. Absent such a benchmark, pricing would become a political process, which would create uncertainty regarding future prices and likely reduce industry investment in R&D.

The case of a genetically engineered protein that helps reduce anemia in dialysis patients is instructive with regard to the potential for politicization of pricing. This product is covered under Medicare for all individuals (including those under age 65). There is some evidence that the initial price of the new product provided a very high return on R&D to the manufacturer, as well as a high benefit–cost value for society. Its initial price was negotiated between the Health Care Financing Administration (HCFA) and the manufacturer and subsequently codified in legislative amendments (with discretion on the part of HCFA to adjust prices for inflation). Subsequently, the product was the subject of several favorable benefit–cost studies by economists. But the Clinton Administration and several congressmen thought that expenditures exceeded budgets, and congressional action decreased the price. Similar approaches to vaccines that reflected arbitrary government pricing would be devastating to vaccine R&D.

Under a subsidy approach, individual providers or health insurance plans would purchase vaccines and would then be reimbursed by government payments at a certain percentage of their cost. In many cases, the price of the vaccine would shift to the subsidy amount, which would be set at a level that would encourage manufacturers to invest in R&D. There could be differences, however, between the subsidy amount and the price paid. Manufacturers could charge more than the subsidy, although doing so would remove the vaccine from the mandate. Manufactures could also charge lower prices in response to the negotiating leverage of large purchasers or buying cooperatives. But even if prices stayed at the subsidy level, manufacturers would still be able to compete on the basis of quality, service, and product enhancements. Thus, while the subsidy might equal the market price in many cases, it would preserve some aspects of the market. This alternative would also provide a formula-based method for setting the subsidy that would be less subject to political manipulation than pure government purchasing. While no strong evidentiary base clearly establishes the relative superiority of different approaches to setting such a subsidy, a government purchase approach would be untenable to manufacturers.

By combining features of the voucher and insurance mandate alternatives, this strategy some of the disadvantages of each. The most serious of these is the complexity of having two separate administrative and regulatory functions—one to administer the voucher and one to monitor and enforce the mandate.

This approach could also be expected to increase federal expenditures for vaccines at least as much as and probably substantially more than any of the other alternatives. Higher costs would result from both expanded public coverage and higher prices. One of the key practical issues would be how to determine a subsidy amount that would encourage vaccine development without allowing expenditures to increase more than necessary. While this approach would preserve a private market for vaccines, using a subsidy based on the calculated societal benefit of a vaccine could stimulate prices to increase substantially to subsidy levels. As McGuire (2003) explains, if a subsidy formula allows prices to rise to the level of the calculated societal benefit, no benefit will remain for the consumer. The calculation of societal benefits and of subsidy amounts based on those benefits presents a variety of technical challenges and could require politically difficult legislative decisions regarding key assumptions used in the calculations.

Finally, implementation of this alternative would require substantial amendments to established law in numerous areas (e.g., Employee Retirement Income Security Act, Public Health Act, Medicare, Medicaid, SCHIP). A comprehensive legislative strategy would be necessary to reduce the risk of an incremental and uneven approach.

WEIGHING THE ALTERNATIVES

Each strategy outlined above has certain advantages and disadvantages in addressing the two key objectives addressed by the committee: (1) assuring access to recommended vaccines and (2) sustaining the availability of vaccines in the future. The decision process used by the committee in selecting among these alternatives was an exercise in identifying and making difficult trade-offs that often involved direct conflicts between these objectives. For example, two of the approaches—expanding the eligibility categories for VFC and moving to a universal purchase system— address primarily the access objective by eliminating underinsurance and reducing incentives for providers to refer patients away from their routine source of care for immunizations. But both approaches expand government involvement in the purchase of vaccines, and thus potentially undermine investment in production capacity and the development of new vaccines by the vaccine industry. In contrast, the block grant approach emphasizes the importance of a decentralized, pluralistic market that would likely encourage competition and investment in the vaccine industry. But the block grant approach could be detrimental to access by fragmenting eligibility and funding streams, and creating multiple standards that would limit federal oversight and control in the event of a multi-state outbreak.

Other approaches involve more practical problems. Vouchers, for example, would foster pluralistic markets in which government intervention would be limited to subsidizing the purchase of vaccines. Vouchers would both encourage vaccine industry investment and improve access by relieving clinicians of the burden of checking eligibility requirements for vaccine purchases. But using vouchers as the principal mechanism for financing immunization for children and eligible adults would require the creation of an enormous administrative infrastructure for a relatively small benefit.

The alternatives examined by the committee vary substantially in their complexity in terms of both legislative and implementation requirements. A straightforward expansion of VFC, for example, would be both legislatively simpler and easier to implement than other alternatives. Moreover, an alternative to implementing a new policy immediately is to wait for the results of new research and demonstration projects, and certain aspects of the alternative approaches are more amenable to research and demonstration than others. For example, a demonstration of a voucher system implemented in a few sites would likely reveal much about the system's practicality, acceptance, cost, and effectiveness. Conversely, a demonstration of changes in the federal purchasing system would not succeed because the desired market effects on pricing and industry investment could not be tested in selected locations. Nevertheless, evaluation research would be valuable during the implementation phase of any of these alternatives to monitor its impact and permit midcourse adjustments to fine-tune the policy.

Summary of Recommendations

Recommendation 1: The committee recommends the implementation of a new insurance mandate, combined with a government subsidy and voucher plan, for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP).

Recommendation 2: The Secretary of the Department of Health and Human Services should propose changes in the procedures and membership of ACIP so that its recommendations can associate vaccine coverage decisions with social benefits and costs, including consideration of the impact of the price of a vaccine on recommendations for its use.

Recommendation 3: As part of the implementation of recommendations 1 and 2, the National Vaccine Program Office should convene a series of stakeholder deliberations on the administrative, technical, and legislative issues associated with a shift from vaccine purchase to a vaccine mandate, subsidy, and voucher finance strategy. In addition, the Centers for Disease Control and Prevention (CDC) should sponsor a postimplementation evaluation study (in 5 years, for example). CDC should also initiate a research program aimed at improving the measurement of the societal value of vaccines, addressing methodological challenges, and providing a basis for comparing the impact of different measurement approaches in achieving national immunization goals.

