According to Jason McDonald, a spokesman for the CDC, "if you are unvaccinated and you come in contact with measles, there's a 90% change you will get it" (Sifferlin). Approximately, 1 in 10 children are not protected against infectious diseases through vaccinations (Daley and Glanz). With vaccine preventable diseases on the rise, there is a strong correlation between the current amount of infectious disease outbreaks and the lack of vaccinated children. Due to a combination of religious principles, previous falsified research, and questionable health risks, parents are apprehensive to vaccinate their children. 

Over the past ten years, there have been major multistate outbreaks of the worst vaccine preventable disease: measles, mumps, whooping cough, and chicken pox.  These four diseases spread like wild fire. Once one person gets infected, it is difficult to stop the spread or identify the source. The most dangerous and contagious disease, measles, is identifiable by a large, red splotchy rash and is accompanied by a dry cough and cold like symptoms (Sifferlin). Though these symptoms do not sound dangerous, cases of measles have caused deaths. Alexandra Sifferlin, TIME writer, stated in her article, "4 Diseases Making a Comeback Thanks to Anti-Vaxxers", that "on average, there are about 60 cases reported in the U.S. every year". Most recently, an outbreak of measles that began at Disneyland in California has added 52 cases of measles to the state of California alone (Almasy). Similar outbreaks of mumps, chicken pox, and whooping cough, have originated from unvaccinated children; the 2013 California whooping cough outbreak and the 2012 chicken pox outbreak both emerged from a singular unvaccinated child. If those two children had been injected with vaccines that are 90% effective, outbreaks that affected more than 9,080 people could have been prevented (Sifferlin). Parents fail to consider others or think about the bigger picture when choosing whether or not to vaccinate their child; vaccinating their child could prevent thousands of others from getting infected. 

Less known, mumps outbreaks are prevalent among college campuses. Why? Students studying abroad return to the United States with not only souvenirs and great memories, but also with the vaccine preventable mumps virus. From 2011-2014, 67 mumps cases were reported at Ohio State University, University of California at Berkeley, and Loyola University Maryland (Sifferlin). According to the Centers for Disease Control and Prevention in their factsheet on mumps, "before the U.S. mumps vaccination program started in 1967, about 186,000 cases were reported each year" and "since the pre-vaccine era, there has been more than 99% decrease in mumps cases in the United States" (CDC). This fact aids to prove that the introduction of vaccines has dramatically reduced the amount of infectious disease cases in the United States. Now that cases are not common, a child vaccination goal of 100% coverage is crucial in order to prevent random spurts of outbreaks. 

Religious or even personal principles account for a portion of parents that choose not to vaccinate their children. Unlike parental fears over Autism or other health risks, parents that put off vaccination due to religious or personal objection against vaccinations can receive an exemption that gives their children immunity from the required school vaccinations. Out of the fifty states, "[all] forty-eight [continental] states allow exemptions to vaccination for religious reasons" (The College of Physicians of Philadelphia). This number will soon change in the middle of 2016; California will stop accepting this exemption due to the Disneyland measles outbreak. Although parents use religious objections as a reason not to vaccinate, the mainstream religions such as Hinduism, Buddhism, Jainism, Judaism, Christianity, Amish, Christian Scientists, Jehovah's Witnesses, and Islam, have no recorded documentation or statement against the use of vaccinations. As a matter of fact, most of these religions are accepting and even endorse certain vaccines. The only prevalent religion that has spoken out against vaccines is the Dutch Reformed Church. In the Netherlands, the Dutch Reformed Church community experienced a 1,226 case measles outbreak in 2013 (Arizona Partnership for Immunization). In special circumstances, parents with personal belief opposition can receive a state granted exemption similar to a religious exemption. These parents must submit a form to their school district stating their personal objection, and in Washington, parents must explain the objection to a health care provider (Arizona Partnership for Immunization). Unless there is specific evidence, which there is no evidence from the religious angle, parents should not be able to use religious objection as a way to escape vaccinations. 

