Erin Marshall and Faculty Mentor: Lacey Eden, College of Nursing
Introduction
Herd immunity requires that 95% of a population is immunized in order to be effective. In Utah,
only 75.2% of children have received all of the recommended vaccinations by age two1. Herd
immunity is of great importance to a population because it protects those who cannot be
immunized (such as newborns and those with chronic illnesses). These individuals are offered
some protection because when the majority of a population is immunized, the disease has little
opportunity to spread within the community2. In Utah, the number of individuals that choose not
to immunize themselves or their children is constantly increasing. Those who choose not to be
immunized cause the herd immunity in our population to decline and eventually it will become
nonexistent, putting those who cannot be immunized at risk for contracting preventable diseases.
The purpose of this project was to decrease the rate of immunization exemptions in Utah. In
recent years, there has been a decline in the number of people who choose to vaccinate their
children; this has led to deteriorating herd immunity. An increase in immunization rates will
protect not only the vaccinated individual, but will also protect their family and ultimately the
entire population. A secondary purpose of this project was to educate the population about
immunizations and to dispel any misconceptions.
Methodology
After identifying low immunization rates in Utah, we compared immunization exemption rates in
Utah with exemption rates in other states. We found that Utah is one of only 17 states that allows
parents to obtain an exemption for personal reasons. Of these 17 states, 13 require parental
education before the obtaining the exemption, however, in Utah, no parental education is
required for any type of exemption. Recognizing this hole in immunization education, it was
determined that a standardized education module could be created to provide parents with correct
information regarding how immunizations work, why they are needed, and to dispel any
misconceptions.
A module outline was created based on current research regarding preventable diseases and Utah
state law. We then collaborated with The Summit Group, a public relations and web design and
development company, and designed and programmed the immunization exemption module. The
module was built around the information and data collected by my mentor and I as well as
collaborative agencies.
Results
Once we completed the immunization module, we asked local associations to review the module.
We reached out to organizations such as, the Utah School Nurses Association, Local Health
Departments, American Academy of Pediatrics, & Utah Medical Association, and each
association reviewed the module and provided us with recommendations and feedback. After
making necessary adjustments, the immunization education module was completed.
In order to implement the immunization module statewide we had to make parental education a
requirement. We created a bill that would require parents to complete the online education
module before they could receive an immunization exemption for their children. After creating
the bill we gained support from a wide variety of associations, we met with our local
representatives, and lobbied for parental education regarding immunizations. In March 2017, the
bill, House Bill 308, was signed by the governor and will be effective on July 1, 2018.
The immunization module process and results were presented at various conferences and venues
including the Utah Nurses Association Conference, the College of Nursing Scholarly Works and
Contribution to the Discipline Conference, and the President’s Leadership Council Conference.
While presenting the process and results of the immunization module, many Utah residents
expressed their concern about the low immunization rates and admitted they were not previously
aware of this problem. It was evident that other medical professionals recognized decreasing
herd immunity as a serious issue and strongly supported the implementation of standardized
immunization education.
Discussion
This project resulted in an enriched service-learning environment for students while addressing
an incredibly timely need in the community. Although the implementation of this project is in its
infancy, it is anticipated that standardized education will provide parents with correct
information about immunizations and will result in fewer immunization-exempted children.
Thus, the herd immunity in our state will increase, protecting those who are unable to receive
immunizations. Further evaluation will determine the efficacy of the immunization education
module in Utah. It is our hope that the immunization education module will promote the
administration of immunizations, educate parents about their importance, and increase the herd
immunity in Utah.
Conclusion
In conclusion, immunization exemption rates in Utah are constantly rising. The implementation
of an immunization education module will provide parents with correct information regarding
immunization preventable diseases, how to protect unimmunized children in the event of an
outbreak, and requirements for quarantine based on Utah law. It is suggested that other states
implement standardized education, especially states that permit philosophical exemptions. It is
our hope that by providing standardized education, our communities will better understand how
immunizations work, why they are needed, and will ultimately improve the herd immunity
within our nation.
1 Lampros, J. (2015). Measles outbreaks raise vaccination alarms. Retrieved from
http://www.standard.net/Health/2015/02/04/measles-story
2 Centers for Disease Control and Prevention. (2015). State School Immunization Requirements and
Vaccine Exemption Laws. Retrieved from https://www.cdc.gov/phlp/docs/school- vaccinations.pdf