Vaccination policy

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Vaccination policies aim to produce immunity to preventable diseases. Besides individual protection from getting ill, some vaccination policies also aim to provide the community as a whole with herd immunity. Herd immunity refers to the idea that the pathogen will have trouble spreading when a significant part of the population has immunity against it, reducing the effect an infectious disease has on society. This protects those unable to get the vaccine due to medical conditions, such as immune disorders.{{cite web |url=http://www.ncsl.org/research/health/immunizations-policy-issues-overview.aspx|title=Immunizations Policy Issues Overview|first=National Conference of State|last=Legislatures|website=Ncsl.org|access-date=22 July 2017|archive-date=2 April 2020|archive-url=https://web.archive.org/web/20200402194725/http://www.ncsl.org/research/health/immunizations-policy-issues-overview.aspx|url-status=live}} However, for herd immunity to be effective in a population, a majority of those who are vaccine-eligible must be vaccinated.{{cite journal |last1=Hendrix |first1=Kristin S. |last2=Sturm |first2=Lynne A. |last3=Zimet |first3=Gregory D. |last4=Meslin |first4=Eric M. |title=Ethics and Childhood Vaccination Policy in the United States |journal=American Journal of Public Health |date=February 2016 |volume=106 |issue=2 |pages=273–278 |doi=10.2105/AJPH.2015.302952 |pmid=26691123 |pmc=4815604 }}

Vaccine-preventable diseases remain a common cause of childhood mortality with an estimated three million deaths each year.{{cite report |title=Immunization in Nigeria |date=October 2018 |access-date=28 October 2018 |publisher=Public Health Nigeria |author=Obasi Chinedu |url=https://publichealthng.com/immunization-nigeria-challenges-benefits-prevention/ |archive-date=29 October 2018 |archive-url=https://web.archive.org/web/20181029113729/https://publichealthng.com/immunization-nigeria-challenges-benefits-prevention/}} Every year, vaccination prevents between two and three million deaths worldwide, across all age groups, from diphtheria, tetanus, pertussis and measles.{{cite report |title=Global Immunization Data |date=February 2014 |access-date=23 April 2015 |publisher=World Health Organization |author=UNICEF |url=https://www.who.int/immunization/monitoring_surveillance/global_immunization_data.pdf |archive-url=https://web.archive.org/web/20200413171049/https://www.who.int/immunization/monitoring_surveillance/global_immunization_data.pdf |archive-date=13 April 2020 |url-status=live }}

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With some vaccines, a goal of vaccination policies is to eradicate the disease{{snd}}disappear it from Earth altogether. The World Health Organization (WHO) coordinated the effort to eradicate smallpox globally through vaccination, the last naturally occurring case of smallpox was in Somalia in 1977.{{cite web|url=https://www.who.int/csr/disease/smallpox/faq/en/|title=Frequently asked questions and answers on smallpox|website=World Health Organization|access-date=5 October 2020|archive-date=2 April 2020|archive-url=https://web.archive.org/web/20200402194727/http://www.who.int/csr/disease/smallpox/faq/en/|url-status=live}} Endemic measles, mumps and rubella have been eliminated through vaccination in Finland.{{cite journal |last1=Peltola |first1=Heikki |last2=Jokinen |first2=Sari |last3=Paunio |first3=Mikko |last4=Hovi |first4=Tapani |last5=Davidkin |first5=Irja |title=Measles, mumps, and rubella in Finland: 25 years of a nationwide elimination programme |journal=The Lancet Infectious Diseases |date=December 2008 |volume=8 |issue=12 |pages=796–803 |doi=10.1016/S1473-3099(08)70282-2 |pmid=19022194 }} On 14 October 2010, the UN Food and Agriculture Organization declared that rinderpest had been eradicated.{{cite web |url=http://www.scientias.nl/runderpest-is-niet-meer/17926 |title=Runderpest is niet meer |author=Caroline Kraaijvanger |work=Scientias |date=15 October 2010 |access-date=25 November 2020 |language=nl |archive-date=14 August 2017 |archive-url=https://web.archive.org/web/20170814175722/https://www.scientias.nl/runderpest-is-niet-meer/17926/ |url-status=live }} The WHO is currently working to eradicate polio,{{cite web|url=http://polioeradication.org/who-we-are/strategy/|title=GPEI-Strategy|website=polioeradication.org|access-date=22 July 2017|archive-date=11 May 2020|archive-url=https://web.archive.org/web/20200511034200/http://polioeradication.org/who-we-are/polio-endgame-strategy-2019-2023/|url-status=live}} which was eliminated in Africa in August 2020 and remained only in Pakistan and Afghanistan at the time.{{cite news |url=https://www.parool.nl/wereld/afrika-heeft-polio-verslagen-dankzij-de-mede-door-bill-gates-betaalde-vaccins~bff73c3b/ |title=Afrika heeft polio verslagen, dankzij de mede door Bill Gates betaalde vaccins |author=Chris van Mersbergen |work=Het Parool |date=26 August 2020 |access-date=25 November 2020 |language=nl |archive-date=28 October 2020 |archive-url=https://web.archive.org/web/20201028235610/https://www.parool.nl/wereld/afrika-heeft-polio-verslagen-dankzij-de-mede-door-bill-gates-betaalde-vaccins~bff73c3b/ |url-status=live }}

