It was recently announced that all parents in France will be legally obliged to have their children vaccinated from 2018.
Mandatory vaccination is something that’s long been debated.
On the ‘pro’ side are those who say that legislation has had a dramatic effect in other areas of public health and safety (such as the indoor smoking ban, and use of seatbelts) so why not do the same with immunisation?
Others are more reserved however, expressing concerns that there is a lack of evidence that mandatory vaccination actually helps to increase uptake.
Why should vaccines be mandatory?
Vaccination is one of the most effective public health interventions in the world for saving lives and promoting good health. Only clean water, which is considered to be a basic human right, performs better.
Despite this, uptake of vaccines has reduced in some countries and this is thought to be partly caused by misguided concerns over vaccine safety.
When vaccines control disease, parents are less likely to witness the devastating effects of vaccine preventable infectious diseases first hand. It is then easy for misplaced anxiety or suspicion about vaccines to override concerns about the disease itself.
When vaccination rates decline, we start to see a resurgence of infectious diseases.
That’s why some countries are choosing to make vaccination mandatory. However, the effectiveness of this approach varies in countries which have already implemented it.
What do we know about mandatory vaccination so far?
In all 50 US states it is mandatory for children over five to receive vaccinations prior to enrolment in state licensed public schools, and often private schools or day care facilities. All states have exemptions on medical grounds, almost all states grant religious exemptions and only a few states allow philosophical exemptions for those who object to immunisations because of personal, moral or other beliefs.
Rates of exemptions have increased in recent years and studies have shown that vaccine exemptions tend to cluster geographically, leaving some communities at greater risk for disease outbreaks.
Additionally it seems that some parents delay vaccinating their children until they start school. This is not ideal because babies are much more vulnerable to the diseases for which vaccines are scheduled in the first year of life. They need that protection early.
There has also been an increase in rates of home schooling which is speculated could be an unintended consequence of the legislation.
In US states with the strictest laws, the rates of whooping cough and measles are significantly lower, which suggests that if exemptions are harder to come by then mandatory vaccination may be more effective.
In Australia a requirement for children to meet immunisation schedules has for a long time been attached to childcare payments. In an attempt to further improve vaccination rates, exemptions were removed as of January 2016. Six months later it was reported that more than 148,000 children who had not been up to date with their immunisations met their requirements as a result.
Is there a better way?
Making vaccination compulsory is not the only way to obtain high vaccination rates. The UK has held an enviably high uptake rate for many years with the vast majority of parents choosing to vaccinate their children.
Research into how to further improve uptake rates amongst vaccine hesitant parents suggests that talking concerns through with a trusted health professional is beneficial. Additionally, practical issues such as making sure that vaccines and health care are easy to access is essential. Many families who don't vaccinate are not averse to it but simply have difficulty getting convenient appointments or don’t get reminders when their children are due vaccines.
Perhaps making vaccination a core part of the educational curriculum could help future generations be less hesitant to vaccinate.
One thing we know for sure is that meningitis and septicaemia are deadly diseases that strike without warning, and vaccination has proved to be the only way to prevent it.
Whether mandatory vaccination is the best way to achieve high uptake of vaccines remains under debate. The impact this has in France will be of great interest.