Importance of Early Childhood Vaccination

Research Statement

Vaccination is referred to the administration of vaccine for helping the immune system of the body develop antibodies for protecting individuals against a certain disease. The vaccination of the children between the ages of 0-4 years is vital to protect them from serious illness because during the early years the immune system of the child is growing. Thus, the immune system in the undeveloped form could not offer greater protection like the adults to avoid children from getting infected by serious diseases. However, in the recent years in the UK, it is seen that the rate of vaccination of the children between the ages of 0-4 years has considerably decreased that have raised serious issues regarding health of the children. Thus, the proposal is set out to understand the reason for the falling number of child vaccination between the ages of 0-4 years in the UK. Moreover, it will focus on informing the importance of childhood vaccination and the strategies to be implemented to avoid the risk factors that have raised the issues.

Discussion of Background

The studies regarding child vaccination indicate that children from birth within 5 years of age are offered vaccine regarding various deadly or life-threatening diseases to protect from illness. This is because in the initial years the immune system of the children is still developing and they have not yet developed to provide necessary protection from different host-virus that is deadly in nature. Moreover, the child in their early years from 0-4 years are exposed to various germs without their concern and get easily infected as they do not adequate knowledge to protect themselves from such viruses (Baehner et al. 2016; Edwards, 2015; Weiner et al. 2015; Simon et al. 2015). Thus, the children in their early years without their concern get exposed to deadly viruses that take advantage of their yet developing immune system to easily attack the children compared to the adults. This is the main reason why vaccination is more important for children between the ages of 0-4 years as at this time the children are unable to protect themselves from deadly viruses that easily affect them. The vaccination of the children between the ages of 0-4 years is important because it is able to save the lives of the children. It is evident because deadly diseases such as polio, diphtheria and others that have once killed millions of children over the world have been able to be eliminated only with the administration of DTaP and polio vaccine (Nakayama et al. 2018). This is evident as in the UK it was reported that in 1942 there were 55,000 cases of diphtheria among children out of which 3,500 caused death. However, with the administration of vaccine the death and incidence of the disease have been able to be controlled and only four deaths were reported due to diphtheria in the UK in the last 20 years (vk.ovg.ox.ac.uk, 2018). In the US, in the last decade, only cases of diphtheria deaths were reported from the country (www.cdc.gov, 2019). In the US, before the availability of polio vaccine in the 1950s, there were more than 15,000 cases related to paralysis of children and adults were reported. However, at the present with the effect of the vaccine polio has been totally eradicated from the US as well as the UK (www.cdc.gov, 2019). The vaccines are provided to the children after long and careful examination of by the health professionals and others. After administration of vaccine, some children may report of redness of the area, pain, redness of area and others that leads to their discomfort. Some children may report of allergic reaction that can be controlled with proper medication intervention and support. Thus, many parents may avoid vaccination of the children as they feel they cannot hurt their children (Englund, 2016). However, the administration of vaccine to the children in the early years is effective and safe way to protect them from greater illness and thus it is important to be administered. The child vaccination is also essential because it not only protects the children as well as it helps to protect others in the environment that may get infected (Maman et al. 2015). This is because vaccine helps to control various infectious diseases that may spread through coughing, sneezing, contact and others of the children with the others. It may create epidemic and result in spread of disease.