The manufacturer removed the tetanus vaccine from the federal contract, claiming that the government price cap was too low to sustain its production. In presenting the fiscal year 2004 federal budget, President Bush proposed amendments to the VFC legislation to remove price caps; this action would allow the tetanus and diphtheria vaccine to be restored to the VFC program.

Some of these approaches were summarized in background papers prepared for the committee, including Fairbrother and Haidery (2002), Hay and Zammit (2002), and McGuire (2003). Others were included in recent reports on vaccine supply by GAO (2002) and NVAC (2003).

Diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, haemophilus influenzae type b, hepatitis B, varicella (chickenpox), and invasive pneumococcal disease.

The VFC entitlement was initially restricted to FQHCs. In January 2003, President Bush announced his intention to seek legislation that would amend the VFC legislation to include all state and local health clinics as access sites (U.S. Department of Health and Human Services, 2003).

Following implementation of the program, the uninsured continued to have the highest usage of public health clinics for vaccinations (52 percent). Public health usage was 35 percent for those with private insurance but partial well-child coverage, 35 percent for those with Medicaid, 43 percent for the underinsured (private insurance, no well-child coverage), and 14 percent for those with private health insurance and full coverage for well-child care.

Between 1997 and 2001, average immunization rates for the 3:4:1:3 series increased as follows: 74.1–77.3 percent in VFC-only states, 74.2–77.8 percent in enhanced-VFC states, 78.7– 80.9 percent in limited universal purchase states, and 78.0–78.1 percent in universal purchase states (CDC, 2002a; CDC, 1998; calculations by the committee).

Cite this Page Institute of Medicine (US) Committee on the Evaluation of Vaccine Purchase Financing in the United States. Financing Vaccines in the 21st Century: Assuring Access and Availability. Washington (DC): National Academies Press (US); 2003. 6, Conclusions and Alternative Strategies.
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108 Vaccination Research Topics & Best Vaccine Essay Topics

Welcome to our list of vaccination research topics! This page contains only the best vaccine topics for essays and papers on child immunization, COVID-19, and other issues. Feel free to pick the catchiest research title about vaccines from our list!

🏆 Best Essay Topics on Vaccination

👍 good vaccination research topics & essay examples, 🎓 most interesting research titles about vaccines, 💡 simple vaccine essay topics.

Vaccines: Should Parents Avoid Vaccinating Their Children? In this research paper, we will try to establish the benefits of damages of child vaccination and draw a conclusion whether parents should or should not avoid vaccinating their children.
Childhood Vaccination as Healthcare Priority Policy Issue This essay presents the controversial issue of childhood vaccination as a healthcare priority policy issue that requires the immediate attention of legislators.
Childhood Vaccination: Policy-Priority Issues The issue of vaccinations is often discussed on an international level. Governments do not underestimate the importance of immunization.
Teaching Plan: Immunizations and Vaccinations In an immunization schedule, provided by the Centers for Disease Control and Prevention, eighteen diseases are marked as possible to prevent with the help of appropriate vaccinations.
Childhood Vaccination Policy in Florida This paper discusses the policy issue of childhood vaccination in Florida where parents can exempt their children from vaccinations due to religious reasons.
2009 H1N1 Flu Pandemic, Vaccination and Rates Extensive studies of the virus confirmed that it possessed certain characteristics that had not been detected in similar viruses before.
Vaccination as a Public Health Policy Issue The controversy surrounding vaccination of children is caused primarily by the miscommunication between the scientific community and the general public.
Pharma Controversy Presentation: Vaccination and Autism Parents often associate MMR vaccination with autism. No qualitative evidence for the MMR vaccination-autism link.