The likely behavior of individuals when offered vaccines can be modeled economically using ideas from game theory.{{cite journal |last1=Bauch|first1=Chris T.|last2=Earn|first2=David J. D.|date=2004-09-07|title=Vaccination and the theory of games|journal=Proceedings of the National Academy of Sciences|language=en|volume=101|issue=36|pages=13391–13394|doi=10.1073/pnas.0403823101|issn=0027-8424 |pmid=15329411 |pmc=516577|bibcode=2004PNAS..10113391B|doi-access=free}} According to such models, individuals will attempt to minimize the risk of illness, and may seek vaccination for themselves or their children if they perceive a high threat of disease and a low risk to vaccination.{{cite journal |last1=Damnjanović |first1=Kaja |last2=Graeber |first2=Johanna |last3=Ilić |first3=Sandra |last4=Lam |first4=Wing Y. |last5=Lep |first5=Žan |last6=Morales |first6=Sara |last7=Pulkkinen |first7=Tero |last8=Vingerhoets |first8=Loes |title=Parental Decision-Making on Childhood Vaccination |journal=Frontiers in Psychology |date=13 June 2018 |volume=9 |pages=735 |doi=10.3389/fpsyg.2018.00735 |pmid=29951010 |pmc=600888 |doi-access=free }} However, if a vaccination program successfully reduces the disease threat, it may reduce the perceived risk of disease enough so that an individual's optimal strategy is to encourage everyone but their family to be vaccinated, or (more generally) to refuse vaccination once vaccination rates reach a certain level, even if this level is below that optimal for the community.{{cite journal | vauthors = Fine PE, Clarkson JA | title = Individual versus public priorities in the determination of optimal vaccination policies | journal = American Journal of Epidemiology | volume = 124 | issue = 6 | pages = 1012–20 | date = December 1986 | pmid = 3096132 | doi = 10.1093/oxfordjournals.aje.a114471 }}{{closed access}}{{cite journal |last1=Shim |first1=Eunha |last2=Chapman |first2=Gretchen B. |last3=Townsend |first3=Jeffrey P. |last4=Galvani |first4=Alison P. |title=The influence of altruism on influenza vaccination decisions |journal=Journal of the Royal Society Interface |date=7 September 2012 |volume=9 |issue=74 |pages=2234–2243 |doi=10.1098/rsif.2012.0115 |pmid=22496100 |pmc=3405754 }} For example, a 2003 study predicted that a bioterrorist attack using smallpox would result in conditions where voluntary vaccination would be unlikely to reach the optimum level for the U.S. as a whole,{{cite journal | vauthors = Bauch CT, Galvani AP, Earn DJ | title = Group interest versus self-interest in smallpox vaccination policy | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 100 | issue = 18 | pages = 10564–7 | date = September 2003 | pmid = 12920181 | pmc = 193525 | doi = 10.1073/pnas.1731324100 | bibcode = 2003PNAS..10010564B | doi-access = free }} and a 2007 study predicted that severe influenza epidemics cannot be prevented by voluntary vaccination without offering certain incentives.{{cite journal | vauthors = Vardavas R, Breban R, Blower S | title = Can influenza epidemics be prevented by voluntary vaccination? | journal = PLOS Computational Biology | volume = 3 | issue = 5 | pages = e85 | date = May 2007 | pmid = 17480117 | pmc = 1864996 | doi = 10.1371/journal.pcbi.0030085 | bibcode = 2007PLSCB...3...85V | doi-access = free }}

Governments often allow exemptions to mandatory vaccinations for religious or philosophical reasons, but decreased rates of vaccination may cause loss of herd immunity, substantially increasing risks even to vaccinated individuals.{{cite web |title=Parent's Guide to Childhood Immunizations |url=https://www.cdc.gov/vaccines/pubs/parents-guide/downloads/parents-guide-508.pdf |author=Centers for Disease Control and Prevention |publisher=Department of Health and Human Services |id=CS250472 |date=August 2014 |access-date=17 September 2017 |archive-date=23 November 2017 |archive-url=https://web.archive.org/web/20171123143906/https://www.cdc.gov/vaccines/pubs/parents-guide/downloads/parents-guide-508.pdf |url-status=live }} However, mandatory vaccination policies raise ethical issues regarding parental rights and informed consent.{{cite web|url=https://www.who.int/bulletin/volumes/91/4/12-113480/en/|title=WHO – Ethical considerations for vaccination programmes in acute humanitarian emergencies|website=Who.int |access-date=5 October 2020|archive-date=2 April 2020|archive-url=https://web.archive.org/web/20200402194731/http://www.who.int/bulletin/volumes/91/4/12-113480/en/}}

Fractional dose vaccination is a strategy that trades societal benefit for individual vaccine efficacy,{{cite journal |last=Hunziker|first=Patrick|date=2021-07-24|title=Personalized-dose Covid-19 vaccination in a wave of virus Variants of Concern: Trading individual efficacy for societal benefit|url=https://precisionnanomedicine.com/article/26101-personalized-dose-covid-19-vaccination-in-a-wave-of-virus-variants-of-concern-trading-individual-efficacy-for-societal-benefit |journal=Precision Nanomedicine|volume=4|issue=3|pages=805–820 |language=en|doi=10.33218/001c.26101|issn=2639-9431|doi-access=free |access-date=18 August 2021|archive-date=9 October 2021|archive-url=https://web.archive.org/web/20211009194402/https://precisionnanomedicine.com/article/26101-personalized-dose-covid-19-vaccination-in-a-wave-of-virus-variants-of-concern-trading-individual-efficacy-for-societal-benefit|url-status=live}} has proven to be effective in randomized trials in poverty diseases,{{cite journal|last1=Vannice|first1=Kirsten|last2=Wilder-Smith |first2=Annelies |last3=Hombach |first3=Joachim |date=2018-08-16 |title=Fractional-Dose Yellow Fever Vaccination — Advancing the Evidence Base |journal=New England Journal of Medicine |volume=379 |issue=7 |pages=603–605 |doi=10.1056/NEJMp1803433|issn=0028-4793 |pmid=29995585 |s2cid=205114579 |doi-access=free}}{{cite journal |last1=Nelson|first1=Katherine S. |last2=Janssen |first2=Julia M. |last3=Troy |first3=Stephanie B. |last4=Maldonado |first4=Yvonne |date=January 2012 |title=Intradermal fractional dose inactivated polio vaccine: A review of the literature |journal=Vaccine |language=en |volume=30 |issue=2 |pages=121–125 |doi=10.1016/j.vaccine.2011.11.018|pmid=22100886}} and in epidemiologic models{{cite journal |last1=Chen |first1=Zhimin |last2=Liu |first2=Kaihui |last3=Liu |first3=Xiuxiang |last4=Lou |first4=Yijun |date=February 2020 |title=Modelling epidemics with fractional-dose vaccination in response to limited vaccine supply |journal=Journal of Theoretical Biology |language=en |volume=486 |pages=110085 |doi=10.1016/j.jtbi.2019.110085 |pmid=31758966 |bibcode=2020JThBi.48610085C |hdl=10397/94076 |s2cid=208254350 |hdl-access=free}} was thought to hold a significant potential for shortening the COVID-19 pandemic when vaccine supply is limited.

