University of Nevada-Reno School of Community Health Sciences CHS 450/650: The History, Science and Politics of Vaccines

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1 University of Nevada-Reno School of Community Health Sciences CHS 450/650: The History, Science and Politics of Vaccines Times: and, 9:30-10:45 AM Instructors: Trudy Larson, MD Location: Lombardi 204 Office: 203-B Lombardi Building Phone: (best way to contact) Office Hours: By appointment. Please contact Bonnie Coker at for appointments. Course Description: The purpose of this class is to introduce students to the complex history of vaccines and identify the important scientific advances, social pressures, political trends and public health challenges that impact vaccine development. Using an interdisciplinary approach, this course will explore the forces that impacted vaccine discovery and use through lecture, interactive discussion and debate, guest presentations, student presentations, written assignments, service learning opportunities (as available) and selected readings. Current vaccine controversies will be explored in the context of past events and future vaccine needs. Vaccines were identified as the most important public health advance in the 20 th century and students will have the opportunity to debate, discuss and expand their knowledge to make important decisions for themselves, their families and their community as it relates to the use of vaccines. The course will present information about a variety of topics, including the historical timeline of vaccine development, the science of vaccinology and immune response, epidemics and surveillance, descriptions of vaccines and the diseases they prevent, legislative and regulatory activity regarding vaccines, politics and the anti-vaccine movement, vaccines and bioterrorism and the impact of vaccines on global public health. Core Objectives: This is a Core Capstone course that satisfies CO13 (Integration & Synthesis): Students will be able to integrate and synthesize Core knowledge, enabling them to analyze open-ended problems or complex issues. CHS 450 also satisfies CO9 (Science, Technology & Society): Students will be able to connect science and technology to real-world problems by explaining how science relates to problems of societal concern; be able to distinguish between sound and unsound interpretations of scientific information; employ cogent reasoning methods in their own examinations of problems and issues; and understand the applications of science and technology in societal context. This course also integrates CO1 (Effective Composition & Communication) and CO3 (Critical Analysis & Use of Information) through its issue paper. Prerequisite: 1) Biology 100 or higher; 2) CH 201, 3) Eng 102 and 4) Junior or Senior class standing. Required Text: Mnookin, Seth. (2011) The Panic Virus: A True Story of Medicine, Science and Fear, Simon & Schuster. Epidemiology and Prevention of Vaccine-Preventable Diseases (2012). 12 th Ed. 2 nd printing. The Pink Book only available on the web. Print copies are out of stock. Artenstein, Andrew W. (ed) (2010) Vaccines: A Biography. Springer. (required for CHS 650) Other required readings:

2 Additional course materials will be either distributed in class or posted on WebCampus and noted in class prior to the due date. Other resources: American Academy of Pediatrics, Red Book, 2012 Artenstein, Andrew W. (ed) (2010) Vaccines: A Biography. Springer. (required for CHS 650) Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR) online at cdc.gov Journal of Infectious Diseases Pediatric Infectious Diseases Journal Vaccine American Journal of Epidemiology Course Objectives: 1. Explore the social, political and scientific context of vaccine development through the centuries 2. Discuss the causes and ramifications of the current anti-vaccine movement 3. Provide evidence of the impact of vaccines through discussion of vaccine preventable diseases and the change in their epidemiology due to vaccine utilization 4. List the challenges of vaccine development in the context of federal regulation and litigation 5. Consider a vaccine response to a bioterrorism threat and detail the necessary steps of creating, disseminating and monitoring the new vaccine. Student Learning Outcomes: (tied to Core Objectives 3,9,13) 1. List and describe the major epidemics and plagues of the world. 2. Discuss the historical timeline of vaccine development and tie it to scientific, social and political events of the time. 3. Describe vaccine preventable diseases, details of the vaccine and how it works, and epidemiological impacts of use and disuse of the vaccine. 4. Analyze the anti-vaccine movement of today in the context of the social and political issues of the past and present. 5. Identify and use appropriate professional references for vaccine related topics. 6. Demonstrate the ability to advocate for or against the use of vaccines using sound scientific and epidemiologic information. 7. Identify the steps from discovery to wide spread implementation of vaccines and the associated challenges. Course Requirements: Media update: CHS 450 students will briefly present a recent vaccine issue that was depicted in the media and will facilitate a class discussion of the issue. The original source and a short summary (1 page) of the issue will also be turned in (SLO 5). Good sources for media updates:1) (vaccine) 2) 3) CHS 650 students will categorize the media updates monthly and provide a more in-depth review of the trends that contributed to the media information (2 pages). Individual and group quizzes: There will be 4 individual or group quizzes given in class. Quizzes will cover content directly from lecture, textbook, guest presentations, or films and cover all SLOs. For the group quizzes, small groups will get together to discuss and agree upon the answers. Exams: There will be four exams. Exam content will come from lectures, readings, guest presentations, and films shown in class. Exam format will be multiple choice, short answer, true and false and short essay. 2