Vaccination Misconceptions in Old Adults This research focuses on the importance of education to improve the older populace’s willingness to get influenza vaccinated.
Mandatory Vaccination of Children in the USA The issue of child immunization is particularly relevant to nursing, as nurses see the consequences of poor vaccination rates regularly.
Flu Vaccination Side Effects as a Cause of Refusal Flu vaccinations are considered to be an important part of population health programs in most developed countries.
Human Papillomavirus Vaccination Among Adolescents Human papillomavirus (HPV) represents a significant threat to global health, which points to the need for implementing effective interventions targeted at its elimination.
Vaccinations for Children: Issues and Recommendations for Positive Change This paper discusses vaccinations for childrens, in particular, security, privacy, and confidentiality regulations, laws, and principles related to data management and access.
Childhood Vaccination: Ethical Case Study The problem of moral behavior of nurses in situations of a difficult choice, decision-making, or conflict is actively discussed in the scholarly medical literature.
Health of Vaccinated and Unvaccinated Children The article by Mawson et al. evaluates the effectiveness of vaccination concerning improving the health of children when compared to infants who did not receive immunization.
The Views on HPV Vaccination in Sweeden The purpose of this article is to outline the research on the views on HPV vaccination assessed by school nurses in Sweeden.
Vaccination Challenges and New Disease Outbreaks Vaccinations are the subject of heated debate in society because of their effectiveness, philosophical rationale, and religious relevance.
Why Vaccination Is So Discussed Now? Vaccination is one of the most debatable topics since many arguments for and against immunization confuse young parents who want to take the right decision.
An Outbreak of the Irrational: Refusion from Measles Disease Vaccination Today people do not face measles disease and its consequences, and for this reason, they are not afraid of it enough. The paper discusses the reasons for refuse from vaccination.
Conflicted State of Mind: Vaccination and Ethics An increasing number of people have come to oppose vaccination on personal or ideological grounds, undermining the protection it provides.
The H1N1 Influenza Virus: Benefits of Vaccination The basic structure of an effective vaccine and the characteristics of virus mutations will help find a way to immunize against a new flu strain and prevent another epidemic.
Mandatory Swine Flu Vaccination The swine flu vaccine is a vaccine that was developed to control the spread of the swine flu pandemic. These vaccines include Pandemix and Celvapan manufactured by Baxter.
The Benefits of Vaccination Outweigh the Risks Medical researchers have succeeded in producing vaccines to help bodies fight pathogens that might overwhelm them.
Seasonal Influenza Vaccination Program The following paper is focused on the Center for Disease Control (CDC) vaccination program on seasonal influenza.
Compulsory Vaccination for Staff of Nursing Homes Because the COVID-19 vaccine will soon be available for the public, officials must make getting it compulsory for the staff of nursing homes and long-term care facilities.
Advantages and Disadvantages of Vaccination Vaccinations have been in use for a very long time now and they have helped save millions of lives and changed the endings of many life stories.
COVID-19: Information About Vaccination This work investigates the phenomenon of vaccine development in the context of a coronavirus pandemic and discusses the progress already achieved.
Vaccination: Child Immunization on the Government Level The experts say that the hesitancy to vaccinate children is one of the biggest threats to public health and the most dangerous mistakes a person can make.
Applying Ethical Principles in Determining Vaccination Decisions Vaccination is beneficial regardless of the adverse effects that come along. Communities should be sensitized through seminars on vaccines.
Human Papillomavirus (HPV) Vaccination for All The health care system in the United States introduced HPV to the public in 2006 following its approval by the Food and Drug Administration.
Human Papillomavirus Vaccination in Children The purpose of this paper is the identification of Human Papillomavirus vaccination effectiveness among children of both genders from 9 to 18 years old.
Americans’ Readiness to Coronavirus Vaccination The purpose of this paper is to summarize the statistic scales, considering whether Americans are ready to get a COVID-19 vaccine and the reasoning behind them.
Support for Seasonal Influenza Vaccination Requirement Among US Healthcare Personnel The study analyzes an article titled ‘New Approaches for Influenza Vaccination of Healthcare Workers’. The article focuses on the effectiveness of compulsory vaccination.
Racial Inequalities in the Context of Pandemic Vaccination To concretize the study, a current journalistic article in The New York Times was chosen to highlight racial inequalities in the context of pandemic vaccination.
Mandatory Vaccination: Benefits and Reasons Vaccines are a critical public health tool in preventing disease transmission, reducing morbidity and mortality, and building herd immunity.
COVID-19: Vaccination Program All healthcare workers need to get the COVID-19 vaccine when available because of their increased exposure to this deadly disease.
“Should We Take a Selfie After Getting Vaccinated?” Summary The article’s central point “Should We Take a Selfie After Getting Vaccinated?” is that society is divided into groups with contrasting opinions on the issue.
Disease in Vaccinated Populations This academic work is a laboratory report summarizing the results of a practical simulation of the epidemiological dynamics of a simulated population.
Vaccination Against the Covid-19 Among Healthcare Professionals This paper investigates the adoption of Covid-19 vaccination among academics and resident doctors at the University of Drugs and Pharmacy “Nicolae Testimitanu” in Moldova.
Wearing a Mask after Vaccination Controversial issues regarding collective security during the COVID-19 pandemic often include discussions of if a sanitary mask fulfills the functions assigned to it or not.
Benefits of Vaccination against Coronavirus Among the numerous recent healthcare advancements, vaccines occupy a specific place for their unique benefits for individuals and society in general.
Autism and Vaccination: The False Health Claim One of the most popular false health claims concerns the relationship between autism and vaccination, suggesting that the latter causes the former.
COVID-19 Measures: Masks for Vaccinated The main point in the essay is that employees should continue to wear a mask in the workplace even after being fully vaccinated.
The COVID-19 Vaccination: Side Effects The most significant side effect of the COVID-19 vaccination is severe allergy among patients who have never experienced any other kind of allergy.
Vaccinations Against COVID-19 in Canada: A Structural-Functionalism Perspective This post will examine and discuss the current vaccination drive against COVID-10 in Canada from the structural-functionalist perspective.
Importance of Employees Getting Vaccinated There is a need to ensure an effective vaccine is administered to employees to ensure that humans can interact freely for effective resumption of normal business activities.
Ethical Principles: Parents’ Vaccination Concerns This case study reviews the ethical and moral choices of doctors who aim to convince parents to vaccinate their children.
The COVID-19 Vaccination: Resistance and Protests Vaccination remains a pivotal prevention strategy against the COVID-19 pandemic. However, resistance to vaccination continues to dictate the ‘health politics’ of many nations.
Should We Get Vaccinated for COVID-19? Vaccinations present the only viable option for preventing the transmission of COVID-19 as well as reducing the risks of adverse symptoms.
Should Vaccinations Be Required for Public School Students? Vaccination of the population today remains the most acute and discussed problem in light of the events associated with the COVID-19 pandemic.
Measles Vaccinations in Colorado State The paper states that with the outbreaks of measles nationwide, it is high time for state legislators to consider measures to combat the disease.
COVID-19 Vaccination: Necessity of Excessiveness Despite the risks and rare opposition, mass vaccination continues to be an essential step toward stopping the COVID-19 virus from impacting the world.
Vaccination of Healthcare Workers Vaccination is the most effective way of protection against COVID-19: a highly contagious disease often followed by a set of serious complications.
COVID-19 Debate: Masks for Vaccinated After reviewing credible sources regarding COVID-19 measures of prevention, it is clear that masks should not be mandatory for individuals who are vaccinated.
Ineffective COVID-19 Vaccination in Afro-Americans The present work shows the essence of comprehending African American subcultures and history to help raise COVID-19 vaccine awareness and acceptance.
The COVID-19 Vaccination Hesitancy: Rhetorical Analysis This rhetorical analysis paper focuses on a video, presented by John Oliver, which discusses the prevalent skepticism surrounding the COVID-19 vaccination process in the US.
The COVID-19 Anti-Vaccination Decision This paper is about how people argue against the COVID-19 vaccination, how they live with it, and how the rest of society is trying to adapt to the anti-vaccine decision.
Vaccination and Immunization Promotion In the paper, the value of vaccination in the current conditions will be discussed. Next, we will investigate the existing myths about immunization.
The COVID-19 Vaccination and Racial Issues The hypothesis for the present research is that even in developed countries, the COVID-19 vaccine doses may be distributed unequally among white people and racial minorities.
Vaccination and Its Economic Implications The development of vaccines has significant implications for the pharmaceutical market. Disease prevention eliminates the need to create drugs to treat them.
The Effect of Vaccinated Travel Lanes in Singapore The recent introduction of Vaccinated Travel Lanes (or VTL) in Singapore allows passengers with recognized vaccination certificates to use airlines on special terms.
Mandatory COVID-19 Vaccination for Healthcare Employees Employees must be aware of the danger posed by the disease and undergo any procedures that will benefit the patient.
Vaccination Issue Concerning the COVID-19 Pandemic This paper discusses the current vaccination issue concerning the COVID-19 pandemic. Large numbers of patients worldwide refuse vaccines.
HPV Anti-Vaxxers Policy: Anti-Vaccination Attitudes Smoking and drinking are risk factors for developing OPSCC, and competing illnesses are a likely cause of mortality in this population.
The Importance and the Benefits of Vaccinating Children Vaccination is the most effective safe strategy for preventing infectious diseases and reducing disability and mortality from infectious pathology.
Public Schools and Vaccination of Youth Vaccines could be described as safety measures to prevent illnesses by stimulating an immune system to produce a prepared defense against a particular sickness.
Vaccination and Associated Advantages Vaccines work with an individual’s natural immunity to build protection against infections, thus reducing the risks of getting infected.
Poliovirus and Importance of Vaccination The type of vaccination used for poliovirus plays a significant role in its effectiveness. In particular, the oral poliovirus vaccine deems insufficiently effective.
Vaccination and Its Effects on the Health Care System
Targeting Head and Neck Cancer by Vaccination
HPV Vaccination and Cancer Prevention
Mandatory Vaccination Requirements for School Children
Vaccination Programs and Its Impact on Public Health
The Humoral Immune Response to BCG Vaccination
Renaissance Island Anthrax Test Vaccination
The Benefits and Effects of the Gardasil Vaccination in Children
Social Psychological Reasons for Increasing Vaccination Rates
Ethics, Mandatory Vaccination, and the HPV Vaccine
Vaccination Crisis and Controversies of Africa
The MMR Vaccination and Autism
Anti Vaccination Movement and Its Effects on Children‘s Well
Vaccination Against Lyme Disease: Past, Present, and Future
The Ethical Theories and Issues Surrounding Vaccination in America
Immunological Mechanisms of Vaccination
Vaccination Coverage and Reasons for Non-vaccination in Istanbul
Correlates of Protection Induced by Vaccination
Public Doubts About Vaccination Safety and Resistance Against Vaccination
COVID-19 Vaccination Hesitancy in the United States: A Rapid National Assessment
The Issues Preventing the Proper Vaccination of Children in America
Measles Dynamics and Vaccination Diffusion
Smallpox Vaccination for Critical Public Service Workers
Vaccination Myths and Its Effects on the Public Eye
Childhood Immunizations and Universal Vaccination
State Required Vaccination and Its Effects on Children
The Anti Vaccination Movement Decreasing Child Safety
Vaccination and Effective Smallpox Vaccine
Prevnar Vaccination Production Process
Vaccination for Babies 0-6 Months
Disease Eradication: Private Versus Public Vaccination
The Ethical Issues and Morality of Flu Vaccination
Cultural and Social Factors of Vaccination
Vaccination Can Save the Nation
Service Members Anthrax Vaccine Vaccination
Svir Epidemic Models With Vaccination Strategies
The Contribution of Vaccination to Global Health: Past, Present and Future
Panuveitis Following Vaccination for COVID-19
Vaccination Against Coronaviruses in Domestic Animals
Complex Correlates of Protection After Vaccination
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These essay examples and topics on Vaccination were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

