Couse:
Introduction
On June 3 2013 New Jersey Senate’s Health, Human Services and Senior Citizens committee vice chair Senator Fred H. Madden and Senator Madden introduced the Bill S2832; an Act concerning the pertussis vaccine and supplementing. The bill proposes that birthing facilities and hospitals make available information on pertussis vaccines for adults to new mothers. The bill serves as a cautionary measure against the infection of infants by pertussis through transmission from adults in their immediate environment.
Pertussis, also called whooping cough, is a respiratory infection caused by a bacteria Bordetella pertussis and it is highly contagious. It is associated for its overwhelming as vicious coughing that result to difficulty in breathing. Mainly, it is spread via coughs, sneezes or direct contact with infected secretions (Plotkin, Orenstein & Offit, 2008). It is a life threatening disease in people of all ages but mostly in babies younger than six months it is life threatening. In adults and adolescents it mostly causes a persistent cough only but in infants it causes complications like pneumonia and fits. It may also cause brain damage due to prolonged loss of oxygen. Statistics show that most cases of hospitalization and eventual death occur in infants of six months or less (Plotkin, Orenstein & Offit, 2008). It is the most Vaccine-preventable disease. In the United States, almost 30,000 cases of pertussis were recorded and the shocking thing about that was the fact that a majority of the cases went without being treated. As the cases go unreported by the adults, the illness in children is very dangerous as it is a life frightening disease for children as it is seen as a common cold, running nose, and fever at the initial stages but it leaves them gasping for air something that children are not well equipped to handle as their adults counterparts making it dangerous as indicated exceeding.
Infants have got very low immunity levels and as such are prone to contracting communicable diseases easily. Immunizing them is a primary cautionary measure but since studies show that immunization does not guarantee water tight prevention, it is imperative to have a secondary measure in vaccinating the risk factors that predispose the infants (Plotkin, Orenstein & Offit, 2008).
Even though adults may have been vaccinated as children, immunization through booster doses is sometimes required to maintain immunity. Adult immunization at times depends on age, indigenous status, occupation and vaccination history and future health plans. With action taken pursuant of the bill, more people around newborns will be vaccinated (Plotkin, Orenstein & Offit, 2008). Those that should be vaccinated include; expectant mothers and new mothers and those in regular contact with the newborn (for instance family members and nannies). Medical surveys have shown that up to 80% cases of pertussis in infants are as a result of contact with family members and especially a parent (Neustaedter, 2002).
Description of Proposed Policy
There have been recommendations by the Advisory Committee on Immunization Practices for the Centers of Disease Control and Prevention that Tdap (tetanus-diptheria-acellular pertussis) to new mothers and other adult members of the family. These recommendations have been voluntary without any laws to support them. In an attempt to lower the death cases caused by pertussis, the New Jersey Senate was presented with a bill that sought to strengthen the advisory committee’s stand and prevent transmission of pertussis to infants by 70% (Neustaedter, 2002).
The proposed policy was sponsored by Senator Fred H. Madden, Jr. and Senator Madden and received further support widely across Senate especially from the assemblywomen. The proposal requires hospitals and birthing facilities to provide new mothers as well as their family members with information about pertussis vaccines for adults as a cautionary measure against infant cases of pertussis as it is very dangerous to the infant especially from their families. The information is meant to be offered not only to the mothers but also to any other individuals that are close family member who are existent during the time of birth of a child (Neustaedter, 2002). In addition, this is to be done by any employee or worker that has been appointed by a health facility or hospital where the child has been born to disseminate the information. It is also imperative to note that this information dissemination is usually done moments before they are discharged from the health facility that they were being served at. The proposal is an act that seeks to supplement Title 26 of the Revised Statutes meant to be enacted by the senate and the General assembly of New Jersey.
The proposal in its introduction catered for the way forward to ease implementation and produce results at a faster rate. In their recommendation, the Commissioner of Health should prepare information literature on vaccines against pertussis in adults and make the same available to all the hospitals and birthing places. (Birthing places in this context represents the inpatient and ambulatory health care facilities that are licensed by the Department of Health to provide birthing and newborn care services (Neustaedter, 2002). The information provided should include risks of pertussis, mortality rates among infants, efficacy and availability of the vaccine and the pros of vaccinating new mothers and other close members of the family.
It also requires that all birthing facilities including hospitals in the state should provide the information provided as per the preparation and provision of the commissioner of Health. These facilities should make available the literature to the new mother and any other adult member of the family present at birth or during discharge. The staff should also have the literature and be at hand to guide new mothers and family members through the provided material and vaccination procedures.
Assemblywomen Linda Greenstein, Lorreta Weignberg and Valerie Huttle also signed on as sponsors of the bill. Assemblywoman Lorreta Weignberg opined that;
Contact and Discussions with Senator Madden’s assistance named Mike Wallace.
