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Argument Analysis

Midwestern State University


March 31, 2019


Johnson, S. R. (2020). Healthcare workers get top priority for COVID vaccine, but hospitals may not mandate it. Modern Healthcare50(44), 16.


The increased hesitancy, delay, or refusal for measles vaccinations and the recent increase in this disease, is a growing concern that has reached a global level. The following two articles in this analysis demonstrate the effects that this anti-vaccine movement has had, by first documenting a measles outbreak that occurred in Brooklyn, New York, in the summer of 2013. Second, by a presenting a modeling study that simulates the substantial health and economics consequences that a potential outbreak would have on the country. Both studies have been summarized, acknowledging both successes and limitations in each. I have expressed my view about each article and give a summarization of how I feel this issue can be addressed in the future.

Argument Analysis

Fallout from parental hesitancy, delay, or refusal of vaccinations, is the leading factor resulting in the resurrection of previously eliminated diseases. This crusade is commonly known as the Anti-Vaccine or “Anti-Vaxx” Movement. One study focuses on the “real-life” consequences and economic burdens caused by this movement and the effects that one imported case of measles had on Brooklyn, a populous borough of New York City in the summer of 2013 (Rosen, Arciuolo, Khawja, Giancotti and Zucker, 2018). Lo and Hotez (2017) set out to answer the growing concerns of the anti-vaxx movement and how infectious diseases, specifically measles, could have a detrimental impact on not only public health systems, but on economics resources in the United States. Measles is a highly contagious viral infection which typically includes high fever with a rash which presents itself as flat red spots located on the upper torso. Transmission occurs both by airborne and respiratory droplets, with an infectious period of 4 days prior to the appearance of a rash and 4 days post (Rosen et al., 2018). Due to the mode of transmission for measles, a large outbreak can occur from a single case (Rosen et al., 2018). In 2000, the United States declared measles eradicated (Rosen et al., 1028), however there has been a recent decline in vaccinations due to celebrity advocacy and the spread of pseudo-science regarding the perceived dangers of vaccines (Lo and Hotez, 2017). The authors pose that the hesitancy of vaccinations has caused the emergence of preventable childhood diseases. The reader will consider the documented cases and mathematical models to evaluate and substantiate their claims.

On March 13, 2013, a teenager returned to New York City following a trip aboard to London, England. This trip coincided with an outbreak of the measles virus genotype D8, which had spread throughout the United Kingdom (Rosen et al., 2018). This importation of the virus from a single individual resulted in a total of 58 confirmed cases of measles, with six generations of transmission, within two Orthodox Jewish neighborhoods in Brooklyn, New York (Rosen et al., 2018). The authors painstakingly list conclusive statistical data from the New York City Department of Health and Mental Hygiene (DOHMH) regarding the investigation of case patients, laboratory confirmation of the measles, IgM results or RT-PCR analyses and the age and vaccination status of the 58 case patients (Rosen et al., 2018). They concluded that the transmission of the virus occurred between eight extended families and presumed the other sources of transmission included occupants in their apartment dwelling, friends, community gathering areas and heath care facilities (Rosen et al., 2018). In addition to the 58 case patients, 3,351 people were also discovered to be exposed contacts; 66% had received the required double dose of the measles vaccination and 11% had received a single dose (Rosen et al., 2018). The exposure contact immunity status of the remaining 23% was listed as either susceptible or unknown (Rosen et al., 2018). DOHMH set up an extensive community outreach program where local health care providers, as well as schools and day-care facilities, were on heightened alert for new cases. Public notices were distributed through the media along with a telephone “hotline” for citizens to call with questions or concerns. Twelve different bureaus and 87 employees of the DOHMH were enlisted to assist in the outbreak between March 13, 2013, and June 9, 2013 (Rosen et al., 2018). The price tag for this preventable outbreak of measles, cost the City of Brooklyn roughly $400,000.00 (Rosen et al., 2018). Rosen et al., (2018) stated the confinement of the virus was “resource intensive,” requiring “the redirection of resources away from other public health activities” (p. 815). It was one of the largest post-eradicated outbreaks in the United States (Rosen et al., 2018).

