 In the last century, the general health and life expectancies of human beings has drastically improved. This is due to the better understanding of how the body works, what exactly poses a threat to us, and how to deal with and treat disease. One major revolution in public health over the last hundred years has been the process of vaccination. Vaccination originated in 1796 and is defined as " ... a biological preparation that improves immunity to a particular disease" (Schor, 90). Vaccines are a form of disease prevention, and one that has had great success throughout history. Once common, and possibly deadly diseases are no longer a part of the modern day world due to vaccination. People are living longer, leading healthier lives, and stopping the spread of pathogens due to vaccination. Although it seems like there are only benefits to being vaccinated, some people don't believe they are as beneficial as they are made out to be. Some parents refuse to vaccinate their children because they believe the vaccine is going to harm rather than help their children. This has caused a great debate: Should vaccination be mandatory, or should there be choice involved? Many believe that there are too many benefits to vaccination, and the only exemptions should be medically based. Others believe that they should have a say in whether they or their child receives vaccinations and when. Due to the fact that there are so many benefits to vaccination, and that many of the claims that they are harmful are based off of opinion or incorrect science, people shouldn't be able to exempt themselves or their children from vaccination schedules, unless medically necessary, for the benefit of public health.

An important thing to know when determining the value of vaccination in a society is how the immune system works when you are sick and how vaccines interact with the body. When a microbe, or pathogen, enter the body, the immune system identifies the pathogen and creates the appropriate cells to fight and kill the pathogen. This is known as an immune response and signs that it is occurring include a fever, aches, coughing, sneezing, and similar symptoms. After the initial immune response, the adaptive immune response takes place. This is when T-cells and B-cells fight off the pathogen, but also record information about them, allowing for easy recognition should the pathogen ever enter the body again (TEDEducation). This simple recognition allows the body to easily fight off the pathogen if you were to encounter it again, so easily that you often don't feel symptoms of the disease after the initial encounter.

 Like it was previously mentioned, vaccines are injections with weakened or killed pathogens that enter the body. "The agent stimulates the body's immune system to recognize the agent as foreign, destroy it and remember it so that the immune system can more readily recognize and destroy any of these organisms that it later encounters" (Schor, 90). Vaccines allow for the adaptive immune system to develop immunity to a pathogen, but doesn't expose the person to the full strength version of the disease. The three main type of vaccines used in this manor are live attenuated vaccines: vaccines that are made of the weakened version of a pathogen, inactive vaccines: made with a dead version of the pathogen, and subunit vaccines: vaccines made with only the antigen of a pathogen (TEDEducation). The antigen is the part of the pathogen that triggers the immune response in the body. This allows for an immunity to be developed, but no form of the pathogen would enter the body (TEDEducation). All three types of vaccine allow for an immune response to occur, without the disease itself occurring. Thus, an immunity is formed.

Disease prevention is the main reason that vaccines are beneficial to a society. Diseases such a polio, measles, mumps, rubella and more that were once major concerns in the past are no longer a worry due to vaccines. One example of a serious disease eradicated by vaccination is smallpox. Smallpox is a serious, sometimes fatal viral disease that is very contagious. Symptoms include a painful rash and large pus filled blisters that form during infection (Smallpox). When smallpox was still prevalent, there as no treatment or cure. "Between 1900 and 1904, just prior to the advent of a smallpox vaccination program in the United States, there were 48,164 cases of smallpox in the US alone. There have been no cases in the United States since 1950, and none in the world since 1977" (Ferrance,169). Similar statistics can be seen when looking at the effects of vaccination on other diseases, like polio. "In the early 1950's, the United States averaged 16,316 cases of paralytic polio per year. With the advent of first the Salk and then the Sabin vaccines, we have now been polio free in North America for several years, and the end of Polio on planet Earth is likely only a few more years away" (Ferrance, 169). Without wide spread vaccination, smallpox, polio, and other diseases wouldn't have been totally eradicated, and we would still be dealing with them today. People would be living shorter lives and many would have to deal with these terrible diseases. Vaccination is necessary so that we don't bring back these eradicated diseases and can live more pleasurable lives without the threat of disease and death. 

