Everyone has memories as a child of sitting in the waiting room of the doctor's office, with clammy hands, waiting to receive their yearly shots. The influenza or commonly known as flu vaccination is optional and not mandated by the government or schools for children to receive at their yearly check up.  The influenza virus is highly contagious because it spreads from salvia and originates in animals such as pigs and wild birds. With that being said, the influenza virus spreads like wild fire through schools, places of work and homes, however, society does not see this virus as a threat. Since the vaccine is optional, people over look the severity of the virus but when the virus is contracted, people can be bed ridden for weeks or even hospitalized. The question is why is the influenza vaccine not mandated in order to keep the public in good health.  If the government's job is to uphold and protect the community, they should begin to implement legislation regarding the influenza vaccine to keep our community safe. In order to protect the country from illness, educating the public on the flu vaccine and putting laws in place for receiving the vaccine is necessary. 

To elaborate on the severity of the influenza virus, the virus is unlike any other virus with symptoms that can cause people to become malnourished and highly contagious. Many complications can arise from the flu such as pneumonia, which can be fatal. According to the CDC, Center for Disease Control, on average over 200,000 cases of hospitalizations due to the influenza virus are reported each year. With the large population size of the United States, 200,000 seems to be a small number however, on average 36,000 of the 200,000 people infected with the influenza virus die because of the virus each year (Berkley). These deaths are entirely preventable and should not happen with proper vaccination and care before flu season arrives. As stated in the article, " Influenza- Associated Hospitalizations in the United States", the majority of the hospitalizations are from "the elderly over the age of 85 and children under the age of 5" (Thompson 1). The hospitalization rate is drastically increasing over the years due to the increased population of elderly people in the United States. Since the influenza virus progresses over time, most of the hospitalizations are due to respiratory infections and pneumonia, which attack the body's immune system, compromising the body's natural ability to fight off the virus. The United States population is not informed of these drastic statistics aiding to the reason why people choose to not be vaccinated. The government's responsibility to the public is to use this information to inform the states, so legislation can be put in place to ensure the population receives the flu vaccine. 

In addition to the hospitalization records, in 2009 a different flu virus strain pandemic struck, commonly known as the "swine flu". It began in Mexico, resulting in the shut down of the city in order to control the viscous spreading of the disease. The World Health Organization declared the virus a pandemic, which means they stop counting specific cases. Luckily, the swine flu was contained to Mexico and did not enter into the United States but as said in Seth Berkley's Ted talk, "our luck is running out." Berkley explains the public only has matter of time before another pandemic out break occurs, that would affect the American people who still do not see the influenza virus as a threat. The swine flu did get a reaction out of the American people, causing some people to wear masks over their faces on a daily basis. Yet the scare did not encourage more people to receive the flu vaccine. The health of the American people should not be left up to luck or chance. The medical field is constantly adapting to reassure the public that what is being injected into their bodies is safe and in place for their protection. Government organizations such as the CDC are put in place so that pandemics do not break out. Passing legislation to mandate the influenza vaccine would be a precautionary measure to ensure the public is safe. 

In addition, Young children and the elderly are most susceptible to sever complications from the influenza virus. The main areas for the spread of disease within children are school systems and child-care facilities. Children receive annual check ups before attending school for that year to ensure the spread of disease in the schools will be minimal; however the flu vaccine is not required.  Schools and childcare facilities create a highly contagious environment because of close quarters of students and poor hygiene practices. The influenza virus takes children from school for weeks and also removes their parents from jobs to care for their sick children. The CDC published an article that states, "To protect against outbreaks of disease, all 50 states have legal requirements for specific immunizations for children attending these centers. However, only two states, Connecticut and New Jersey, require immunization against influenza" (Hadler 181). A study was conducted after acknowledging this information that reviewed statistics from 2009-2010 of Connecticut's influenza rates in children. Remarkably, requiring the flu vaccine decreased the influenza virus hospitalizations of children by 12%, making Connecticut have the lowest percentage of hospitalizations as a result of the influenza virus in the country (Hadler 184). By changing the connotation of the flu vaccine from recommended to required, will reduce hospitalizations from complications of the virus and the spread of the virus will decrease within public places. This information justifies the fact that implementing policy on requiring the influenza vaccine has a positive effect and is achievable. 

Furthermore, education is the backbone to the American society. Proper education allows the public to make decisions based on concrete information instead of not doing something simply because one does not understand. This is true with the influenza vaccine because information is not readily available regarding the vaccine.  In the article "Do people who intend on getting a flu shot actually get one," discussion was surrounding the fact that it is our physician's job to ensure people are educated on the influenza vaccine. The article states, "Only 2% of those who do not intend to be vaccinated were vaccinated by the end of the season and that a lack of perceived benefit and need may play a key role in explaining low uptake" (Harris 1313).  The solution to the "lack of perceived benefit" is to ask patients simple questions and provide clear information on the benefits of the vaccine. By explaining to patients that receiving the flu vaccine reduces the risk of contracting the vaccine "ranging from 61% to 91% in different age groups" (Heikkinen 226), the public will see no downsides to receiving the vaccine. Since the vaccine is matched every year to the strain of flu circulating, they cannot be certain the vaccine for that year will be 100 percent effective. The public needs to be informed that in order to ensure the highest success rate, each vaccine is composed of 3 different strains of the flu virus that are matched with the strains of the current year. Many people do not know that the flu virus changes every year, which is why the vaccines effectiveness is not guaranteed causing the public to feel the vaccine is not important. Another misconception about the vaccine explained by the CDC, is that its sole purpose is to fully eliminate the virus. The purpose of the vaccine is pre-immunization of the body, meaning implant "pre-trained forces in you're body to recognize and defeat foes" (CDC). When the body already has antibodies, it helps to lessen the severity of symptoms if the flu virus is contracted (CDC). The basic information on how the vaccine works and the options people have to receive it will inform the public on why the vaccine is so important. 

