Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps. Issue 39 (18th September 2018) - MacDonald, Noni E.
Highlights: Globally, many countries have enacted, strengthened or contemplated mandatory infant and/or childhood immunization. No standard approach to mandatory immunization; varies from soft/flexible to rigid/hard. Varies in terms of vaccines included, age groups covered, penalties, degree of enforcement, and if AEFI compensation. There are ethical, legal and public health implications. Meager evidence on benefits of hard mandatory; may have unintended consequences. Mandatory immunization does not guarantee improved vaccine uptake rate. Abstract: Globally, infant and childhood vaccine uptake rates are not high enough to control vaccine preventable diseases, with outbreaks occurring even in high-income countries. This has led a number of high-, middle-and low income countries to enact, strengthen or contemplate mandatory infant and/or childhood immunization to try to address the gap. Mandatory immunization that reduces or eliminates individual choice is often controversial. There is no standard approach to mandatory immunization. What vaccines are included, age groups covered, program flexibility and rigidity e.g. opportunities for opting out, penalties or incentives, degree of enforcement, and whether a compensation program for causally associated serious adverse events following immunization exists vary widely. We present an overview of mandatory immunization with examples in two high- and one low-income countries to illustrate variations, summarize limited outcome data related to mandatory immunization, and suggest key elements to consider when contemplating mandatory infant and/or child immunization. Before moving forward with mandatory immunization, governments need to assure financial sustainability, uninterrupted supply and equitable access to all the population. Other interventions may be more effective and less intrusive than mandatory. If mandatory is implemented, this needs to be tailored to fit the context and the country's culture.