Smallpox is known today as one of the deadliest plagues in the world. Between 1900 and 1979, this disease killed about 300 million people and disabled millions more (Loria, n.p.). Fortunately, Edward Jenner set the stage for a revolution in public health and safety by creating the first vaccine for smallpox. Jenner's discovery and publication allowed the disease to become completely dormant today. Without this step toward population immunity, smallpox would still be an epidemic and our population would greatly suffer. 

After hundreds of years and countless discoveries for immunity, vaccinations are now widely considered one of the biggest scientific improvements in history; however, today in the United States they have become an idea surrounded by myths and the thought they don't matter anymore. Many people forget what vaccinations have done for our health since Edward Jenner's first smallpox vaccine and how much they have impacted public health. Vaccines are critical in maintaining individual and public health; therefore, they should become mandatory. 

Like most science topics, vaccinations are highly controversial. Nonetheless, as stated by Centers for Disease Control and Prevention (CDC), vaccinations "save up to 3 million lives a year around the globe" (Doan, n.p.). Saving lives is what health care is centered around and those 3 million individuals are standing today because of such a monumental invention. Ben Balding, graduate of Harvard Law School, declared "next to clean water, no single invention has had so profound an effect on reducing mortality from childhood diseases as has the widespread introduction of vaccines" (Balding, n.p.). As a result of vaccinations, our society has overcome hundreds of viruses and casualties. This can be seen in Leon Farrant's pre-vaccine and post-vaccine diagram below. It demonstrates how much vaccinations have decreased the morality rate in the United States. Therefore, mandatory vaccinations should be carefully considered. Vaccinations are associated with myths, religious or personal liberty concerns, economic questions and health care professional opinions, but they all point to why vaccinations better the overall health of our population and why herd immunity should be sought after.

Farrant, Leon. Vaccination has eliminated or reduced a wide range of once-common diseases in the U.S. Digital image. Business Insider. 3 Feb. 2015. Web. 3 Apr. 2016. Farrant, Leon. Vaccination has eliminated or reduced a wide range of once-common diseases in the U.S. Digital image. Business Insider. 3 Feb. 2015. Web. 3 Apr. 2016. First, vaccinations are widely considered harmful from myths that have been published and believed by the public. This includes how vaccines cause harmful side effects on patients. In reality, each vaccination is tested thousands of times on humans and over an extended period of time. For example, the rotavirus vaccinations were "tested on 130,000 children" and the human papillomavirus (HPV) was "tested on 30,000 women" and both were watched over a course of 20 years (Szabo, n.p.). 

Another myth adopted by the public involves how vaccinations can cause Autism and the influenza vaccine sometimes causes patients to get the flu. In 1998, a flawed study published in The Lancet established how vaccinations cause children to have Autism. The article was retracted in 2010 by the British Medical Journal for being an "elaborate fraud" and for "deliberately falsifying medical data" (Szabo, n.p.). However, once panic has sunk into the public, it is difficult to rein in. 

In addition, countless people talk about how someone got the flu shot and in return got the flu. These two events are completely unrelated. According to the Centers for Disease Control and Prevention (CDC), the viruses in vaccinations are dead and cannot cause a patient to get sick. On the other hand, FluMist is the nasal spray version of the flu shot and it contains the weakened virus. However, this still cannot cause the flu or flu-like symptoms. This virus strain is specifically engineered to reproduce in the nose where it is administered and cannot duplicate in the lungs to cause influenza. In regards to the vaccine causing the virus, it takes about two weeks for the body to fully develop immunity to the virus and patients typically receive their shot when the flu is already circulating in the population. This allows a gap where someone can catch the virus and get sick, but it is caused from the environment not the flu shot or FluMist itself. 

Overall, Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia, explains how the U.S. Food and Drug Administration (FDA) "requires pharmaceutical companies to prove that their product doesn't pose a threat when added to the existing vaccine schedule" (Szabo, n.p.).  This is proven by the amount of research done on each vaccination and how no vaccine can cause harmful side effects such as Autism or the disease itself.

