[
]
Parents' versus children's rights
Medical ethicist Arthur Caplan argues that children have a right to the best available medical care, including vaccines, regardless of parental opinions toward vaccines, saying, "Arguments about medical freedom and choice are at odds with the human and constitutional rights of children. When parents won't protect them, governments must." However, government entities, such as Child Protective Services, can intervene only when the parents directly harm their child via abuse or neglect, considering a child does not have the ability to give or take away consent. Although withholding medical care meets the criteria of abuse or neglect, refusing vaccinations does not, as the child is not being harmed directly.
To prevent the spread of disease by unvaccinated individuals, some schools and doctors' surgeries have prohibited unvaccinated children from being enrolled, even where not required by law. Doctors who refuse to treat unvaccinated children harm both the child and public health, and may be considered unethical when parents are unable to find another provider. Opinion on this is divided, with the largest professional association, the American Academy of Pediatrics
The American Academy of Pediatrics (AAP) is an American professional association of pediatricians, headquartered in Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C.
Background
The Academy was found ...
, saying that exclusion of unvaccinated children may be an option under narrowly defined circumstances.
One historical example is the 1990–91 Philadelphia measles outbreak, which led to the deaths of nine children in an anti-vaccination faith healing
Faith healing is the practice of prayer and gestures (such as laying on of hands) that are believed by some to elicit divine intervention in spiritual and physical healing, especially the Christian practice. Believers assert that the healin ...
community. Court orders were obtained to have infected children given life-saving medical treatment, against the wishes of their parents, and also for healthy children to be vaccinated without parental consent.
In schools and daycare
Vaccination requirements for access to daycare and schools increase vaccine uptake in the United States and there is evidence that these requirements may decrease disease. However, the majority of studies of mandatory vaccination took place in the US and the cultural climate in United States is quite different from other industrialized nations. A study shows that many Europeans countries have whooping cough
Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious bacterial disease. Initial symptoms are usually similar to those of the common cold with a runny nose, fever, and mild cough, but these are followed by two or t ...
vaccination rates as high as those in the United States despite no mandates. Canada has a similar vaccination to the US despite 13 states having no vaccine mandates, which may in part be due to vaccination programs taking place in school in Canada.
Deliberate naturally acquired immunity through infection
In the United Kingdom, children are not vaccinated against chickenpox
Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab ...
despite the availability of a vaccine
A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified. since the 1990s. This is because evidence suggested that naturally acquired immunity provides superior immunity to the immunity acquired through vaccination. Modelling predicted that vaccinating children would increase the number of cases amongst adults and the Joint Committee on Vaccination and Immunisation
The Joint Committee on Vaccination and Immunisation (JCVI) is an independent expert advisory committee that advises United Kingdom health departments on immunisation, making recommendations concerning vaccination schedules and vaccine safety. ...
were concerned that more pregnant women would become infected.
Planning vaccination policy
Vaccination committees
Vaccination policy is typically proposed by national or supranational advisory committees on immunization, and in many cases, is regulated by the government.
Vaccination strategy models
Predictive vaccination strategy models play an important role in predicting effectiveness of vaccination strategies at population level. The may, e.g., compare the sequence of age groups to be vaccinated and study the outcome in terms of caseload, deaths, length of a pandemic, healthcare system load, and economic impact.
Evaluating vaccination policy
Vaccines as a positive externality
The promotion of high levels of vaccination produces the protective effect of herd immunity
Herd immunity (also called herd effect, community immunity, population immunity, or mass immunity) is a form of indirect protection that applies only to contagious diseases. It occurs when a sufficient percentage of a population has become im ...
as well as positive externalities in society. Large scale vaccination is a public good, in that the benefits obtained by an individual from large scale vaccination are both non-rivalrous and non-excludable, and given these traits, individuals may avoid the costs of vaccination by "free-riding"[ off the benefits of others being vaccinated.][ The costs and benefits to individuals and society have been studied and critiqued in stable and changing population designs. Other surveys have indicated that free-riding incentives exist in individual decisions, and in a separate study that looked at parental vaccination choice, the study found that parents were less likely to vaccinate their children if their children's friends had already been vaccinated.
]
Trust in vaccination
Trust in vaccines and in the health system is an important element of public health programs that aim to deliver life-saving vaccines. Trust in vaccination and health care is an important indicator of government work and the effectiveness of the social policy. The success in overcoming diseases and in vaccination depends on the level of trust in vaccines and health care. The lack of trust in vaccines and immunization programs can lead to vaccine refusal, risking disease outbreaks, and challenging immunization goals in high- and low-income settings. Today, the medical and scientific communities obviously face a big challenge where vaccines are concerned, namely enhancing the trust with which the general public regards the entire endeavor. Indeed, earning the public's trust in public health is a big challenge. Accurately, studying the trust in vaccines, and understanding the factors that affect the reduction of trust, allows authorities to build an effective vaccine campaign and communication strategies to fight the disease. Trust is a key parameter to work with before and while undertaking any vaccine campaigns. The state is responsible for providing smart communication, and to inform a population about diseases, vaccines, and the risks of both. The WHO recommends that states work long-term, to build population resilience against vaccine myths and scares, to develop a strong campaign that is well prepared to respond to any event that may erode trust, and respond immediately to any event which may erode trust in health authorities.
Cost-benefit: United States
The first economic analysis of routine childhood immunizations in the United States took place in 2001, and reported cost savings over the lifetime of children born that year. Other analyses of the economic costs and potential benefits to individuals and society have since been evaluated. In 2014, the American Academy of Pediatrics
The American Academy of Pediatrics (AAP) is an American professional association of pediatricians, headquartered in Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C.
Background
The Academy was found ...
published a decision analysis that evaluated direct costs, such as program costs, vaccine cost, administrative burden, negative vaccine-linked reactions, and transportation time lost to parents. The study focused on several communicable diseases, including diphtheria, tetanus, pertussis, measles, hepatitis A and B, and varicella (chickenpox
Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab ...