3 Reaction papers: There will be three brief (1-2 pages) reaction papers where you will be asked to reflect on issues raised in films, guest presentations, or service learning activities. Issues paper: The purpose of this assignment is to write a professional paper that explores a current issue in vaccines (SLO 5 and others). The CHS 450 paper must be at least 8 (double spaced) pages and will have 3 main sections: 1) description of the issue; 2) historical, political, social, health and/or economic factors that impact the issue; and 3) recommendations for policy, program, and/or research development. For CHS 650, the paper must also contain an additional 2 pages and include the above sections plus a section (4) on the public health impact of the selected issue. Course Points: A maximum of 500 points can be obtained in this course 10 points: Media update 40 points: 4 quizzes (10 points each) 75 points: Exam 1 75 points: Exam 2 75 points: Exam 3 75 points: Exam 4 60 points: 3 brief (1-2 page) reaction papers ( 20 points each) 90 points: Issue paper 1) Description of the vaccine issue (20 points) 2) Historical, political, social, health, and/or economic impact factors (30 points) 3) Policies, programs, and intervention recommendations (20 points) 4) Writing style (20 points) Grading: A % of points C 74-76% of points A % of points C % of points B % of points D % of points B 84-86% of points D 64-66% of points B % of points D % of points C % of points F 0-59% of points Course Policies: Regular class attendance is expected. You will not be successful in this class if you do not attend. Your grade will be directly related to activities that occur in class (e.g., individual and group quizzes, group exercises, lectures will form the basis of exam questions). Please plan to attend the entire class period. If you need to leave class early please notify the instructor and sit near an exit so that you do not disturb other students. If you miss a class, it is your responsibility to get materials from another student in the class. If you miss a class that involves material for a reaction paper or a quiz, you will not be able to make it up. All assignments are to be turned in by the beginning of class on the day specified. Two points will be deducted from the total for each day the assignment is late (this includes assignments that are not turned in at the beginning of class). No assignments will be accepted after the last class period of the semester. There will be no make-up quizzes. There will be no make-ups for exams without an official statement for the absence by a doctor, dean, or other appropriate official. 3

4 As is the policy in the School of Community Health Science, 25% of your grade on all written assignments will be based on content, clarity, and synthesis of ideas, as well as writing style, including organization, works cited, grammar, punctuation and spelling. If students have any difficulties, personal problems or conflicts, please let the instructor know as soon as possible. Please also let me know if you have difficulties with any assignment. Most things can be worked out ahead of time. Do not assume that things can be corrected after the fact. Cell phones and smart phones will be turned off before entering the classroom. You cannot be engaged in class and participating fully if you are on your computer or phone for other purposes. Be respectful and be present in class. Everyone in class has both a right and an obligation to participate in discussions, and if called upon, should try to respond. All questions, perspectives, and opinions are important and valuable you are encouraged to share and discuss.. Be able to use WebCampus to participate in the class (look for documents and files, check grades, take quizzes, etc.). Student responsibilities: Submit all assignments complete, according to instructions, and on time no late assignments. Attend and be prepared for class by reading and completing all assigned work in advance. Cooperate, support, and be respectful of your fellow colleagues and with the instructor. Communicate with faculty concerning any issues or difficulties, preferably BEFORE it becomes a significant problem. Full effort on all assignments do not pick for points we will do all we can to be fair, but you earn your grades. Adhering to the university s academic standards including those governing academic dishonesty; this includes: cheating, plagiarism or fraud. All exams are to be taken without the aid of books, notes, study sheets, other persons, any electronic device (such as cell phones, PDA s, Blackberry, computers), or any other method. Serious grading consequences will result for students accused of academic dishonesty and will follow established University and School of Community Health Sciences policy Dr. Larson s Responsibilities: To provide course content that is timely, pertinent, and current, based on sound research, not hearsay Be on time and prepared for all classes Provide consultation, advisement and/or problem-solving time for students Provide clear instructions regarding assignments and expectations Be prepared to provide and consider evaluations and feedback Return work turned into class in a timely manner (usually within one week, with the exception of the issues paper) Dr. Larson s Idiosyncrasies I respond best when you call me Dr. Larson (or Dr. L) because I m more comfortable in a more formal environment during class. I do, however, enjoy humor, discussion and creative noise when we do our work. I believe in the ability of students to engage in meaningful self-learning and to take responsibility for their own outcomes. I don t give grades; you earn them 4

