Mandatory Vaccination

Across the world, mass vaccination programs run by governments or third-sector organizations have saved countless lives; minimized human suffering; and maintained economic, social, and cultural functioning. Vaccination programs predominantly focus on diseases that once ravaged the infant and early childhood years. However, with significant global variation, vaccination programs also exist for adolescents, pregnant women, new parents, the elderly, and people with comorbidities as well as catch-up or booster programs for particular age groups or vaccines. Governments and organizations also run annual influenza vaccination programs for entire populations or key workers, and health-care and education workers may be subject to additional vaccination requirements. The commonality of all mass vaccination programs is that the state adopts a key role in planning, coordinating, and funding them, or implementing mechanisms to ensure vaccines’ receipt by populations. The state’s role makes mandatory vaccination a possibility. Numerous scholarship forms the evidence base for the safety, efficacy, and necessity of vaccines. However, vaccination as a practice has consistently been accompanied by a minority who doubt and refuse, either for some or all vaccines. Concern about refusal has grown in recent years. An extensive Oxford Bibliographies article, “Vaccine Hesitancy,” explains why doubt and refusal develop and persist, how scholars make sense of it, and how governments and health-care providers can address it. However, hesitancy is not the only determinant of suboptimal vaccine uptake. Vaccination programs can also fail to reach populations due to insufficient generation of demand, inefficient or inappropriate service provision, cost barriers, and access barriers. Understanding the determinants of undervaccination in any given region, country, or population group will be essential to determining what strategies, including mandatory vaccination, are appropriate. Mandatory vaccination is just one strategy among a suite of tools that governments and organizations can employ to increase uptake of vaccines by particular cohorts. Mandatory vaccination is receiving current attention due to governments in several high-income jurisdictions recently utilizing it to address parents’ vaccine hesitancy. However, as the scholarship in this article illuminates, many jurisdictions’ mandatory childhood vaccination policies predate current concerns around hesitancy. Mandates have long performed key roles in the governance of vaccination uptake, including in contexts where attention to other programmatic aspects or health promotion practices may be lacking. The author would like to acknowledge the assistance of Amy Morris in the writing of the Mandatory Vaccination of Health-Care Workers—Policies, Experiences, and Impact and the Mandatory Vaccination—Attitudinal Studies sections of this article.