), but did not include seasonal flu vaccines. Estimated costs and benefits were adjusted to 2009 dollars and projected over time at three percent interest. Of the theoretical group of 4,261,494 babies, beginning in 2009, who had followed a standard childhood immunization schedule under the Advisory Committee on Immunization Practices
The Advisory Committee on Immunization Practices (ACIP) is a committee within the United States Centers for Disease Control and Prevention (CDC) that provides advice and guidance on effective control of vaccine-preventable diseases in the U.S. c ...
guidelines "will prevent ∼42,000 early deaths and 20 million cases of disease, with net savings of $13.5billion in direct costs and $68.8billion in total societal costs, respectively." In the United States, and in other nations, there is an economic incentive and "global value" to invest in preventive vaccination programs, especially in children as a means to prevent early infant and childhood deaths. Socioeconomic disparities have been found to hinder reasonable access to vaccinations in the U.S., and it has also been found that even were such status is not a factor, "racial ethnic minority adults are less likely than whites to receive preventive care including vaccination".
Cost-benefit for older adults
There is an economic incentive to establish vaccination programs for older adults as the general population is aging due to increasing life expectancy and decreasing birth rates. Vaccinations can reduce the issues linked with both polypharmacy and antibiotic-resistant bacteria in the older demographic with comorbidities by preventing infectious diseases and decreasing the necessity of polypharmacy and antibiotics. One study done in Western Europe found that the estimated cost of vaccinating one person over a lifetime against 10–17 potentially debilitating pathogens would be between €443–€3,395 (€493–3,778 in 2022; $502–3,849 USD). Another study found that if 75% of adults over 65 were vaccinated against seasonal influenza, 3.2–3.8 million cases and 35,000–52,000 influenza-related deaths could be avoided, and €438–558million saved annually, solely on the European continent.
International Organizations
In 2006, the World Health Organization and UNICEF created the Global Immunization Vision and Strategy (GIVS). This organization created a ten-year strategy with four main goals:
* to immunize more people against more diseases
* to introduce a range of newly available vaccines and technologies
* to integrate other critical health interventions with immunization
* to manage vaccination programmes within the context of global interdependence
The Global Vaccination Action Plan
Global means of or referring to a globe and may also refer to:
Entertainment
* ''Global'' (Paul van Dyk album), 2003
* ''Global'' (Bunji Garlin album), 2007
* ''Global'' (Humanoid album), 1989
* ''Global'' (Todd Rundgren album), 2015
* Bruno ...
was created by the World Health Organization and endorsed by the World Health Assembly in 2012. The plan which is set from 2011 to 2020 is intended to "strengthen routine immunization to meet vaccination coverage targets; accelerate control of vaccine-preventable diseases with polio eradication as the first milestone; introduce new and improved vaccines and spur research and development for the next generation of vaccines and technologies."
By country
Table
Argentina
In December 2018, Argentina enacted a new vaccine policy requiring all persons who are medically able, both adults and children, to be vaccinated against specified diseases. Proof of vaccination is required to attend any level of school, file for a marriage license, and request any kind of government ID, including a passport or driver's license. The law requires the government to pay for all aspects of vaccinations and deems vaccination to be a national emergency; vaccines are exempt from internal and customs taxes.
Australia
In an effort to boost vaccination rates in Australia
Australia, officially the Commonwealth of Australia, is a sovereign country comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands. With an area of , Australia is the largest country by ...
, the Australian Government
The Australian Government, also known as the Commonwealth Government, is the national government of Australia, a federal parliamentary constitutional monarchy. Like other Westminster-style systems of government, the Australian Governmen ...
decided, starting on 1January 2016, certain benefits (such as the universal "Family Allowance" welfare payments for parents of children) would no longer be available for conscientious objectors of vaccination. Those with medical grounds for not vaccinating continue to receive such benefits. The policy is supported by a majority of Australian parents as well as the Australian Medical Association
The Australian Medical Association (AMA) is an Australian public company by guarantee formed as a professional association for Australian doctors and medical students. The association is not run by the Australian Government and does not regu ...
(AMA) and Early Childhood Australia
Early Childhood Australia is an early childhood advocacy organisation in Australia, acting in the interests of young children, their families and those in the early childhood education and care field. Its chief executive officer is Samantha Page. ...
. In 2014, about 97 percent of children under seven were vaccinated, although the number of conscientious objectors to vaccination had increased by 24,000 to 39,000 in the previous decade.
The government began the Immunise Australia Program to increase national immunization rates. They fund a number of different vaccinations for certain groups of people. The intent is to encourage the most at-risk populations to get vaccinated. The government maintains an immunization schedule.
In most states and territories, children can consent to vaccinations if they are judged Gillick competent; normally, this applies to children aged 15 or older. In South Australia
South Australia (commonly abbreviated as SA) is a States and territories of Australia, state in the southern central part of Australia. It covers some of the most arid parts of the country. With a total land area of , it is the fourth-largest o ...
, the ''Consent to Medical Treatment and Palliative Care Act 1995'' allows children 16 and older to consent to medical treatment. Additionally, children under this age can be immunized if judged capable of informed consent.[ In ]New South Wales
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, nickname =
, image_map = New South Wales in Australia.svg
, map_caption = Location of New South Wales in AustraliaCoordinates:
, subdivision_type = Country
, subdivision_name = Australia
, established_title = Before federation
, es ...
, children can consent to medical treatment at the age of 14.
When several COVID-19 vaccine
A COVID19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 (COVID19).
Prior to the COVID19 pandemic, an e ...
s were nearing completion in November 2020, Australian Prime Minister Scott Morrison announced that all international travelers who fly to Australia without proof of a COVID-19 vaccination would be required to quarantine
A quarantine is a restriction on the movement of people, animals and goods which is intended to prevent the spread of disease or pests. It is often used in connection to disease and illness, preventing the movement of those who may have been ...
at their own expense.
