IHP 610 9-1 Project Two
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9-1 PROJECT TWO
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9-1 Project: Project Two
Adam Mirkin
Southern New Hampshire University
IHP 610: Health Policy and Law
Dr. James Dockins
November 19, 2023
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Introduction
Health Policy Issue
Vaccinations for adults worldwide became a hot topic in healthcare within the last several
years as the COVID-19 vaccine came to fruition and was implementing on a fast track, with a
large amount vaccine hesitancy present. Once individuals reach adulthood at 18, they are able to
opt in or out of vaccination as they wish, for any number of reasons, and are also able to block
their children from receiving them. In certain situations and within certain groups, primarily
those with professional licensures, the vaccine may in fact be mandated by their regulating body.
The reason for specifically mentioning the COVID vaccine in this conversation would be that it
is far and away the most recent example, and the misinformation about the vaccine as well as the
illness led to a high degree of confusion and uncertainty. On the other hand, it is unquestionably
certain the immunizations in adult for things like the flu, pneumonia, and even shingles has led to
an increased individual and herd immunity among the vaccinated population.
Stakeholders Impacted
Those stakeholders who experience some level of impact due to the hesitancy of adults to
receive vaccines start with employees of public health care agencies as they will likely be the
main advocates for vaccinations and providers of education for the general public. Additionally,
those who have contracted or are vulnerable to contracting these diseased would be impacted, as
a simple vaccination could have prevented the disease of limited its strengths.
Influence on Decision Making
Stakeholder Needs
When considered the needs and goals of public health organizations and those affiliated
with them, it is clear that their interest is in the highest percentage of vaccinated adults as
possible. As the number increases, society gets closer to achieving herd immunity, a state where
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the public as a whole becomes less susceptible to contracting a disease due to a high level of
immunity (APIC, 2021). Some diseases are less contagious and, in these cases, a lower level of
immunization would be acceptable in achieving herd immunity. This would greatly lower the
potential risk of a community experiencing an outbreak, which would be considered to be an
urgent public health crisis. A lower overall contraction rate is much better for a community, as
healthy communities are more productive in addition to being safer. Pollard & Bijker (2021) put
forth a 95% vaccination rate as the benchmark for achieving herd immunity in a given
community. While this is a goal, there are often reasons that this number is not reached every
time, but getting as close to 95% as possible will provide a great deal of aid in achieving public
health goals. The rise of COVID-19 led to the presence of vaccine requirements among some
employers and health agencies. Although there was a list of exemption reasons, adherence to this
policy has the end result of establishing a healthier community.
Some communities are designated as underserved similarly to some populations being
considered vulnerable. In the case of adult vaccinations, this can be countered by providing
continued education to vulnerable population communities. Additionally, these areas can be
targeted by advocacy groups to enhance the awareness of the need to be immunized (Bach, et al.,
2019). These advocacy groups are quite often the only means of public health education that
some communities receive, and a higher level of education and awareness often cause and
improvement in the quality of healthcare decisions made by a community.
Health Policy Influence
Those who have influence in vaccination policy without experiencing any direct financial
impact is limited to the public health agencies, governmental and otherwise, legislators and other
policy makers, and the individuals utilizing health services. In this situation, stakeholders such as
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doctors, hospitals, and pharmaceutical companies would need to be excluded, as they do derive
some of their financial well-being from producing or providing immunizations.
Benefits and Disadvantages
When it comes to increasing vaccine prevalence and awareness, all potential stakeholder
groups will see benefit from increased adult immunization rates. Healthcare providers and
organizations will experience a lowered incidence rate of disease in their area. While some
employees of companies requiring immunization may face some additional strain initially, the
end result will also be moving closer to achieving herd immunity in their community (Sarkis,
2019). Since herd immunity is a net positive for any community and/or population, those groups
who see increased immunization as a drawback would be limited. The primary group in this
scenario could potentially be those in an underserved population, as their general lack of
information and knowledge could lead to them remaining unvaccinated and at risk.
