PDC Test - Litigation, Regulation, and Education — Protecting the Public’s Health Through Childhood Immunization

You can earn 0.25 PDC by passing the exam following this article, which has been approved for publication by NCRA's Council of the Academy of Professional Reporters.

The questions are based on the material in the article but some may require additional research. Send your answer sheet to NCRA's Continuing Education Office, 8224 Old Courthouse Road, Vienna, VA 22182, and enclose a check for $40 (member) or $50 (non-member) to cover the processing fee. 

Litigation, Regulation, and Education — Protecting the Public’s Health Through Childhood Immunization

Recently, three special masters of the U.S. Court of Federal Claims issued carefully reasoned, strongly worded opinions, rejecting claims that medical and scientific evidence could demonstrate causal links between thimerosal-containing vaccines or measles-mumps-rubella (MMR) vaccination and the development of chronic health conditions, such as autism, immune dysfunction, and gastrointestinal dysfunction.

The three cases were test cases drawn from more than 5,000 similar claims filed under the National Vaccine Injury Compensation Program, which was established in 1988 in response to concerns that lawsuits against vaccine manufacturers and administrators were threatening the nation’s childhood vaccine supply.

The concern of the lawmakers for families who must deal with the daily chronic challenges is quite evident throughout the more than 600 pages of legal decisions. The lawmakers were convinced that the parents had filed their claims in good faith. However, they were far less sympathetic to the evidence offered and the experts who testified on behalf of the families. The special masters opined that “the overall weight of the evidence is overwhelmingly contrary to the petitioners’ causation theories.”

The success of childhood immunizations programs can, in part, be traced to state laws requiring parents to provide evidence that their children have been vaccinated as a prerequisite for enrollment in schools and day-care centers. Although state authority to implement childhood immunization mandates is anchored in fundamental constitutional principles, the states’ processes for structuring those programs have become politicized.

States attempt to strike some balance between the power to require vaccination and consideration for parental beliefs by allowing for exemptions from vaccine requirements. Most states permit exemption on religious grounds, and a growing number of states permit exemption claims based on broader philosophical or personal objections.

Not surprisingly, states with expansive bases for exemption and limited administrative requirements for fulfilling exemption requests have more parents opting out of vaccinating their children. This trend increases the likelihood of outbreaks of vaccine-preventable diseases and creates potential geographic “hot spots” where high concentrations of exempted children could compromise community-wide protection.

The benefits of vaccination to the child and the public are widely known and may be demonstrated with the use of scientific data. But parents weigh choices about vaccination using conceptions of risk, benefit, and trust that are broader than anything that can be demonstrated through statistics or biology. Trust can be enhanced by improving the transparency of the decision-making process for approving and enforcing vaccination mandates.

For our childhood immunization program to continue to be successful, our health care system must offer greater support for primary care physicians, who serve as advocates for patient participation in sound preventive care strategies. The Internet and the media offer unprecedented opportunities for the public to be informed (and misinformed) about health-related topics. However, parents’ understanding of such matters should be fostered primarily through dialogue with their children’s physicians as partners in care.

As national health care reform efforts move forward, policymakers should be encouraged to support physicians’ efforts to engage in preventive care interventions, such as efforts to educate patients as well as distribute vaccines in many communities.
Barbara Johnson of Nutley, N.J., is a participating member in NCRA.

The exam for this article is located on the NCRA Web site at http://ceusandtesting.NCRAonline. org. By passing the exam, you can earn .2 CEUs. The questions are based on the material in the article, but some may require additional research.

Questions for Litigation, Regulation, and Education – Protecting the  Public’s Health Through Childhood Immunization

1. State authority to mandate childhood immunization is not anchored in fundamental constitutional provisions.
A. True
B. False   

2. More parents opt out of vaccinating their children in states where:
A. There are few cases of measles, mumps and rubella.
B. There are many cases of pneumonia.
C. The mosquito population has been controlled.
D. There are limited administrative requirements.    

3. Benefits of vaccination to the child are:
A. Not widely known.
B. Demonstrated with the use of scientific data.
C. Never discussed at schools.
D. All of the above.        

4. Parental trust can be enhanced by improving transparency of decision-making for approving and enforcing vaccination mandates.
A. False
B. True       

5. The number of Special Masters who recently heard a matter regarding immunization at the U.S. Court of Federal Claims was:
A. 5
B. 3
C. 8
D. 1                          

6. The claims involved in the immunization hearing included:
A. That medical and scientific evidence could demonstrate causal links between thimerosal-containing vaccines and the development of chronic health conditions.
B. That diseases caused by vaccination included autism.
C. That diseases caused by vaccination included both immune and gastrointestinal dysfunction.
D. All of the above.    

7. Most states permit exemption on religious grounds.
A. True
B. False                        

8. Most states permit exemptions based on:
A. Income of the parents.
B. Education level of the parents.
C. Whether the parents are married.
D. Personal and philosophical objections.               

9. There were only six cases drawn from over 5,000 claims.
A. True
B. False                                       

10. The National Vaccine Injury Compensation Program was established in:
A. 1975
B. 1988
C. Response to parental requests.
D. All of the above.                         

11. The National Vaccine Injury Compensation Program was established in response to concerns that lawsuits against vaccine manufacturers were threatening the nation’s childhood vaccine supply.
A. False
B. True                                        

12. The Special Masters evinced no concern for the everyday problems that parents of children with the chronic diseases noted were experiencing.
A. Partially true.
B. False.
C. Partially false.                 

13. Primary care physicians help keep our immunization programs working by:
A. Accepting as patients only children who have been immunized.
B. Working as advocates for immunization.
C. Insisting that parents obey the rules.
D. Testing thimerosal on animals.                       

14. Distribution of vaccine in communities is an important physician component in national health care reform efforts.
A. True
B. False                                                    

15. An important facet of parents’ understanding of the need for immunization  is:
A. Their children’s physician.
B. Close relatives input.
C. Reading medical literature as it becomes available.
D. Working in the local library.                                       

16. The Special Masters opined that:
A. Parents should not be involved in the matter of childhood immunization.
B. Children should be free to make their own choices regarding immunization when they reach ten years of age.
C. Needles should never be used to administer serums.
D. “The overall weight of the evidence is overwhelmingly contrary to the petitioners’ causation theories.”                                          

17. When states allow exemptions to immunization, there is the potential for creating:
A. A new group of exceptionally happy children.
B. The probability of sunburn.
C. Geographic hotspots where high concentrations of exempted children could compromise community-wide protection.
D. Better medical care for the very young and very old.