As well as education, the availability of the vaccine plays a vital role in how much of the population can be vaccinated. Over the years the availability as increased drastically because of advancements in technology; however, the process of getting the vaccine has stayed the same. As explained in Berkley's Ted talk, the flu vaccine is created from chicken eggs and each egg creates 2 doses of the vaccine. The process of producing the vaccine begins in the spring in order for it to be ready for flu season in the fall. Once the vaccine is mass-produced, getting it out to the consumer quickly and effectively is half the battle. The free flu shot campaign has taken over drug stores such as CVS and Walgreens during the fall and winter months. They offer all day flu shots that are available at the consumer's convenience. As stated earlier, children's yearly check ups are given in the months of July and August before school starts, when the flu vaccine is not readily available until October. By having the flu shots available in drug stores people do not have to make an additional appointment with their physician in order to receive the vaccine. The increased availability is a step in the right direction for increasing uptake of the vaccine but still does not fix the problem of the vaccine being optional. If the vaccine is required, then the public is forced to make their health and the health of others a priority. 

Similarly to availability increases, advancements in medical technology have created a new form of the flu vaccine. An article written in 1940 and published by Public Health newspaper states that the first flu vaccine was funded by the Rockefeller foundation. The article states, "The extensive epidemic of influenza in Puerto Rico presented the first real opportunity of testing the Rockefeller vaccine" ("First Flu Vaccine"). The article expresses the fact that since 1940 the flu vaccine has been researched and changing for many years. Recent advancements have led to the newest variation called influenza vaccine live intranasal (LVAI), commonly known as flu-mist. In the article, "Vaccine safety- achieving the proper balance," advantages of LVAI are stated to, "Include its intranasal route of administration and induction of both mucosal and systemic immune responses." The new way of administering the vaccine is more appealing to the public because it removes the element of the needle. While this way sounds like a full proof plan, people that have asthma cannot receive the vaccine because of the respiratory side effects. More research and testing is being put into LVAI but since people do not feel the vaccine is important, they do not produce large amounts of the new discovery. Other contagious diseases such as polio and smallpox that were eradicated by vaccinations (Berkley), explain how further research and larger amounts of vaccination could also eradicate influenza virus. If the severity of the flu virus creates a larger conversation, then more money will be invested into research advancements towards the vaccine and make it more effective.  

While many positives results come from requiring the influenza vaccine, ethical issues arise when passing legislation requiring citizens to receive a vaccine. An article published in the American Journal of Nursing addresses the ethical issue of requiring all nurses to receive the flu vaccine. The article explains a dispute between the Washing State Nurses Association (WSNA) and Virginia Medical Center, where the medical center threated to terminate employees if they did not receive the influenza vaccination. WSNA states, " the hospital was correct to encourage vaccination, but incorrect to mandate vaccination with threat of termination." (Olsen 76) The case never came to an agreement because both parties agreed that the flu vaccination should be highly recommended. The ethical issues of this case could have been avoided if all citizens were required to receive the flu vaccine. By doing so, all discrepancies of only requiring the medical professionals to receive the vaccination would be eliminated. Administration of the flu vaccine does not differ from any of the other vaccines required at yearly check ups, making the argument of ethical wrong doing incorrect. In the article, "The ANA Code of Ethics states, "The nurse's primary commitment is to the patient"; this entails an obligation to take some risk on the patient's behalf." (Olsen 76) When entering the position as a caregiver, the responsibility to keep yourself and the patient out of harms way is the most important, as explained in the article. Receiving the vaccine limits the threat of spreading illness, which is the responsibility of our medical professionals and government. To rely on "herd immunity" meaning the immunity of those who can no longer transmit the illness because a high percentage of the population has been vaccinated (Olsen 77), is also ethically incorrect because relying on others for the safety of the population does not ensure safety. Herd Immunity only works if a large amount of the population is vaccinated but "less then 40% of health care providers receive the vaccine, which is far to less for herd immunity" (Olsen 77). The only way to ensure the publics safety from spreading illness is monitoring the uptake of the vaccine. While the arguments of ethical discrepancy's to receive the vaccine are understood, the issue of not spreading illness and protecting the public out way the negatives. 

To conclude, the public's health is in the hands of the government officials. The public looks to the government for guidance and information. The job of the government is to educate the public on how to be healthy and responsible members of society. Stating that the vaccine is highly recommended does not ensure uptake of the vaccine. To press the countries luck on when the next pandemic will strike, as stated by Seth Berkley's Ted Talk, is irresponsible especially when research has presented clear evidence that requiring the vaccine will reduce influenza related hospitalizations and cases per year, as it did in Connecticut. By starting with the children and elderly, the age groups most susceptible to complications, an environment can be created in school systems and care centers that does not fester with contagious viruses. The growing population of elderly should be required to receive the vaccine due to the harmful effects on a weak immune system. After addressing the ethical issues of requiring a vaccination, it became known that the argument did not explain why the influenza vaccination differs from any other vaccine required today. To require the American population to receive the influenza vaccination once a year will ensure public safety from pandemic outbreak and control contagious illness spreading during the winter season. 