Furthermore, vaccination exemptions due to religion or philosophical reasons play a negative role in herd immunity. In Ben Balding's Harvard Law School course paper, he explains how "almost every state grants religious exemptions for those with sincere religious beliefs opposing vaccination" (Balding, 1). This grant allows for mandatory vaccinations to not go against First Amendment Free Exercise rights. Despite this, many people take advantage of the exemption and some even take it to a philosophical level when they are not successful in receiving an exemption for religion. 

Some parents, who believe vaccinations have harmful effects and do not want their children receiving them regardless of religious views, oppose vaccinations by only submitting a letter stating the immunization goes against their beliefs. This philosophical exemption frequently occurs in California, where one can easily get out of a required vaccination for public school for example. 

Above all, this causes a danger in herd immunity. Balding explains how exemptions can cause a cluster of people with the same view points about mandatory vaccinations with either religious or philosophical reasons. Having a cluster in a specific geographic area can then lead to a serious outbreak within the small unprotected area. Balding states how clusters of exemptions "pose an increased risk of spread of diseases not only to their immunized peers, but also to the surrounding, largely vaccinated population" (Balding, 11). This demonstrates how vaccinations, when underappreciated, can resurface their deadly viruses in the United States. For example, measles is very rare in the United States, but the World Health Organization reported there was approximately "900,000 measles-related deaths in developing countries" in 1999 (Macdonald, n.p.). Since this virus has not been wiped out on a global scale, the vaccination is still important to protect the public and to not cause pockets in the United States from exemptions which would produce a serious outbreak.

As a matter of fact, there was a measles outbreak in the United States. On January 14, 2015, Disneyland confirmed the measles infection and soon it spread like wildfire to fourteen states. According to the CDC, no source for the outbreak was identified out of the 125 lab-confirmed cases. The CDC also stated "that 12% of the measles cases associated with Disneyland were vaccinated" (Fisher, n.p.). This reveals how many of the people infected did not receive the recommended two measles vaccine doses. In addition, out of the 125 confirmed cases, 110 were California residents. This ratio demonstrates how exemptions, in California in particular, causes pockets in the population where an outbreak can occur like Balding explained. 

As a final point, religious and philosophical exemptions should become more difficult to obtain. One should not be able to avoid an important vaccination without a sincere and authorized reason. Right now in the United States, people are taking advantage of this loop hole for mandatory vaccinations and it is hurting our population's immunity. Those who fully reject vaccinations do not see the big picture that widespread participation in vaccinations is the key to success and everyone needs to appreciate this medical invention to its full potential. By mandating vaccinations, the United States would not have outbreaks such as the one last year in Disneyland and the population could avoid the panic surrounding it.

Vaccinations, not to mention, have multiple positive economic effects on our country. Taking a step back for a second, preventing something from happening seems like a better idea than dealing with it after it occurs. Well, vaccinations should be seen in the same light. It is much cheaper to prevent a virus or disease than fight it off once someone has it. Treating a patient who is sick can be very expensive between medications and hospital staying costs, not to mention the possibility of a disability thus causing difficulties in gaining a steady income. Kevin Loria, Business Insider writer, explains how there was 4.1 million children born in 2009 and how they will save $13.5 billion in health care treatment costs alone when receiving the necessary vaccinations created for a healthy life. Similarly, the CDC expects there to be $63 billion in savings between 2011 and 2020 for health care expenses caused by three popular vaccines: Pneumococcal, Rotavirus and Haemophilus Influezae Type B. Moreover, these three vaccinations are also projected to prevent 102 million illnesses and 3.7 million deaths between the same time period. 

Lastly, hospitals have recently been implementing mandatory vaccinations among healthcare professionals. According to Alexandra Stewart, only 40% of healthcare professionals received the influenza vaccinations between 2004 and 2008. In order for herd immunity to be achieved, the vaccination rate needs to surpass 90%; however, with this low rate of professionals receiving the vaccine, it is more likely for patients to contract influenza. In response to this, the Virginia Mason Hospital, a subdivision of Virginia Mason Medical Center in Seattle, was "the first non-profit hospital to implement a 100 percent staff influenza immunization goal and a fitness for duty requirement as an important patient safety effort to save lives" (Stewart, n.p.). All employees and registered nurses were mandated to receive their vaccinations by the new year in 2005 and if they failed to do so they would be terminated. This situation greatly contrasts to other hospitals in the United States. Hospitals typically provide free face masks and hand cleaner for those who are not already vaccinated. However, these hospitals only have a total of 55% of healthcare professionals who receive the vaccination which greatly falls short of the recommended 90% for herd immunity. 