As a reader I was impressed with the credibility and detail of the data provided in this study. As a health care professional I am acutely aware of the dangers of the measles virus. However, the manner in which the authors presented the information based on a verifiable outbreak was astounding. One case infected 58 people and exposed over 3,351 more at the cost of approximately $400,000.00 (Rosen et al., 2018). The authors sought to shed light on how a single measles outbreak placed an undue burden on a city’s allocation of resources, both used to discover and contain the virus. I feel they were successful in their endeavor and their findings could be used as a tool to educate and disseminate the anti-vaccine movement.

The excruciating process in which parents must decide on whether or not to vaccinate their children is fraught with a labyrinth of information on which they are left to decipher. For some it is easy, it a strong moral belief based on religion or culture, but for others it is established in the spread of false information regarding the dangers of vaccinations and the ill-perceived notion that the disease itself is extinct. Lo and Hotez, (2017) developed a stochastic mathematical model which focused strictly on children from the ages of 2 to 11 years old. They used data from the US Centers for Disease Control and Prevention (CDC) to simulate measles, mumps and rubella (MMR), vaccination coverage. The data gathered from the CDC ChildVaxView, 2013-2015 replicates vaccine coverage for children between the ages 2 to 5 years old (Lo and Hotez, 2017). For children between the ages of 5 to 11 years old, it was gathered from CDC SchoolVaxView, 2010-2015 (Lo and Hotez, 2017). Lo and Hotez (2017) also used the CDC SchoolVaxView data for “state-level prevalence of vaccine hesitancy, defined as nonmedical (e.g., personal belief) exemptions of childhood vaccination” (p.888). They predicted a 1% to 8% per state reduction in vaccine coverage, which also represented the increase in widespread non-medical exemptions (Lo and Hotez, 2017). Based on literature from various state and local health institutions, the estimated cost of a single measles case is approximately $20,000 for state and local expenses only; no estimated financial burden for the family was included (Lo and Hotez, 2017). Regarding statistical analysis, the model was based on a measles outbreak ensuing two chance events, both simulated imported cases in U.S. counties, one by way of contact with a child, and one by way of multiple contacts (Lo and Hotez, 2017). The results of this model concluded that a 5% decline in MMR vaccinations in children residing in the U.S. “would result in a three-fold increase in national measles cases” (p.890) in the 2 to 11 years age group, for a total of 150 new cases of measles, costing the public $2.1 million dollars (Lo and Hotez, 2017).

Although this article does not document the events of an actual outbreak as the previous one does, it does focus more on cause and effect of the anti-vaccine movement. Lo and Hotez (2017) document limitations of their study such as the narrow focus on the age group (2 to 11 years old) and the data from CDC containing “variation(s) in reporting standards from individual states” (p. 891). Even with these noted limitations and conservative estimates, the authors successfully address the effect that even a minute decline in vaccination coverage, had a substantial increase in the number of cases of measles. In order to improve the credibility of this study I would attempt to include all age groups; this study scarcely touches on the fact that infants from 0 to 1 years old are more vulnerable to this virus and not eligible to receive the vaccine until after 12 months of age. In an attempt to gather more information regarding the status of vaccine coverage and exemption, I believe I would encounter the same issue as the authors did, with the discrepancy of how states report standards. I would attempt to push for not only more education regarding anti-vaccination, but would also focus on the process in which it is conveyed.

I feel both articles presented different approaches to the anti-vaccine movement. Rosen et al., (2017) documented the effects from a health and economic stand point; how one imported case of measles from an unvaccinated teen impacted a populous city such as Brooklyn, New York. Lo and Hotez (2018) approached the subject by the use of a stochastic mathematical model, demonstrating how just a small sample of the population (children ages 2 to 11 years old), could be effected by an imported case of measles and a steady decline in vaccine refusals.