At various times, governments and other institutions have established policies requiring vaccination with the aim of reducing the risk of disease. An 1853 law required universal vaccination against smallpox in England and Wales, with fines levied against people who did not comply. These policies stirred resistance from a variety of groups, collectively called anti-vaccinationists, who objected on ethical, political, medical safety, religious, and other grounds.{{cite journal |vauthors=Wolfe RM, Sharp LK |date=August 2002 |title=Anti-vaccinationists past and present |journal=BMJ |volume=325 |issue=7361 |pages=430–2 |doi=10.1136/bmj.325.7361.430 |pmc=1123944 |pmid=12193361}} In the United States, the Supreme Court ruled in Jacobson v. Massachusetts (1905) that states have the authority to require vaccination against smallpox during a smallpox epidemic.{{cite journal |vauthors=Mariner WK, Annas GJ, Glantz LH |title=Jacobson v Massachusetts: it's not your great-great-grandfather's public health law |journal=American Journal of Public Health |volume=95 |issue=4 |pages=581–90 |date=April 2005 |pmid=15798113 |pmc=1449224 |doi=10.2105/AJPH.2004.055160}} All fifty U.S. states require that children be vaccinated to attend public school,{{cite journal |vauthors=Walkinshaw E |title=Mandatory vaccinations: The international landscape |journal=CMAJ |volume=183 |issue=16 |pages=E1167–8 |date=November 2011 |pmid=21989473 |pmc=3216445 |doi=10.1503/cmaj.109-3993}} although 47 states provide exemptions based on religious or philosophical beliefs.{{cite web |url=http://vaccines.procon.org/view.resource.php?resourceID=003597 |title=State Vaccination Exemptions for Children Entering Public Schools – Vaccines – ProCon.org|website=vaccines.procon.org|access-date=21 July 2017|archive-date=2 April 2020|archive-url=https://web.archive.org/web/20200402194733/http://vaccines.procon.org/view.resource.php?resourceID=003597|url-status=live}} In the European Union, the 2021 case of Vavřička and Others v. the Czech Republic,Applications 47621/13, 3867/14, 73094/14, 19306/15, 19298/15, and 43883/15 (ECtHR April 8, 2021). decided by the European Court of Human Rights (ECtHR), held that the nation of the Czech Republic did not violate the European Convention on Human Rights by imposing a vaccination mandate on children in that country.{{cite web |url=https://www.npr.org/sections/coronavirus-live-updates/2021/04/08/985318387/european-court-backs-mandatory-vaccinations-laws-for-children |title=European Court Backs Mandatory Vaccinations For Children |first1=Bill |last1=Chappell |publisher=NPR |date=April 8, 2021 |access-date=4 January 2024 |archive-date=9 February 2022 |archive-url=https://web.archive.org/web/20220209050508/https://www.npr.org/sections/coronavirus-live-updates/2021/04/08/985318387/european-court-backs-mandatory-vaccinations-laws-for-children |url-status=live }}{{cite web |url=https://eulawlive.com/op-ed-its-about-proportionality-strasbourg-clarifies-human-rights-standards-for-compulsory-vaccination-programmes-by-dolores-utrilla/ |title=Op-Ed: "It's about proportionality! Strasbourg clarifies human rights standards for compulsory vaccination programmes" |first1=Dolores |last1=Utrilla |publisher=EU Law Live |date=April 8, 2021 |access-date=4 January 2024 |archive-date=9 February 2022 |archive-url=https://web.archive.org/web/20220209050208/https://eulawlive.com/op-ed-its-about-proportionality-strasbourg-clarifies-human-rights-standards-for-compulsory-vaccination-programmes-by-dolores-utrilla/ |url-status=live }}

Forced vaccination (as opposed to fines or refusal of services) is uncommon, and typically happens only as an emergency measure during an outbreak. This has been reported in parts of China.{{cite web|date=2021-09-28|title=China's use of force and coercion to drive up its COVID-19 vaccination rate is not the answer|url=https://www.hrw.org/news/2021/09/28/chinas-use-force-and-coercion-drive-its-covid-19-vaccination-rate-not-answer|access-date=2021-12-04|website=Human Rights Watch|language=en|archive-date=29 June 2022|archive-url=https://web.archive.org/web/20220629151207/https://www.hrw.org/news/2021/09/28/chinas-use-force-and-coercion-drive-its-covid-19-vaccination-rate-not-answer|url-status=live}} Compulsory vaccinations greatly reduce infection rates for the diseases they protect against.{{cite journal |doi=10.1007/BF03391666 |title=Ethical Issues Concerning Vaccination Requirements |journal=Public Health Reviews |volume=34 |year=2012 |last1=Amin |first1=Alvin Nelson El |last2=Parra |first2=Michelle T |last3=Kim-Farley |first3=Robert |last4=Fielding |first4=Jonathan E | name-list-style = vanc |doi-access=free }}

Common objections included the argument that governments should not infringe on individuals' freedom to make medical decisions for themselves or their children, or claims that proposed vaccinations were dangerous. Many modern vaccination policies allow exemptions for people with compromised immune systems, allergies to vaccination components, or strongly held objections.{{cite journal |vauthors=Salmon DA, Teret SP, MacIntyre CR, Salisbury D, Burgess MA, Halsey NA |title=Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future |journal=Lancet |volume=367 |issue=9508 |pages=436–42 |date=February 2006 |pmid=16458770 |doi=10.1016/S0140-6736(06)68144-0 |s2cid=19344405}}{{closed access}}

