Political and Legal Issues in Vaccination



This chapter begins with a brief introduction from the literature on the main issues and players involved in political controversy over vaccine use. One major federal level political challenge regarding vaccine safety is discussed involving US Congressman Dan Burton. Recent state level legislation has centered on passage of laws addressing parental rights regarding vaccination decisions, based on various safety concerns, while generally seeking to continue a primary focus on protection of society from communicable diseases. Controversial state and institutional policies are discussed that include daycare, school, and health care personnel (HCP) immunization mandates intended to optimize immunization rates. Exemption legislation that has focused on eliminating or limiting the power of mandates has generated much debate as well. Parental rights and “values” controversies are discussed relative to concerns raised by social conservatives that the human papillomavirus (HPV) vaccine promotes immoral behavior among youth. In conclusion, one new political and legal controversy is discussed that bodes to significantly impact public health in general, as well as access to immunizations, namely, the 2010 health care reform legislation provisions addressing public access to vaccines and insurance coverage of immunization services across the lifespan.


Hepatitis Mercury Insurance Coverage Influenza Income 


  1. 1.
    Colgrove JK. State of immunity: the politics of vaccination in twentieth-century America. Berkeley, CA: University of California Press; 2006.Google Scholar
  2. 2.
    Kirkland A. The legitimacy of vaccine critics: what is left after the autism hypothesis? J Health Politics. 2012 February;37(1):69–97.CrossRefGoogle Scholar
  3. 3.
    New Testament House Churches. Ron Paul, unlike Huckabee is for health freedom. URL: http://www.freewebs.com/daughtersofsara/christiansexposehuckabee.htm Updated February 14, 2008. Accessed 9 Mar 2012.
  4. 4.
    Steve Watson (Health Truth Revealed.com). Nationwide revolt continues to grow as presidential candidate denounces FDA and forced immunization. URL: http://www.healthtruthrevealed.com/full-page.php?id=1544502201&&page=article Posted January 23, 2008. Accessed 9 Mar 2012.
  5. 5.
    Age of Autism (Daily web newspaper of the autism epidemic). Ron Paul’s stance against vaccine mandates featured on Huffington Post. URL: http://www.ageofautism.com/2012/01/ron-pauls-stance-against-vaccine-mandates-featured-on-huffington-post.html Posted January 11, 2012. Accessed 9 Mar 2012.
  6. 6.
    YouTube Interview of Ron Paul by Lew Rockwell. Ron Paul and Lew Rockwell discuss Obamacare, swine flu and big government. URL: http://www.ronpaul.com/2009-08-27/ron-paul-and-lew-rockwell-discuss-obamacare-swine-flu-and-big-government/ Conducted August 18, 2009. Accessed 9 Mar 2012.
  7. 7.
    Yerman MG. An interview with Dr. Diane M. Harper, HPV expert. HuffPost Healthy Living. Posted December 28, 2009 at 06:14 PM ET. URL: http://www.huffingtonpost.com/marcia-g-yerman/an-interview-with-dr-dian_b_405472.html. Accessed 22 May 2012.
  8. 8.
    Chustecka Z. HPV vaccine deemed safe and effective, despite reports of adverse events. Medscape Medical News. Posted August 8, 2008. URL: http://www.medscape.com/viewarticle/578110. Accessed 22 May 2012.
  9. 9.
    Kirby D. Evidence of Harm (Web site). URL: http://www.evidenceofharm.com/. Accessed May 22 2012.
  10. 10.
    Kirby D. Evidence of harm: mercury in vaccines and the autism epidemic: a medical controversy. New York, NY: St. Martin’s Griffin; 2006.Google Scholar
  11. 11.
    Kennedy Jr RF. Another autism case wins in vaccine court. HuffPost Health Living. Posted February, 24, 2009, 08:37 PM ET. URL: http://www.huffingtonpost.com/robert-f-kennedy-jr-and-david-kirby/vaccine-court-autism-deba_b_169673.html. Accessed 23 May 2012.
  12. 12.
    Lauerman K. Correcting our record: We’ve removed an explosive 2005 report by Robert F. Kennedy Jr. about autism and vaccines. Here’s why. Salon. Posted January 16, 2011 at 12:01 PM CST. URL: http://www.salon.com/2011/01/16/dangerous_immunity/. Accessed 23 May 2012.
  13. 13.
    Burton D. Autism. URL: http://burton.house.gov/issues/autism. Accessed 9 Mar 2012.
  14. 14.
