Childhood Vaccination: Policy Priority Issue

Table of Contents


Childhood vaccination is a standing issue in Florida as 6.4% of parents refused to vaccinate their children (Florida Department of Health, 2017). Up to 93% of that number were exempt from vaccination due to religious reasons (Florida Department of Health, 2017). 6.4% of Florida’s population of children under 18 equals more than 240000 people which is a very significant amount. The diseases the vaccine is supposed to guard against can potentially damage the brain or lead to death in most severe cases. Even a small number of people is enough to cause a problem to the community, which is why it is essential to combat this issue (Phadke, Bednarczyk, Salmon, & Omer, 2016). Nurses may take a leading role in promoting vaccination among religious people and legislators, namely, Frederica S. Wilson, a representative of the 24th congressional district in Miami-Dade County, who would help take action against DH 681 Form that allows exemption from vaccination due to religious reasons.


Most of the vaccine-preventable viruses such as measles, smallpox, mumps, and rubella were conquered a long time ago. It is generally assumed that an outbreak would not happen provided there is an overwhelming majority of people who are vaccinated against viruses. The importance of the issue is seen in the fact that intentional refusal of vaccination endangers the community’s health. The basic reproductive rate for most of the diseases is estimated at the level of 85-95% meaning that for the reproductive rate to remain at 0, a community would need to achieve 95% of vaccination rate (Nyhan, Reifler, Richey, & Freed, 2014). The higher the numbers of vaccinated people, the lower are the chances of an outbreak. Researchers note, that in recent years, the number of people who refuse or delay vaccination grows steadily, which may result in an outbreak (Phadke et al., 2016). In the epidemic reports victims of the viruses were undervaccinated or intentionally unvaccinated people in up to 93% of cases (Phadke et al., 2016).

DH 681 Form or Religious Exemption from Immunization is practically the only law that allows abstaining from vaccination. It guarantees that no inquiries concerning parents’ reasons for not vaccinating their child will be undertaken (“Florida state vaccine requirements,” 2018). A document requires only a signature from a parent that admits that a religious conflict is present and their child cannot be vaccinated. It is highly doubtful that Bible, Torah, or Koran have some words that literally ban the use of a vaccine against measles. Letting people endanger the health of their children and the children of their neighbors for no apparent reason and with no explanation needed leaves a window of opportunity for abusers who boycott vaccination out of sheer disbelief in the usefulness of a vaccine. As it was stated earlier, the most common reason for legal exemption from vaccination, which later led to the outbreaks, was religion.

Another way to exempt a child from being vaccinated is for medical reasons. Often it presupposes a medical condition that conflicts with the components of a vaccine or cases of severe allergic reactions. Such cases do not exceed 2 percent of the population. Since the outbreak targets mostly unvaccinated children, those who could be vaccinated and refused using DH 681 could endanger kids with poor health unable to take vaccine due to medical conditions. Therefore, such legal practice needs to be reviewed.

Options to Alleviate the Issue

One of the measures to change the existing legal practice of exemption from vaccination based on religious preferences is to raise awareness of the problem through a talk with the local legislator. Frederica S. Wilson could help initiate a campaign on canceling or reviewing DH 681. It also appears to be wise to consult colleagues in a clinic where the author is currently employed to have their support. The support could be measured in a form of a collective petition to the legislator with a request to kindly review the proposal and probably give a suggestion on how to proceed.

Changing the state law could be a time-consuming operation that requires a lot of effort from a legislator and the community, which makes it a challenging but nonetheless rewarding task. Another option that does not involve changing the law is to try an educative approach. Community health nurses may visit parents who refuse or postpone their children’s vaccinations and try encouraging them to opt for vaccination explaining the danger it poses to the community.

Evaluation of Options

The first option appears to be hard to implement. There is no guarantee that even with the help of a congress representative there is something that could be done to review the law. Also, public opinion on DH 681 could be different from the author’s point of view which may complicate the legal action. The second option has already been implemented, unfortunately with little success (Nyhan et al., 2014). Despite nurses’ best efforts, some of the people still refused to hear any facts about the danger of under vaccination. Such state of affairs indicates that the primary objective should be efforts to convince legislators and colleagues to support the initiative and appeal to the state officials with a request to review the legal practice.

A primary concern is to change DH 681 in a way that does not let the abusers use it to abstain from vaccination. Specifically, the current requirements for the absence of reasoning should be modified. A parent willing to submit the form should be required to argue how their religious beliefs do not let them vaccinate their child. In addition, such parent should mention that he or she is cognizant of the fact that by leaving their child unprotected by vaccine he or she endangers the children who by the state of their health cannot be vaccinated. Such an addition to a written form should be submitted to the head of a school where a child receives education. This amendment must first be discussed with nurse colleagues and, provided they agree with its contents, they can be asked to sign a petition in support of such endeavor. The petition and the amendment project should then be taken to a legislator mentioned above. The administrative and legislative resources that she possesses may be enough to start a campaign to amend this state law. The legislator may appeal to the government of Florida with a request to amend the procedure of approving the form DH 681. The status of the issue may be checked with the legislator personally or via emailing her secretary. Managing to change the policy would close the gap in the legislation that allows abusers to use it while hiding under the veil of religion.


Child vaccination is a serious public issue. A refusal to vaccinate a child may result in other children being infected with a virus which may start an epidemic. Even a small percentage of unvaccinated people is enough to put the whole community in danger of having serious health issues, brain damage, and even death among children. To alleviate this issue, nurses should take a leading role in raising awareness of their colleagues and local legislator, Frederica S. Wilson, in order to amend the legal way of refusing vaccination under the pretext of religion with no explanation needed. Such legal practice should be reviewed and amended in a way that requires a close examination of reasons and understanding of the consequences of undervaccination.


Florida Department of Health. (2017). Web.

(2018). Web.

Nyhan, B., Reifler, J., Richey, S., & Freed, G. L. (2014). Effective messages in vaccine promotion: A randomized trial. Pediatrics, 133(4), e835-e842.

Phadke, V. K., Bednarczyk, R. A., Salmon, D. A., & Omer, S. B. (2016). Association between vaccine refusal and vaccine-preventable diseases in the United States: A review of measles and pertussis. JAMA, 315(11), 1149-1158.

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