In 1904, in the city of Rio de Janeiro, Brazil, following an urban renewal program that displaced many poor, a government program of mandatory smallpox vaccination triggered the Vaccine Revolt, several days of rioting with considerable property damage and a number of deaths.{{cite journal |doi=10.1017/S0022216X00014784 |title='Living Worse and Costing More': Resistance and Riot in Rio de Janeiro, 1890–1917 |journal=Journal of Latin American Studies |volume=21 |issue=1–2 |pages=241–266 |year=2009 |last1=Meade |first1=Teresa |s2cid=145241097 | name-list-style = vanc }}

Compulsory vaccination is a difficult policy issue, requiring authorities to balance public health with individual liberty:

{{blockquote|Vaccination is unique among de facto mandatory requirements in the modern era, requiring individuals to accept the injection of medicine or medicinal agent into their bodies, and it has provoked a spirited opposition. This opposition began with the first vaccinations, has not ceased, and probably never will. From this reali{{not a typo|s}}ation arises a difficult issue: how should the mainstream medical authorities approach the anti-vaccination movement? A passive reaction could be construed as endangering the health of society, whereas a heavy-handed approach can threaten the values of individual liberty and freedom of expression that we cherish.}}

An ethical dilemma may emerge when health care providers attempt to persuade vaccine-hesitant families towards receiving vaccinations as this persuasion may lead to violating their autonomy. Investigation of different types of vaccination policy finds strong evidence that standing orders and allowing healthcare workers without prescription authority (such as nurses) to administer vaccines in defined circumstances increase vaccination rates, and sufficient evidence that requiring vaccinations before attending child care and schools also does so.{{cite journal |vauthors=Briss PA, Rodewald LE, Hinman AR, Shefer AM, Strikas RA, Bernier RR, Carande-Kulis VG, Yusuf HR, Ndiaye SM, Williams SM |title=Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. The Task Force on Community Preventive Services |journal=American Journal of Preventive Medicine |volume=18 |issue=1 Suppl |pages=97–140 |date=January 2000 |pmid=10806982 |doi=10.1016/S0749-3797(99)00118-X |url=https://zenodo.org/record/1260089 |access-date=5 August 2018 | archive-date=22 January 2021 |archive-url= https://web.archive.org/web/20210122221710/https://zenodo.org/record/1260089 |url-status=live}}{{closed access}} There is also evidence that mandatory vaccination policies for healthcare workers, for instance for influenza shots, increase uptake.{{cite journal |date=2010 |title=Mandatory Influenza Vaccination of Healthcare Workers: A 5-Year Study |url=https://www.researchgate.net/publication/45284400 |journal=Infection Control and Hospital Epidemiology}} One argument among public health professionals is that compulsory vaccination is necessary in severe circumstances, but that it should be approached carefully in order to avoid polarizing the population and decreasing trust in the long term.{{cite web|last=Ro|first=Christine|title=Why mandatory vaccination is nothing new |url=https://www.bbc.com/future/article/20211029-why-mandatory-vaccination-is-nothing-new|access-date=2021-12-04 |website=Bbc.com |language=en |archive-date=2 June 2022|archive-url=https://web.archive.org/web/20220602192836/https://www.bbc.com/future/article/20211029-why-mandatory-vaccination-is-nothing-new|url-status=live}}

Many countries (Canada, Germany, Japan, and the United States) have specific requirements for reporting vaccine-related adverse effects; others (Australia, France, and the United Kingdom) include vaccines under their general requirements for reporting injuries associated with medical treatments.{{cite book |first1=Brian Dean |last1=Abramson |title=Vaccine, Vaccination, and Immunization Law |publisher=Bloomberg Law |year=2019 |section=8|pages=11 }} A number of countries have both compulsory vaccination and national programs for the compensation of injuries alleged to have been caused by a vaccination.{{cite book |first1=Brian Dean |last1=Abramson |title=Vaccine, Vaccination, and Immunization Law |publisher=Bloomberg Law |year=2019 |section=9|pages=44 }}

In November 2021, during a COVID-19 outbreak, Austria banned unvaccinated individuals from leaving their home apart from going to work, buying essential supplies, or exercise, in an effort to reduce the spread of disease.{{Cite news|last=Schuetze|first=Christopher F. |date=2021-11-14|title=Austria's new lockdown confines the unvaccinated to their homes.|language=en-US|work=The New York Times |url=https://www.nytimes.com/2021/11/14/world/europe/austria-unvaccinated-lockdown.html|access-date=2021-12-19|issn=0362-4331|archive-date=11 May 2022|archive-url=https://web.archive.org/web/20220511171728/https://www.nytimes.com/2021/11/14/world/europe/austria-unvaccinated-lockdown.html |url-status=live}} During the fourth wave of the COVID-19 pandemic, with a low vaccination rate compared to the rest of Western Europe (79%), the Austrian government made vaccination mandatory.{{Cite news |url=https://www.nytimes.com/2021/11/19/world/europe/austria-covid-vaccine-mandate-lockdown.html |title=Austria Announces Covid Vaccine Mandate, Crossing a Threshold for Europe |newspaper=The New York Times |date=19 November 2021 |access-date=21 November 2021 |archive-date=21 November 2021 |archive-url=https://web.archive.org/web/20211121180907/https://www.nytimes.com/2021/11/19/world/europe/austria-covid-vaccine-mandate-lockdown.html |url-status=live |last1=Horowitz |first1=Jason |last2=Eddy |first2=Melissa }}