It is also lawful for workplaces in Australia to mandate vaccines. The legality of this was upheld in the Fair Work Commission
The Fair Work Commission (FWC), until 2013 known as Fair Work Australia (FWA), is the Australian industrial relations tribunal created by the '' Fair Work Act 2009'' as part of the Rudd Government's reforms to industrial relations in Austral ...
case '' Kimber v Sapphire Coast Community Aged Care Ltd'' in 2021.
Austria
Austrian vaccine recommendations are developed by the National Vaccination Board (german: text=Nationales Impfgremium), which is part of the Federal Ministry of Social Affairs, Health, Care and Consumer Protection.
Children aged 14 and older can be vaccinated without parental consent. Starting in February 2022, COVID-19 vaccines are mandatory for all residents over the age of 18.
Brazil
Vaccinating children has been mandatory in Brazil since 1975, when the federal government instituted the National Immunization Program. The compulsory character was written into law in 1990, in the Statute of Children and Adolescents (Art. 14, Para. 1). Parents in Brazil who don't take their children to be vaccinated run the risk of being fined or charged with negligence.
Canada
Vaccination in Canada is voluntary.[ While vaccination is generally required to attend school in ]Ontario
Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central Ca ...
and New Brunswick
New Brunswick (french: Nouveau-Brunswick, , locally ) is one of the thirteen provinces and territories of Canada. It is one of the three Maritime provinces and one of the four Atlantic provinces. It is the only province with both English and ...
, there are exemptions given to those who are opposed.
Under the mature minor doctrine
The mature minor doctrine is a rule of law found in the United States and Canada accepting that an unemancipated minor patient may possess the maturity to choose or reject a particular health care treatment, sometimes without the knowledge or ...
, minors capable of granting informed consent
Informed consent is a principle in medical ethics and medical law, that a patient must have sufficient information and understanding before making decisions about their medical care. Pertinent information may include risks and benefits of treat ...
can be vaccinated without parental approval.
Alberta
British Columbia
New Brunswick
Ontario
Quebec
China
China has passed the World Health Organization's (WHO) regulatory vaccine assessments, demonstrating that they adhere to international standards. The Chinese government's Expanded Program on Immunization (EPI) was created in 1978 and provides certain obligatory vaccines, named Category1 vaccines, for free to all children up to 14 years of age. Initially, the vaccines consisted of Bacillus Calmette-Guérin
Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB). It is named after its inventors Albert Calmette and Camille Guérin. In countries where tuberculosis or leprosy is common, one dose is recommended ...
(BCG) vaccine, oral polio vaccine (OPV), measles vaccine (MV) and diphtheria, tetanus and pertussis (DPT vaccine
The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis (whooping cough), and tetanus. The vaccine components include diphtheria and tetanus toxoids and either kil ...
). By 2007, the vaccine list was expanded to include hepatitis A, hepatitis B, Japanese encephalitis
Japanese encephalitis (JE) is an infection of the brain caused by the Japanese encephalitis virus (JEV). While most infections result in little or no symptoms, occasional inflammation of the brain occurs. In these cases, symptoms may include he ...
, A + C meningococcal polysaccharide, mumps, Rubella
Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and ...
, hemorrhagic fever, anthrax, and leptospirosis. Category2 vaccines, such as the rabies vaccine, are private-sector, non-obligatory vaccines that are not included in neither EPI nor the government health insurance. Due to the privatized nature of Category2 vaccines, these vaccinations are associated with low coverage rates.
Both the Changsheng Bio-Technology
Changsheng Bio-Technology Co., Ltd. () is a biotechnology company based in Changchun Jilin, China, specializing in vaccines. It was founded in 1992 as a state-owned enterprise but became a family-owned private company in 2003.
It reported 566 m ...
Co Ltd and the Wuhan Institute of Biological Products have been fined for selling ineffective vaccines. In December 2018, China enacted new laws imposing strict controls over the production and inspection of aspects of vaccine production from research, development, and testing through production and distribution.
Costa Rica
In November 2021, Costa Rica added COVID-19 to the list of infectious diseases required to be vaccinated against. The vaccine is mandatory for children between the ages of 5 and 18.
Finland
France
In France, the High Council of Public Health is in charge of proposing vaccine recommendations to the Minister of Health. Each year, immunization
Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an infectious agent (known as the immunogen).
When this system is exposed to molecules that are foreign to the body, called ''non-s ...
recommendations for both the general population and specific groups are published by the Institute of Epidemiology and Surveillance. Since some hospitals are granted additional freedoms, there are two key people responsible for vaccine policy within hospitals: the Operational physician (OP), and the Head of the hospital infection and prevention committee (HIPC).[ Mandatory immunization policies on BCG, ]diphtheria
Diphtheria is an infection caused by the bacterium '' Corynebacterium diphtheriae''. Most infections are asymptomatic or have a mild clinical course, but in some outbreaks more than 10% of those diagnosed with the disease may die. Signs and s ...
, tetanus
Tetanus, also known as lockjaw, is a bacterial infection caused by ''Clostridium tetani'', and is characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually ...
, and poliomyelitis
Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 70% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe sym ...
began in the 1950s and policies on Hepatitis B
Hepatitis B is an infectious disease caused by the '' Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection.
Many people have no symptoms during an initial infection. ...
began in 1991. Recommended but not mandatory suggestions on influenza
Influenza, commonly known as "the flu", is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These symptom ...
, pertussis, varicella, and measles
Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than , cough, ...
began in 2000, 2004, 2004, and 2005, respectively.[ According to the 2013 INPES Peretti-Watel health barometer, between 2005 and 2010, the percentage of French people between 18 and 75 years old in favor of vaccination dropped from 90% to 60%.