    Advocates for Children's Health Affected by Mercury Poisoning (A-CHAMP). Rep. Dan Burton Opposes Secret Hearing (including pdf of a December 18, 2006 letter by Representative Burton to Attorney General Alberto Gonzales of the U.S. Justice Department protesting alleged intent to not provide public access to these proceedings). URL: http://autismactioncoalition.org/vaccinecourtsecrecyburton.html. Accessed 6 Apr 2012.
  15. 15.
    Ginger Taylor (Blog: Adventures in Autism posted June 27, 2007). Dan Burton Addresses Congress on the Vaccine Hearings (this blog presents purported excerpts of a speech by Dan Burton in the House of Representatives on Tuesday, June 19, 2007). URL: http://adventuresinautism.blogspot.com/2007/06/dan-burton-addresses-congress-on.html. Accessed 6 Apr 2012.
  16. 16.
    U.S. House of Representatives. H.R. 2832 (110th): Comprehensive comparative study of vaccinated and unvaccinated populations act of 2007 (110th Congress, 2007-2009). Published online by Govtrack.US. URL: http://www.govtrack.us/congress/bills/110/hr2832#. Accessed 23 May 2012.
  17. 17.
    Anon. Immunizations: Thimerosal and Mercury. Published by National Conference of State Legislatures. April 2011. URL: http://www.ncsl.org/issues-research/health/immunizations-policy-issues-overview.aspx. Accessed 24 May 2012.
  18. 18.
    Health Policy Tracking Service. Trends in State Public Health Legislation: Chapter 8: Immunizations. January 1, 2006 – December 31, 2006. Publisher: Healthy States Initiative. Issued January 12, 2007. URL: http://www.healthystates.csg.org/NR/rdonlyres/C8C2CCDC-8F07-47C1-8789-F12C3E0ECB39/0/Chapter8Immunizations.pdf. Accessed 3 Jun 2012.
  19. 19.
    State of Nebraska. Legislative Bill, LB1158. Published during 98th Legislature, 2nd Session (2004). URL: http://uniweb.legislature.ne.gov/bills/search_past.php (keyword: LB1158). Accessed 26 May 2012.
  20. 20.
    State of Nebraska. Legislative Bill, LB569. Published during 99th Legislature, 1st Session (2005). http://uniweb.legislature.ne.gov/bills/search_past.php (keyword: LB569). Accessed 26 May 2012.
  21. 21.
    State of Nebraska. Legislative Bill, LB790. Published during 99th Legislature, 2nd Session (2006). http://uniweb.legislature.ne.gov/bills/search_past.php (keyword: LB790). Accessed 26 May 2012.
  22. 22.
    State of Nebraska. Legislative Bill, LB49. Published during 100th Legislature, 1st Session (2007). http://uniweb.legislature.ne.gov/bills/search_past.php (keyword: LB49). Accessed 26 May 2012.
  23. 23.
    State of Nebraska. Legislative Resolution, LR357. Published during 98th Legislature, 2nd Session (2004). URL: http://uniweb.legislature.ne.gov/bills/search_by_keyword.php (keyword: LR357). Accessed 26 May 2012.
  24. 24.
    Anon. Timeline: Thimerosal in vaccines (1999-2010). Centers for Disease Control and Prevention (CDC). URL: http://www.cdc.gov/vaccinesafety/Concerns/thimerosal/thimerosal_timeline.html. Last updated March 29, 2012. Accessed 26 May 2012.
  25. 25.
    Hinman AR, Orenstein WA, Williamson DE, Darrington D. Childhood immunization: laws that work. J Law Med Ethics. 2002;30(3 Special Supplement):122–7.PubMedGoogle Scholar
  26. 26.
    Anon. State Information: State mandates on immunization and vaccine-preventable diseases. Published by the Immunization Action Coalition. Last updated on November 28, 2011. URL: http://www.immunize.org/laws/varicel.asp. Accessed 26 May 2012.
  27. 27.
    Davis MM, Gaglia MA. Associations of daycare and school entry vaccination requirements with varicella immunization rates. Vaccine. 2005;23:3053–60.PubMedCrossRefGoogle Scholar
  28. 28.
    Centers for Disease Control and Prevention. Hepatitis B (Chapt 9). In: Epidemiology and prevention of vaccine-preventable diseases. 12th ed. Atkinson W, Wolfe C, and Hamborsky J eds. Washington DC: Public Health Foundation, 2011; 115-138. URL: http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html. Accessed 20 Oct 2012.
  29. 29.
    Anon. State Information: Hepatitis B prevention mandates for daycare and K-12. Published on by the Immunization Action Coalition. Last updated on May 26, 2011. URL: http://www.immunize.org/laws/hepb.asp. Accessed 26 May 2012.