Value Conflict Analysis
Conflicts may arise among groups and subgroups whose ideas and beliefs regarding
vaccination policy and its implementation. There are some groups, including some religious
sects, who operate under the belief that they have the right to make the choices related to their
own health without any regulations infringing on such. For these groups, mandatory vaccination
has become a rallying cry for individual healthcare autonomy without their being any reason to
give up this independence. When encountering these groups, it may be most useful to focus on
education in other areas to see a greater gain in public health metrics.
General Decision Making
Policymakers are definitively able to have their decision making influenced by varying
groups of stakeholders. Those who work in public health analysis are able to provide key
policymakers with data gleaned from research projects. In no uncertain terms, this data confirms
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the facts on the front lines and provides those in charge with data related to individual’s with a
stake in the process, to determine potential courses of action. One data point looms large when
considering vaccination, with that being the infection rates in the unvaccinated in concert with
the increased risk of spreading disease by avoiding vaccination. Even though it is not a direct
financial effect, the vaccination rate can cause a change in infection rate as the two points are
directly correlated with each other.
Influence on Financial Practices
Stakeholder Needs
Regarding the issue of increasing the awareness and rate of adult vaccinations, the
primary issue putting stakeholders at risk would usually be individuals choosing to decline these
injections out of choice/preference as opposed to a legitimate medical reason. For his reason, as
well as others for the sake of improved public health, it would be beneficial for immunization
levels to increase. The primary list of stakeholders is exceedingly long, and the primary
inclusions within the list are wide ranging. The most directly affected would be those who are
involved in public and/or private health are practices, the other persons present in such an
environment, obviously the patients themselves, and finally the numerous secondary contacts of
these individuals who may contract a preventable illness. For those who do work in health care
facilities, the need is very real as there are possible scenarios which could potentially result in
being out of work for a long period or, still worse, an in-house epidemic that could make a
facility or practice inoperable for a time (Burki, 2021). It largely goes without saying that an
inordinate financial burden would be placed on those affected.
As far as potential vaccine recipients go, there would likely be great benefit in providing
some sort of financial incentive to those who are willing to move forward with immunization.
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Particularly in areas with a more financially depressed population, these additional funds could
be viewed as a windfall and help with some day to day needs but also potentially overcome some
previously existing barriers to receiving effective preventative and reactive care. Additionally,
the most important result from vaccinating these populations would potentially reduce both the
infection and mortality rates, which would have a snowball effect and reduce the burden on a
strained health care environment (Burki, 2021). Practitioners willing to relocate to these
communities would also alleviate the infection risk they face in the more populated areas.
Financial Influence
When considering the strongest potential wielder of influence on the previously
mentioned stakeholders, governmental actors will likely fill that role. All branches and agencies
of the government, combined, have the greatest influence on the development and
implementation of regulatory and legislative actions related to health care. On a federal level, the
FDA is almost wholly responsible for the testing and approval of new treatments, including the
vaccinations mentioned in this discussion. In concert with the CDC, the FDA builds and shapes
policy initiatives geared towards improving awareness of and access to new health care methods
and practices in areas that would be considered underserved and largely marginalized. The key
item attached to these initiatives is the funding needed to incentivize their widespread acceptance
and implementation and prioritizing the necessary areas could lead to a higher adoption rate for
vaccines with the possibility of this feeding into additional efforts. In creating this financial
incentive initiatives, the federal government would need to collaborate closely with individual
states to coordinate these efforts and the allocation of funds to ensure that the program is
implemented in a way that meets their goals. (Institute of Medicine, n.d.). Secondary
stakeholders who would see financial benefit would be healthcare providers who are able to treat
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a greater variety of conditions rather than focusing on illnesses which do have approved
vaccines, as well as the overall economic system as employers would no longer lose work days
to preventable illnesses.
Benefits and Disadvantages
There are far more overall benefits than drawbacks to achieving an increased vaccination
rate. The main beneficiary would be the overall public health and the system it has set up to serve
the population. The proposed financial incentives will be distributed to the manufacturers of the
vaccines, but also spread proportionally throughout the communities who are successfully seeing
an increase in immunization rate (Rodrigues & Plotkin, 2020). The communities affected will
also benefit as a whole, with vaccinations providing an improvement in infection rates as well as
a commensurate effect on the mortality rate. Epidemics would be curbed before they were able to
seriously take hold, while herd immunity would be developed and aid in the overall health of
those who are exempt from certain vaccinations due to potential health risks and/or conflicts in
belief system.