The essay topic collection was published on May 10, 2022 . Last updated on September 14, 2023 .

My Davidson | A Student Blog Student-to-Student: Advice from Davidson College Students on the College Essay

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Current Davidson College students share their tips and tricks for navigating and writing the college essay.

About the Authors

This piece was written by Senior Fellows in Davidson College's Office of Admission & Financial Aid; Zaynab Abuhakema ’24, Nathanael Bagonza ’24, Chloe Boissy Stauffer ’24, Kelsey Chase ’24, Amanda Fuenzalida ’24, Olivia Howard ’24 (she/her), Ann Nishida ’24, Lilly Sirover ’24, Samuel Waithira ’24 and Ruby Zhou ’24.

Learn more about them below.

Zaynab Abuhakema ’24 (she/her) is a physics major and theatre minor from Summerville, South Carolina.

“Just be honest! We want to know more about YOU and why you can see yourself at Davidson. Tell us about your passions in the way that makes the most sense to you. Have someone read over it if you want, but don’t worry too much about the technical part. Just show us who you are the best way you can on a page.”

Nathanael Bagonza ’24 (he/him) is an English major from Haverhill, Massachusetts.

“Don’t worry about if your writing is ‘great’ or not; rather, be intentional in ensuring that your essays demonstrate who you are and what you are passionate about! I ended up becoming an English major writing a collection of essays for my senior honors thesis, but what made my application essays work from day one was telling stories that really spoke to my true, authentic self.”

Chloe Boissy Stauffer ’24 (she/her) is an environmental studies and political science double major from Lake Atitlan, Guatemala.

“A couple pages of writing will never capture your whole story- admissions counselors understand this. In order to communicate an accurate snapshot of who you are, try thinking of one hobby, one accomplishment, or one interaction that you think best reflects your overall skill set and worldview. By using one or two examples to ‘anchor’ your story, you can frame your personality, backstory and values. Whatever you write, make sure it’s authentic to who you are because that’s who we want to get to know.”

Kelsey Chase ’24 (she/her) is a political science major from Concord, New Hampshire.