Throughout my years as a health care provider, I have had extensive training regarding the administration and containment of infectious diseases. I am aware that the majority of these diseases can be contained or even eradicated through a vaccine program. As a parent, I too have agonized over the decision on whether or not to vaccinate my children and risk the “fact” that they could become autistic through my decisions as their parent. The authors made their focus of this argument on the disease process, rather than the vaccine itself. Rosen et al., (2017) had a greater impact on me due to the fact that this study was based on an actual event. According to recent reports in the news, the majority of States offer some form of vaccine exemption for either medical or non-medical personal belief. I believe the findings in the above studies can have an impact on passing laws to first eliminate the non-medical exemption and secondly, deny public access to any government funded schools, parks, buildings, and facilities for those who refuse to abide by said laws. With implementation of such measures, we could once again eradicate measles and other vaccine preventable diseases. I recognize the extremity of these proposed laws and the outcry of the violation of personal rights that would ensue. However, a violation of the rights of personal safety for the health and well-being of the majority of Americans, has already been violated by those who refuse vaccinations; evidence of this would be the 3,351 residents of the boroughs of Brooklyn in New York City.


Lo, N. C., & Hotez, P. J. (2017). Public health and economic consequences of vaccine hesitancy for measles in the United States. JAMA Pediatrics, 171(9), 887-892. doi:10.1001/jamapediatrics.2017.11695

Rosen, J. B., Arciuolo, R. J., Khawja, A. M., Fu, J., Giancotti, F R., & Zucker, J. R. (2018). Public health consequences of a 2013 measles outbreak in New York City. JAMA Pediatrics, 172(9), 811-817. doi:10.1001./jamapediatrics.2018.1024

Argument Analysis

To better understand research methods, you will obtain and analyze two conflicting RESEARCH

articles on the diversity issue of your choice. You will explore the ways in which they are and

are not examples of credible scholarship by answering the guiding questions below for each

piece of literature. You will explore the ways in which they are and are not examples of

credible scholarship by answering the following guiding questions for each piece of literature.

1. Identify the author’s/authors’ research question.

2. Identify the hypothesis/es being tested.

3. Document at least three instances where statistical information was

displayed. Where did these numbers come from? Were they believable or

trustworthy? Why?

4. If you sought to answer the same research question, what two things would

you do to improve the credibility of the study and your findings?

5. Should findings from the study (or your own) be used to modify law?

Explain your opinion.

6. What is your personal response to the author’s/authors’ argument?

7. In what ways does your positioning influence the way you perceive the

author’s/authors’ argument?

Argument Analysis

Nuña Bidness?
COUN 2413


• This presentation focuses on the types of sexism that occur in the workplace.
The two categories are benevolent sexism and hostile sexism. Each category
of sexism demonstrates the difference a women may feel between the two in
a workplace. The feelings can either be positive or negative depending on the
type of sexism and the type of women they are. Both categories believe that
women are less capable than men and should not be in superior roles.

Hostile Sexism and Benevolent Sexism in the

• Benevolent sexist believe that women are delicate, weak, and fragile. The men
in the workplace may see the women as incompetent and should not be held
up to higher standards. “Benevolent sexists should believe that women are not
suited for positions of power” (Hideg, 2016, p. 9). Benevolent sexism is a
simple way of saying that women should be at home and not getting their
delicate hands dirty.

• Hostile sexist believe that women seek power to gain control over men. The
men who feel that way tend to be lower status males with more to lose. They
feel threatened by the women and become more hostile towards them.


• The research for the presentation was conducted using the Midwestern State
University Library Database with Academic Search Complete, EBSCOhost,
and CINAHL Complete . The journals used were Journal of Personality & Social
Psychology and British Journal of Social Psychology. Keywords used during the
search were “benevolent sexism” and “hostile sexism”. Literature reviews
used for the presentation were published between 2015-2016.

Article #1: The Compassionate Sexist? How Benevolent Sexism
Promotes and Undermines Gender Equality in the Workplace

• The article by Ivona Hideg and D. Lance Lerris
describes how benevolent sexism promotes and
undermines gender equality in the workplace.