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The vaccination of the children at the early ages of 0-4 years is able to save time as well as minimise healthcare costs for them. This is because lack of administration of vaccine such as polio vaccine on children in the early years leads them to develop prolonged medical condition or disability that would lead families to spend increased amount of finances for treatment of the child (Moro et al. 2018). The vaccination of the children is also effective as it helps to protect the future generation and even helps in eliminating life-threatening diseases permanently. This is evident as America in 2015 was the first country who reported that they have eradicated rubella. This means that the risk of pregnant women in the country who will pass the disease to the foetus or children to be affected by the disease after their birth is eradicated (www.who.int, 2015). The reason behind lack of proper vaccination of the children can be numerous. In the study of MacDonald (2015), reason to create decline in child vaccination is often reported to parental resistance. This is because parents are the main individuals who look after the children in the early years and are responsible to arrange proper care for them. Thus, the resistance of the parents to avoid getting their child vaccinated leads the children to remain devoid of immunization making them vulnerable to be affected by deadly diseases. As mentioned by Bianco et al. (2019), the lack of proper availability of child care services and awareness regarding vaccination among the parents causes decline in child vaccination rate coverage. This is because the parents without the knowledge of the importance of vaccination for their newborn or children under the age 0-4 years often neglect to take their children for vaccination. The study of Browne et al. (2015) informed that cultural, educational and spiritual factors may be responsible for creating lower rates of vaccination among the children in early years. This is evident from the figures which inform that out of 1256 individuals 49 preferred to use conventional medicine, 83 reported to use spirituality as source of knowledge and 86 reported lack of openness regarding vaccination as the key reason for having negative attitudes towards accepting vaccination. The hesitancy to execute child vaccination by parents may arise due to negative beliefs such as breastfeeding which is regarded as more essential than vaccine to create immunity among the children against deadly diseases (Goldstein et al. 2015). Moreover, the past experiences such as prolonged or complex vaccination process for child may avoid parents to vaccinate their children (www.who.int, 2013). This is because the parents feel it leads to the discomfort of the child. The acceptance to execute child vaccination may occur out of reluctance among the parents to comply with the suggested vaccination schedule (www.who.int, 2013). The lack of perception of the vulnerability of certain disease for which the children are administered vaccination may lead parents to avoid immunising their children. This is because the parents are not concerned regarding the consequence of such diseases thus they neglect vaccination. Forced vaccination may also cause a decline in child vaccination. This may not be due to safety reason but as a result of the notion regarding forced immunisation of the children.

Rationale of the research

The vaccination of the children from birth till 4 years is seen to be vital as during this course the immune system of the children remains underdeveloped and the vaccines act as support to protect the children from a serious illness. However, in the UK, it is informed that coverage rate of administering 9 out of the 12 routine vaccines provided to the children between the ages of 0-4 years have declined in 2017-18 compared to the previous year (www.bbc.com, 2018). This is evident as the DTaP (Diptheria, Tetanus, Pertussis)/IPV (wild-type poliovirus)/Hib (Haemophilus influence type B) vaccine coverage to be made for children at 12 months has declined by 1.6% for the fifth year in a row to 93.1%. It can be seen from the figures related to DTaP/IPV/Hib vaccine coverage made for children in the UK before they reach their first birthday where it is mentioned that in the coverage percentage is 93.1% in 2017-18 whereas in 2016-17 it was 93.4% and in 2012-11 it was 94.7% (files.digital.nhs.uk, 2018). The other figures regarding MMR (Measles, Mumps, Rubella) vaccine converge that is to be provided to children within 2 years of age indicates that it fell to 91.2% in 2017-18 compared to the 91.6% coverage in 2016-17 that was lowest since the last five years. Thus, the figures indicate that MMR vaccine coverage has fallen by 1.5% since the past 5 years (files.digital.nhs.uk, 2018). The Hib/MenC (meningococcal C conjugate) vaccine coverage to be provided to children within 0-1years has fallen in the UK by 1.5% in 2017-18 since 2012-11. The PCV coverage has also fallen from 93.5% in 2016-17 to 93.3% in 2017-18 (files.digital.nhs.uk, 2018). Thus, the figures indicate that the vaccination coverage has created decline is providing protection to the children between 0-4 years of age in the UK from serious illness. The fall in child vaccination coverage in the UK is an issue because it would lead to loss of more children being unable to have immunity to fight against life-changing or deadly diseases like diphtheria, tetanus, polio and others (van Wijhe et al. 2016). The disease such as diphtheria is seen to primarily infect the throat and upper part of the airways that later produces a toxin that damages other internal body organs in children. The poliovirus causes muscles of the children to be weakened resulting them to face hindrance in moving and in later life develop disability (Liang et al. 2018; Shirreff et al. 2017). Thus, it can be seen that the decline of vaccination of the children between 0-4yeras in England is going to increase greater life-threatening complication, disability at a younger age and other adversities.

The issue of decline in child vaccination has presently become an issue because it has already raised increased incidence of deadly diseases among the children who did not take vaccination. It is evident as Public Health England informed that since 1st January to 10th September in 2017, 876 cases were confirmed for measles in England. The officials informed that most of the cases are related to children who have not taken measles vaccination before (www.independent.co.uk, 2018). This indicates that decline in child vaccination coverage in the UK is going to create an increased incidence of the deadly disease in the country that may cause increased death of children at an early age. Thus, this study will be performed to shed light on the causes and factors that are creating a decline in child vaccination in the UK so that effective strategies can be built to control them to avoid creating havoc and spread of deadly diseases among the children in the country.

