Background Mandatory vaccination is becoming an increasingly important policy intervention for governments trying to address low vaccination rates. However, the evidence about which countries have mandatory vaccination policy worldwide and discussions surrounding their impact has largely been limited to high-income countries. While many recent publications discuss the issue, none provide a comprehensive list. This is an obvious gap in the discussion about the merits of introducing mandatory vaccination into countries. Methods We draw on extensive desk-based research analysing a mixture of sources, including national, regional, and international vaccination policy reports, international health institution websites, ministry of health websites, and media reports. We supplemented this material by contacting a variety of health authorities, such as PAHO and the WHO as well as country's ministries of health. Results We have compiled the first comprehensive list of vaccination policies worldwide, covering 149 countries. This list indicates whether a country has a mandatory vaccination policy and the strictness of the mandate on a scale ranging across four levels. We provide an overview of the state of mandatory vaccination across different countries, set out the general trends and issues, and engage into a discussion about why, how, and where mandatory vaccination is put in place. We also provide several case studies, which highlight the limitations of vaccine mandates because other factors such as exemptions, penalties or enforcement play an important role in their actual effect on immunisation rates. Conclusions Our key finding is that the majority of low- and middle- income countries have mandatory vaccination policies but low vaccination rates because of problems with vaccine supply, delivery, and access.
We provide an overview of disease control across borders through the example of yellow fever, exploring different public health interventions and arrangements for international cooperation. From quarantine to country vaccine entry requirements our paper discusses the implications for health diplomacy in the context of COVID-19.
Travel restrictions have become a common disease control measure during the 2019 Coronavirus disease pandemic (COVID-19). Measures have ranged from quarantines when entering a country to outright travel bans. Yet more widespread travel restrictions in the form of country vaccine entry requirements have been in place for a long time for another diseaseyellow fever. We track the historical underpinnings and policy developments that have led to stringent vaccine entry requirements today. We also discuss the political issues raised by health measures imposed on borders and discuss the reasons behind some clear regional differences. Almost no European countries currently have vaccine entry requirements, while at the other end of the spectrum, the majority of countries in the African region do, making vaccine entry requirements a global south phenomenon. We argue that vaccine entry requirements should be reassessed in the future as an underused public health tool, likely to become increasingly common. Vaccine entry requirements have proved effective in controlling the international spread of yellow fever but more can be done to ensure better use of this measure. Caution is needed due to the close links between public health and politics, evident since the first travel restriction in quarantines.
Vaccine hesitancy does not only concern human vaccines but incorporates One Health policies also; including vaccination of cattle and badgers as part of the government’s bovine tuberculosis eradication strategy for England. Both digital and social media can propagate healthcare misinformation and thus affect vaccine policy support. The use of social media monitoring to understand real-time public perceptions of One Health policies is crucial to identify misinformation and address public concerns appropriately to achieve successful policy implementation. Digital and social media data surrounding two government announcements regarding the bovine tuberculosis eradication strategy for England were collected and screened using the Meltwater media monitoring platform. Communication patterns were studied using InfraNodus. Twitter analysis was conducted to identify key influencers, public engagement, and trending communications. Online social media activity increased rapidly after each announcement. Initially, badger culling took primary public concern and major influencers were identified. Cattle vaccination dominated discussion after the second announcement, with public perception being influenced by increased online activity from news sites, animal welfare charities, governmental bodies, and medical professionals. The greatest ambiguity towards the strategy was detected within farming communities, with the main disparity existing between cattle vaccination and badger culling opinions. Social media monitoring has potential use in surveying public perception of government policy, both prior to, and after implementation to identify and address areas of miscommunication and misinformation to improve public support for One Health policies.
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