Since the sponsoring senators have busy schedules, the best source of information regarding the bill was Senator Madden’s aide by the name Mike Wallace. Mr. Wallace is the senator’s advisor on governance and policy implementation.
Question One. Senator Madden co-sponsored the bill that seeks to provide information on the issues of pertussis in birthing facilities and by large control the risk factors at predispose infants to contracting the disease from adult members of their families. This however seems long overdue and follows the Advisory Committee on Immunization Practices for the Centers for Disease Control and Prevention has been advocating for the same since 2005, so why now and what difference do you project in approach as opposed to the advisory committee’s?
Mike Wallace: This bill does not seek to stand as a private bill but rather as a supplement of the advocacy of the Advisory Committee on Immunization Practices for the Centers for Disease Control and Prevention. There is a need to push further legislation as well as the preventative measures that will help control the predisposing factors of infants contracting pertussis by helping those around them care and show them care through actively getting vaccinated. It is evidently clear that through vaccination, the spread of the disease will be contained and many individuals will have been prevented from it.
Question Two. There are other numerous diseases and conditions that need the active participation of the population to curb and control, most of these are handled through community health and education, why was the bill so definite and particular on pertussis only? Why didn’t the senator come up with a bill that seeks to create a robust and more effective community health policy that would cater for many more diseases and health conditions?
Mike Wallace: This bill is limited to pertussis but it does not limit the probability of having similar gestures for other medical conditions. Taking all the diseases and health conditions within a locality and try to combat them will be a sure way of failing. Hence, it with such reason that the senator started with one not because it is so important than the others, no but it is due to the fact that one had to start from somewhere and it so happened that this particular illness was the starting point. Beside, various illnesses have different effects as well as different ways and approaches to tackle them. For a better and enhanced handling of the disease, it was better for the senator to start with one. This should actually serve as a pilot for more health information bills to come and it is only a matter of time for other bills to be proposed for a healthy living of the populace. Another imperative point to note is that it does not compete with community health services but rather seeks to strengthen and enhance them through dissemination of crucial information. It is in fact faster, easier and cheaper.
Question Three. Where will the proposal find funding? Do we expect more of the taxpayers’ money to be used in the implementation and maintenance of the services? Will those seeking the service have to pay?
Mike Wallace: The dissemination of information will be through pamphlets and medical-staff counseling all of which are cost effective methods and ways of accomplishing the objective. This should be a cost effective method due to the fact that it will not need the taxpayers to be taxed further for the purposes of funding the bill. As for the staff’s role in counselling, they will not be added more work load but rather they will be acting within their job specification. This is bearing in mind that they job does not end at treatment of the patient but rather it as well entails the curing and it is here that the counselling element comes in. Equivalently, the informational material will be printed by the Department of Health. That implies that there will be no extra cost will be needed for the purposes of producing written materials on the bill bearing in mind that such provisions are already catered for within the budget. Equally important to note as well is that the vaccines have always been free and that will not be expected to change since it falls in that same category of preventing and protecting the populace from getting affected by communicable diseases. It can therefore be deduced from these facts that the bill will be both effective for the taxpayers and for the state as they will be incurring very minimal additional cost for the implementation and execution of the bill. Therefore, there is no expectation of rise in costs for either the state or the people.
Question Four. The bill fails to address the transition from the birthing facilities to the vaccination centers. Doesn’t this increase the disparities and what is the plan to have 100% vaccination for the adult family members of homes with newborns?
Mike Wallace: The long-term goal is to have 0% transmission of pertussis from adults to infants. This can be achieved by bringing vaccination centers to the birthing facilities and extensive prenatal reach out to expectant families during prenatal clinics. Additionally, the information will have been passed through various means as it has been indicated herein. It is thus expected that those members of the family who will not be reached for the vaccination due to various reasons will make an effort to get the vaccine due to the fact that they will have received the knowledge and gotten the importance of getting the vaccine. This of course will take time to deliver for various factors such as there is a lot of knowledge that the populace have to be given for them to get the importance of receiving vaccines as well as the larger area to be covered but it will happen in the long run as long as you and me support the bill the only way that it can be made to see the light of the day.
Discussion of Mike Wallace’s position
Mike Wallace views the bill as a workable legislation that will easily be passed, enacted and executed within health facilities without fluctuation in expectation. He exudes confidence since to him it is a low budget proposal that almost has a negligible cost on the state as well as to the taxpayers who are already taxed highly according to them. However, the question of how to follow up the transition from the birthing facilities to the actual vaccination seems a shadowy expectation not planned for a fore hand. There is little, if any, guidance on the way forward from the office of the senator on measures to make sure that public finances are not just watered down an ambitious plan that was not well thought due to the ‘low budget tag’. Should this be a public stunt, a political gesture; as are many public policy bills, then the senate will be gambling with the loss of public finance in a white elephant project that will stall midway. Should the investment of time and resource fail to increase the number of people taking the vaccine then it sure will be a waste of time and money.
