Mandatory vaccination: does it work in Europe?

Gary Finnegan

Gary Finnegan

November 27th, 2017

Gary Finnegan

‘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.’


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.


  1. rdr


    May 21st, 2019

    >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?

    People who understand which statistic is important for the understanding of effectiveness of the vaccine, i.e. educated people.

    >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

    Lies. It’s highly infectious, dangerous disease that can maim (multiple dangerous complications) and kill you. (1 per 1000 cases)

    >I had measles without vaccination

    Nobody cares about your story, anecdotes don’t matter at all in medicine.

    >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)

    People die of flu because they are not immunized, same with “cut on their finger”. (tetanus)
    Yes, we should vaccinate people based on the local epidemiological status.

    >I’d say that today Western Europe is actually in better shape than the US with regards to health

    Of course, because of objective, measurable factors such as cost of medical care, accessibility and others which is no secret.

    >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

    Yes, it’s ridiculous to think that we should care about public health – absolutely.
    The probability of any serious adverse effects is incomparable to the risks regarding complication after measles.

    >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

    Mass hysteria – you mean the mentioning of undeniable facts and personal choices that lead to this situation? Weird definitions you are using chap.

    >This is about money and control and has nothing to do with health

    This is indeed about money (vaccinating is cheaper than mass disease containment) and about control (of public health).

    >All one has to do is give it fuel with proper nutrition, exercise, hygiene and avoid stress

    Absolute denialist lies which nobody cares about, and no health system practices.

    >Let common sense prevail, not mass media hysteria.

    Indeed, let’s end the anti-vaccine propaganda and embrace evidence-based medicine.

    • Linda


      May 29th, 2019

      Thank you for writing this. I wholeheartedly agree.

    • jane mariouw

      jane mariouw

      June 25th, 2019

      there has never been a govt true placebo study done to prove vaccine safety. there has never been a govt. long term controlled vaxxed vs. unvaxxed study done to prove effectiveness.
      death rates, then case numbers of all infectious diseases fell by 99% from 1900-1960 before vaccines were used. clean water, seeage and garbage systems plus better living standards and better nutrition were the reasons. not vaccines. look it up on govt statistics charts.

      • Gary Finnegan

        Gary Finnegan

        June 25th, 2019

        Hi Jane, thanks for your message. This comes up a lot but it is well explained here and here.

      • Nthabiseng


        November 16th, 2019

        Thank you Jane! Germany just mandated the measles vaccine. I am very upset.

    • RDR: Please message me

      RDR: Please message me

      July 28th, 2019


  2. Pingback


    June 6th, 2019

    […] that is that a raft of countries have either talked about making vaccinations mandatory or have made it mandatory. With the measles epidemic across Europe being a particularly strong factor.  Now, these dolts […]

  3. jane mariouw

    jane mariouw

    July 6th, 2019

    the WHO recommends 5 days of vit A plus fluids, food and rest for measles.

    for the number one killer of children world wide( diarrhea), the WHO recommends making your own electrolyte water.

    • Gary Finnegan

      Gary Finnegan

      July 8th, 2019

      The WHO recommends two doses of measles vaccination to prevent measles.

      • Rtp


        July 18th, 2019

        And the WHO is wrong about everything. What’s your point? The WHO literally make up millions of deaths caused by measles in sub-Saharan Africa (they don’t even have useful cause of death data in those countries) in order to make their vaccine programs look good.

        The fact is that there is no observational evidence that anybody has ever died of measles in all of history. Doctors just decide to blame measles when somebody dies because it suits their narrative. But no doctor has ever actually observed a measles virus jump from one person to another and immediately cause illness and death.

        What is more, most doctors won’t diagnose/test for measles if the patient is vaccinated so the apparent fall in measles cases since the vaccine is meaningless. Kids still get rashes but they just don’t get called measles – they get called roseola, 5th disease and hand foot and mouth.

  4. Samantha


    September 14th, 2019

    Hi Gary,

    I see responding you responding to comments respectfully, and I thank you for that! My question after reading this article is, knowing the risks for vaccines as well as the benefits, do you believe that there are some vaccines that are not worth the risk in receiving. Per ingredients, are here some that may not be best for a one size fits all approach?

    • Gary Finnegan

      Gary Finnegan

      September 16th, 2019

      Thanks Samantha,
      We can’t give specific medical advice – please ask your doctor.
      I can tell you that I have had all vaccinations recommended for me, and that my own kids are fully vaccinated too. I must now remind my mother to have her flu vaccine 🙂

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