Conversely, there are some potential areas that would see some drawbacks and place
some population segments at a disadvantage if immunization rates do increase. Some employers
may implement stricter vaccination mandates within their workplaces, and those who have
elected to remain unvaccinated will definitely see their risk of unemployment rise. While in most
cases underprivileged and outlying communities are at a natural disadvantage within the health
care system, this would not necessarily be the case with a vaccination program. There would
likely be a sharp increase in auxiliary services designed to provide increased accessibility to
health care services and systems.
Competing Value Conflicts
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When there are situations or issues that have a high level of impact in an area with people
who care deeply about the outcome, there are bound to be value conflicts that crop up. In terms
of public policy, these situations mostly exist when two competing factions strongly believe they
are in the right, while others have the opposing belief that theirs is the right option. Value
conflicts in adult vaccinations can occur due to differing belief systems on either the science or
principle of the vaccination, and sometimes both. In these situations, there is rarely a clear
“winner” as one side will end up dissatisfied and the only viable option is to increase awareness.
Financial Decision Making
When devising methods of implementing financial incentives for individuals to get
vaccinated as well as for health care organizations to encourage patients to receive them,
considering the financial needs of those involved will go a long way towards increasing
motivation. Individuals receiving vaccines will have less hospital bills in the short and long term
as a result of vaccinations, and hospitals will be able to shift focus to providing services with an
increased profit level. On an individual level, the number of vaccinated people will rise in the
event that financial incentives, either direct payments or a gift card giveaway, are provided to
those who are willing to become vaccinated.
Recommendation
Position Statement
It is in the best interest of all stakeholders as well as the population at large to move
forward towards implementation of a broad policy to increase the adult immunization rate. This
initiative would ideally be two-fold, with one side dedicated to increasing the awareness of
vaccinations and their general safety and the other focusing on providing incentives to
individuals and organizations to advocate for this policy’s continued relevance. These efforts will
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be focused on providers recommending vaccinations while providing information on their safety
and utility while also seeking to encourage their patients to recognize that the price of
immunization is almost entirely subsidized by their insurers and/or government agencies. For
populations who are largely underserved and marginalized within the healthcare system, this
program will be strengthened by providing literature and information to them in cultural and
language appropriate formats (AJMC, 2020). This literature should ideally be authored at a
federal and state level to provide a consistent trickle-down of information, and should always be
on the edge of innovation with information specific to both existing vaccines as well as those
currently in development. With the focus squarely on awareness and education, the population
should see an erosion of the immunization barriers with a commensurate increase in vaccination
rate and more timely development of herd immunity.
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References
AJMC. (2020). Vulnerable populations: Who are they? https://www.ajmc.com/view/nov06-
2390ps348-s352/
APIC. (2021). Herd immunity. https://apic.org/monthly_alerts/herd-immunity
Bach, A. T., Kang, A. Y., Lewis, J., Xavier, S., Portillo, I., & Goad, J. A. (2019). Addresssing
common barriers in adult immunizations. Expert review of vaccines, 18(11).
Burki, T. (2021). Challenges in the rollout of Covid-19 vaccines worldwide. The Lancet
Respiratory Medicine, 9(4).
College of Physicians of Philadelphia. (n.d.) Ethical issues and vaccines: Cultural perspectives
on vaccination. https://historyofvaccines.org/vaccines-101/ethical-issues-and-
vaccines/cultural-perspectives-vaccination
Pollard, A. J., & Bijker, E. M. (2021). A guide to vaccinology: from basic principles to new
developments. Nature reviews immunology.
Rodridgues, C., & Plotkin, S. (2020). Impact of vaccines: health and economic perspectives.
https://www.frontiersin.org/articles/10.3389/fmicb.2020.01526
Shen, A. K., & Orenstein, W. (2020). Continued challenges with Medicaid coverage of adult
vaccines and vaccination services. JAMA Network Open, 3(4).