Fear of autism accounts for the largest majority of anti vaccine parents. The idea that vaccines caused autism originated from a fraudulent study by Andrew Wakefield in 1998; however, from 1999 to the present, research has fully shown that there is no connection between vaccines and autism (Daley and Glanz). In a TedTalk "Autism-what we know (and what we don't know yet)" by Wendy Chung, Chung states that one of the ingredients in vaccinations that were believed to cause autism was removed from vaccinations in 1992. In Lauren Mechling's in "What We Know About Autism: Separating the Science From the Scandal", Mechling provides a quote from Eric Hollander, MD, director of the Autism and Obsessive Compulsive Spectrum Program and a professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine and Montefiore Medical Center in New York: "It's positively clear there is no relationship between the vaccine and autism" (Mechling).  In another article by Susan Brink "One Thing We Know about Autism: Vaccines Aren't to Blame", Brink includes comments from Paul Offit, a doctor, who says that this debate should no longer continue, but people fail to accept the facts (Brink). Many doctors and research have confirmed that vaccines do not cause autism. There has been a rise in the numbers of children with autism, but vaccines are not to blame. The cause of the autism spike is not for sure known, but genetics can be looked at as a contributing factor to autism. The older the parents, the more risk of genetic defects in children. However, genetic factors are not the only thing being looked at as a cause of autism; both a combination of genetics and environmental factors such as air pollution could potentially be the cause of autism (Brink). Parents who believe in the Autism vaccination myth should do further research on Autism itself; informed parents understand that the cause of autism is unknown. 

Besides autism, parents are also concerned about other health risks that come with vaccinations. Parents have made the argument that the vaccination schedule as well as the ingredients in a vaccine can create health risks for a child. The essay "The Childhood Vaccine Schedule Is Unsafe" by Neil Z. Miller exposes the potential dangers of injecting babies with multiple vaccinations at one time (Miller). Miller lists and describes the nine ingredients of vaccines; each ingredient contains toxins that are not beneficial to the body. Miller then goes on to explain how the amount of vaccines that babies are injected with during their first months of life is harmful and unnecessary; babies are injected with this amount of drugs to provide convenience to the parents (Miller). Occasionally, children suffer from adverse effects of multiple vaccinations, which result in injury or even death. In "The A.A.P. Has a New Vaccine Schedule. Will You Follow It", Dell' Antonia examines The American Academy of Pediatrics answer to parents' concerns over the vaccine schedule for children. Many parents refuse to vaccinate their child due to the amount of toxins that are injected at one time. To counter this, the American Academy of Pediatrics has come out with an alternative vaccine schedule. Vaccine schedules are crucial to the fight against infectious diseases. A schedule must be tested vigorously before it can be put out to the public, since vaccines have the ability to counteract against each other. 

The importance of a 100 percent vaccination coverage rate is outlined through the concept of herd immunity. Doctor Romi Libster, in her TedTalk "The Power of Herd Immunity", explains how herd immunity through vaccination protects a whole community. Libster provides an example of a city to begin her explanation as to how herd immunity works; essentially, if just one individual gets sick, they can spread this infection from person to person and therefore infect an entire community (Libster). Vaccinations prevent this. The only way to achieve herd immunity is by having a community vaccinated in a threshold percentage meaning a certain number of the percentage must be above the threshold number to prevent an outbreak. Libster goes on to counter the vaccinations cause adverse effects argument by stating that the benefits outweigh the complications. Libster ends with giving a personal anecdote about how a large outbreak was stopped in her town thanks to vaccines. In an article "U.S. Vaccination Rates High, but Pockets of Unvaccinated Pose Risk", Julie Steenhusen discusses how pockets of unvaccinated kindergarten age children pose a large public health issue. Director of the National Center for Immunization and Respiratory Diseases area of the CDC, Dr. Anne Schuchat comments on how communities with unvaccinated children are exposed to outbreaks of disease (Libster). In order to be enrolled in school, children must follow the vaccination schedule mandatory in all states. Vaccination coverage data has become a helpful tool in figuring out what states hold the highest and lowest rates of vaccination. Using this data, areas with low vaccination areas can take extra steps to get a larger coverage area. 