“I read a lot of Common App essays during my college process, not because I wanted to study them or compare them to my own, but because I genuinely thought they were fascinating to read. This helped me realize that it’s helpful to think about writing the essays for a peer rather than an admissions officer. Don’t worry about what you think the admissions officers want to hear; rather, write an essay that you think would help potential friends understand you at your core. I would also advise against your parents or adults taking too much editorial control over your essay — you want your essay to sound like you, which is someone who’s 17 or 18 years old, not a professional. It can definitely be helpful to have someone read over it just to catch grammar mistakes or awkward phrasing, but what matters most is that you feel like it really conveys something important about who you are.”

Amanda Fuenzalida ’24 (she/her) is a biology major from Naples, Florida and Santiago, Chile.

“When I think about the personal essay, I always think about growth, because that is what life is, a continuous growing process. And at 17–18 years, you do not have to have everything figured out or have decided what you want to for the rest of your life. But what you can do well is reflect on the experiences that have made you the person you are at this very moment. And thinking about this personal statement, I would think maybe what are key major parts of my life that have shaped me to be who I am, that make you proud of yourself. Reading back your essay, you should feel that sense of pride, that this essay reflects the person you (not anyone else) are proud you have become.”

Olivia Howard ’24 (she/her) is a biology and German Studies double major from Dacula, Georgia.

“I do not consider writing to be my strong suit, and I remember the dread and fear I had when I was writing my college essays. Essays are intimidating, and you might feel lost trying to fit your story into the limits that are set. My advice to you is to be patient with yourself and allow who you are to come through on the page. Do not over stress about having the most complex grammar and sentence structure, but rather focus on writing what matters to you. It is okay to not be an award-winning writer who uses metaphors and various literary devices. A lot of times it is better to tell your story in a simple way rather than using flowery language and fluff that does not get your point across.”

Ann Nishida ’24 (she/her) is a biology major and music minor from Ridgewood, New Jersey.

“The focus is on you . The essay portion is a chance for the admission counselors to see a side of you that a transcript or test score won’t fully represent. A good starting point in discovering your unique qualities may be to ask yourself Why ? Why am I passionate about certain activities, why do I interact with my environment in a certain way, why do I want to go to Davidson, etc. Good luck!”

Lilly Sirover ’24 (she/her) is a biology major and public health minor on the premedicine track from Haddonfield, New Jersey.

“As someone who prefers speaking over writing, I highly recommend using a voice recording app to talk through your essay ideas as you begin the writing process. Talking through your unique strengths, challenges you have navigated, a personal experience that changed your perspective, a topic that you are endlessly curious about, or something else personal to you allows your story to develop naturally.”

Samuel Waithira ’24 (he/him) is an economics major and applied mathematics minor from Nairobi, Kenya.

“Be genuine with every aspect of your application. Do not try to mold your application into what you believe the college wants. When you present your true self, you build trust with the admissions team, showing that you have confidence in who you are. Remember that each applicant is unique, and colleges are often looking for a diverse student body. By being genuine, you can showcase your individuality and the qualities that set you apart from other applicants.”

Ruby Zhou ’24 (she/her) is an English major on the predental track from Houston, Texas.

“Start writing. I have a tendency to procrastinate whenever I have a daunting task looming over me, and I just need to start writing or I’ll never get it done. The writing might sound horrible and you might feel embarrassed, but if you think about it, the earlier you start, the more time you have to change “bad” writing to something beautiful.”

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November 2, 2023

The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies (2013)

Chapter: 7 conclusions and recommendations.

Conclusions and Recommendations

COMMITTEE RESPONSE TO ITS STATEMENT OF TASK

This final chapter highlights selected findings and conclusions and presents recommendations for each section of the committee’s statement of task. The preceding chapters, especially Chapter 6 , include many assessments that may be construed as the committee’s preferences among the alternatives presented but that fall short of formal recommendations.

Vaccine safety is critically important, but a determination of safety is ultimately a value judgment. For example, some might believe that a serious adverse event that occurs once in 1 million doses is “safe enough” relative to the benefit of preventing a serious disease, whereas others may consider that risk unacceptably high. The committee did not set a specific numerical target or goal for what should be considered “safe enough.” Instead, the committee made a judgment based on the literature that failed to link adverse effects to schedule exposures or multiple immunizations, concluding that there is no evidence that the schedule is not safe.

The committee recognized that final decisions about research studies must await knowledge of further evidence, including biological plausibility and/or epidemiological evidence, feasibility, cost, and the exact circumstances of stakeholder concerns, before the planning and conduct of specific research projects. In turn, the committee believes that it would be inappropriate to make unqualified recommendations without this knowledge. The committee notes that stakeholder concerns may be used to drive a search for scientific evidence (biological or epidemiological), although such concerns would not be sufficient motivation to embark

on costly clinical research, such as new randomized controlled trials or cohort studies.

The committee thus decided to make five general recommendations. Three recommendations focus on improvements to understanding stakeholder concerns, harmonizing research methods, and sequencing the process for selecting research questions. Two recommendations focus on research methods, including randomized controlled trials and data systems that would enable ongoing and improved observational studies.

Statement of Task (Part I): Review scientific findings and stakeholder concerns related to the safety of the recommended childhood immunization schedule.

Summary of Stakeholder Concerns

The committee’s findings and conclusions about stakeholder concerns are presented in Chapter 4 . Although the committee identified the concerns of some parents about the number, frequency, and timing of immunizations in the overall immunization schedule, the committee did not find in its literature review that clinicians, public health personnel, or policy makers have similar safety concerns. Among the latter groups, the childhood immunization schedule is considered to be among the most effective and safe of the public interventions available to prevent serious disease and death. However, although health care professionals have much information about individual vaccines, they have much less information about the effects of administration of multiple vaccines at a single visit or the timing of the immunizations. Additionally, the cited concerns of health care professionals include efficacy of certain vaccines as well as appropriate delivery and communication regarding the recommended childhood immunization schedule.

