Immunization Nation: Vaccines in Pittsburgh and Beyond

by Ana Driscoll

“Parents have the right to make health care choices for their children. Parents and parents alone.”

This was one concerned mother’s statement at a July 2016 public hearing on a motion to mandate the human papillomavirus (HPV) vaccine for all seventh graders in Allegheny County. The Allegheny County Board of Health did not pass the mandate, which would have required all 11 and 12 year olds enrolled in either public or private schools to receive all three doses of the vaccine by seventh grade. The board instead opted to implement a general program aimed at boosting immunization rates.

 According to the Jewish Healthcare Foundation, only 27 percent of girls and 21.8 percent of boys ages 14 to 17 in Allegheny County had received all three doses of the HPV vaccine in 2014. Not surprisingly, HPV immunization rates are substantially higher across the nation as a whole. According to the Centers for Disease Control, in the same year, 60 percent of adolescent girls and 42 percent of adolescent boys had received the vaccine.

How do other vaccination rates in Allegheny County compare to those in the rest of the United States? And how do conversations about immunization in Pittsburgh reflect national trends?

While HPV vaccination rates are extraordinarily low in Allegheny County, vaccination rates are above the national average for many other immunizations normally given to babies and toddlers as shown in Figure 1.   

The controversy surrounding Allegheny County Board of Health’s HPV vaccine mandate highlights that concerns about vaccinations are active in the United States. According to a 2015 poll conducted by the Pew Research Center, only 83 percent of adults believe that vaccines are safe. The numbers are even more striking when the generation gap is considered: while only 5 percent of adults 50 and older believe that vaccines are unsafe, 12 percent of those ages 18-49 do.  Furthermore, as shown in a Pew Research Center 2014 poll, some 41 percent of American adults ages 18 to 29 and 35 percent of those ages 30 to 49 believe that vaccinations should not be mandated.  Clearly, Americans are hesitant to support required immunizations, even if they believe that vaccines are generally safe. But why?

While parents who do not support mandatory immunizations most often cite their doubts about the safety of vaccines, other common concerns include the desire to protect religious and individual freedoms and a distrust of government mandates. As the quoted mother shows, the same concerns about parental choice are reflected in the debate about the HPV vaccine mandate in Allegheny County.

According to the Allegheny County Health Department’s deputy director of public policy and community relations, the biggest concern about the mandate was that vaccination should be a parental choice rather than a government decision. One mother at the public hearing was “glad [the Allegheny County Board of Health] removed the mandatory language,” which reflects more opposition to a government mandate than concern about the safety of the HPV vaccine. This is consistent with the gap seen in national polling between the percentage of adults who think that vaccines are safe and the percentage of those who believe that vaccinations should be mandated.

In other states where either mandates or exemption loopholes have been considered, parents tend to express similar concerns about the freedom to make decisions for their children. For instance, after Rhode Island implemented a statewide HPV vaccine mandate for 11 and 12 year olds, some opposed the mandate not due to safety concerns, but rather because they were uncomfortable with the idea of the state dictating vaccination decisions. Meanwhile, in California, a law prohibiting the use of personal or religious vaccination exemptions provoked the concern of parents who believed that “all of a sudden the state wants to get between a parent and a child.” Ultimately, one thing remains clear: in order for immunization rates to increase, we must find a way to address the concerns of hesitant parents.