Aim

The aim of the study is to identify the reason for the decline in vaccination of children between 0-4 years of age in the UK.

Objectives

To identify the causes of the decline in vaccination of children between 0-4 years age To evaluate the impact of the decline in vaccination of children between 0-4 years age To analyse the challenges related to vaccination coverage for children of 0-4 years of age To suggest strategies to increase vaccination of children between 0-4 years age

Research Questions

What are the causes of the decline in vaccination of children between 0-4 years of age?

What is the impact of the decline in vaccination of children between 0-4 years of age?

What are the challenges related to vaccination coverage for children of 0-4 years of age?

What strategies are to be adopted to increase vaccination coverage for children between 0-4 years of age?

Methodology

Research Philosophy

The Positivism and Interpretivism are the two research philosophy to be used often in executing studies. According to McMillan (2015), positivism philosophy is the process in which quantifiable observations are made that leads to develop statistical analysis of the data. This nature of research philosophy is explicitly used for executing quantitative studies. In positivism research philosophy, the data collection is made through scientific verification of information. As criticised by Buchana et al. (2018), interpretivism is the process in which the researcher think that access to real information is through social constructs. The interpretivism philosophy is used for executing qualitative studies as it helps in integrating the perception of human regarding the study topic. In this study, the positivism research philosophy will be used as it is going to follow quantitative research strategy. The benefit of positivism is that it avoids the integration of the human perception in collection and analysis of the data to develop findings in resolving the raised question in the study (Fox and Aranko, 2017). Thus, it helps to avoid the development of error in the study that may arise due to the differential interpretation of the results on the integration of human perceptions in studies. The limitation of interpretivism is that it related with the subjective nature of the research approach and creates greater room for the development of biases and error on the study on researcher's behalf (Iyamu and Mgudlwa, 2018). Thus, to ensure greater reliability and less error in the study interpretivism will not be used.

Research Approach

The inductive and deductive approaches are two types of research approaches that are commonly implemented in executing research. As asserted by Chapman et al. (2015), inductive research approach initiates with making observations and implementing theories that are to be proposed at the end of research process. Thus, it is seen to be bottom-top approach in executing studies where the hypotheses regarding the studies are not developed. As criticised by Hamad et al. (2016), the deductive approach includes identifying the hypothesis at the initiation of the study based on the existing information and theories and then developing a research strategy for testing the identified hypothesis. This indicates that the deductive research approach uses a top-bottom approach. In this research, the deductive research approach will be used. The advantage of using deductive research approach is that it helps in clearly explaining the concepts and variables involved in casual relationships as well as assist in measuring the concepts in a quantified manner (Foley and Timonen, 2015). The deductive approach is also to be used as it helps in generalising the findings of the study to some extent and thus the findings identified in the study as the reason behind the decline in child vaccination coverage in the UK can also be perceived as cause of the decline of child vaccination in other countries and globally. The limitation of the inductive approach is that it offers limited scope to the researcher in the exploration of the study and may include inaccurate references in explanation of findings (São José et al. 2017). This may lead to develop error in the study and so this approach will not be used in executing this study.

Research Design

The exploratory, explanatory and descriptive research designs are mainly used in executing studies. As per Safdar et al. (2016), the explanatory research design is implemented in studies where the effective background of the topic is not available. They are often used to inform the cause-effect relationship in studies. As commented by Berger et al. (2017), the exploratory design is implemented in studies where the research problem is not clearly mentioned and the intention of the study is to establish priorities and develop operation definitions. Thus, the exploratory and explanatory designs are often used in researches where the aim and objectives of the studies are not clearly defined. As argued by Kim et al. (2017), the descriptive research design is referred to as a scientific method where through observation the subject behaviour is explained without influencing the findings in any way. This indicates that descriptive design looks both at the positive and negative aspect of the behaviour of the subject to explain the findings. The advantage of the descriptive design is that it critically analyses the raised research problem and takes into consideration the positivity and negativity factors related to the study, in turn, providing enriched results (Willis et al. 2016). Thus, in this study, descriptive research design will be used. This study already has a clearly mentioned research aim and objectives which makes it invalid to use exploratory and explanatory research design.