Although the 2010 National Vaccine Plan addresses the need to provide health care providers with more timely, accurate, and transparent information about the benefits and risks of vaccines, the plan does not specifically address strategies to assist providers with questions about the safety of the immunization schedule (HHS, 2010). The committee concluded that parents and health care professionals would benefit from more comprehensive and detailed information with which to address parental concerns about the safety of the immunization schedule. Such information should clearly address vaccine-preventable diseases, the risks and benefits of immunizations, and the safety of the immunization schedule.

The committee’s literature review highlighted the lack of high-quality evidence supporting stakeholder concerns (the priority stakeholders are listed in Box 4-1 ) about the immunization schedule. In its role to ensure

vaccine safety, the federal government has already prioritized the engagement of stakeholders in multiple activities, as detailed in the 2010 National Vaccine Plan and implementation efforts, as well as the Centers for Disease Control and Prevention’s Immunization Safety Office scientific agenda (CDC, 2011; HHS, 2010). However, an effective national vaccine program will require more complete information on stakeholder concerns about the safety of the immunization schedule, the severity of vaccine-preventable diseases, individual- and population-level immunization rates, vaccine efficacy, and the delivery and supply of vaccines recommended in the childhood immunization schedule. Improved communication between public health authorities and parents requires improvements to the clarity of the information provided, as well as the building of trust and the use of a systematic approach to elicit public concerns. Further research into the type of questions that parents seek to answer by the use of the scientific methods of social, behavioral, and decision science is indicated.

On the basis of the committee’s literature review and public testimony, the committee strongly endorses the need for research to understand the public’s knowledge, beliefs, and concerns about vaccines and vaccine-preventable diseases in particular, which is a key strategy in the 2010 National Vaccine Plan (HHS, 2010). It must be acknowledged that the methods used in most immunization studies do not permit a detailed analysis of the impact of parental concerns on the decision to immunize their children. Although the committee found that the largest safety concerns exist among a subset of parents, the concerns of multiple stakeholders should be included as part of the efforts of the National Vaccine Program Office (NVPO). For example, health care providers have much knowledge about individual vaccines but less information about the effects of administering multiple vaccines at a single visit or the timing of the immunizations.

Recommendation 4-1: The committee recommends that the National Vaccine Program Office systematically collect and assess evidence regarding public confidence in and concerns about the entire childhood immunization schedule, with the goal to improve communication with health care professionals, and between health care professionals and the public regarding the safety of the schedule.

Summary of Scientific Findings

The committee’s findings and conclusions about the safety of the immunization schedule on the basis of the information in the scientific literature are presented in Chapter 5 . The committee encountered two major issues. First, the concept of the immunization “schedule” is not well developed in the scientific literature. Most vaccine research focuses on the health outcomes associated with single immunizations or combinations of vaccines

administered at a single visit. Even though each new vaccine is evaluated in the context of the overall immunization schedule that existed at the time of review, individual elements of the schedule are not evaluated once it is adjusted to accommodate a new vaccine. Key elements of the immunization schedule—for example, the number, frequency, timing, order, and age at the time of administration of vaccines—have not been systematically examined in research studies.

The second major issue that the committee encountered during the review of the scientific literature was uncertainty over whether the scientific literature has addressed all health outcomes and safety concerns. The committee could not determine whether its list of health outcomes was complete or whether a more comprehensive system of surveillance might identify other outcomes of potential safety significance. In addition, the conditions of concern to some stakeholders, such as immunological, neurological, and developmental problems, are illnesses and conditions for which the etiology, in general, is not well understood. Further research on these conditions may clarify their etiologies.

Finally, the committee found that evidence from assessments of health outcomes in potentially susceptible subpopulations of children who may have an increased risk of adverse reactions to vaccines (such as children with a family history of autoimmune disease or allergies or children born prematurely) was limited and is characterized by uncertainty about the definition of populations of interest and definitions of exposures and outcomes. Most children who experience an adverse reaction to immunization have a preexisting susceptibility. Some predispositions may be detectable prior to vaccination; others, at least with current technology and practice, are not (IOM, 2012, p. 82).

In summary, to consider whether and how to study the safety and health outcomes of the entire childhood immunization schedule, the field needs valid and accepted metrics of the entire immunization schedule (the “exposure”) and clearer definitions of health outcomes linked to stakeholder concerns (the “outcomes”) in rigorous research that will ensure validity and generalizability.

Recommendation 5-1: To improve the utility of studies of the entire childhood immunization schedule, the committee recommends that the National Vaccine Program Office develop a framework that clarifies and standardizes definitions of

key elements of the schedule ,
relevant health outcomes, and
populations that are potentially susceptible to adverse events.

Statement of Task (Part II): Identify potential research approaches, methodologies, and study designs that could inform this question, including an assessment of the potential strengths and limitations of each approach, methodology, and design, as well as the financial and ethical feasibility of doing them.

Summary of Methodological Issues

The committee’s findings and conclusions about research approaches are presented in Chapter 6 . The committee parsed the phrase “this question” in Part 2 of the statement of task into four broad research questions in Box 7-1 .

The committee then discussed general research approaches with the potential to answer these questions: ongoing research with data from existing data systems, research with enhanced data from existing data systems, prospective observational studies, and randomized controlled trials. The committee also recognized that to advance the knowledge about the safety

BOX 7-1 Leading Research Questions of Interest to Select Stakeholders

How do child health outcomes compare between those who receive no vaccinations and those who receive the full currently recommended immunization schedule?
How do child health outcomes compare between (a) those who receive the full currently recommended immunization schedule and (b) those who omit specific vaccines?
For children who receive the currently recommended immunization schedule, do short- or long-term health outcomes differ for those who receive fewer immunizations per visit (e.g., when immunizations are spread out over multiple occasions), or for those who receive their immunizations at later ages but still within the recommended ranges?
Do potentially susceptible subpopulations—for example, children from families with a history of allergies or autoimmune diseases— who may experience adverse health consequences in association with immunization with the currently recommended immunization schedule exist?

of the immunization schedule, certain enhancements to the research infrastructure will be needed, as detailed in Chapter 6 .