Perhaps the most important reason why vaccination should be necessary is that vaccination creates herd immunity in a society. Herd immunity is when the majority of a population is immune to a disease, so those who are not immune never come into contact with the disease themselves (The Power of Herd Immunity).  Some people aren't able to receive vaccination due to being allergic to a certain ingredient in the vaccine, a very weak immune system, they are too young or old, or other reasons. Or due to the fact that vaccines are not 100% effective all the time, someone who received a vaccine may not be immune to the disease they were vaccinated for (The Power of Herd Immunity). These people don't have the benefit of being immune and are susceptible to contracting vaccine preventable diseases at no fault of their own. Herd immunity is how these people can be kept safe from these diseases. In order for herd immunity to exist, a certain amount of the population needs to be immune. If this percent of the population, or threshold, isn't reached, a community does not have herd immunity and those who are not immune run the risk of getting sick. The threshold is dependent upon different characteristics of both the disease and the immune response created by the vaccine, meaning that it is different for every disease (The Power of Herd Immunity). For herd immunity to exist, as many people as possible need to be vaccinated to ensure that this threshold is reached and that people will be safe, vaccinated or not. This is the main reason that there should be no vaccination exemptions, other than for medical reasons. This ensures that enough of the population is immune and that the threshold is achieved. It's one thing if not being vaccinated only impacted yourself, but there are too many people in society who rely on another person's immunity to keep them safe from potentially deadly diseases for people to be skipping on vaccinations.

An additional reason people shouldn't be exempt from vaccination is that there are many other benefits other than just prevention for the one disease the vaccination was created for. There are social and economic benefits that occur as most of a population is vaccinated. This is easier to see when countries that don't have high vaccinated population introduce more vaccines to more of the population. When Brazil, The Russian Federation, India, China, and South Africa increased the amount of vaccines administered to children, the effects were very visible. Not only did the amount of disease in children decrease, but less money was being spent by hospitals and patients for treatments, 21 million USD in India alone (Mirelman, 455). Vaccination in these countries also led to improved health, aided in cognitive development, educational attainment and labor productivity (Mirelman, 455). These benefits in individuals help create a better, safer, and healthier society overall. People are also living longer, healthier lives. This enables them to contribute more to society for a longer period of time than when vaccines weren't administered. Many vaccines also have non-specific effects in the body, which means they impact the body in other, beneficial, ways that just how they were intended to impact the body. Improving the body's immunity against one disease can help it to become immune to other diseases too (Schor, 90). Edward Jenner was the first person to try and create a vaccine using the pathogen itself. He injected the smallpox pathogen into a child, who then became immune to the disease (TEDEducation). It was later discovered that this vaccine also healed other parts of the body, like irritating skin rashes (Schor, 90). Administering vaccines helps someone become a healthier human being in more ways then just what the vaccine was intended to do.

Although tested and proved to be effective, many people don't agree with vaccination for many reasons. Doctors M. Daley and J. Glanz report the three top reasons why parents don't want their children vaccinated in their article Straight Talk About Vaccination. "Some do not believe their children are at risk for diseases such as polio, measles and tetanus, which are now rarely seen in the U.S. Others do not believe that certain vaccine-preventable diseases, such as chicken pox and measles, are particularly serious. And many worry about the safety of vaccines. The concerns may be about immediate, well-defined side effects such as fever or may take the form of anxiety that vaccines might harm the immune system or cause chronic diseases years later" (Daley, Glanz, 33). Vaccines contain chemicals and other ingredients, not just the pathogen itself. Many people believe these chemicals shouldn't be injected into the human body, and that there are side effects to human health when they are. Examples of some of the different chemicals and ingredients found in the  DTaP-HebB-IPV vaccine, which prevents  diphtheria, tetanus, pertussis, all known subtypes of  hepatitis B virus, and 3 types of poliomyelitis, are formaldehyde, glutaraldehyde, aluminum hydroxide, aluminum phosphate, lactalbumin hydrolysate, polysorbate 80, neomycin sulfate, polymyxin B, yeast protein, calf serum, Fenton medium (containing bovine extract), modified Latham medium (derived from bovine casein), modified Stainer-Scholte liquid medium, and Vero (monkey kidney) cells (Campbell,8-9). Many people also believe that vaccines, the measles, mumps, and rubella (MMR) vaccine in particular, lead to autism. Because of this information, many people believe that vaccination should be choice and that exemptions are necessary to protect that choice.