  30. 30.
    Mast EE, Margolis HS, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of Hepatitis B virus infection in the United States. MMWR R & R. 2005; 54(RR16):1-23. URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm. Accessed 20 Oct 2012.
  31. 31.
    Anon. State Information: Varicella prevention mandates. Published by the Immunization Action Coalition. Last updated May 26, 2011. URL: http://www.immunize.org/laws/varicel.asp. Accessed 26 May 2012.
  32. 32.
    Zimmerman RK, Mieczkowski TA, Mainzer HM, et al. Understanding physician agreement with Varicella immunization guidelines. Prev Med. 2002;35:135–42.PubMedCrossRefGoogle Scholar
  33. 33.
    Anon. Hepatitis B Vaccine: The untold story: Parents question forced vaccination as reports of hepatitis B vaccine reactions multiply. Published on the National Vaccine Information Center website. 2012. URL: http://www.nvic.org/nvic-archives/newsletter/untoldstory.aspx. Accessed 26 May 2012.
  34. 34.
    Gabriel T and Grady D. In Republican race, a heated battle over the HPV vaccine. New York Times. September 13, 2011. URL: http://www.nytimes.com/2011/09/14/us/politics/republican-candidates-battle-over-hpv-vaccine.html?_r=2. Accessed 2 June 2012.
  35. 35.
    Gibbs N. Defusing the war over the “promiscuity” vaccine. Time U.S. 2006; June 21. URL: http://www.time.com/time/nation/article/0,8599,1206813,00.html. Accessed 3 June 2012.
  36. 36.
    Liddon NC, Leichliter JS, Markowitz LE. Human papillomavirus vaccine and sexual behavior among adolescent and young women. Am J Prev Med. 2012;42(1):44–52.PubMedCrossRefGoogle Scholar
  37. 37.
    Edwards D. Bachmann on HPV vaccine: Mental retardation a ‘very real concern’. RawReply website (with NBC Today Show video of Matt Lauer interview with Michelle Bachman). 2011 September 13. URL: http://www.rawstory.com/rawreplay/2011/09/bachmann-on-hpv-vaccine-mental-retardation-a-very-real-concern/. Accessed 3 June 2012.
  38. 38.
    Mulcahy N. Bioethicists offer $11,000 for proof of HPV vaccine story. Medscape Pediatrics News. 2011September 15. http://www.medscape.com/viewarticle/749775?src=mpnews&spon=9. Accessed 3 June 2012.
  39. 39.
    Helderman RS. Senate panel kills bill to end Virginia’s HPV vaccine mandate. The Washington Post. February 17, 2011. URL: http://voices.washingtonpost.com/virginiapolitics/2011/02/a_senate_committee_has_killed.html. Accessed 2 June 2012.
  40. 40.
    DeBonis M. Laws aren’t enough to make sure girls are vaccinated for HPV. The Washington Post. September 27, 2011. URL: http://www.washingtonpost.com/local/dc-politics/laws-arent-enough-to-make-sure-girls-are-vaccinated-for-hpv/2011/09/27/gIQAJQ6O3K_story.html. Accessed 2 June 2012.
  41. 41.
    Anon. School and childcare vaccination surveys: School vaccination requirements, exemptions & web links. Centers for Disease Control and Prevention website. URL: http://www2a.cdc.gov/nip/schoolsurv/schImmRqmt.asp. Accessed 3 June 2012.
  42. 42.
    Anon. State information: Hepatitis B prevention mandates for colleges and universities. Published by the Immunization Action Coalition. Last updated June 29, 2010. URL: http://www.immunize.org/laws/hepbcollege.asp. Accessed 26 May 2012.
  43. 43.
    Anon. State information: Meningococcal prevention mandates for colleges and universities. Published by the Immunization Action Coalition. Last updated June 2, 2011. URL: http://www.immunize.org/laws/menin.asp. Accessed 26 May 2012.
  44. 44.
    Anon. State information: States with influenza or pneumococcal (PPV) vaccine mandates for residents in long-term care facilities. Published by the Immunization Action Coalition. Last updated June 26, 2008. URL: http://www.immunize.org/laws/ltc.asp. Accessed 26 May 2012.
  45. 45.
    Anon. State immunization laws for healthcare workers and patients (interactive web resource). Published by the CDC. Current as of March 2012. URL: http://www2a.cdc.gov/nip/StateVaccApp/statevaccsApp/default.asp. Accessed 26 May 2012.
  46. 46.
