Mandatory vaccination: does it work in Europe?

Gary Finnegan

Gary Finnegan

November 27th, 2017

Gary Finnegan
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‘As Europe battles measles outbreaks, Italy, Romania, France and Finland are tightening their vaccination laws. The benefits are questionable. ’

Compulsory vaccination was first introduced in the UK – where no vaccines are currently mandated – through the 1853 Vaccination Act. The law required that all children ‘whose health permits’ be vaccinated against smallpox, and obliged physicians to certify that vaccination had taken place. Parents who refused vaccination could be fined £1.

Since then, vaccine mandates have evolved to include a variety of incentives and penalties. In some US states, children cannot access public schools without being vaccinated; in Australia, compliance with childhood immunisation schedules has been linked to pre-school admission (‘No jab, no play’) and to family assistance payments (‘No jab, no pay’).

In most instances where vaccine mandates are in force, they apply only to childhood immunisation. However, vaccination is a condition of employment in some institutions – notably in healthcare facilities. This is not a legal mandate per se but is a form of discrimination accepted in several jurisdictions. In principle, mandates – like vaccines – can be for people of all ages.

The state of play in Europe

In Europe, the picture is mixed. A 2010 study of 27 EU countries (plus Iceland and Norway) found that 15 had no mandatory vaccines. In the meantime, Italy has added 10 vaccines to its list of compulsory vaccines; France and Romania are preparing new laws that would penalise parents of unvaccinated children; and Finland will introduce legislation in March 2018 that requires health and social care providers to ensure staff are immunised against measles, varicella, pertussis and influenza. The diversity of measures taken suggests no proven strategy exists that can be universally applied. 

So, why is there a trend towards mandates and other legal instruments? Political science research on the value of international sanctions against rogue nations has found that while they are often ineffective, sanctions may give some satisfaction to the government implementing the rules. The same may apply to vaccine mandates. ‘Sanctions are often more about the sender than the recipient,’ says Dr Katie Attwell, University of Western Australia, ‘Maybe it’s more of an emotional experience for those who want to punish a country – or, in in the case of vaccinations, a citizen – that deviates from the norm.’

The impact of mandates in European countries has been assessed by the EU-funded ASSET project which found no clear link between vaccine uptake and mandatory vaccination. The report, which has been cited by the European Commission in response to questions from Members of the European Parliament states: ‘The enforcement of mandatory vaccinations does not appear to be relevant in determining childhood immunisation rate in the analysed countries. Those [countries] where a vaccination is mandatory do not usually reach better coverage than neighbour or similar countries where there is no legal obligation.’

ASSET experts have also argued that while mandatory vaccination might fix a short-term problem, it is not a long-term solution. Better organisation of health systems and strong communication strategies may prove more effective. ‘Mandatory vaccinations for both healthcare workers and the public can obtain a rapid improvement in immunisation rates, but in the end, have high costs, especially in term of litigation,’ says Dr Darina O’Flanagan, previous Director of Health Protection Surveillance Centre Ireland and a member of the Advisory Forum of the European Centre for Disease Control 2005-2016.

This is echoed by the EU Commissioner with responsibility for health, Dr Vytenis Andriukaitis ‘The legitimate goal of achieving the highest possible immunisation rates can be attained through less stringent policies, and most Member States prefer the adoption of ‘recommendation policies’ or else a mix of obligation/recommendation policies,’ according to EU Commissioner.

In the meantime, Italy – and by 2018, France and Romania – will be a real-world testbed for the implementation of broad vaccine mandates in the 21st century. Prof Pierluigi Lopalco, University of Pisa, says mandates may polarise public opinion. ‘Consider the Three Cs (Confidence, Complacency and Convenience),’ he says. ‘Mandates do not improve vaccine confidence; they make opposition to vaccination even stronger. However, they are a powerful way to break complacency and this new approach should make vaccination services more convenient and efficient.’

