Black Hawk County Public Health

Black Hawk County Board of Health

Position Statement on Immunizations

Original Adoption: November 29, 2017; Revised: April 29, 2026

(References used in the development of the position statement are shown at the end of the statement.)

Overview

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• The Black Hawk County Board of Health (Board) supports access to immunization across the lifespan as a core public health approach.
• Immunizations are a proven strategy to protect individuals and communities from serious, preventable infectious diseases.
• Immunizations have reduced illness, disability, and death, contributing to longer life expectancy and improved quality of life across the United States.
• Reducing the spread of certain diseases through immunization helps avoid costs related to emergency visits, hospitalizations, and follow-up care.
• The Board supports policies that maintain and improve access to immunization, including requirements in settings such as childcare and schools. Strong evidence shows that these policies are effective at protecting public health and preventing disease.

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The Board recognizes that immunization recommendations evolve over time as science advances. These recommendations should be guided by rigorous, transparent review based on scientific evidence. When changes are not made through this review, they can create uncertainty for families, providers, schools, and public health agencies. For this reason, the Board’s position emphasizes the importance of relying on the best available scientific guidance, along with the practical experience of professional medical and public health organizations. It also highlights the need for clear and consistent information that helps patients and families make informed choices, respects their role in decision making, and protects community health.

Public Health Importance

Immunization is considered one of the greatest public health achievements in history. Routine immunization has dramatically reduced (and in some cases nearly eliminated) diseases that once caused widespread illness, long-term disability, and death, such as measles, whooping cough (pertussis), influenza, and meningococcal disease. Maintaining high immunization coverage remains essential to protecting public health. In Iowa, most children receive recommended immunizations, and these high coverage levels help keep disease rates low and prevent costly outbreaks. At the same time, state data also show a growing proportion of school-aged children who are under or un-immunized.

When immunization rates fall below protective thresholds, the risk of outbreaks increase. This places individuals, families, schools, healthcare systems, and local economies a trisk. Even small declines in coverage, particularly in specific communities or age groups, can increase the risk of outbreaks and disrupt the protection that high immunization rates provide.

Safety and Effectiveness

Immunizations used in the United States undergo extensive testing for safety and effectiveness before they are approved. They are also continually monitored. A growing body of scientific evidence demonstrates that immunizations reduce the risk of infection, severe illness, hospitalization, long-term complications, and death. Routine childhood immunizations have substantially reduced hospitalizations and deaths from certain diseases in the United States and have helped avoid significant medical costs by preventing serious illness.

Like all medical interventions, immunizations can have side effects. Most of these are mild and temporary. Serious side effects are rare and are continuously monitored through multiple national vaccine safety systems, including the Vaccine Adverse Event Reporting System (VAERS). This system allows healthcare providers, manufacturers, and the public to report and review potential safety concerns. When immunization injuries do occur, mechanisms such as the National Vaccine Injury Compensation Program exist to support affected individuals and families.

Transparency and Public Trust

Public trust is foundational to effective public health practice. The Board acknowledges that families may have questions about immunization recommendations, safety, and changing guidance. The Board supports:

• Transparent communication about what is known, what is still being studied, and how     recommendations are developed
• Open discussion between patients, families, and trusted healthcare providers
• Shared clinical decision-making, when appropriate, grounded in evidence and individual health circumstances
• Clear distinction between scientific uncertainty and misinformation

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The Board recognizes the role of multiple expert bodies, including professional medical organizations and public health associations, in evaluating evidence and issuing guidance. In times of rapid or contested policy change, reliance on well-established, peer-reviewed, and clinician-informed recommendations is essential to avoid confusion and maintain access to care.

Population Benefit

Immunization protects individuals and the broader community. Some people cannot be immunized due to age (such as infants) or medical conditions (such as people with cancer or those who are immunocompromised). High immunization coverage protects these people and allows them to participate in everyday activities.

The Board recognizes that access to immunization is not evenly distributed. Barriers may include cost, transportation, clinic hours, language, health literacy, and misinformation. Public health has a responsibility to reduce these barriers and ensure that all residents—regardless of income, geography, or background—have access to timely immunization services when they need them.  