• The hypothesis for their research was if
benevolent sexism was beneficial to women in
the workplace or if it was negative. This was also
in terms of gender employment equity and how
certain jobs are meant for males and others for

• In the article there are 3 instances that suggest the benefit of
benevolent sexism towards women in the workplace.

• The first instance was a study measuring benevolent and hostile
sexism in the workplace by conducting a survey to participants
in college as well as individuals applying for a full-time job.
However, the study was not very accurate because the
possibility of stereotyping was possible and would result

• The second instance was a study that suggested compassion as
a big factor towards benevolent sexism. It stated that
compassion was the reason that women were suggested to have
less stressful jobs that were for women.

• A third instance was a study that that suggested women be in a
feminine job (human resource management) and not in a
masculine (finance) position.

Article #1 continued…

• The studies that were conducted demonstrated that benevolent sexism supported the hiring of women for feminine roles. If I
were to conduct my own research, I would ask both men and women during their hiring process a series of questions and have
them come in a few weeks later to ask again after they have gone through educational training.

• My findings would not be used to modify the law because benevolent sexism is not dangerous. It may be undermining towards
women who may feel they are more capable than men, but this type of sexism does not actually pose a threat in a physical way.

• The authors’ argument suggest that benevolent sexism is beneficial to women and I partially agree with them. It is good that
men be compassionate towards women and should treat them with respect. Having a women do a less physical job is not
necessarily undermining them, but it should be perceived as the man protecting the women.

• My position as a female who is happy not overseeing other people in the workplace may make others believe that all females feel
that way. However, other women may have different opinions that would later result in those same women fighting for equal
rights as the men. Those females seek the opportunity to be superior to the men.

Article #2: Hostile sexism (de)motivates women’s social
competition intentions: The contradictory role of emotions

• The article by Lemonaki, Manstead, and Maio
conducted a research on hostile sexism and
how it affects women in the workplace.

• The hypothesis for their research was if the
knowledge of hostile sexism affected the
thoughts and emotions of the women whom
they experimented on.

• In the article there are 2 studies that suggest that hostile sexism affects the
behavior of a women in the workplace

• During the first study a series of undergraduate women read an article
during a course that they were taking. In the article it was suggested that
women have not progressed over the years despite their abilities to try and
be respected as much as the men. After the women read the article they were
asked if they felt confident in themselves and the majority agreed they did
not feel socially ready to compete against the men.

• The second study was conducted towards staff and students at a university.
They read an article that talked about sexism and how it affected women.
After they read the article forms of anger and frustration increased.
However, the hostile sexism lowered their levels of security and readiness to
compete against the men. The results can be believable because the second
study was similar to the first study and had similar results..

Article #2 continued…
• If I were to conduct my own research on how hostile sexism affects women in the workplace, I would not use articles

to manipulate the women into thinking they can or can not go against the men. I would simply have a male and female
compete for a higher-level position and encourage both equally that either one is well deserving of the position. I
would also conduct my research for high school students going against valedictorian or a top university. I would
encourage everyone that they have the same abilities and have their mindsets equal towards each other.

• I’m not sure my findings would modify the law. I do believe that both men and women should be treated equally.
However, hostile sexism is something that has been around for years and it would take more than a few studies and
articles to truly make a change.

• The authors argument suggest that hostile sexism decreases a women’s ability to feel confident going against the men
despite their emotions of anger and frustration they may feel against them. I do believe that any person male or female
who is emotionally put down will not have the same confidence they may have had before. Hostile sexism is an
emotional attack towards women that may seem harmless but, in the end, it can truly make a women feel powerless.

• I am a women who did not feel threatened by benevolent sexism, but I do feel a little angered with hostile sexism. I
am a women who would want to go up against a man, but I would not feel confident doing so. I do not feel like I am
smarter than most men because I do not feel stronger than most women.

Personal Thoughts

• Benevolent and hostile sexism are both issues that tend to show up in the workplace.
A women may either feel threatened by this or not. As I stated before, benevolent
sexism is not necessarily a threat because the male is putting the women first and
being respectful to her. However, hostile sexism is emotionally hurtful to women
because a male is undermining her and saying she is not good enough.

