Background:
Declining vaccination coverage and increasing hesitancy is a
worldwide concern. Many countries have implemented mandatory vaccination
policies to promote vaccination. However, mandatory vaccination policies
differ significantly by country. Beyond case studies, no comprehensive study
has compared these policies or the penalties for non-compliance on a global
scale.
Methods:
We conducted extensive keyword, policy, and literature searches to
identify mandatory national vaccination policies globally and develop a
comprehensive database. A mandatory national vaccination policy was defined
as a policy from a national authority that requires individuals to receive
at least one vaccination based on age or to access a service. Two reviewers
independently evaluated evidence for a mandate and whether non-compliance
penalties were incorporated. We categorized penalties into four types, based
on the nature of the penalty. These penalties impact an individual’s
financial, parental rights, educational (i.e., child’s school entry
and access), and liberty status. We rated the severity within each
category.
Results:
Of 193 countries investigated, 54% (n = 105) had evidence of a
nationwide mandate as of December 2018. The frequency, types, and severity
of penalties varied widely across all regions. We found that 59% (n = 62) of
countries with national mandates defined at least one penalty for
non-compliance with a vaccine mandate. Among those, educational penalties
(i.e., limiting a child’s entry or ongoing access to school) were the
most common (69%; n = 43), with most countries with educational penalties
refusing school enrollment until vaccination requirements are met (81%; n =
35).
Conclusion:
We undertook a comprehensive assessment of national mandatory
vaccination policies and identified a diversity of penalties in place to
promote compliance. Our results highlight the need to critically evaluate
the implementation of non-compliance penalties in order to determine their
effectiveness and to define best practices for sustaining high vaccination
uptake worldwide.