5 Proposed Class Calendar Dates Content Readings & Assignments 1/20 Day 1 1/22 Day 2 Course description, syllabus review Epidemics and Plagues (SLO 1) a. History of infectious disease outbreaks and impact on life b. Discuss plague, smallpox, cholera, and influenza Epidemics and Plagues (SLO 1) a. Continuing history of outbreaks and impact on life FILM on influenza (SLO 1,2,3) Chap 1 Artenstein* Chap 1-2 Panic Virus Chap Artenstein* 1/27 Day 3 Thurs 1/29 Day 4 2/3 Day 5 2/5 Day 6 2/10 Day 7 2/12 Day 8 Epidemiology/Surveillance (SLO 1) a. Introduce the ways in which disease is followed and characterized (CDC, local, etc.) b. Active and passive surveillance c. Definitions in epidemiology Science of Vaccinology (SLO 2,3) a. The immunology of responding to infectious diseases b. List the types of vaccine: passive and active Guest Speaker: James Seabolt, Pharm D GROUP QUIZ History of Vaccinology (SLO 2) a. Timeline of vaccine development b. Discuss pioneers of vaccine development: Jenner, Pasteur, Salk c. Discuss historical events that impacted vaccine development History of Vaccinology (SLO 2) Continued discussion of the historical events that impacted vaccine development EXAM REVIEW EXAM 1 Vaccines and the diseases they prevent: Rashes (SLO 3) a. Varicella b. Measles, mumps and rubella Reaction paper #1 due The Principles of Epidemiology in Public Health Practice Lesson 1: Sections 1,2,3,4,5 (on reserve) On the web: do sections 1,2,3,4,5 SS1978.pdf Chap 3 Artenstein* Pink book: Chap 1 Journal article: Correlates of Vaccine-Induced Immunity by Stanley A. Plotkin in Clinical Infectious Disease journal. Sanofi Pasteur, Doylestown, and Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania Chap 5* Artenstein ntifying-pathogens-and-transmission-vectors (brief animated history of vaccines-fun to watch) Chap 1,2 Artenstein Chap 9 Artenstein* melines/all Pink book: 12,14,19,21 Paper topic due Chap 13, 15 Artenstein 5

6 2/17 Day 9 2/19 Day 10 2/24 Day 11 2/26 Day 12 3/3 Day 13 3/5 Day 14 3/10 Day 15 3/12 Day 16 Vaccines and the Diseases they Prevent: GI and GU (SLO 3) a. Rotavirus, b. Hepatitis A and B, human papilloma virus Vaccines and the Diseases they Prevent: Managing Strain Types (SLO 3) a. influenza b. polio Toxoids (SLO 3) c. diphtheria, pertussis, tetanus QUIZ Killer of Babies: Polysaccharide Bacteria (SLO 3) d. Hemophilus influenza type B (HiB), e. Pneumococcal, meningococcal Vaccine Review (SLO 3) a. Review vaccine table Film on polio (SLO 1,2,3) EXAM 2 Politics of vaccines through history (SLO 2,4) a. Ethics of early vaccination studies Pink Book: chap 18, 8, 9, 10 Chap 17,19 Artenstein Pink book: chap 11, 17 Chap 11 Artenstein (Chap 12 optional) Pink book: chap 6,15,20 Chap 7 Artenstein Pink book: chap 7,16, 13 Chap 16 Artenstein Pink book: Chap 17 Polio Paper bibliography due for approval Chap 12 Artenstein Reaction paper #2 due The Panic Virus: Chap 3,4 ical-issues-and-vaccines 3/24 Day 17 3/26 Day 18 3/31 Day 19 4/2 Day 20 Politics of vaccines through history (SLO 2,4)) a. Truth or Lies; proving success Mandatory vaccination programs (SLO 2,4) a. US, international, travel b. Public good vs. individual threat Vaccine Safety and Public Perception (SLO 2,4) a. Review of safety information b. Theoretical risk vs. vaccine threats Vaccine adverse events and the national vaccine injury act (SLO 3,4) QUIZ ural-perspectives-vaccination 5/30/110530crbo_books_specter NRS: Vaccine law in Nevada "Vaccination mandates: The public health imperative and individual rights." Law in public health practice (2003): by Malone, Kevin M., and Alan R. Hinman. Pink Book: Chap 4 Post-licensure monitoring of HPV vaccine in the United States Lauri E. Markowitz, et al Centers for Disease Control and Prevention (in Vaccines 28 (2010)) rticles/misconceptions-about-vaccines The Panic Virus: Chap 14,15,16 Paper draft due for peer review 6