• I do believe that the women should be respected equally but I also believe that they
should be nurtured and cared for. The man should do the heavy lifting and the
stressful jobs, but the career women should also have the right to do the same job if
she wanted and get equally paid for it.


• Hideg, I., & Ferris, D. L. (2016). The compassionate sexist? How
benevolent sexism promotes and undermines gender equality in
the workplace. Journal of Personality & Social Psychology, 111(5),
706–727. Doi:10.1037/pspi0000072.

• Lemonaki, E., Manstead, A. S. R., & Maio, G. R. (2015). Hostile
sexism (de)motivates women’s social competition intentions: The
contradictory role of emotions. British Journal of Social
Psychology, 54(3), 483–499. Doi:10.1111/bjso.1210.


Citation: Varol, S.; Catma, S.; Reindl,

D.; Serieux, E. Primary Factors

Influencing the Decision to Vaccinate

against COVID-19 in the United

States: A Pre-Vaccine Analysis. Int. J.

Environ. Res. Public Health 2022, 19,

1026. https://doi.org/10.3390/


Academic Editor: Paul B.


Received: 15 December 2021

Accepted: 11 January 2022

Published: 18 January 2022

Publisher’s Note: MDPI stays neutral

with regard to jurisdictional claims in

published maps and institutional affil-


Copyright: © 2022 by the authors.

Licensee MDPI, Basel, Switzerland.

This article is an open access article

distributed under the terms and

conditions of the Creative Commons

Attribution (CC BY) license (https://



International Journal of

Environmental Research

and Public Health


Primary Factors Influencing the Decision to Vaccinate against
COVID-19 in the United States: A Pre-Vaccine Analysis
Serkan Varol 1,* , Serkan Catma 2 , Diana Reindl 3 and Elizabeth Serieux 4

1 Department of Engineering Management, University of Tennessee at Chattanooga, Chattanooga,
TN 37403, USA

2 Department of Business Administration, University of South Carolina Beaufort, Bluffton, SC 29902, USA;
[email protected]

3 Department of Nursing and Health Professions Business, University of South Carolina Beaufort, Bluffton,
SC 29902, USA; [email protected]

4 Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98105, USA;
[email protected]

* Correspondence: [email protected]

Abstract: Because vaccine hesitancy is a dynamic trait, it is critical to identify and compare the
contributing factors at the different stages of a pandemic. The prediction of vaccine decision making
and the interpretation of the analytical relationships among variables that encompass public percep-
tions and attitudes towards the COVID-19 pandemic have been extensively limited to the studies
conducted after the administration of the first FDA-approved vaccine in December of 2020. In order to
fill the gap in the literature, we used six predictive models and identified the most important factors,
via Gini importance measures, that contribute to the prediction of COVID-19 vaccine acceptors and
refusers using a nationwide survey that was administered in November 2020, before the widespread
use of COVID-19 vaccines. Concerns about (re)contracting COVID-19 and opinions regarding manda-
tory face covering were identified as the most important predictors of vaccine decision making. By
investigating the vaccine acceptors and refusers before the introduction of COVID-19 vaccines, we
can help public health officials design and deliver individually tailored and dynamic vaccination
programs that can increase the overall vaccine uptake.

Keywords: vaccine hesitancy; COVID-19 vaccination; mask mandate; predictive modeling

1. Introduction

Since 11 March 2020, when the World Health Organization declared the novel coron-
avirus disease (COVID-19) outbreak a global pandemic, the world has grappled with how
to contain and minimize its devastating effects [1]. To date, mandates to attempt to curtail
the virus spread have varied from mask-wearing to curfews, to social distancing measures,
and to other policy and behavioral interventions. Despite these measures, COVID-19, as of
November 2021, was still one of the top causes of death in the US [2].