Medical ethicist Arthur Caplan argues that children have a right to the best available medical care, including vaccines, regardless of parental opinions toward vaccines, saying, "Arguments about medical freedom and choice are at odds with the human and constitutional rights of children. When parents won't protect them, governments must."{{cite journal |last=Caplan |first=Arthur L |title=Do Children Have Vaccination Rights? |url=https://www.medscape.com/viewarticle/902956 |journal=Medscape Business of Medicine |access-date=2 February 2019 |archive-date=19 October 2019 |archive-url=https://web.archive.org/web/20191019161113/https://www.medscape.com/viewarticle/902956 |url-status=live }}{{cite web| url=https://www.seattletimes.com/opinion/anti-vaccine-misinformation-denies-childrens-rights/| title=Anti-vaccine misinformation denies children's rights| date=18 April 2018| access-date=2 February 2019| archive-date=5 April 2019| archive-url=https://web.archive.org/web/20190405121438/https://www.seattletimes.com/opinion/anti-vaccine-misinformation-denies-childrens-rights/| url-status=live}} However, government entities, such as Child Protective Services, can intervene only when the parents directly harm their child via abuse or neglect, considering a child does not have the ability to give or take away consent. Although withholding medical care meets the criteria of abuse or neglect, refusing vaccinations does not, as the child is not being harmed directly.{{cite web |url=https://med.nyu.edu/highschoolbioethics/module/vaccination|title=Ethics of Vaccinations {{!}} High School Bioethics |website=med.nyu.edu|access-date=30 April 2019|archive-date=30 April 2019|archive-url=https://web.archive.org/web/20190430185448/https://med.nyu.edu/highschoolbioethics/module/vaccination|url-status=live}}

To prevent the spread of disease by unvaccinated individuals, some schools and doctors' surgeries have prohibited unvaccinated children from being enrolled, even where not required by law.{{cite web |title=Should Pediatricians Refuse Unvaccinated Kids? |url=http://live.huffingtonpost.com/r/segment/should-pediatricians-refuse-unvaccinated-kids/53285f162b8c2a24f700070f |website=The Huffington Post |access-date=4 July 2015 |archive-date=4 March 2016 |archive-url=https://web.archive.org/web/20160304200244/http://live.huffingtonpost.com/r/segment/should-pediatricians-refuse-unvaccinated-kids/53285f162b8c2a24f700070f |url-status=live }}{{cite web |last1=Bachai |first1=Sabrina |title=NYC Schools Are Now Allowed To Ban Unvaccinated Kids, Rules Federal Judge |url=http://www.medicaldaily.com/nyc-schools-are-now-allowed-ban-unvaccinated-kids-rules-federal-judge-289614 |website=Medical Daily |access-date=4 July 2015 |date=24 June 2014 |archive-date=5 July 2015 |archive-url=https://web.archive.org/web/20150705181259/http://www.medicaldaily.com/nyc-schools-are-now-allowed-ban-unvaccinated-kids-rules-federal-judge-289614 |url-status=live }} Doctors who refuse to treat unvaccinated children harm both the child and public health, and may be considered unethical when parents are unable to find another provider.{{cite journal |last1=Halperin |first1=Beth |last2=Melnychuk |first2=Ryan |last3=Downie |first3=Jocelyn |last4=MacDonald |first4=Noni |author-link4=Noni MacDonald|title=When is it permissible to dismiss a family who refuses vaccines? Legal, ethical and public health perspectives |journal=Paediatrics & Child Health |date=December 2007 |volume=12 |issue=10 |pages=843–845 |doi=10.1093/pch/12.10.843 |pmid=19043497 |pmc=2532570 }} Opinion on this is divided, with the largest professional association, the American Academy of Pediatrics, saying that exclusion of unvaccinated children may be an option under narrowly defined circumstances.{{cite news |url=http://www.aappublications.org/news/2016/08/29/VaccineHesitancy082916 |title=How to address vaccine hesitancy: New AAP report says dismissal a last resort |last=Rucoba |first=Ruben J. |work=AAP News |date=29 August 2016 |access-date=27 October 2018 |archive-date=27 October 2018 |archive-url=https://web.archive.org/web/20181027143246/http://www.aappublications.org/news/2016/08/29/VaccineHesitancy082916 |url-status=live }}

One historical example is the 1990–91 Philadelphia measles outbreak, which led to the deaths of nine children in an anti-vaccination faith healing community. Court orders were obtained to have infected children given life-saving medical treatment, against the wishes of their parents, and also for healthy children to be vaccinated without parental consent.{{cite web |url=https://www.nytimes.com/2019/04/09/health/measles-outbreak-vaccinations-brooklyn.html|title=New York City Is Requiring Vaccinations Against Measles. Can Officials Do That?|first=Donald G. Jr.|last=McNeil|work=The New York Times|date=9 April 2019|access-date=25 November 2020 |archive-date=6 December 2020|archive-url=https://web.archive.org/web/20201206133016/https://www.nytimes.com/2019/04/09/health/measles-outbreak-vaccinations-brooklyn.html|url-status=live}}{{cite news |url=https://www.npr.org/blogs/health/2015/02/19/386040745/why-a-court-once-ordered-kids-vaccinated-against-their-parents-will |title=Why A Court Once Ordered Kids Vaccinated Against Their Parents' Will |newspaper=NPR |access-date=2015-02-19 |archive-date=19 February 2015 |archive-url=https://web.archive.org/web/20150219201412/http://www.npr.org/blogs/health/2015/02/19/386040745/why-a-court-once-ordered-kids-vaccinated-against-their-parents-will |url-status=live }}

