Hesitancy and refusal: mandatory vaccination may not be the solution

Roberta Villa

Roberta Villa

May 12th, 2016

Roberta Villa

StampaWhen deaths from vaccine-preventable disease hit the headlines, the public debate on mandatory vaccination always resurfaces. Do parents have the right to put their kids’ lives at risk? As car seats and seat belts are compulsory in most countries, why not vaccinations?

Another reason in favour of mandatory vaccination is that, unlike car seats and seat belts, immunisation does not only protect an individual, but can contribute to protecting the entire community, through what is called “herd immunity”. Mass immunisation, in fact, builds a sort of barrier around those who cannot be vaccinated because of their age or health conditions. In other words, it has a social role that could further justify a legal obligation.

However, it is well known that, despite the evidence of the huge benefits of vaccines, a number of families in Europe and US refuses to use them to protect their children. Some people hesitate, delaying vacations or deviating from national vaccine schedules. Misinformation, rumours and hoaxes about vaccination spread through the web, and mainly through social media, bringing with them fear and distrust.
Mandatory vaccination is often suggested as one strategy for countering this crisis.

ASSET is an EU-funded project aimed at favouring social mobilisation, dialogue and multidisciplinary exchanges among all stakeholders involved in preparedness and responding to infectious threats. Its staff performed an analysis to verify whether mandatory vaccinations in Europe are associated with better childhood immunisation coverage rates. The answer, for the three main vaccines considered, is “no”. There is no evidence that mandatory vaccination improves vaccination coverage.

The analysis focused on three relevant vaccinations, on which different policies have been adopted in different countries within the European Economic Area: polio (Pol3), measles (MCV1) and pertussis containing vaccines (DTP3). Information on policies came from the VENICE project, while data on childhood immunisation coverage are from UNICEF.

While the polio vaccine is mandatory in many countries, pertussis vaccines are more often only recommended, even in countries where other vaccinations are compulsory. Moreover, measles vaccination is an important indicator of hesitancy and refusal, since the false claim that it could cause autism is still circulating.

The study shows that, from 2007 to 2013, countries where a vaccination was mandatory did not usually reach better coverage than neighbouring or similar countries where there was no legal obligation. For example, Latvia, where vaccinations are mandatory, does not get better results than other Baltic countries; Denmark and Sweden, despite the same “voluntary” approach, have very different situations, with the former being below the European average immunisation rate, and the latter well above it.

Vaccine hesitancy and refusal is a complex problem for which there is no easy solution. A law may not be enough to solve it.

Roberta Villa, Zadig, on behalf of ASSET project