This virus has taken many lives globally and continues to cause immense suffering
in every aspect of human life. The collaborative efforts of the scientific community, in
conjunction with the support of governmental organizations, led to the development of
various vaccines that are highly effective against severe disease caused by the original strain
of COVID-19. For instance, after Israel vaccinated almost 60 percent of its population, as
of April 23, 2021, the daily number of average fatalities dropped below 10, a steep decline
from the average number of deaths (70) in January [3]. However, due to the introduction of
new variants, such as Delta and Omicron, and a reduction in vaccine effectiveness over
time, in August of 2021, Israel had an average of nearly 7500 daily confirmed cases [2]. The
increase in cases led to an expansion of booster shots in Israel and globally.

Int. J. Environ. Res. Public Health 2022, 19, 1026. https://doi.org/10.3390/ijerph19031026 https://www.mdpi.com/journal/ijerph

Int. J. Environ. Res. Public Health 2022, 19, 1026 2 of 11

The effectiveness of the available COVID-19 vaccines can be evaluated by comparing
the mortality rates among vaccine recipients and unvaccinated individuals. For instance,
the recipients of the booster shots who were 50 years of age or older due to the emergence
of variants had 90% lower mortality than those who did not receive a booster in Israel
during the summer of 2021 [4]. Similarly, according to the Vaccine Safety Datalink project
initiated by the CDC’s Immunization Safety Office, the standardized mortality rate for
recipients of two doses of the Pfizer-BioNTech vaccine was 0.37 person-years, significantly
lower than that for unvaccinated people (1.11 person-years) between 14 December 2020 and
31 July 2021 in the US [5]. During the Delta surge in the summer of 2021, southern states
such as Arkansas, Alabama, Mississippi, where older adults have the lowest vaccination
rates, had the highest death rates from COVID-19 in the US [6].

Although progress is being made, and cases and deaths are diminishing primarily
due to the vaccination campaigns being undertaken around the world and the addition
of booster shots, vaccine hesitancy threatens to undermine or even halt this progress,
especially as new variants of the virus continue to emerge. Knowing who would be likely
to accept or reject the vaccine has critical importance, and could drastically change the
trajectory of the pandemic across the globe. However, the trajectory of COVID-19 vaccine
hesitancy shows that the indecision to be vaccinated has been a fluctuating process. More
than one-third of vaccine-hesitant respondents before introducing COVID-19 vaccines
leaned towards the willingness to be vaccinated after the actual vaccine administration
process started in early 2021 [7]. If this dynamic nature of vaccine hesitancy is recognized
by public health practitioners, health workers, and policy makers, individual messages
and programs to target specific audiences at the different stages of the pandemic, in an
attempt to diminish vaccine hesitancy, may result in a quicker end to the current and future
pandemics. For any vaccination program to be successful, the highest vaccine uptake needs
to be attained. However, vaccine hesitancy, the period of indecision about accepting a
vaccine, continues to be a dynamic and complex concept that requires strategies that should
be individually tailored based on the characteristics of the target populations [8].

The promising developments in the fight against this deadly virus are important
milestones, but the pandemic is far from over. Addressing the global challenges, such as
significant variation in governments’ capabilities, high vaccination costs, and the inability
to effectively allocate and deploy vaccines [9], requires international coordination and
collaborative efforts among developed and developing nations. Although it will take time
and careful planning to end the pandemic worldwide, vaccinating at least 70–80% of the
population to achieve herd immunity at a national level is not a distant dream for some
countries, despite the continuous mutation of the virus.

Much of the existing literature focuses on identifying the predictors that would impact
the willingness to accept (WTA) vaccines using survey data. These variables range from
the socio-demographic characteristics of the participants to the perceptions and attitudes
towards the vaccines; hence, each variable’s statistical relationship with the WTA the
vaccine can be investigated. However, although the results of these studies may have
important implications for understanding vaccine hesitancy by offering an interpretation
of the statistical relationships, the prediction of vaccine decision making [10,11] before the
administration of the first FDA-approved vaccine has rarely been investigated. Thus, this
study used predictive analytics to: (1) analyze the predictability of the vaccine acceptors and
non-acceptors; and (2) identify the individual predictors that strongly influence the vaccine
behaviors when COVID-19 vaccines were only hypothetical in nature. Investigating vaccine
hesitancy around this baseline scenario is an important step to map out how willin