Since 2009, France has recommended meningococcus C vaccination for infants 1–2 years old, with a catch up dosage up to 25 years later. French insurance companies have reimbursed this vaccine since January 2010, at which point coverage levels were 32.3% for children 1–2 years and 21.3% for teenagers 14–16 years old.] In 2012, the French government and the Institut de veille sanitaire launched a 5-year national program to improve vaccination policy. The program simplified guidelines, facilitated access to vaccination, and invested in vaccine research. In 2014, fueled by rare health-related scandals, mistrust of vaccines became a common topic in the French public debate on health. According to a French radio station, as of 2014, three to five percent of kids in France were not given the mandatory vaccines. Some families may avoid requirements by finding a doctor willing to forge a vaccination certificate, a solution which numerous French forums confirm. However, the French State considers "vaccine refusal" a form of child abuse. In some instances, parental vaccine refusals may result in criminal trials. France's 2010 creation of the Question Prioritaire Constitutionelle (QPC) allows lower courts to refer constitutional questions to the highest court in the relevant hierarchy. Therefore, criminal trials based on vaccine refusals may be referred to the Cour de Cassation, which will then certify whether the case meets certain criteria.[
In May 2015, France updated its vaccination policies on diphtheria, tetanus, acellular pertussis, polio, Haemophilus influenzae b infections, and hepatitis B for premature infants. As of 2015, while failure to vaccinate is not necessarily illegal, a parent's right to refuse to vaccinate his or her child is technically a constitutional matter. Additionally, children in France cannot enter schools without proof of vaccination against diphtheria, tetanus, and polio.] French Health Minister, Marisol Touraine, finds vaccinations "absolutely fundamental to avoid disease," and has pushed to have trained pharmacists ''and'' doctors administer vaccinations. Most recently, the Prime Minister's 2015–2017 roadmap for the "multi-annual social inclusion and anti-poverty plan" includes free vaccinations in certain public facilities. Vaccinations within the immunization schedule are given for free at immunization services within the public sector. When given in private medical practices they are reimbursed at 65%.
Germany
In Germany, the Standing Committee on Vaccination (STIKO) is the federal commission responsible for recommending an immunization schedule. The Robert Koch Institute
The Robert Koch Institute (RKI) is a German federal government agency and research institute responsible for disease control and prevention. It is located in Berlin and Wernigerode. As an upper federal agency, it is subordinate to the Federa ...
in Berlin (RKI) compiles data of immunization status upon the entry of children at school, and measures vaccine coverage of Germany at a national level. Founded in 1972, the STIKO is composed of 12–18 volunteers, appointed members by the Federal Ministry for Health for 3-year terms. Members include experts from many scientific disciplines and public health fields and professionals with extensive experience on vaccination. The independent advisory group meets biannually to address issues pertaining to preventable infectious diseases. Although the STIKO makes recommendations, immunization in Germany is voluntary and there are no official government recommendations. German Federal States typically follow the Standing Vaccination Committee's recommendations minimally, although each state can make recommendations for their geographic jurisdiction that extends beyond the recommended list.[ In addition to the proposed immunization schedule for children and adults, the STIKO recommends vaccinations for occupational groups, police, travelers, and other at risk groups.][
Vaccinations recommendations that are issued must be in accordance with the Protection Against Infection Act ( Infektionsschutzgesetz), which regulates the prevention of infectious diseases in humans. If a vaccination is recommended because of occupational risks, it must adhere to the Occupational Safety and Health Act involving Biological Agents.] Criteria for the recommendation include disease burden, efficacy and effectiveness, safety, feasibility of program implementation, cost-effectiveness evaluation, clinical trial results, and equity in access to the vaccine. In the event of vaccination-related injuries, federal states are responsible for monetary compensation. Germany's central government does not finance childhood immunizations, so 90% of vaccines are administered in a private physician's office and paid for through insurance. The other 10% of vaccines are provided by the states in public health clinics, schools, or day care centers by local immunization programs.[ Physician responsibilities concerning immunization include beginning infancy vaccination, administering booster vaccinations, maintaining medical and vaccination history, and giving information and recommendations concerning vaccines.]
Children aged 15 and over can legally consent to being vaccinated, even if their parents expressly object, provided the child gives the impression of being mature, informed, and capable of understanding the risks and benefits of their decision.
Beginning in March 2020, Germany made the measles vaccine compulsory for all children attending school or day care, as well persons employed at schools, day cares, and medical or community facilities.
Ghana
As of January 2022, COVID-19-vaccination is mandatory for staff and students of secondary and tertiary education, employees in all arms of government, health workers, security personnel, and commercial drivers.[
]
Greece
As of January 2022, COVID-19-vaccination is mandatory for all people aged 60 or older. There is a monthly 100 euro fine for noncompliance.
India
Ireland
In the Republic of Ireland
Ireland ( ga, Éire ), also known as the Republic of Ireland (), is a country in north-western Europe consisting of 26 of the 32 counties of the island of Ireland. The capital and largest city is Dublin, on the eastern side of the island. ...
, childhood vaccination (up to age 16) requires the consent of the parents. The Department of Health strongly recommend vaccinations.
Italy
As aging populations in Italy bring a rising burden of age-related disease, the Italian vaccination system remains complex. The fact that services and decisions are delivered by 21 separate regional authorities creates many variations in Italian vaccine policy. There is a National committee on immunizations that updates the national recommended immunization schedule, with input from the ministry of health representatives, regional health authorities, national institute of health, and other scientific societies. Regions may add more scheduled vaccinations, but cannot exempt citizens from nationally mandated or recommended ones. For instance, a nationwide plan for eliminating measles and rubella began in 2001. Certain vaccinations in Italy are based on findings from the National Centre for Epidemiology, Surveillance and Health Promotion are also used to determine miscellaneous vaccination mandates.
Childhood vaccinations included in national schedules are guaranteed free of charge for all Italian children and foreign children who live in the country. Estimated insurance coverage for the required three doses of HBV-Hib-IPV vaccines is at least 95% when the child is two years old. Influenza is the only nationally necessary vaccine for adults, and is administered by general practitioners. To mitigate some public concerns, Italy currently has a national vaccine injury compensation program. Essentially, those who are ill or damaged by mandatory and recommended vaccinations may receive funding from the government as compensation. A 2010 evaluation of vaccine coverage, which covered the 2008 birth cohort, showed a slight decline in immunization insurance coverage rates of diphtheria, hepatitis B, polio, and tetanus after those specific vaccinations had been made mandatory. However, vaccination levels continued to pass the Italian government's goal of 95% outreach.