7 4/7 Day 21 4/9 Day 22 Controversies in Vaccination (SLO 3,4) a. Discuss autism, thimerosal, aluminum, antigen overload The anti-vaccine movement begins and thrives (SLO 4) a. Wakefield s article b. Current anti vaccine movements Draft paper review due back to instructor The Panic Virus: Chap 5,6,7,10,11 The Panic Virus: Chap 8,9,13, /14 Day 23 4/16 Day 24 4/21 Day 25 4/23 Day 26 4/28 Day 27 4/30 Day 28 5/5 Day 29 Weds 5/6 Prep Day 5/12 12:30-2:30 PM EXAM 3 DEBATE: (SLO 6) To Vaccinate or Not Immunizing for the Public s Health (SLO 3,7) a. ACIP recommendations b. Barriers and challenges Vaccinating the Population: Issues and solutions (SLO 3,7) Panel discussion Evaluating success and addressing the future for Vaccines (SLO 3,7) a. Discuss the MMWR, WHO and their coverage of outbreaks and surveillance b. Influenza pandemic preparedness QUIZ New Vaccine development (SLO 7) a. Discuss how new vaccines are developed and how clinical trials are regulated Guest speaker: James Seabolt, PharmD New vaccines and responding to emerging/re-emerging pathogens (SLO 8) a. Bioterrorism and vaccines b. Pandemics and vaccines c. Use of surveillance EXAM 4 Teams to prepare debate on selected vaccines Pink Book: Chap 2,3, Appendix A Reaction paper #3 due Pink Book: Appendix G Successes and failures: Worldwide vaccine development and application Donald P. Francis* Artenstein: Chap 22 mentapprovalprocess/biologicslicenseapplicationsbl aprocess/ucm htm cine-development-testing-and-regulation Professional Paper due David Henderson, The Looming Threat of Bioterrorism, Science (web campus) rticles/biological-weapons-bioterrorismand-vaccines rticles/vaccines-pandemic-threats Last class meeting 7

8 Academic Dishonesty Policy: Academic dishonesty is against university as well as the system community standards. Academic dishonesty is defined as: cheating, plagiarism or otherwise obtaining grades under false pretenses. Plagiarism is defined as submitting the language, ideas, thoughts or work of another as one's own; or assisting in the act of plagiarism by allowing one's work to be used in this fashion. Cheating is defined as (l) obtaining or providing unauthorized information during an examination through verbal, visual or unauthorized use of books, notes, text and other materials; (2) obtaining or providing information concerning all or part of an examination prior to that examination; (3) taking an examination for another student, or arranging for another person to take an exam in one's place; (4) altering or changing test answers after submittal for grading, grades after grades have been awarded, or other academic records once these are official. Disciplinary procedures for incidents of academic dishonesty may involve both academic action and administrative action for behavior against the campus regulations for student conduct. The procedures involve the determination by the faculty member pursuing concerns over alleged cheating or plagiarism as to whether administrative action is warranted, in addition to making a determination as to any academic consequence. Academic action may include: (1) cancelling the student's enrollment in the class without a grade; (2) filing a final grade of "F"; (3) awarding a failing mark on the test or paper in question; (4) requiring the student to retake the test or resubmit the paper. Disabilities: The School of Community Health Sciences supports providing equal access for students with disabilities. If you have a disability and will be requiring assistance, please contact me or the Disability Resource Center (Thompson Building Suite 100) as soon as possible to arrange for appropriate accommodations Disability Resource Center: o Thompson Building, Suite 101 Phone: (775) TTY: (775) am 5 pm, Monday-Friday Counseling Services: o 202 Thompson Building (tel) After hours, Crisis Call Line: (or toll free: ) 8am - 5pm, Monday Friday Academic Success Services: Your student fees cover usage of the Math Center ( or Tutoring Center ( or and University Writing Center ( or These centers support your classroom learning; it is your responsibility to take advantage of their services. Keep in mind that seeking help outside of class is the sign of a responsible and successful student. Audio/Video Recording: Surreptitious or covert video-taping of class or unauthorized audio recording of class is prohibited by law and by Board of Regents policy. This class may be videotaped or audio recorded only with the written permission of the instructor. In order to accommodate students with disabilities, some students may be given permission to record class lectures and discussions. Therefore, students should understand that their comments during class may be recorded. 8