Conclusion

There is no one-size fits all approach to improving vaccine uptake. Some countries with mandates, such as Poland, have high vaccination rates; others, such as Finland, achieve similar results without mandates.

The real power of a mandate is not in coercing reluctant parents to vaccinate children against their will; it is in sending a signal to the wider population that vaccination is a vital part of public health. In this sense, the momentum generated by the debate on mandatory vaccination may have some positive effect. The risk, however, is that it will spark an anti-vaccine backlash equal to – or greater than – this positive signal. This risk would be amplified in cases where vaccine supply or access to vaccination services is not guaranteed, as has been the case in Romania.

A more promising move would be to invest in understanding the behavioural drivers of vaccine acceptance. Including this issue in the forthcoming EU Action Plan on Vaccination, due to be launched in 2018, would be a welcome initiative. In the meantime, it is essential that legislative changes be closely monitored in Italy, Romania, France and Finland – along with policy measures in Germany and other countries where mandates are not in place.

There may not be a silver bullet for vaccine hesitancy but research and sharing experiences are Europe’s best hope for controlling vaccine-preventable diseases.

Comments

  1. Pingback

    Pingback

    December 4th, 2017

    […] As flu season gets underway, the UK’s National Health Service advised that child ‘super spreaders’ must be vaccinated in order to protect elderly relatives, and a review in NEJM discussed the need for a universal influenza vaccine. There were also calls for children to receive the measles, mumps and rubella vaccine following reports of cases in two UK cities. Meanwhile, Vaccines Today asked ‘does mandatory vaccination work in Europe?’ […]

  2. truth

    truth

    March 21st, 2018

    You won’t succeed in imposing mandatory vaccinations in Poland. No way it’ s gonna happen. We know it’s a global agenda

    • bercello

      bercello

      June 7th, 2018

      We did succeeded. There are mandatory vaccinations in Poland. It happened and is happening. It is global agenda, like humanity, logic and common sense.

      • Mac

        Mac

        September 21st, 2018

        No, it is gross abuse of power by the state.

        Vaccination is not a straight forward matter, and there are thousands of children round the world who have been severely damaged by vaccines.

        Compulsory vaccination is medication by force. Do similar to an adult, and you would be in court.

        • Wally

          Wally

          December 14th, 2018

          Can you provide evidence that thousands of children around the world have been severely damaged by vaccines?

          • Heather Chang

            Heather Chang

            March 6th, 2019

            It would be possible to furnish such evidence but very time consuming.

          • Allison

            Allison

            March 12th, 2019

            SIDS is a listed known adverse reaction to vaccination, but most post-mortem examinations do not include inquiries into testing on tissues which would conclusively answer the question of whether a particular SIDS death was related to a recent vaccination. Perhaps this inquiry should be mandatory in all SIDS deaths, and the results be made public, in order to ease the minds of people who fear vaccination. So that, while there does not currently exist any reliable tracking on vaccination deaths and injuries, this would begin that process.

          • clare

            clare

            April 30th, 2019

            yes… simple research will do the trick

        • Yep

          Yep

          March 8th, 2019

          When you go study virology I’ll listen. You think you know a lot probably. I feel for you.

        • Jeroen Goudswaard

          Jeroen Goudswaard

          March 16th, 2019

          There are millions of children that have died of MMR, DTP , hepatitis and tuberculosis. There are no known cases of death caused by vaccination.

      • Mariusz Sochacki

        Mariusz Sochacki

        October 6th, 2018

        Some vaccinations are compulsory for children in Poland. Not for adults. But it looks like even this regulation is going to be repealed in October 2018. Legislation project is already in parliament.

        • Magdalena Ferenc

          Magdalena Ferenc

          November 9th, 2018

          Some? Are you kidding? Most of them are compulsory.

    • Puchkine

      Puchkine

      April 30th, 2019

      Vaccinations are already mandatory in Poland. Just saying….