Vaccination requirements for access to daycare and schools increase vaccine uptake in the United States and there is evidence that these requirements may decrease disease.{{Cite journal |last1=Lee |first1=Cecilia |last2=Robinson |first2=Joan L. |date=2016-06-01 |title=Systematic review of the effect of immunization mandates on uptake of routine childhood immunizations |url=https://www.journalofinfection.com/article/S0163-4453(16)30029-9/abstract |journal=Journal of Infection |language=English |volume=72 |issue=6 |pages=659–666 |doi=10.1016/j.jinf.2016.04.002 |issn=0163-4453 |pmid=27063281|url-access=subscription }}{{Rp|page=661}} However, the majority of studies of mandatory vaccination took place in the US and the cultural climate in United States is quite different from other industrialized nations.{{Rp|page=665}} A study shows that many Europeans countries have whooping cough vaccination rates as high as those in the United States despite no mandates.{{Cite web |title=Pertussis (Whooping Cough) {{!}} Vaccine Knowledge |url=https://vk.ovg.ox.ac.uk/vk/pertussis-whooping-cough |access-date=2022-04-13 |website=vk.ovg.ox.ac.uk |language=en |archive-date=25 June 2022 |archive-url=https://web.archive.org/web/20220625085954/https://vk.ovg.ox.ac.uk/vk/pertussis-whooping-cough |url-status=live }}{{Cite web |date=2022-01-28 |title=FastStats |url=https://www.cdc.gov/nchs/fastats/whooping-cough.htm |access-date=2022-04-13 |website=Cdc.gov |language=en-us |archive-date=12 May 2022 |archive-url=https://web.archive.org/web/20220512021731/https://www.cdc.gov/nchs/fastats/whooping-cough.htm |url-status=live }} Canada has a similar vaccination to the US despite 11 of its provinces and territories having no vaccine mandates, which may in part be due to vaccination programs taking place in school in Canada.{{Rp|page=664}}

In the United Kingdom, children are not vaccinated against chickenpox despite the availability of a vaccine since the 1990s. Modelling predicted that vaccinating children would increase the number of cases amongst adults due to the absence of natural boosting from exposure to chickenpox in day-to-day life. The Joint Committee on Vaccination and Immunisation were concerned that more pregnant women would become infected because immunity in the general population would decrease .{{Cite web|title=Joint Committee on Vaccination and Immunisation Statement on varicella and herpes zoster vaccines |url=https://webarchive.nationalarchives.gov.uk/ukgwa/20120907090205/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_133599.pdf|access-date=2022-01-05|website=webarchive.nationalarchives.gov.uk|archive-date=26 February 2022|archive-url=https://web.archive.org/web/20220226222046/https://webarchive.nationalarchives.gov.uk/ukgwa/20120907090205/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_133599.pdf|url-status=live}}{{Rp|page=10}}

Vaccination policy is typically proposed by national{{cite web |date=2021-08-19 |title=Advisory Committee on Immunization Practices (ACIP) {{!}} CDC |url=https://www.cdc.gov/vaccines/acip/index.html|access-date=2021-08-20 |website=Cdc.gov|language=en-us|archive-url=https://web.archive.org/web/20210521105406/https://www.cdc.gov/vaccines/acip/index.html|archive-date=21 May 2021|url-status=live}}{{cite web |title=Joint Committee on Vaccination and Immunisation |url=https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation|access-date=2021-08-20|website=GOV.UK |language=en |archive-date=20 August 2021|archive-url=https://web.archive.org/web/20210820170926/https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation|url-status=live}} or supranational{{cite journal |last1=Duclos |first1=Philippe |last2=Okwo-Bele |first2=Jean-Marie |last3=Gacic-Dobo |first3=Marta |last4=Cherian |first4=Thomas |date=2009-10-14 |title=Global immunization: status, progress, challenges and future |journal=BMC International Health and Human Rights |language=en |volume=9 |issue=1 |pages=S2 |doi=10.1186/1472-698X-9-S1-S2 |issn=1472-698X |pmc=2762311 |pmid=19828060 |doi-access=free}} advisory committees on immunization, and in many cases, is regulated by the government.{{cite web |title=Government Regulation |website=History of Vaccines |url=https://www.historyofvaccines.org/content/articles/government-regulation |access-date=2021-08-20 |language=en |archive-url=https://web.archive.org/web/20210826114302/https://www.historyofvaccines.org/content/articles/government-regulation |archive-date=26 August 2021 |url-status=live}}

Predictive vaccination strategy models{{cite journal |last1=Drolet |first1=Mélanie |last2=Bénard |first2=Élodie |last3=Jit |first3=Mark |last4=Hutubessy |first4=Raymond |last5=Brisson |first5=Marc |date=October 2018 |title=Model Comparisons of the Effectiveness and Cost-Effectiveness of Vaccination: A Systematic Review of the Literature|journal=Value in Health |volume=21 |issue=10 |pages=1250–1258 |doi=10.1016/j.jval.2018.03.014 |pmid=30314627 |s2cid=52977365 |issn=1098-3015 |doi-access=free}} play an important role in predicting effectiveness of vaccination strategies at population level. The may, e.g., compare the sequence of age groups to be vaccinated and study the outcome in terms of caseload, deaths, length of a pandemic,{{cite journal |last=Hunziker |first=Patrick|date=2021-07-24 |title=Personalized-dose Covid-19 vaccination in a wave of virus Variants of Concern: Trading individual efficacy for societal benefit |url=https://precisionnanomedicine.com/article/26101-personalized-dose-covid-19-vaccination-in-a-wave-of-virus-variants-of-concern-trading-individual-efficacy-for-societal-benefit |journal=Precision Nanomedicine |language=en |volume=4 |issue=3 |pages=805–820 |doi=10.33218/001c.26101 |doi-access=free |access-date=18 August 2021|archive-date=9 October 2021|archive-url=https://web.archive.org/web/20211009194402/https://precisionnanomedicine.com/article/26101-personalized-dose-covid-19-vaccination-in-a-wave-of-virus-variants-of-concern-trading-individual-efficacy-for-societal-benefit|url-status=live}} healthcare system load,{{cite journal |date=2020-07-01 |title=Modeling the impact of mass influenza vaccination and public health interventions on COVID-19 epidemics with limited detection capability |journal=Mathematical Biosciences |language=en |volume=325 |pages=108378 |doi=10.1016/j.mbs.2020.108378 |issn=0025-5564 |pmc=7229764 |pmid=32507746 |last1=Li |first1=Qian |last2=Tang |first2=Biao |last3=Bragazzi |first3=Nicola Luigi |last4=Xiao |first4=Yanni |last5=Wu |first5=Jianhong}} and economic impact.{{cite journal |last1=Deogaonkar |first1=Rohan |last2=Hutubessy |first2=Raymond |last3=van der Putten |first3=Inge |last4=Evers |first4=Silvia |last5=Jit |first5=Mark |date=2012-10-16 |title=Systematic review of studies evaluating the broader economic impact of vaccination in low and middle income countries |journal=BMC Public Health |language=en |volume=12 |issue=1 |page=878 |doi=10.1186/1471-2458-12-878 |issn=1471-2458 |pmc=3532196 |pmid=23072714 |doi-access=free}}