Calling on the Senator’s aide made me realize that I had viewed the bill with a lot of expectation. Just like the bill itself, I failed to put in focus that its workability was yet to be tested and already proved shaky on paper. Mike Wallace’s assertion on the cost effectiveness and lack of guided explanation on the measures put in place to ensure expected transition also showed the issues with the implementation. These are issues that could have been dealt with prior to introduction of the bill to ensure that it is feasible and credible.
The general expectation moreover would be the strengthening community health services, creation of a robust system that caters for pertussis among other diseases and conditions and vaccination by community health workers at the homes. Provision of information only for a population with a poor history of voluntary hospital visits is not the best idea in dealing with a disease that threatens lives of infants. Yes, the information has been given to them through pamphlets as it has been suggested by the assistance but how sure are w that they will understand the information let alone if they will act on them? More ought to be done than just give information. For instance, people ought to be motivated to go get the vaccine. It has been clear from the past that intrinsic motivation has better results in getting people do what they have to do and that can be a sure way of attaining the expected results (Neustaedter, 2002). Another sure way of getting people to go for the vaccination apart from giving the information only is the giving the assurance that their health will be guaranteed. This implies that there will be no side effects of the vaccine and that it is safe to all and to everyone including people from all ages.
Proponents of Proposed Bill/Resistance to Bill
Issues of the bill
Health Status
The bill naturally tries to improve the health situation in the state by minimizing instances of pertussis infection in infants from caregivers and those in constant contact with his child. However, there are a number of issues that concern the health status of the provision of the vaccines to adults that stand out. For instance, Tdap vaccination causes a number of side effects that include fever, redness and soreness where the injection was given, nausea, headache, tiredness and aching muscles. Sometimes these side effects can include allergic reactions (Howson, Howe & Fineberg, 1991). For a population that is not so keen to nurse side effects, these could be health related issues that could make them fail to get vaccinated. However, should there be adequate and quality health education en masse then this could be dealt with.
Access to Care
The bill caters more for information than action. There is plenty of information regarding the adult vaccines since he law will require that the same be provided in all hospitals and birthing facilities. The buck stops with the immunization process and not information on immunization. There are many centers that provide the vaccination services and hence access to them should be easy but the transition from delivery centers to these facilities is not guaranteed. The bill fails to give a way forward on how to ensure that adults in families of newborns get vaccinated. The question therefore is not on the access to care but the response to it.
Health Disparities
Being a free service, the disparities based on cost and proximity may be limited as most people will access the service. However, from perennial health disparity studies, it also is prone to a number of disadvantages. For instance, even though unconfirmed, past indicators could point at race based disparities with blacks and minorities disadvantaged. This is based on the assumption drawn from the cultural background of these groups and their natural attitude towards hospitals. So even as quality is improved and subsidized, disparities persist (Neustaedter, 2002).
Cost Effectiveness
The bill’s proposal is cost effective on the part of the population it is meant to be a free service. Moreover, it is not a new service as it has always been here as proposed by the advisory committee. Vaccination naturally does not bill much on costs and as such, the proposal is cost effective in consideration the amounts it saves that would have otherwise been used for purposes of treatment and medication of the prevented illness.
Conclusion
It can very clearly be deduced from the elucidation that has been given here in that the bill is a worthy addition to the law. This can be due to the fact that it is a useful healthcare policy in consideration of its goals and overall contribution to healthcare among other various factors all of which have been revealed herein. The sponsors seem not to have a clear-cut way forward for actualization of the proposal but should the bill find footing it will be instrumental in curbing pertussis in infants. The implementation is also cost effective except in the instance that the ambition fails to materialize. In such an instance, it will have been a futile waste of public resource bearing in mind that the taxpayers as well as the state is not in a position to loss funds to unrealistic endeavors as the economy is not so friendly to many people at the moment. Pertussis being one of the leading causes of deaths in infants should be controlled at all measures. It is worrying that it is the leading vaccine-preventable disease in number of deaths caused. Such a bill is long overdue and its effects on the situation will hopefully help a desperate situation.
References
Howson C. P., Howe, C. J., Fineberg, H. V. (1991). Adverse Effects of Pertussis and Rubella
Neustaedter, R. (2002). The vaccine guide: Risks and benefits for children and adults. Berkeley, Calif: North Atlantic Books.
Plotkin S. A., Orenstein W. A., and Offit P. A. (2008). Vaccines. Elsevier Health Sciences
Vaccines: A Report of the Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines. National Academies Press