The committee recognizes that the establishment of priorities for research will be a challenge. Thus, the committee proposes a process for setting priorities that recognizes stakeholder concerns and establishes these priorities on the basis of epidemiological and other evidence (based on formal systematic reviews), biological plausibility, and feasibility.

Before the U.S. Department of Health and Human Services (HHS) initiates further research on the entire immunization schedule through its agencies—most notably CDC, FDA, the National Institutes of Health, and NVPO—the biological plausibility of the association of a particular outcome with an aspect of the immunization schedule must be thoroughly reviewed. Along these lines, previous IOM vaccine safety committees have assessed the mechanisms by which vaccines potentially cause adverse events by identifying and evaluating the clinical and biological evidence (from human, animal, and in vitro studies) for individual vaccines. Furthermore, the recent IOM Committee to Review Adverse Effects of Vaccines developed categories for a mechanistic assessment of the weight of the evidence. Each assessment considers clinical information from case reports and clinical and experimental evidence from other sources (IOM, 2012).

Recommendation 6-1: The committee recommends that the Department of Health and Human Services incorporate study of the safety of the overall childhood immunization schedule into its processes for setting priorities for research, recognizing stakeholder concerns, and establishing the priorities on the basis of epidemiological evidence, biological plausibility, and feasibility.

The decision to initiate further studies should be based on an evaluation of three considerations that the committee identified through its review of stakeholder concerns and scientific findings:

epidemiological evidence of potential adverse health outcomes associated with elements of the immunization schedule (such as postmarketing signals or indications of elevated risk from observational studies);
biological plausibility supporting hypotheses linking specific aspects of the immunization schedule with particular adverse health outcomes; and
concern about the immunization schedule’s safety expressed by stakeholders, which should initiate efforts to explore the two previous considerations.

The committee acknowledges the evidence that reducing vaccine coverage is associated with increases in vaccine-preventable disease and found only inconsistent and anecdotal evidence to imply that the recommended immunization schedule is not safe. Furthermore, existing systems for the detection of adverse events provide confidence that the existing childhood immunization schedule is safe, and the committee recognizes that the federal government invests considerable resources to ensure vaccine safety. Nevertheless, some stakeholders have suggested that further work is warranted, such as a comparison of vaccinated children with unvaccinated children or children receiving immunizations on alternative immunization schedules.

The committee supports the National Vaccine Advisory Committee Safety Working Group statement that “the strongest study design, a prospective, randomized clinical trial that includes a study arm receiving no vaccine or vaccine not given according to the current recommended schedule, would be unethical and therefore cannot be done” (NVAC, 2009, p. 38). In Chapter 6 , the committee presents the formidable ethical and feasibility problems associated with the conduct of randomized controlled trials of children who receive all recommended immunizations and children who receive none of them and randomized controlled trials of children who receive all recommended immunizations and children who receive the recommended immunization on an alternative schedule. There are very low observed rates of adverse events with vaccination, which is another factor sffecting feasibility of a randomized controlled trial. Because of these problems, the committee concludes that a randomized controlled trial comparing the recommended schedule with any alternative schedule would be unethical and infeasible and could increase the risk of vaccine-preventable diseases in individuals and in the community.

Furthermore, the committee found that a trial of a modified version of the ACIP schedule—one that would disperse the timing of vaccinations so that children are visiting health care professionals more often but receiving fewer shots at each visit—would be ethical; however, it would add substantial costs to both parents and providers and, moreover, may be unacceptable to insurers if its effectiveness—measured as a decreased rate of adverse safety outcomes—was negligible. This modified schedule would provide immunizations within the time intervals approved by ACIP and would address the concern about immunization with too many vaccines at one office visit, but the committee did not view this option to be feasible for study.

In light of the ethical and feasibility requirements and the available evidence, the committee concludes that new randomized controlled trials of the childhood immunization schedule are not justified at this time.

Recommendation 6-2: The Department of Health and Human Services should refrain from initiating randomized controlled trials of the childhood

immunization schedule that compare safety outcomes in fully vaccinated children with those in unvaccinated children or those vaccinated by use of an alternative schedule.

The committee also reviewed opportunities to study groups that choose not to vaccinate their children by use of a prospective cohort study design. However, such a study would not conclusively reveal differences in health outcomes between unimmunized and fully immunized children for two main reasons. First, the sample populations often suggested for study (such as some religious populations) may be too small to adequately power such a comparative analysis, particularly for very rare adverse health outcomes. Such a study would also need to account for the many confounding variables that separate these naturally occurring unimmunized populations from the average U.S. child, including lifestyle factors and genetic variables.

The committee finds that secondary analyses of existing systems are more promising approaches to examination of the research questions that the committee identified in future studies of the childhood immunization schedule. The Vaccine Safety Datalink (VSD) is a useful collaborative project that could conduct both postmarketing surveillance and longer-term targeted research. The ability to augment routinely collected administrative data in VSD with data from parent interviews and reviews of medical records for a selected study population is an important strength.

VSD is currently the best available system for studying the safety of the immunization schedule in the United States. VSD should strive to improve the generalizability of its data to the U.S. population as a whole by enhancing the quality of its demographic information and by expanding its scope to include more diversity in its study populations. Secondary analyses with data from other existing databases (that might be modeled on VSD) could be a feasible, ethical, and cost-effective means of investigating several research questions that the committee identified. The committee recognizes that the commitment to VSD studies by the managed care organizations currently receiving funding through VSD needs to be sustained to continue to build on existing efforts. The committee concludes that VSD is a valuable component of the federal research infrastructure and will be the best-suited source of data for studying the childhood immunization schedule. Its utility will be expanded with the addition of more detailed demographic data and family medical histories.

Recommendation 6-3: The committee recommends that the Department of Health and Human Services (HHS) and its partners continue to fund and support the Vaccine Safety Datalink project to study the safety of the recommended immunization schedule. Furthermore, HHS should

consider expanding the collaboration with new health plan members and enhancing the data to improve its utility and generalizability.