The promotion of high levels of vaccination produces the protective effect of herd immunity as well as positive externalities in society.{{cite journal | vauthors = Ibuka Y, Li M, Vietri J, Chapman GB, Galvani AP | title = Free-riding behavior in vaccination decisions: an experimental study | journal = PLOS ONE | volume = 9 | issue = 1 | pages = e87164 | year = 2014 | pmid = 24475246 | pmc = 3901764 | doi = 10.1371/journal.pone.0087164 | bibcode = 2014PLoSO...987164I | doi-access = free }} Large scale vaccination is a public good, in that the benefits obtained by an individual from large scale vaccination are both non-rivalrous and non-excludable, and given these traits, individuals may avoid the costs of vaccination by "free-riding" off the benefits of others being vaccinated.{{cite book |title=Economics of the Public Sector|last=Stiglitz|first=Joseph|publisher=Territory Rights Worldwide|year=2000|isbn=978-0-393-96651-0}}{{cite journal | vauthors = Serpell L, Green J | title = Parental decision-making in childhood vaccination | journal = Vaccine | volume = 24 | issue = 19 | pages = 4041–6 | date = May 2006 | pmid = 16530892 | doi = 10.1016/j.vaccine.2006.02.037 }} The costs and benefits to individuals and society have been studied and critiqued in stable and changing population designs.{{cite journal |doi=10.1016/S0047-2727(96)01586-1 |title=Dynamic epidemiology and the market for vaccinations |journal=Journal of Public Economics |volume=63 |issue=3 |pages=383–406 |year=1997 |last1=Francis |first1=Peter J | name-list-style = vanc }}{{cite journal | vauthors = Deogaonkar R, Hutubessy R, van der Putten I, Evers S, Jit M | title = Systematic review of studies evaluating the broader economic impact of vaccination in low and middle income countries | journal = BMC Public Health | volume = 12 | pages = 878 | date = October 2012 | pmid = 23072714 | pmc = 3532196 | doi = 10.1186/1471-2458-12-878 | doi-access = free }}{{cite journal |doi=10.1016/j.jedc.2003.08.001 |title=Optimal tax/subsidy combinations for the flu season |journal=Journal of Economic Dynamics and Control |volume=28 |issue=10 |pages=2037–2054 |year=2004 |last1=Francis |first1=Peter J | name-list-style = vanc }} Other surveys have indicated that free-riding incentives exist in individual decisions,{{cite journal | vauthors = Oraby T, Thampi V, Bauch CT | title = The influence of social norms on the dynamics of vaccinating behaviour for paediatric infectious diseases | journal = Proceedings. Biological Sciences | volume = 281 | issue = 1780 | pages = 20133172 | date = April 2014 | pmid = 24523276 | pmc = 4078885 | doi = 10.1098/rspb.2013.3172 }} and in a separate study that looked at parental vaccination choice, the study found that parents were less likely to vaccinate their children if their children's friends had already been vaccinated.{{cite journal | vauthors = Meszaros JR, Asch DA, Baron J, Hershey JC, Kunreuther H, Schwartz-Buzaglo J |author-link5=Howard Kunreuther| title = Cognitive processes and the decisions of some parents to forego pertussis vaccination for their children | journal = Journal of Clinical Epidemiology | volume = 49 | issue = 6 | pages = 697–703 | date = June 1996 | pmid = 8656233 | doi = 10.1016/0895-4356(96)00007-8 | doi-access = free }}

Trust in vaccines and in the health system is an important element of public health programs that aim to deliver life-saving vaccines. Trust in vaccination and health care is an important indicator of government work and the effectiveness of the social policy. The success in overcoming diseases and in vaccination depends on the level of trust in vaccines and health care. The lack of trust in vaccines and immunization programs can lead to vaccine refusal, risking disease outbreaks, and challenging immunization goals in high- and low-income settings. Today, the medical and scientific communities obviously face a big challenge where vaccines are concerned, namely enhancing the trust with which the general public regards the entire endeavor. Indeed, earning the public's trust in public health is a big challenge. Accurately, studying the trust in vaccines, and understanding the factors that affect the reduction of trust, allows authorities to build an effective vaccine campaign and communication strategies to fight the disease. Trust is a key parameter to work with before and while undertaking any vaccine campaigns. The state is responsible for providing smart communication, and to inform a population about diseases, vaccines, and the risks of both. The WHO recommends that states work long-term, to build population resilience against vaccine myths and scares, to develop a strong campaign that is well prepared to respond to any event that may erode trust, and respond immediately to any event which may erode trust in health authorities.{{cite web

|url=http://www.euro.who.int/en/health-topics/disease-prevention/vaccines-and-immunization/publications/2017/vaccination-and-trust-2017

|title=Vaccination and trust

|publisher=World Health Organization

|access-date=7 April 2014

|archive-date=15 July 2017

|archive-url=https://web.archive.org/web/20170715182224/http://www.euro.who.int/en/health-topics/disease-prevention/vaccines-and-immunization/publications/2017/vaccination-and-trust-2017