  3. Jean

    Jean

    July 6th, 2018

    I don’t understand why some vaccines are mandatory. Like Hepb at birth! HepB is transmitted like AIDS is transmitted. Blood, used needles or sexually. I don’t see newborns having these issues. By the time the child is nearing the sexually active stage in life, a booster is needed because the original vaccine only lasts about 10 years. I think we are over doing things and it could just be the reason you see so many Americans with autoimmune diseases. I can see the need for such vaccines like Polio or measles but it’s gotten out of hand in my opinion.

    • Jeroen Goudswaard

      Jeroen Goudswaard

      March 16th, 2019

      A quick check on the Centre for Disease Control shows that HepB also transmits through saliva.

      • Joe

        Joe

        April 6th, 2019

        Incorrect. Hep B is a blood born pathogen and “ is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.”

        https://www.cdc.gov/hepatitis/hbv/bfaq.htm

      • Dani

        Dani

        April 10th, 2019

        I think you read that wrong.

    • Anna Hoy

      Anna Hoy

      April 25th, 2019

      Hello. Yes, it seems that certain vaccines like HepB could be given at later stage. However the HepB vaccination would also provide protection from HepD infection- a much nastier virus. I think ( I have no proof and haven’t researched the numbers) adding an extra vaccine to the current schedule is easier and more effective in term of numbers of vaccinated people.
      I’m a scientist and a mum of 3- all kids were vaccinated and luckily no side effects. For me it is no brainier. Risk of serious side effect vs risk of child death due to the many diseases he/she could get when unvaccinated. When vaccination rates were high the risk of getting polio or measles were low but now? We had a case of measles and mumps in my daughter nursery- I was pregnant at the time- that was no fun!
      Do compulsory vaccination work? Short term- probably, long term- not so sure. We need to educate people and provide them with reliable information.

  4. Mariusz Sochacki

    Mariusz Sochacki

    October 6th, 2018

    Compulsory vaccinations are nothing more than infringement on freedom of choice. Everyone has a right to decide if wan’t something done to their body or not. IF vaccinations are so critical then educate people and convince them that they should take them by presenting relevant research on how they help and what are the risks. No government has a right to decide for its citizens nor force them to do anything they don’t feel like doing. History teaches us that every service/product sharply drops in quality right after people no longer have choice if they gonna use it or not.

    • Alec

      Alec

      November 2nd, 2018

      While vaccines do affect our rights, not getting them affects everyone around us. For instance, if you did not get the measles vaccine, and contract the measles, you may recover fine. However, while contagious you could have exposed a child too young to be vaccinated or a immunodeficient one to the disease. The fatally rate for immunodeficient people is up to 70%. Addressing your other point about gov’ts forcing people to do things they don’t want to do, that’s kinda the government’s job. Do you pay taxes? As for your last point, can you link some sources about products quality dropping?

      • Lee

        Lee

        January 9th, 2019

        I couldn’t agree more Alec. Not immuniing against preventable disease is a purely selfish act and is a perfect example of how modern society has developed. If people want to retain their ‘freedom of choice’ that’s fine, either go and live in a different community of like minded people or face the consequences of not vaccinating.

        If you refuse vaccines for preventable disease and fall ill, you should be held liable for the full cost of your treatment (all of it, wihout state assistance). If your child being ill can be tangibly linked to other children becoming ill that could not receive the vaccine (through allergies or other issues) you should be held fully liable for the cost of their treatment too. You should not be allowed to use public schools and nurseries etc for your children and should be back of the queue for any associated financial support from the government and when your children grow up, lets see how quicly they thank you for excluding them from certain career paths and limiting their educational options.

        Vaccination are not just about protecting your indvidual child/children. It is about protecting the wider communities from entirely prevetnable disease! NIHCE and the medical professionals in the UK are the people that put their time, effort and knowledge to use protecting YOUR family. It is THEM that know what is best for the community as a WHOLE. if you don’t want to comply with that, find another community to live in. Simple.