    Anon. Honor roll for patient safety. Published by the Immunization Action Coalition. Reviewed on May 18, 2012. URL: http://www.immunize.org/honor-roll/influenza-mandates.asp. Accessed 26 May 2012.
  47. 47.
    Hollmeyer HG, Hayden F, Poland G, Buchholz U. Influenza vaccination of health care workers in hospitals—A review of studies on attitudes and predictors (Review). Vaccine. 2009;27(30):3935–44.PubMedCrossRefGoogle Scholar
  48. 48.
    Quan K, Tehrani DM, Dickey L, et al. Voluntary to mandatory: evolution of strategies and attitudes toward influenza vaccination of healthcare personnel. Infect Control Hosp Epidemiol. 2012;33(1):63–70.PubMedCrossRefGoogle Scholar
  49. 49.
    Babcock HM, Gemeinhart N, Jones M, et al. Mandatory influenza vaccination of health care workers: translating policy to practice. Clin Infect Dis. 2010;50:459–64.PubMedCrossRefGoogle Scholar
  50. 50.
    Abigale L, Ottenberg JT, Wu GA, et al. Vaccinating health care workers against influenza: the ethical and legal rationale for a mandate. AJPH. 2011;101(2):212–6.CrossRefGoogle Scholar
  51. 51.
    Hartocollis A, Chan S. Flu vaccine requirement for healthcare workers is lifted. New York Times. October 23, 2009. URL: http://www.nytimes.com/2009/10/23/nyregion/23flu.html?_r=1. Accessed 27 May 2012.
  52. 52.
    Salmon DA, Teret SP, MacIntyre CR, et al. Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future. Lancet. 2006;367:436–42.PubMedCrossRefGoogle Scholar
  53. 53.
    Anon. Vaccine exemptions. Published by the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health. Last updated August 11, 2011. URL: http://www.vaccinesafety.edu/cc-exem.htm. Accessed 28 May 2012.
  54. 54.
    Anon. States with religious and philosophical exemptions from school immunization requirements. Published by the National Conference of State Legislatures. Last updated February 2012. URL: http://www.ncsl.org/issues-research/health/school-immunization-exemption-state-laws.aspx. Accessed 28 May 2012.
  55. 55.
    Anon. Immunization Legislation Tracking: ASTHO Immunization Legislation Resources. Published by the Association of State and Territorial Health Officials. Last updated on May 9, 2012. URL: http://www.astho.org/Programs/Immunization/Immunization-Legislation-Tracking/Main/. Accessed 28 May 2012.
  56. 56.
    Salmon DA, Sapsin JW, Teret S, et al. Draft Exemption. Published on the Johns Hopkins Bloomberg School of Public Health website. Last updated February 08, 2012. URL: http://www.vaccinesafety.edu/DraftExemption.htm. Accessed 29 May 2012.
  57. 57.
    Anon. Changes to school and childcare immunization exemptions. Published by the Washington State Department of Health. URL: http://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/Exemptions.aspx. Accessed 20 Oct 2012.
  58. 58.
    Yang YT, Debold V. State vaccination requirements and exemption laws. Database housed at Public Health Law Research Program, Temple University (A national program of the Robert Wood Johnson Foundation). Published December 15, 2011. URL: http://publichealthlawresearch.org/data-set/state-vaccination-requirements-and-exemption-laws. Accessed 31 May 2012.
  59. 59.
    HealthCare.gov. Key features of the Affordable Care Act, by Year. Website managed by the U.S. Department of Health & Human Services. URL: http://www.healthcare.gov/law/timeline/full.html. Accessed 3 June 2012.
  60. 60.
    HealthCare.gov. The Affordable Care Act’s Prevention and Public Health Fund in Your State. Website managed by the U.S. Department of Health & Human Services. Last updated February 14, 2012. URL: http://www.healthcare.gov/news/factsheets/2011/02/prevention02092011a.html. Accessed 3 June 2012.
  61. 61.
    American Bar Association. Health care and the high court. In: Hawke (ed). Preview of United States Supreme Court Cases (Special Edition). 2012. URL: http://www.americanbar.org/content/dam/aba/publications/supreme_court_preview/preview-healthcare.authcheckdam.pdf. Accessed 3 June 2010.
  62. 62.
    Anon. Public Health Prevention Fund at center of partisan clash on student loans. Kaiser Health News. 2012 April 27. URL: http://www.kaiserhealthnews.org/Daily-Reports/2012/April/27/prevention-fund-and-student-loans.aspx. Accessed 3 June 2012.

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Pharmacy Practice, School of Pharmacy and Health ProfessionsCreighton UniversityOmahaUSA

Personalised recommendations