Aiming to integrate immunization strategies across the country and equitize access to disease prevention, the Italian Ministry of Health issued the National Immunization Prevention Plan (Piano Nazionale Prevenzione Vaccinale) in 2012. This plan for 2012–2014 introduced an institutional "life course" approach to vaccination to complement the Italian health policy agenda. HPV
Human papillomavirus infection (HPV infection) is caused by a DNA virus from the ''Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and res ...
vaccine coverage increased well, and pneumococcal vaccine
Pneumococcal vaccines are vaccines against the bacterium '' Streptococcus pneumoniae''. Their use can prevent some cases of pneumonia, meningitis, and sepsis. There are two types of pneumococcal vaccines: conjugate vaccines and polysaccharide v ...
and meningococcal C vaccines faced positive public reception. However, both infant vaccine coverage rates and influenza immunization in the elderly have been decreasing. A 2015 government plan in Italy aimed to boost vaccination rates and introduce a series of new vaccines, triggering protests among public health professionals. Partially in response to the statistic that less than 86% of Italian children receive the measles shot, the National Vaccination Plan for 2016–18 (PNPV) increased vaccination requirements. For instance, nationwide varicella shots would be required for newborns. Under this plan, government spending on vaccines would double to €620million annually, and children could be barred from attending school without proving vaccination. Although these implementations would make Italy a European frontrunner in vaccination, some experts questioned the need for several of the vaccines, and some physicians worried about the potential punishment they may face if they do not comply with the proposed regulations.
There were 5,000 cases of measles in 2017, up from 870 in 2016. This rise accounted for 29% of all those in the European Union. The law compelling children to have ten vaccinations to enroll at state schools came into effect in March 2018 but in August 2018 the Five Star Movement
The Five Star Movement ( it, Movimento 5 Stelle , M5S) is a political party in Italy. Its leader and president is Giuseppe Conte, Prime Minister of Italy from 2018 until 2021. The M5S was founded on 4 October 2009 by Beppe Grillo, a comedian an ...
pushed legislation through the Italian Senate
The Senate of the Republic ( it, Senato della Repubblica), or simply the Senate ( it, Senato), is the upper house of the bicameral Italian Parliament (the other being the Chamber of Deputies). The two houses together form a perfect bicameral s ...
abolishing it. It did not pass the Chamber of Deputies
The chamber of deputies is the lower house in many bicameral legislatures and the sole house in some unicameral legislatures.
Description
Historically, French Chamber of Deputies was the lower house of the French Parliament during the Bourbon R ...
but parents did not have to provide schools with a doctor's note to show their children have been vaccinated. By November 2018 the government had changed its stance because of the "measles emergency" and decided to uphold the obligation for children up to the age of 16, teachers and health professionals to be vaccinated. A midwife working at a hospital in central Italy was sacked for refusing vaccination.
Japan
In Japan, there are three types of vaccination practices: Routine (scheduled); Temporary (ad-hoc); and Non-legal. Infections of the first two types are defined by () and its related (). As of January 2020, sixteen infections in total are on the legal listsfourteen are CategoryA diseases (vaccination is not mandatory but recommended to prevent pandemic), and two are CategoryB (not even recommended and only for a personal care purpose).[
Compared to the global standard, Japanese vaccination policy is sometimes described by medical experts as the "Vaccine Gap."] For instance, Japan is the only developed country that does not list mumps on the vaccine schedule.[ It's also noted that the government approval for new combination vaccines usually takes longer than other developed countries, such as the United States.][
One reason behind the vaccine gap is that the government was sued several times for negligence of duty of care and for malpractice liabilities throughout the vaccination history.] The lawsuit risks, particularly the 1992 Tokyo High Court's ruling on the MMR vaccine class action, impacted on law amendment.[ Vaccination is no longer mandatory as of 1994.][ As a result, vaccination rate declined in Japan. The rate of flu vaccination, for example, was 67.9% among schoolchildren in 1979 but dropped down to approximately 20% in 1998–1999. With the rapidly aging society issue, the decline among schoolchildren hit the elderly generation. In 1998–1999 season, deadly flu outbreak spread widely in nursing homes for the elderly as well as inpatients wards. The outbreak was followed by the 2001 amendment of Immunization Act to add flu vaccination for the elderly.][ As of February 2020, flu vaccination under the Act is in CategoryB (for a personal care purpose) only for the elderly.][ However, historical data sets suggest that flu vaccination for schoolchildren is also the key to take care of the elderly.]
In addition to legal and social risk concerns, an issue of the decision-making process underlies the vaccine gap. Unlike the Advisory Committee on Immunization Practices
The Advisory Committee on Immunization Practices (ACIP) is a committee within the United States Centers for Disease Control and Prevention (CDC) that provides advice and guidance on effective control of vaccine-preventable diseases in the U.S. c ...
(ACIP) in the United States, a centralized permanent advisory committee for vaccination policy was not organized in Japan until 2009, when a deadly flu outbreak struck the nation. Since the committee kick-off, however, the vaccine gap has been gradually improved.[
]
Latvia
According to a 2011 publication in '' CMAJ'': The notion of "mandatory" in Latvia differs from that of other nations. Latvia appears unique in that it compels health care providers to obtain the signatures of those who decline vaccination. Individuals have the right to refuse a vaccination, but if they do so, health providers have a duty to explain the health consequences.
Vaccines that are not mandatory are not publicly funded, so the cost for those must be borne by parents or employers, she adds. Funded vaccinations include tuberculosis, diphtheria, measles, hepatitis B, human papillomavirus for 12-year-old girls, and tick-borne encephalitis until age 18 in endemic areas and for orphans.