        • Ian

          Ian

          February 21st, 2019

          Wow. Lee and Alec, that is a very selfish perspective. You might as well ban cars because they are dangerous to others. How about legislate mandatory circumcision to prevent certain communicable diseases? How about mandatory castration to prevent rape? Sounds silly does it not? Well the CDC is not completely on-board with vaccines being 100% safe. The MMR, according to their website, can occasionally cause brain damage. Think on that for a while. A low percentage chance – sure. But what if it was your kid that was damaged? Do you want to live in a state where it is mandatory to “risk” brain damage? What if there was a problem with the batch used on your family? Of course there is never a problem with man made things. They are perfect.

          • Jeroen Goudswaard

            Jeroen Goudswaard

            March 16th, 2019

            I also don’t want to “risk” living in a state where my newborns (who cannot be vaccinated yet) can easily catch a deadly disease. And die of it. This is what happened to 110000 children below the age of 5 worldwide in 2017, because of preventable measles.

          • aimes

            aimes

            March 27th, 2019

            Dangerous driving behavior that leads to people getting killed like drunk driving is already banned. Your argument is a complete fallacy.

        • Allison

          Allison

          March 12th, 2019

          Please elaborate on what should happen when vaccine injuries and deaths occur, or how it should be handled when a vaccinated person spreads disease (which occurs more often than your proposed scenario). These issues are not currently well recognized, and their effects not compensated for in a clear, transparent, and direct manner. Any force taken must also include these considerations.

        • Jeroen Goudswaard

          Jeroen Goudswaard

          March 16th, 2019

          At this point in time it is hard for private daycare/schools/swimming pools etc to only accept vaccinated children. Usually this not allowed on grounds of religious freedom or anti-discrimination laws. Let’s start making this possible everywhere.

        • sean

          sean

          April 27th, 2019

          You are widely misinformed about vaccination.

      • Allison

        Allison

        March 12th, 2019

        Any virus or bacteria could kill a completely immunosuppressed person, so I find issue in saying that a medical procedure with risks should be mandated in order to protect someone who could die from the common cold. I believe there are better and more effective ways to increase uptake, but using a minority of the population who rarely go out anyway as a reason doesn’t hold up well to argument.

      • Anna Housholder

        Anna Housholder

        March 28th, 2019

        when asked to take a manditory shot, as Josey Wales said “I Recon NOT ” !

    • wendy rudd

      wendy rudd

      April 28th, 2019

      The research is there. A choice not to be vaccinated you say? Is it fair on children and family who either can die, or develop a severe disability because of someone else choice that could have been so easily prevented? Is it fair on the taxpayer to pay for the medical costs and long term care involved? Where’s my choice then?

  5. Pingback

    Pingback

    January 10th, 2019

    […] Gary Finnegan na łamach Vaccines Today, magazynu związanego z przemysłem farmaceutycznym, wskazuje, że sensowność przymusu jest wątpliwa. Badania wskazują, że nie istnieje żaden związek […]

  6. Dumitru

    Dumitru

    January 25th, 2019

    Lee you are payed by somebody? You are talking about free society, you speak like a nazi. You are insane? Do you really think institutions, government, medical systems care about you and your health? what age are you, 4? Knowledge about health and how to have a healthy body and mind and how and when to have kids, and to keep a baby healthy that is what you have to know. To be independent and not dependent of some “magical pill”. You have zero idea about the political and economical power of medical corporation and their purpose. Money is their purpose and not your health. Have you any idea of what being healthy is or how to achieve health? You should do your homework and change your life and your habits. If you cannot, other people can and they do not need your “help”. All the western world is just sick near death, and cannot live without being heavily dependent on pills, do search the statistics, mental health included? it is scary. How is that possible with so much “information”, “vaccinations”, “pills”, “specialists” ? Only the pharmaceutical industry is growing not the general health of population. You should check the statistics of health problems in western world and then you should check the evaluation of financial power of medical and pharmaceutical corporations.Then compare and then ask you again if really those strangers, money makers, really care about your baby.