 Although most schools require certain immunizations before attendance, there are certain exemptions that exist for certain people. Medical exemption is fairly common, and necessary. People who cannot receive vaccines to remain healthy shouldn't be required to receive the vaccination. In this case, medical exemptions make perfect sense and help protect the health of those participating. The two other exemptions that exist in the United States are for religious reasons, and personal belief exemptions. As of right now, fifty states allow for medical exemption, forty-eight allow for religious exemption, and twenty states allow for personal belief exemptions (Vaccination). All of the above reasons fall into the personal belief category of exemptions, so people are allowed to skip on vaccinations if they believe these to be true.

Although every parent is obviously trying to do what is best for their child and their own health, vaccine exemptions for personal beliefs are not the way to do that. There are many diseases that people will not be exposed to, so it may make sense to skip on certain vaccines. However, should these diseases reappear, or if someone were to travel to an area where they still exist, they will have absolutely no immunity to it and they will get sick. When it comes to diseases that older generations lived through but we have vaccines for now, it may appear not necessary to vaccinate against them and just have the individual stick it out. However, vaccination is still important and necessary because certain diseases, like chicken pox, can be very dangerous later in life if one does not get it as a child. Also, someone who has chicken pox also has the shingles virus living inside of them, and that can appear anytime throughout your adult life (Chickenpox). The chicken pox vaccine is essential to making sure you don't run the risk of developing chicken pox too late in life, and allows you to avoid shingles too. In regard to vaccination side effects and causing conditions like autism, many of those clams are false. Typical side effects of vaccines are swelling at the injection sight and a mild fever (Daley,32). Other side effects may be due to an allergic reaction to something present in the vaccine, which in that case a medical exemption should be taken. Also, "a study has shown that children who received the MMR and had autistic older siblings were no more likely to develop autism than children who were vaccinated and didn't have any autistic older siblings. In fact, the relative risk of autism among those with older autistic brothers or sisters was lower if they were vaccinated compared with those who were not vaccinated " (Park). This study was made in response to the information that many parents were reluctant to vaccinate their younger children after learning that the older sibling has autism. 

Most, if not all, of the reasons people have come up with to exempt themselves from vaccinations can be proven to be incorrect. In reality the risk involved in getting a vaccine is much less than the risk of contracting the disease and spreading it to others. So, although skipping out on vaccines isn't a good idea, perhaps reform in the vaccination industry is needed. The vaccination industry is an industry that is worth billions. Also, vaccine companies don't have to pay for anything going wrong if the government requires the specific vaccine, even if the fault was the company's (Campbell,8). Knowing this makes it easier to understand why some people have hesitation toward getting vaccinated. This combined with the largely inaccurate information that is being spread, show vaccines in a negative light. In order to get more of the public vaccinated, people need to become more educated on what vaccines are and how they work, and pharmaceutical companies need to take a more responsibly for their product.

At the moment there is work being done in the United States to ensure that less people are being exempt from vaccination based on personal opinions. There is also work being done to ensure that legislation about vaccination is based upon scientific fact, not opinion. "Evidence-based vaccine policymaking aims to control communicable disease by urging decision makers to base policies on the best available evidence rather than politics or personal views. The results of this approach, such as smallpox eradication, have been dramatic" (Orenstein, Yang, 99).  Although it may sound harsh to limit people's choice when it comes to disease prevention, it is the best decision for public health. Progress is being made through legislation passed in each individual state. "Washington, Oregon, and California now require persons seeking non-medical exemption to obtain the signature of a health care professional attesting to discussion of the benefits and risks of vaccination and non-vaccination" (Orenstein, Yang, 101). This ensures that people are made aware of exactly what they are doing, and may even change their minds when they hear the correct facts about vaccines.

The issue of vaccination exemption is important in society because it truly impacts everyone. Everyone is susceptible to disease and everyone can potentially be immune to them too. However, when people chose not to vaccinate themselves or their children, they are putting themselves and the community they live in at risk. As more and more people chose not to vaccinate, the chances on individuals getting sick increases, along with the chances of diseases that haven't been seen in years returning. As more and more people aren't immune, the work that has been done to preserve public health in the last century becomes undone. This isn't just a personal problem that only impacts the individual, but rather society as whole. It's important that people are correctly educated and know the facts instead of believing false information that leads to them not getting vaccinated. Vaccination is definitely one of the best medical advancements of the last century, and has contributed to society in many positive ways. It has saved countless lives and has even eradicated certain diseases from the planet. Money is being saved and people are leading healthier and more fulfilling lives. This is why vaccination is essential, and necessary, for a society. 