CONCLUDING OBSERVATIONS

The committee’s efforts to identify priorities for recommended research studies did not reveal a base of evidence suggesting that the childhood immunization schedule is linked to autoimmune diseases, asthma, hypersensitivity, seizures or epilepsy, child developmental disorders, learning disorders or developmental disorders, or attention deficit or disruptive behavior disorders. While the committee found that there is no scientific evidence to justify the majority of safety concerns, perceptions dictate parental support and actions. Therefore further study of the full immunization schedule as well as further study to understand stakeholder perceptions and how they are formed may help improve awareness and education efforts. Stakeholder concerns should be one of the elements used to drive searches for scientific evidence, but these concerns alone, absent epidemiological or biological evidence, do not warrant the initiation of new high-cost randomized controlled trials. The committee concludes that data from existing data systems may be used to conduct observational studies and offer the best means for ongoing research efforts of the immunization schedule’s safety.

The committee found no significant evidence to imply that the recommended immunization schedule is not safe. Furthermore, existing surveillance and response systems have identified adverse events known to be associated with vaccination. The federal immunization research infrastructure is strong. A key component is the VSD project, which with ongoing support will be able to feasibly address the committee’s identified key research questions. Although the committee concludes that protection of children from vaccine-preventable diseases is of higher importance than testing of alternative immunization schedules without epidemiological or biological evidence indicating a safety problem, VSD should continue to examine the health outcomes of people who choose alternative schedules.

Looking to the future, the committee supports the work of the federal research infrastructure in ensuring that stakeholders are involved in all stages of development, implementation, evaluation, and dissemination of the immunization schedule. As electronic medical records become more commonly used, they may provide an opportunity to capture complete immunization data linked with hospital discharge records that will be useful to future studies. Further, the Post-Licensure Rapid Immunization Safety Monitoring (PRISM) program may have the capability to monitor rare adverse events potentially associated with the childhood immunization schedule. Initiatives such as the National Children’s Study also hold promise; it

will be one of the most comprehensive research efforts focused on studying children’s health and development.

The childhood immunization schedule may become more complex over time as scientific advances are made and new vaccines are developed. Feasible research approaches to study potential adverse health outcomes will emerge only with a sustained and substantial federal commitment to research on vaccine safety.

CDC (Centers for Disease Control and Prevention). 2011. Immunization Safety Office scientific agenda. Atlanta, GA: Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention.

HHS (Department of Health and Human Services). 2010. 2010 National Vaccine Plan. Washington, DC: Department of Health and Human Services.

IOM (Institute of Medicine). 2012. Adverse effects of vaccines: Evidence and causality . Washington, DC: The National Academies Press.

NVAC (National Vaccine Advisory Committee). 2009. Recommendations on the Centers for Disease Control and Prevention Immunization Safety Office draft 5-year scientific agenda. Washington, DC: National Vaccine Advisory Committee.

Vaccines are among the most safe and effective public health interventions to prevent serious disease and death. Because of the success of vaccines, most Americans today have no firsthand experience with such devastating illnesses as polio or diphtheria. Health care providers who vaccinate young children follow a schedule prepared by the U.S. Advisory Committee on Immunization Practices. Under the current schedule, children younger than six may receive as many as 24 immunizations by their second birthday. New vaccines undergo rigorous testing prior to receiving FDA approval; however, like all medicines and medical interventions, vaccines carry some risk.

Driven largely by concerns about potential side effects, there has been a shift in some parents' attitudes toward the child immunization schedule. The Childhood Immunization Schedule and Safety identifies research approaches, methodologies, and study designs that could address questions about the safety of the current schedule.

This report is the most comprehensive examination of the immunization schedule to date. The IOM authoring committee uncovered no evidence of major safety concerns associated with adherence to the childhood immunization schedule. Should signals arise that there may be need for investigation, however, the report offers a framework for conducting safety research using existing or new data collection systems.

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Yes, ChatGPT can help with your college admissions essay. Here's what you need to do to stay within the rules.

Students who use tools like ChatGPT to write their college essays need to walk a fine line.
Colleges will likely penalize students who submit completely AI-generated applications.
Using AI to edit or draft the essays may be acceptable though, a tutoring company founder says.

The education sector has had a rough ride with generative AI.

After the release of ChatGPT, some colleges and schools were quick to put a blanket ban on the bot when students began using it to write their essays. Professors and teachers were left with the difficult task of navigating the new concept of AI plagiarism.

Now, several colleges have changed their tune and are encouraging students and staff to use generative AI as a tool — as long as they don't use it to cheat. However, the guidance is still pretty vague, especially when it comes to admissions and college essays.

"The landscape is shifting, but colleges are not unified in their approach to GPT," Adam Nguyen, founder of tutoring company Ivy Link , told Insider. "If you look across the landscape of college admissions, especially elite college admissions, there are no clear rules on whether you could use GPT or not."

In February, I tested the chatbot's ability to write college application essays . The results were relatively successful , with two private admissions tutors agreeing the essays definitely passed for ones written by a real student and probably would have had a shot at most colleges, but probably not the most selective institutions.

There are telltale signs when an entire essay is AI-generated, Nguyen said. For example, there tends to be a lot of repetition, and the essays are generally mediocre.

"If an essay is clearly written by AI, I think they will penalize the student and that application," Nguyen said.

While it's clear students should be writing their own work, it's less clear if students are allowed to use the tech to help them draft or edit essays.

As colleges grudgingly accept that AI is not going anyway, Nguyen said there's a fine line for students to walk.

"If you fill in the details, restructure the essay, and provide the specific language and sentences, that will make the essay your own," he said. "I think many colleges would be fine with that."

He continued, "I would suggest not using it as a default. If you're really stuck, you could use it to start." He suggested that, as a general rule, at least 80% of the essays needed to be edited and changed to be on the safe side.

"If an essay's really good, it won't raise any suspicion, and I don't think most colleges will care that you use GPT to start, as long as they can't tell either," he added.

Watch: What is ChatGPT, and should we be afraid of AI chatbots?

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