    • Peggy Roupas

      Peggy Roupas

      March 8th, 2019

      Couldn’t agree more dumitru

    • Jeroen Goudswaard

      Jeroen Goudswaard

      March 16th, 2019

      The measles vaccine prevented more than 20 million deaths in the 21st century (CDC). Provided for free by governments and produced at near cost by big pharma.

  7. Alan Poskitt

    Alan Poskitt

    March 28th, 2019

    Before 1963, measles was a benign childhood disease that has actual health benefits. Having measles not only results in life-long specific immunity to measles, but also in life-long non-specific immunity to degenerative diseases of bone and cartilage, sebaceous skin diseases, immunoreactive diseases and certain tumors as demonstrated by Ronne (1985).
    However, the minute the measles vaccine became “FDA approved” in 1963, measles not-so-mysteriously became a “deadly” disease.
    Childhood diseases are easily treatable. Vaccine injuries (especially deaths)—not so much.
    — ROBERT S. MENDELSOHN, M.D.

    • Gary Finnegan

      Gary Finnegan

      April 2nd, 2019

      This is simply not true.
      Before the measles vaccine, the virus killed more than 2 million people per year globally. Today, this number is down thanks to vaccines and better management of cases. However, the disease still kills more than 100,000 people annually.
      Measles was never a benign illness. Most people recover well; some do not.

      • Ramon Simpson

        Ramon Simpson

        April 9th, 2019

        “Before the measles vaccine…” What are you referring to, the Dark Ages? The reason why deaths go down has to do with people living with better hygiene, food and sanitation in other words a healthier life style. Funny how always the decrease of casualties is attributed to the introduction of vaccines. The number of deaths attributed to measles was already going down in the U.S. world before the vaccine was introduced (same with polio vaccine).
        Here’s a nice excerpt from the National Vaccine Information Center:
        “The CDC attributes the drop in reported measles cases and deaths in the U.S. to use of the measles vaccine beginning in the mid-1960’s, however, published measles morbidity and mortality data give evidence that death rates for measles had dropped significantly in the U.S. before the measles vaccine was introduced in 1963.”
        Here’s the link for whomever wants to read it: https://www.nvic.org/vaccines-and-diseases/Measles/measles-history-in-america.aspx
        You will also find references in the article to the statistics that were researched to come to that conclusion. One is from the U.S Department of Health, Education and Welfare (887 pages).
        Happy reading Gary.

        • Gary Finnegan

          Gary Finnegan

          April 9th, 2019

          Hi Ramon,
          Hygiene and access to healthcare were reducing death rates in developed countries – but the disease was still circulating before the vaccine was introduced. When the vaccine came in, the decline in death rate accelerated because there were fewer cases. The level of misery and hospitalisation due to measles also fell.

          @all: The ‘National Vaccine Info Center’ website linked above is a US-based anti-vaccine site, albeit one with a nice website and serious-sounding name.

  8. Ramon Simpson

    Ramon Simpson

    April 9th, 2019

    Sorry Gary but you said “Today, this number is down thanks to vaccines…”.
    That’s simply not true for the U.S. . It was already going down BEFORE the introduction of the vaccine.
    Alan Poskitt was clearly referring to the U.S. and you decided to answering him by talking about global cases. That’s apples and pears. In underdeveloped nations casualties are still higher but that’s because there is less hygiene, sanitation and less healthy food, in short these people already have a weaker immune system because of a less healthy environment causing increasing risk of fatal casualties.

    Also the fact that the link is from an anti vaccine site is irrelevant. They use official government data to come to their conclusion which you can check for yourself. Please tell me where their conclusion is flawed with references to their article and the sources they use. I’ll wait.