Policies such as immunization requirements for childcare and school entry have been shown to increase immunization coverage, strengthen community protection, and reduce the spread of disease. The Board supports policies that help keep immunization rates high and ensure everyone gains meaningful health benefits.

Economic Responsibility

Immunization is a cost-effective public health strategy that can prevent illness before it requires expensive medical care like hospitalizations and follow-up care. This can eliminate costs for individuals, families, insurers, and public programs.

Disease outbreaks can also create costs for communities. These include missed work and school days, school and childcare closures and disruptions, out-of-pocket medical costs, and the need for local public health response activities such as case investigation, testing, and communication. Preventing outbreaks helps limit these avoidable disruptions to daily life, education, and local services.

Programs such as the Vaccines for Children (VFC) program ensure that recommended immunizations remain available at no cost to eligible families who want them. Maintaining strong immunization systems protects prior public investments in disease control and helps local governments avoid preventable response costs.

Board of Health Recommendations

The Black Hawk County Board of Health:

1. Affirms support for immunizations across the lifespan as a cornerstone of disease     prevention and community well-being.
2. Supports evidence-based immunization recommendations developed through rigorous     scientific review, including guidance from independent professional medical and public health organizations.
3. Encourages strong partnerships between public health and healthcare providers,     recognizing clinicians as trusted sources of vaccine information and key partners in education, delivery, and shared decision-making.
4. Supports policies that maintain and strengthen vaccination requirements for childcare,     school, and other high-risk settings, with medical exemptions when clinically indicated.
5. Opposes policies that unnecessarily weaken immunization systems, reduce access to     vaccines, or increase the risk of vaccine-preventable disease outbreaks.
6. Commits to transparent, respectful communication with the public, acknowledging     questions and concerns while clearly conveying the compelling evidence supporting immunization.
7. Supports efforts to reduce barriers to vaccination, including outreach, education, and access for underserved populations.

The Board stands ready to serve as a nonpartisan, science-informed resource to legislators, community leaders, and residents on immunization policy and practice.

‍References

American Academy of Pediatrics. (2024). Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2024.

Centers for Disease Control and Prevention. (1999). Ten great public health achievements —United States, 1900–1999. Morbidity and Mortality Weekly Report, 48 (12), 241–243.

Centers for Disease Control and Prevention. (n.d.). Vaccine safety systems.

Centers for Disease Control and Prevention. (2024). Vaccines for Children (VFC) program.

Centers for Disease Control and Prevention. (2026). CDC acts on Presidential memorandum to update childhood immunization schedule (January 5, 2026). U.S. Department of Health and Human Services.

Food and Drug Administration. (2023). Vaccine development—101.

Immunize.org. (2025) Vaccines Work! CDC statistics demonstrate dramatic declines in vaccine-preventable diseases when compared with the pre-vaccine era.

Iowa Department of Health and Human Services. (2024). School immunization audit report.

Lee, C., & Robinson, J. (2016). Systematic review of the effect of immunization mandate son uptake of routine childhood immunizations. Journal of Infection, 72 (6), 659–666.

Omer, S. B., Salmon, D.A., Orenstein, W. A., deHart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360 (19), 1981–1988.

Ozawa, S., et al.(2016). Return on investment from childhood immunization in low- and middle-income countries, 2011–2020. Health Affairs, 35(2), 199–207. https://doi.org/10.1377/hlthaff.2015.1086

Stratton, K., Ford, A., Rusch, E., Clayton, E. W., Committee to Review Adverse Effects of Vaccines, & Institute of Medicine (Eds.). (2011). Adverse Effects of Vaccines: Evidence and Causality. National Academies Press (US).

Whitney, C. G., Zhou, F., Singleton, J., & Schuchat, A. (2014). Benefits from immunization during the Vaccines for Children program era—United States, 1994–2013. Morbidity and Mortality Weekly Report, 63(16), 352–355.

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