Beginning at age 14, minors can consent to vaccination in Latvia without parental permission.
Malaysia
In Malaysia
Malaysia ( ; ) is a country in Southeast Asia. The federal constitutional monarchy consists of thirteen states and three federal territories, separated by the South China Sea into two regions: Peninsular Malaysia and Borneo's East Mal ...
, mass vaccination is practised in public schools. The vaccines may be administered by a school nurse
School nursing, a specialized practice of public health nursing, protects and promotes student health, facilitates normal development, and advances academic success. School nurses, grounded in ethical and evidence-based practice, bridge the gap b ...
or a team of other medical staff from outside the school. All the children in a given school year are vaccinated as a cohort
Cohort or cohortes may refer to:
* Cohort (educational group), a group of students working together through the same academic curriculum
* Cohort (floating point), a set of different encodings of the same numerical value
* Cohort (military unit) ...
. For example, children may receive the oral polio vaccine in Year One of primary school (about six or seven years of age), the BCG in Year Six, and the MMR in Form Three of secondary school. Therefore, most people have received their core vaccines by the time they finish secondary school.
Mexico
Mexico has a multi-year program for immunisation of children. The immunisation of children is fully covered by the government of Mexico.[ Mexico has an adverse events committee to monitor the adverse effects of vaccination as well as a standing technical advisory group on immunization.][
The recommended vaccine schedule for children in Mexico contains vaccinations against sixteen vaccine preventable diseases.] Vaccine doses administered in Mexico are usually valid in the United States.[ The immunization schedule for children in Mexico is as follows:
In addition, Vitamin A is offered to all children of one year of age enrolled in nurseries or children's rooms.
]
New Zealand
Minors aged 16 and older may consent to vaccination without parental approval.
Nigeria
In Nigeria
Nigeria ( ), , ig, Naìjíríyà, yo, Nàìjíríà, pcm, Naijá , ff, Naajeeriya, kcg, Naijeriya officially the Federal Republic of Nigeria, is a country in West Africa. It is situated between the Sahel to the north and the Gulf o ...
, the Expanded Programme on Immunization (EPI), was introduced in 1978 to provide free immunization against polio, measles, diphtheria, whooping cough, tuberculosis, and yellow fever to Nigerian children less than two years old. This free immunization can be obtained at any primary healthcare provider in the country. The vaccines are usually administered by a government health care worker. They also conduct routine vaccination visits in schools where all the children in a given school are vaccinated.
Pakistan
Facing numerous minor polio epidemics, the Pakistani government has now ruled that polio vaccination is mandatory and indisputable. In a statement from Pakistani Police Commissioner Riaz Khan Mehsud, "There is no mercy, we have decided to deal with the refusal cases with iron hands. Anyone who refuses he vaccine
He or HE may refer to:
Language
* He (pronoun), an English pronoun
* He (kana), the romanization of the Japanese kana へ
* He (letter), the fifth letter of many Semitic alphabets
* He (Cyrillic), a letter of the Cyrillic script called ''He'' in ...
will be sent to jail."
Panama
COVID-19 vaccination may become mandatory for government employees. Unvaccinated employees may be forced to take unpaid leave. Having completed the vaccine schedule for schoolchildren up to the child's age, is required for access to the government's main scholarship program.
Russia
As of 2019, immunization is voluntary in Russia. In May 2021, Russian President Vladimir Putin
Vladimir Vladimirovich Putin; (born 7 October 1952) is a Russian politician and former intelligence officer who holds the office of president of Russia. Putin has served continuously as president or prime minister since 1999: as prime min ...
said that mandating COVID-19 vaccines would be "impractical and impossible."
Samoa
In the wake of a declared measles epidemic, Samoan authorities made vaccination against measles
Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than , cough, ...
compulsory in November 2019.
Slovenia
According to a 2011 publication in '' CMAJ'':[ Slovenia has one of the world's most aggressive and comprehensive vaccination programs. Its program is mandatory for nine designated diseases. Within the first three months of life, infants must be vaccinated for tuberculosis, tetanus, polio, pertussis, and Haemophilus influenza type B. Within 18 months, vaccines are required for measles, mumps, and rubella, and finally, before a child starts school, the child must be vaccinated for hepatitis B. While a medical exemption request can be submitted to a committee, such an application for reasons of religion or conscience would not be acceptable. Failure to comply results in a fine and compliance rates top 95%, Kraigher says, adding that for nonmandatory vaccines, such as the one for human papillomavirus, coverage is below 50%.
Mandatory vaccination against measles was introduced in 1968 and since 1978, all children receive two doses of vaccine with a compliance rate of more than 95%. For TBE, the vaccination rate in 2007 was estimated to be 12.4% of the general population in 2007. For comparison, in neighboring Austria, 87% of the population is vaccinated against TBE.
]
South Africa
In South Africa vaccination is voluntary.
The South African Vaccination and Immunisation Centre (SAVIC) began in 2003 as an alliance between the South African Department of Health, vaccine industry, academic institutions, and other stakeholders. SAVIC works with the WHO and the South African National Department of Health to educate, research, provide technical support, and advocate for country-wide vaccinations.
Spain
Spain's 19 autonomous communities
eu, autonomia erkidegoa
ca, comunitat autònoma
gl, comunidade autónoma
oc, comunautat autonòma
an, comunidat autonoma
ast, comunidá autónoma
, alt_name =
, map =
, category = Autonomous administra ...