After the measles outbreak in Disneyland California, states are starting to change their legislature to prevent exemptions and progress towards a greater vaccination coverage area. In the CNN article, "California Vaccine Bill Would Ban Belief Exceptions", by Michael Martinez and Amanda Watts outlines the main points of the California Vaccine Bill. This bill would prevent a family's personal and religious beliefs as an exemption from vaccinating their children. In the event a parent does not vaccinate their child, the child would have to either be home-schooled or participate in a different homeschooling option like a multifamily private home school, or a public school's independent study (Martinez & Watts). As a whole the bill would give parents little options to how they want to educate their child, which is ethically debatable. The outbreak in Disneyland can be attributed to the lack of people vaccinated in California, which causes small outbreaks to turn into larger, more dangerous ones. California is not the only state to deny the personal belief restriction; there are approximately 32 other states that agree.

The positive message of vaccinations needs to be spread to parents early on before it negatively affects children. The article "Straight Talk about Vaccination" by Matthew F. Daley and Jason M. Glanz focuses on child vaccination and why parents should be educated on vaccinations before their child is born. According to Daley and Glanz, "right now pediatricians typically bring up the need for vaccines during the well-baby checkup held about two months after birth" (Daley and Glanz). In this checkup time, roughly six shots need to be scheduled for the infant. However, the conversation about vaccinating a child should begin earlier, even before pregnancy, to ensure that the parent receives the proper information to make the decision.  

Doctors are not the only health care providers that should be informing parents on vaccinations. Nurse practitioners are important people in the process and are starting to become well versed on vaccinations. Victoria Lynn Anderson in her informational article "Promoting Childhood Immunizations" discusses how nurse practitioners can ease parents' view on vaccines by providing them with evidence-based information. The article begins with a brief overview on the history of vaccines as well as the issues that parents have with vaccines for their children. Anderson provides tables of evidence that outline the difference in numbers for vaccine preventable diseases in years 1950-1911 to present; these tables show that cases of vaccine preventable diseases have gone down in number once vaccines were introduced (Anderson). Later in the article, Anderson answers the mostly common asked questions by parents to practitioners. These questions range from how effective vaccines are to what ingredients are in vaccines. Each answer to these questions is backed with scientific evidence. Anderson includes sources from 1900 to 2014, which adds to the credibility of her article. Since the article is unbiased and strictly informative, Anderson's article should be distributed to parents as a guide; all of their questions would be answered in the article. The time that parents have with their doctors is slim, therefore parents could receive the packet prior to the meeting and then any further questions could be discussed with the doctor. 

Currently, the topic of vaccinations has come to light due to the pulling of the anti-vaccination documentary, Vaxxed: From Cover-Up to Catastrophe, from the Tribeca Film Festival. The documentary claims to have discovered a link between vaccines and autism as well as claim that the government and CDC have been covering up information supporting his link. In a report on the topic, the Guardian stated that the "the controversial film was directed by Andrew Wakefield" who was the doctor that first, reported a link between autism and vaccines (Yuhas). The study got retracted and Wakefield's medical license was stripped. In an effort to clear his name, Wakefield directed the film. Has Wakefield been credible this entire time? Although the film was stripped from the Tribeca Film Festival schedule, Vaxxed premiered in New York City on April 1st. Following the release, there is sure to be discussion and further research on the claims Wakefield and other doctors make in the film.  

After heavily researching every aspect of vaccinations, the fears and potential health risks towards vaccines does not outweigh the consequences of not receiving a vaccine. The main change that can be made to increase the vaccination coverage area is to inform parents during pregnancy rather than at the two-month well baby check up. Both doctors and nurse practitioners should be well informed on everything involving vaccinations in order to be able to answer nervous parents' questions. Specifically for nurse practitioners, an information session should be required for them to attend that covers vaccinations; the informational article by Victoria Lynn Anderson should be used as a guide in the information session and given to the practitioners at the end as a reference tool. Fraudulent research, such as Andrew Wakefield's should continue to be suppressed to prevent false information from reaching parents; in order to progress towards a 100 percent vaccination coverage area in the United States, potential and worried parents should not view documentaries such as Vaxxed that are filled with faulty information and bias. Instead, parents should be reading an article like Anderson's that contains only specific scientific evidence. Compared to how the public viewed vaccinations at the time of Wakefield's study, the public view has changed dramatically. There are more supporters of vaccinations and over the coming years, the supporters will continue to grow. 