    • Gary Finnegan

      Gary Finnegan

      April 11th, 2019

      Ramon, I think you are conflating data about number of cases and number of deaths.
      I agreed (it’s a fact) that number of deaths in the US, where you are, were falling for some of the reasons we’ve both stated before the vaccines arrived. But there were still lots of cases and outbreaks. It was vaccines that drove down the number of cases dramatically in developed countries. It even helped eliminate the disease in the Americas – something we never achieved here in Europe because vaccination rates were never quite high enough. If it were just a case of hygiene, healthcare, diets etc., Europe would have got there ahead of the Americas. Most US states wouldn’t have anything like the healthcare that Denmark or the Netherlands offers to all resident. And although I’ve never been, I doubt Central and South America could match Germany or Ireland on those scores.
      Of course, the Americas success has been partly undermined by imported cases from Europe – a fact which should embarrass us greatly. It shows that if we drop our guard – i.e. let vaccination rates slide – outbreaks can recur even in the most modern cities and countries in the world.

      • Ramon Simpson

        Ramon Simpson

        April 12th, 2019

        Gary,
        I don’t understand you’re way of thinking. You agree that the numbers of deaths has decreased (by 98% between 1900 and 1963) BEFORE the vaccine was introduced in the USA in 1963 but you say that the amount of CASES did not.
        I would say, who cares?
        Measles is a CHILDHOOD disease. It’s not dangerous at all as long as people live in an environment with proper living conditions, nutrition and health care so in first world countries where people would have enough of a basis level of health it’s definitely NOT necessary to vaccinate.
        I had measles without vaccination, was sick for a few days and I’m immune for life now! If measles is still a threat in other parts of the world all one needs to do is improve their living standards. That won’t make the measles go away of course (neither would vaccines, the insert actually says that side effects of the vaccine can be….measles) but it will not be life threatening. Children would be sick for a few days and afterwards be fine (and immune for life). I’m sure a lot of people still die of the flu in underdeveloped countries or the common cold, a cut on their finger or malnutrition just because their living standards are abysmal. That doesn’t mean we should vaccinate them for every little thing (although Big Pharma would probably be happy with that)
        90,000 people die around the world from measles every year according to the WHO. Malnutrition especially vitamin A deficiency is the primary cause of death in those cases. In fact 75-92% of measles hospitalizations in the United States are also due to vitamin A deficiency. Even the CDC admits that before measles mass vaccination program was introduced, nearly everyone contracted measles and obtained lifetime immunity by age 15.
        Also I would like to let you know that I lived most of my life in Europe, not the US, and have been living in Australia for the last 9 years. The above I found by just doing my own research WHICH I WOULD RECOMMEND EVERYONE TO DO.
        I’m from the Netherlands originally, have lived there for 39 years in perfect health and have never been given a measles vaccine, nor chicken pox , mumps, rubella. Had all childhood diseases and am immune for life!

        I’d say that today Western Europe is actually in better shape than the US with regards to health. Every time I visit the US, which I regularly do (I’m actually in the US while I type this), I cannot help but noticing the amount of medication people use. The fact that people from the US are the most obese probably also speaks volumes (38.2% of the adult population as per OECD). I find it ridiculous that a harmless childhood disease as measles needs to be “eradicated” when the vaccines that are supposed to treat them have side effects that are often worse than the disease they are supposed to prevent (again measles being one of them but also: anaphylaxis, anaphylactoid reactions, angioneurotic edema (including peripheral or facial edema), bronchial spasm, vasculitis, Stevens-Johnson Syndrome, erythema multiforme, urticaria, rash, diarrhea, thrombocytopenia, purpura, regional lymphadenopathy, leukocytosis, the list goes on, please have a read: https://www.drugs.com/sfx/measles-virus-vaccine-side-effects.html.)
        The current “outbreak” the US currently has and the hysterical mass media making sure everybody notices is something that makes me shake my head every time I hear about it. It’s clear that news station’s biggest sponsors are the pharmaceutical industries. In 2014 the global vaccine market was worth over 32 billion dollars and was expected to reach over 59 billion by the year 2020 making it the number one source of profit for the industry.
        This is about money and control and has nothing to do with health. People have a fully functioning immune system 6 months after birth. All one has to do is give it fuel with proper nutrition, exercise, hygiene and avoid stress. Let common sense prevail, not mass media hysteria.