, consisting of 17 Regions and two cities, follow health policies established by the Inter-Territorial Health Council that was formed by the National and Regional Ministries of Health. This Inter-Territorial Council is composed of representatives from each region and meets to discuss health related issues spanning across Spain. The Institute of Health CarlosIII (ISCIIII) is a public research institute that manages biomedical research for the advancement of health sciences and disease preventions. The ISCIII may suggest the introduction of new vaccines into Spain's Recommended Health Schedule and is under direct control of the Ministry of Health. Although the Ministry of Health is responsible for the oversight of health care services, the policy of devolution divides responsibilities among local agencies, including health planning and programing, fiscal duties, and direct management of health services. This decentralization proposes difficulties in collecting information at the national level. The Inter-Territorial Council's Commission on Public Health works to establish health care policies according to recommendations by technical working groups via letters, meetings, and conferences. The Technical Working Group on Vaccines review data on vaccine preventable diseases and proposes recommendations for policies. No additional groups outside the government propose recommendations. Recommendations must be approved by the Commission of Public Health and then by the Inter-Territorial Council, at which point they are incorporated into the National Immunization Schedule.
The Spanish Association of Pediatrics, in conjunction with the Spanish Medicines Agency, outlines specifications for vaccination schedules and policies and provides a history of vaccination policies implemented in the past, as well as legislature pertaining to the public currently. Spain's Constitution does not mandate vaccination, so it is voluntary unless authorities require compulsory vaccination in the case of epidemics. In 1921, vaccination became mandatory for smallpox
Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) c ...
, and in 1944 the Bases Health Act mandated compulsory vaccination for diphtheria and smallpox, but was suspended in 1979 after the elimination of the threat of an epidemic. The first systematic immunization schedule for the provinces of Spain was established in 1975 and has continuously been updated by each autonomous community in regard to doses at certain ages and recommendation of additional vaccine not proposed in the schedule.
The 2015 schedule proposed the newest change with the inclusion of pneumococcal vaccine for children under 12 months. For 2016, the schedule plans to propose a vaccine against varicella in children at 12–15 months and 3–4 years. Furthermore, the General Health Law of 1986 echoes Article 40.2 from the Constitution guaranteeing the right to the protection of health, and states employers must provide vaccines to workers if they are at risk of exposure. Due to vaccination coverage in each Community, there is little anti-vaccine activity or opposition to the current schedule, and no organized groups against vaccines. The universal public health care provides coverage for all residents, while central and regional support programs extend coverage to immigrant populations. However, no national funds are granted to the Communities for vaccine purchases. Vaccines are financed from taxes, and paid in full by the Community government. Law 21 in Article 2.6 establishes the need for proper clinical documentation and informed consent by the patient, although written informed consent is not mandated in the verbal request of a vaccine for a minor. The autonomous regions collect data, from either electronic registries or written physician charts, to calculate immunization coverage.
Switzerland
The Swiss vaccination schedule and recommendations are developed by the Federal Vaccination Commission and the Federal Office of Public Health
The Federal Office of Public Health (FOPH) is the Swiss federal government’s centre for public health and a part of the Swiss Federal Department of Home Affairs.
In addition to developing national health policy, it also represents the inte ...
in collaboration with the cantons.
Minors aged 12 and older may consent to immunization with the Pfizer–BioNTech COVID-19 vaccine
The Pfizer–BioNTech COVID-19 vaccine ( INN: tozinameran), sold under the brand name Comirnaty, is an mRNA-based COVID-19 vaccine developed by the German biotechnology company BioNTech. For its development, BioNTech collaborated with Amer ...
without parental approval.
Tanzania
According to the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
vaccination coverage in Tanzania was more than 90% in 2012. An Electronic Immunisation Register has been established, which permits online access to the medical records of mothers and infants, enabling vaccination teams in remote areas to operate more effectively, especially with nomadic people. It also helps to coordinate stock levels and order new supplies.
United Kingdom
In the United Kingdom, the purchase and distribution of vaccines is managed centrally, and recommended vaccines are provided for free by the NHS. In the UK, no laws require vaccination of schoolchildren.[
Children aged 16 and 17 can consent to immunizations without parental consent. Under the Gillick test, children under 16 can consent to vaccination over parental objections if they demonstrate a mature understanding of the ramifications of the procedure.
]
United States
In the United States, the Advisory Committee on Immunization Practices
The Advisory Committee on Immunization Practices (ACIP) is a committee within the United States Centers for Disease Control and Prevention (CDC) that provides advice and guidance on effective control of vaccine-preventable diseases in the U.S. c ...
makes scientific recommendations regarding vaccines and vaccination schedules that the federal government, state governments, and private health insurance companies generally follow. See Vaccination schedule for the schedule recommended in the United States.
All fifty states in the U.S. mandate immunizations for children to enroll in public school, but various exemptions are available depending on the state. All states have exemptions for people who have medical contraindications to vaccines, and all states except for California
California is a state in the Western United States, located along the Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the most populous U.S. state and the 3rd largest by area. It is also the m ...
, Maine
Maine () is a state in the New England and Northeastern regions of the United States. It borders New Hampshire to the west, the Gulf of Maine to the southeast, and the Canadian provinces of New Brunswick and Quebec to the northeast and nor ...
, Mississippi, New York, and West Virginia allow religious exemptions, while sixteen states allow parents to cite personal, conscientious, philosophical, or other objections.
An increasing number of parents are using religious and philosophical exemptions: researchers have cited this increased use of exemptions as contributing to loss of herd immunity
Herd immunity (also called herd effect, community immunity, population immunity, or mass immunity) is a form of indirect protection that applies only to contagious diseases. It occurs when a sufficient percentage of a population has become im ...
within these communities, and hence an increasing number of disease outbreaks.
The American Academy of Pediatrics
The American Academy of Pediatrics (AAP) is an American professional association of pediatricians, headquartered in Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C.
Background
The Academy was found ...
(AAP) advises physicians to respect the refusal of parents to vaccinate their child after adequate discussion, unless the child is put at significant risk of harm (e.g., during an epidemic, or after a deep and contaminated puncture wound). Under such circumstances, the AAP states that parental refusal of immunization constitutes a form of medical neglect
In the context of caregiving, neglect is a form of abuse where the perpetrator, who is responsible for caring for someone who is unable to care for themselves, fails to do so. It can be a result of carelessness, indifference, or unwillingness and ...
and should be reported to state child protective services agencies. Several states allow minors to legally consent to vaccination over parental objections under the mature minor doctrine
The mature minor doctrine is a rule of law found in the United States and Canada accepting that an unemancipated minor patient may possess the maturity to choose or reject a particular health care treatment, sometimes without the knowledge or ...