When this Virginia Mason Hospital broadcasted their new policy, the Washington State Nurses Association (WSNA) claimed it violated personal liberty. The hospital was forced to cancel the program and rehire employees who did not comply with the program before. Conversely, other hospitals around the country have implemented their own mandatory vaccination programs on other terms. As a result, some have reported they have a 99% healthcare professional vaccination rate. For example, this evolution took place at the Rhode Island Department of Health. They made vaccinations mandatory for healthcare professionals who have direct patient contact in 2012. The Service Employees International Union (SEIU) took this Rhode Island policy and announced it was "unconstitutional and impermissible under the National Labor Regulations Act (NLRA) and the Health Insurance Portability and Accountability Act (HIPPA)" (Steward, n.p.). Concerning this, the NLRA protects the rights of a workplace's employees while HIPPA protects patients and their personal information. These two are very strict programs in the healthcare system. Fortunately, when brought to the state court, the policy was found to have "a legitimate interest in preventing the spread of influenza" and the required vaccination protected the safety and well being of the state's citizens (Stewart, n.p.). 

Once healthcare professionals receive the mandatory vaccinations, it prevents transmission of diseases to patients and assists in maintaining the viability of the entire workforce. In this case, legal rights prove to be a challenge in hospitals. However, from past programs such as the Virginia Mason Hospital and Rhode Island Department of Health and developing programs nationwide, state regulations establish how mandatory vaccinations for healthcare employees better the population and how the safety of patients overrides the freedom of choice. 

There are also a handful of programs in place to assist in improving vaccinations that are already on the market. One of these is the Vaccine Adverse Event Reporting System (VAERS). It allows recipients of vaccines to report any issues associated with any vaccine. The major point of this program is to report problems. Once reported, the claims must be investigated and proven to be true. This can sometimes be confused and myths may spread about a particular vaccine from a false claim. However, once data is collected and research is completed, it can be used to alter a vaccine if there is a direct correlation between the vaccine and a harmful effect which is uncommon considering how much testing goes into making a vaccination available for the public.

As previously stated, vaccinations are one of the most important inventions in scientific history. They have saved millions of lives and will continue to do so in the future when used and regulated correctly. As stated by Kevin Loria, "vaccines that remain in the vial are 0% effective" (Loria, n.p.). Vaccines were created and are still used because they are effective and tame viruses. When one does not receive their vaccinations, it has the potential to harm not only themselves and also those around them. Also, Balding explains how "without a mandatory program in place, one would still expect to see regular occurrences of the disease" (Balding, 25). This goes hand in hand with the Disneyland measles outbreak in 2015. If everyone had been vaccinated with the two doses of measles vaccine, there would not have been 125 cases in fourteen different states. 

In addition, people do not understand how important vaccinations are and how they are still needed in order to retain a healthy population. We need to step back and reflect on vaccinations, such as smallpox, and recognize how much they have improved our population. Without Edward Jenner's first vaccine invention and countless vaccinations that followed, our world would be plagued with disease on a daily basis thus increasing the United State's mortality rate. Since so much time has passed since we have seen a major outbreak of almost dormant diseases such as smallpox, our population seems to forget how important it is to continue to receive the vaccinations that prevent them. There is always a possibility these diseases can resurface especially when people are exempted for religious or philosophical reasons, when they are not correctly educated and when clusters of unvaccinated people form and cause outbreaks. 

Overall, vaccines have profoundly improved the quality of life for the entire world. The effectiveness of vaccinations proves how we have evolved as a species and how the benefits of vaccinations remarkably outweigh the negatives. We need to take a stand, as a population, and protect how far we have come. For this generation and future generations, diseases need to stay out of reach and that is only possible if everyone receives the vaccines necessary to maintain herd immunity and a healthy population. 

To be brief, vaccinations need to be appreciated for the huge impact they have over our lives. At arms reach, we have a way to save lives and protect society. This needs to be used to its full potential so nobody has to see a loved one or child suffer from a disease that easily could have been prevented with a simple trip to the doctor. 

