Mandatory vaccination: does it work in Europe?

Gary Finnegan

Gary Finnegan

November 27th, 2017

Gary Finnegan
Share

‘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. rdr

    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

      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

        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

      Thanks!

  2. Pingback

    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

        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

    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 🙂

  5. Sunny

    Sunny

    January 10th, 2020

    Hi Gary,
    Why do you think the databases that contain adverse effects of vaccines reported by users, (eg. CDC’s Vaccine Safety Datalink and WHO’s AEFI data) are not made easily available to 3rd parties and independent researchers? Wouldn’t making that data easily accessible, increase people’s confidence in vaccines?

    • Gary Finnegan

      Gary Finnegan

      January 10th, 2020

      Hi Sunny,
      Fair question. The answer is that I don’t know. I didn’t realise the CDC/WHO would not work with academic researchers on this kind of topic – is that what you are suggesting? Are you an academic researcher?
      Perhaps they don’t post it online for wider consumption but in that case there may be data privacy and research ethics concerns. There could also be concerns about how the data is represented, deliberately or otherwise, by people not qualified to interpret them. For example, the databases might contain reports of events rather than a list of events where the cause has been established.
      Hope that helps.
      Gary

      • Sunny

        Sunny

        January 10th, 2020

        Hi Gary, I have a background in data and data science. I will soon need to decide on vaccination for our first child. So I have been researching literature for some time. Frankly, from all the documentation I have seen so far, the pro-vax narrative seems thinner in evidence than the anti-vax narrative. (It COULD be this is because the pro-vax group targets the average consumer who does not have the appetite to understand studies while anti-vax targets the market that is hungry for some kind of “intricate conspiracy theory”)
        This particular web page was a refreshing change from other pro-vax pages which frankly sound like “canned commercials”. This web page is the first one I have come across, that has actually points to a response to one of the most common questions from the anti-vax groups : why has the government not conducted a long-term placebo study of vaxxed vs unvaxxed subjects.
        The general attitude from most pro-vax groups and individuals toward anti-vax groups seems to one of condescension. They also make no attempt to actually address the questions posed, dismissing everything as “misinformation”. And then there is the non-willingness to provide data to researchers and even people in power (eg. https://www.latimes.com/archives/la-xpm-2002-may-03-na-vaccine3-story.html ). I think that will only make consumers more paranoid. I have heard various anti-vax researchers state that CDC will not make its Vaccine Safetey Datalink database easily accessible, even to professional researchers. Here is what CDC’s website has to say about accessing VSD:
        https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/vsd/index.html#access
        So I see that they make certain specific datasets available. But imo, that makes them appear even more fishy. In this day and age, information can easily be cleansed to remove personally-identifiable data.
        I haven’t formally requested the CDC dataset myself. If they won’t give it to prominent leaders of the anti-vax movement, I don’t think they would give it to other researchers.
        Overall, I think most people are vaccinating only because they still trust their pediatrician, they don’t have the time and/or inclination to research and they are too scared to do anything that is “not the norm”. But I think that will change.
        I could go on and on and cite examples of specific studies that are leading a person like me to hesitate with vaccinating. But I am going to guess that is not the scope of this website?

        • Gary Finnegan

          Gary Finnegan

          January 13th, 2020

          Hi Sunny,
          Thanks for your kind comments. I agree that respect should be the basis for these conversations. Unfortunately, plenty of people online prefer to trade insults or be condescending.
          I would take issue with your suggestion that if the CDC wouldn’t give data to ‘prominent leaders of the anti-vax movement’ that they won’t give it to other researchers. I don’t have any connection to the CDC but my guess is that people known to be anti-vax activists have made up their mind and are not genuinely academic researchers. The statement on their site sound like they would be open to requests from accredited researchers. They probably wouldn’t hand it over to a health journalist like me(!), but perhaps scientists and doctors would be better placed if they had a clear research question to pursue.
          You’re obviously well able to find and analyse data so I’m surprised you’ve come to the conclusion that you might opt out of vaccinating your child. You won’t be surprised to hear that I came to the opposite conclusion when it was time for my kids to have their vaccines. It seems to me that vaccines are necessary (witness the recent measles outbreaks when vaccination rates drop) and are a safe and effective way to stay healthy. My kids even had vaccines that are not on the schedule: chickenpox, which was not offered in all EU countries; and Meningitis B because it was not available when the older one was an infant. But I realise I might be exceptionally vigilant because I’ve read so many cases of people affected by vaccine-preventable diseases.
          In any case, keep an open mind and talk to your paediatrician. If they are a good doctor I’m sure they would discuss your concerns and try to answer questions based on what you’ve found online. You don’t have to take their advice so it’s no harm to ask them to listen to you and to listen to what they have to say.
          Good luck with your decision!

  6. Rey

    Rey

    January 13th, 2020

    I have a child with Autism, and have worked at a funeral home, one of the saddest days was a Mom sobbing on how she was going to afford the funeral and medical bills. Her husband was in the hospital, not working because of measles. Her 10 month old dead because of measels. Does everyone die because of this disease, no. But why should you be allowed to risk the lives of your loved ones and others for a preventable disease? I personally believe if you are terrified of Austim more than possible death, remove your child from society until about five, and then vaccinate your child.

    • Gary Finnegan

      Gary Finnegan

      January 14th, 2020

      Thanks for they Rey.
      We should repeat that vaccines don’t cause autism, but your point is still well made.

  7. Sunny

    Sunny

    January 16th, 2020

    Gary, Thanks. Regarding measles, have you come across any scientific published studies which measure the measles immunity (titres) of adults (ideally adults over age 30) who received their last adult MMR dose 10 years prior? I can’t find any

    • Gary Finnegan

      Gary Finnegan

      January 17th, 2020

      Hi Sunny, measles immunity seems to be very long – up to 200 years (although nobody has lived to 200 years!) https://www.ncbi.nlm.nih.gov/pubmed/?term=17989383

      If you’ve had two doses of the measles vaccine, or if you’ve had measles, you are very likely to be immune.

  8. Sunny

    Sunny

    January 17th, 2020

    Wouldn’t this study delight the anti-vaccination narrative?
    Here is what it reads towards the end:

    “On average, subjects were 52 years of age at the conclusion of the study, and most had contracted natural measles, mumps, or rubella infections during childhood. It is unknown whether vaccine-induced immunity is as long-lived as that induced by natural infection.”

    What would help for parents is to have a study that follows *vaccinated* adults for a decade or two after their last MMR.

  9. Sunny

    Sunny

    January 17th, 2020

    Here is a few that I found since my last comment. They track the existence of immunity in adults who were given 1 or 2 doses as kids. Not exactly what I was hoping to find but still good. If you come across studies which checking for waning immunity after adult vaccination, let me know. In the meanwhile, I shall read through these:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC130661/
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234812/
    https://academic.oup.com/jid/article/189/Supplement_1/S123/821041

    I

Page 2 of 2