.
Immunizations are compulsory for military enlistment in the U.S. However, exceptions exist, but may be determined by an uneven process. The suppression of religious exemptions to the military COVID-19 vaccination mandate was successfully proven by members of the Air Force and overturned in the Sixth Circuit federal court of appeals in September of 2022, when evidence was presented that more than 99% of requests for religious exceptions were systematically denied approval, though other kinds of exemption requests were more often granted. The judge had previously awarded class action status to the case, extending the suit to cover an estimated more than 12,000 joint plaintiffs.
All vaccines recommended by the U.S. government for its citizens are required for green card
A green card, known officially as a permanent resident card, is an identity document which shows that a person has permanent residency in the United States. ("The term 'lawfully admitted for permanent residence' means the status of having been ...
applicants. This requirement stirred controversy when it was applied to the HPV vaccine
Human papillomavirus (HPV) vaccines are vaccines that prevent infection by certain types of human papillomavirus (HPV). Available HPV vaccines protect against either two, four, or nine types of HPV. All HPV vaccines protect against at least HP ...
in July 2008 due to the cost of the vaccine. In addition, the other thirteen required vaccines prevent highly contagious diseases communicable through the respiratory route, while HPV is spread only through sexual contact. In November 2009, this requirement was canceled.
Though the federal guidelines do not require written consent to receive a vaccination, they do require doctors give the recipients or legal representatives a Vaccine Information Statement (VIS). Specific informed consent laws are made by the states.
Schools
The United States has a long history of school vaccination requirements. The first school vaccination requirement was enacted in the 1850s in Massachusetts to prevent the spread of smallpox. The school vaccination requirement was put in place after the compulsory school attendance law caused a rapid increase in the number of children in public schools, increasing the risk of smallpox outbreaks. The early movement towards school vaccination laws began at the local level including counties, cities, and boards of education. By 1827, Boston had become the first city to mandate that all children entering public schools show proof of vaccination. In addition, in 1855 the Commonwealth of Massachusetts had established its own statewide vaccination requirements for all students entering school, this influenced other states to implement similar statewide vaccination laws in schools as seen in New York in 1862, Connecticut in 1872, Pennsylvania in 1895, and later the Midwest, South, and Western US. By 1963, 20 states had school vaccination laws.
These vaccination laws resulted in political debates throughout the United States, as those opposed to vaccination sought to repeal local policies and state laws. An example of this political controversy occurred in 1893, in Chicago, where less than ten percent of the children were vaccinated, despite the twelve-year-old state law. Resistance was seen at the local level of the school district as some local school boards and superintendents opposed the state vaccination laws, leading the state board health inspectors to examine vaccination policies in schools. Resistance proceeded during the mid-1900s and in 1977 a nationwide Childhood Immunization Initiative was developed with the goal of increasing vaccination rates among children to ninety percent by 1979. During the two-year period of observation, the initiative reviewed the immunization records of more than 28 million children and vaccinated children who had not received the recommended vaccines.
In 1922, the constitutionality of childhood vaccination was examined in the Supreme Court case ''Zucht v. King''. The court decided that a school could deny admission to children who failed to provide a certification of vaccination for the protection of the public health. In 1987, there was a measles epidemic in Maricopa County, Arizona, and ''Maricopa County Health Department v. Harmon'' examined the arguments of an individual's right to education over the state's need to protect against the spread of disease. The court decided that it is prudent to take action to combat the spread of disease by denying unvaccinated children a place in school until the risk for the spread of measles had passed.
Schools in the United States require an updated immunization record for all incoming and returning students. While all states require an immunization record, this does not mean all students must get vaccinated. Exemptions are determined at a state level. In the United States, exemptions take one of three forms: medical, in which a vaccine is contraindicated because of a component ingredient allergy or existing medical condition; religious; and personal philosophical opposition. As of 2019, 45 states allow religious exemptions, with some states requiring proof of religious membership. Until 2019, only Mississippi, West Virginia and California did not permit religious exemptions. However, the 2019 measles outbreak led to the repeal of religious exemptions in the state of New York and for the MMR vaccination in the state of Washington. Prior to 2019, 18 states allowed personal or philosophical opposition to vaccination, but the measles outbreak also led to the repeal of these exemptions in many states. Research studies have found a correlation between the rise of vaccine-preventable diseases and non-medical exemptions from school vaccination requirements.
Mandatory vaccinations for attending public schools have received criticism. Parents say that vaccine mandates to attend public schools prevent one's right to choose, especially if the vaccinations could be harmful. Some people believe being forced to get a vaccination could cause trauma, and may lead to not seeking medical care/attention ever again. In the constitutional law, some states have the liberty to withdraw to public health regulations, which includes mandatory vaccination laws that threaten fines. Certain laws are being looked at for immunization requirements, and are trying to be changed, but cannot succeed due to legal challenges. After California removed non-medical exemptions for school entrance, lawsuits were filed arguing for the right for children to attend school regardless of their vaccination history, and to suspend the bill's implementation altogether.[ However, all such lawsuits ultimately failed.
As of 2022, 300 American colleges and universities mandate that their students receive a COVID-19 booster. A study in the Journal of Medical Ethics concludes that the cost of these mandates likely outweigh the benefits. For example, to prevent one COVID hospitalization over a 6-month period, 31,000 to 42,000 adults in that age group would have to get a third mRNA booster; and those boosters will result in at least 18 "serious adverse events" (SAEs) for that single prevented hospitalization.]
See also
* World Immunization Week
* Vaccination requirements for international travel
Vaccination requirements for international travel are the aspect of vaccination policy that concerns the movement of people across borders. Countries around the world require travellers departing to other countries, or arriving from other countr ...
References
{{Vaccine safety
Policy, Vaccination
Pharmaceuticals policy