Sampling Method

There are mainly two types of sampling methods that are probability sampling and non-probability sampling. As asserted by Sedgwick (2015), probability sampling includes selection of participants or subjects for the study in a random manner where the participants represent the whole population. Thus, it offers an advantage for the subjects to have an equal opportunity of getting selected for the study from the whole population. As argued by Almajali et al. (2016), in non-probability sampling the subjects are selected for the study on the purpose. This indicates that all the individuals in the population do not have an equal opportunity of getting selected. In this study, both sampling methods will be used. The probability sampling method will be used for gathering subjects for the quantitative data collection. Thus, for the survey, a total of 75 subjects will be selected who are parents of children between 0-4 years of age out of a total population of 100 individuals. The benefit of using probability sampling is that it offers less judgement and is cost-effective along with takes less time in executing the study (Provenzano-Castro et al. 2016). The non-probability sampling will be used in collecting qualitative data. This means that while gathering participants for the interview this method will be used according to which 5 health professionals are to be interviewed regarding their understanding about the cause of decline in child vaccination coverage in the UK.

Research Strategy

The research strategy informs about the process implemented by the researcher to resolve the encountered research problem in the study. The different kinds of research strategy include experimentation, survey, case study analysis and others. In this study, survey and interview strategy will be used. As commented by Whitehead et al. (2015), the survey is the process in which the goal is to get maximum insight regarding the population based on which the study is being performed. The benefit of using survey strategy is that it helps in gathering increased amount of data within minimum time and cost. As argued by Denniston et al. (2019), interview is the process in which data is gathered by proper conversation between individuals. This is beneficial because it helps to examine the feelings and emotions of the participants to understand the detailed information that raises to the identified problem in the study. In this study, mixed research strategy will be used to use the advantages of each research strategy and neglect the limitation suffered by each strategy while using them individually.

Data Collection

The primary research will be followed in executing the study and mixed, qualitative and quantitative data collection are data collection methods used under the primary research. As mentioned by Maragh‐Bass et al. (2017), quantitative data collection is the process in which numeric or statistical form of data is collected and presented with the help of charts and graphs. The benefit of this method is that it helps in collecting wider amount of data within short amount of time but the limitation is that only objective information is collected. As commented by Leung (2015), qualitative data collection is the process in which the feelings and emotions of the participants are identified. The advantage of using this method is that it provides detailed information to make decision in resolving the raised problem in the study but the limitation is that it includes increased time in conducting the study. Thus, in this study, mixed data collection method will be used which means both qualitative and quantitative data collection method will be used so that one’s weakness is resolved by another’s strength. In quantitative data collection, closed-ended questionnaires will be provided to the participants through the help of email and social media. In qualitative data collection, the semi-structured questionnaires are to be used and the participants will be interviewed by using Skype.

Data Analysis

The quantitative data will be analysed by transforming the transcripts into percentage data which will be presented with the help of charts and graphs. The interview transcripts will be collected from the participants and through- in-depth analysing the qualitative data will be presented.

Ethical Considerations

The ethical consideration of the study is important so that the researcher does violate the set standards or norms mentioned for conducting the study. The Data Protection Act 1998 informs that no personal data of the individuals are to be used without their prior consent (www.legislation.gov.uk, 1998). Thus, while conducting the study the informed consent of the participants will be taken by mentioning them in details regarding the way their responses are to be used in conducting the study. In order to respect for anonymity and confidentiality, the name of the participants will not be used and anonymity is to be maintained to ensure confidentiality. The participants will not be forced in taking part in the study and they will be free to withdraw if they think their privacy is being hindered. In order to ensure beneficence, the transcripts developed from the participants will be destroyed by executing the study so that no information may be leaked that may cause harm to the participants.

Limitation and Biases

The limitation to be encountered while executing the study is lack of proper amount of finance. Moreover, the limitation to be experienced in the study is it single country of interest ass it reduces the scope of the research to develop more results. The restricted access to few articles and studies that are inertly related to the study topic will create limitation of the study. This is because such circumstances lead to hindered collection of findings required for enriched execution of the study. The presentation of the findings may have biases of the perception of the researcher that will create limitation for the study. This is because such condition leads to error in analysis and presentation of data.

Proposed Findings

The findings that will be collected in the study is going to inform about the reason and key factors that are creating decline in vaccination coverage for children between 0-4 years of age in the UK. The impact of decline in child vaccination on the health situation of the country will also be informed along with the challenges that are being faced by health professionals in managing child vaccination. Lastly, strategies are to be informed that will be taken in controlling the raised problem.

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