|url-status=live

}} A review of 34 studies into communication strategies to tackle untruths about vaccines has also suggested strategies that are helpful, such as communicating scientific consensus and using humour to dispel myths, and unhelpful, such as scare tactics.{{Cite journal |last=Fischer |first=Kathrin |date=2023-07-13 |title=How to tackle vaccine misinformation: what works? |url=https://evidence.nihr.ac.uk/alert/how-to-tackle-vaccine-misinformation-what-works-and-what-doesnt/ |access-date=2024-05-31 |website=NIHR Evidence |doi=10.3310/nihrevidence_58944 |language=en-GB |archive-date=26 December 2023 |archive-url=https://web.archive.org/web/20231226114033/https://evidence.nihr.ac.uk/alert/how-to-tackle-vaccine-misinformation-what-works-and-what-doesnt/ |url-status=live |url-access=subscription }}{{Cite journal |last1=Whitehead |first1=Hannah S. |last2=French |first2=Clare E. |last3=Caldwell |first3=Deborah M. |last4=Letley |first4=Louise |last5=Mounier-Jack |first5=Sandra |date=January 2023 |title=A systematic review of communication interventions for countering vaccine misinformation |url=https://doi.org/10.1016/j.vaccine.2022.12.059 |journal=Vaccine |volume=41 |issue=5 |pages=1018–1034 |doi=10.1016/j.vaccine.2022.12.059 |issn=0264-410X |pmc=9829031 |pmid=36628653 |access-date=31 May 2024 |archive-date=5 June 2024 |archive-url=https://web.archive.org/web/20240605184434/https://www.sciencedirect.com/science/article/pii/S0264410X22015936?via%3Dihub |url-status=live }}

The first economic analysis of routine childhood immunizations in the United States took place in 2001, and reported cost savings over the lifetime of children born that year.{{cite journal | vauthors = Zhou F, Santoli J, Messonnier ML, Yusuf HR, Shefer A, Chu SY, Rodewald L, Harpaz R | title = Economic evaluation of the 7-vaccine routine childhood immunization schedule in the United States, 2001 | journal = Archives of Pediatrics & Adolescent Medicine | volume = 159 | issue = 12 | pages = 1136–44 | date = December 2005 | pmid = 16330737 | doi = 10.1001/archpedi.159.12.1136 | doi-access = }} Other analyses of the economic costs and potential benefits to individuals and society have since been evaluated.{{cite journal |author1=Zhou F |author2=Shefer A |author3=Wenger J |author4=Messonnier M |author5=Wang LY |author6=Lopez A |author7=Moore M |author8=Murphy TV |author9=Cortese M |author10=Rodewald L |title=Economic evaluation of the routine childhood immunization program in the United States, 2009 |journal=Pediatrics |volume=133 |issue=4 |pages=577–85 |date=April 2014 |pmid=24590750 |doi=10.1542/peds.2013-0698 |doi-access=free}} In 2014, the American Academy of Pediatrics published a decision analysis that evaluated direct costs, such as program costs, vaccine cost, administrative burden, negative vaccine-linked reactions, and transportation time lost to parents. The study focused on several communicable diseases, including diphtheria, tetanus, pertussis, measles, hepatitis A and B, and varicella (chickenpox), but did not include seasonal flu vaccines. Estimated costs and benefits were adjusted to 2009 dollars and projected over time at three percent interest. Of the theoretical group of 4,261,494 babies, beginning in 2009, who had followed a standard childhood immunization schedule under the Advisory Committee on Immunization Practices guidelines "will prevent ≈42,000 early deaths and 20 million cases of disease, with net savings of $13.5{{spaces}}billion in direct costs and $68.8{{spaces}}billion in total societal costs, respectively." In the United States, and in other nations,{{cite journal |vauthors=Gargano LM, Tate JE, Parashar UD, Omer SB, Cookson ST |title=Comparison of impact and cost-effectiveness of rotavirus supplementary and routine immunization in a complex humanitarian emergency, Somali case study |journal=Conflict and Health |volume=9 |pages=5 |year=2015 |pmid=25691915 |pmc=4331177 |doi=10.1186/s13031-015-0032-y |doi-access=free}}{{cite journal |vauthors=van Hoek AJ, Campbell H, Amirthalingam G, Andrews N, Miller E |title=Cost-effectiveness and programmatic benefits of maternal vaccination against pertussis in England |journal=The Journal of Infection |volume=73 |issue=1 |pages=28–37 |date=July 2016 |pmid=27108802 |doi=10.1016/j.jinf.2016.04.012 |s2cid=22494052 |url=http://researchonline.lshtm.ac.uk/2634797/1/van%20Hoek%20etal%20JoI%20accepted.pdf |access-date=5 August 2018 |archive-date=19 July 2018 |archive-url= https://web.archive.org/web/20180719044542/http://researchonline.lshtm.ac.uk/2634797/1/van%20Hoek%20etal%20JoI%20accepted.pdf |url-status=live }}{{cite journal |vauthors=Diop A, Atherly D, Faye A, Lamine Sall F, Clark AD, Nadiel L, Yade B, Ndiaye M, Fafa Cissé M, Ba M |title=Estimated impact and cost-effectiveness of rotavirus vaccination in Senegal: A country-led analysis |journal=Vaccine |volume=33 |pages=A119–25 |date=May 2015 |issue=Suppl 1 |pmid=25919151 |doi=10.1016/j.vaccine.2014.12.065 |doi-access=free}} there is an economic incentive and "global value" to invest in preventive vaccination programs, especially in children as a means to prevent early infant and childhood deaths.{{cite journal |vauthors=Ehreth J |title=The global value of vaccination |journal=Vaccine |volume=21 |issue=7–8 |pages=596–600 |date=January 2003 |pmid=12531324 |doi=10.1016/S0264-410X(02)00623-0}} Socioeconomic disparities have been found to hinder reasonable access to vaccinations in the U.S., and it has also been found that even if such status is not a factor, "racial ethnic minority adults are less likely than whites to receive preventive care including vaccination".{{cite web |url=https://www.historyofvaccines.org/index.php/content/articles/ethical-issues-and-vaccines|title=Ethical Issues and Vaccines |website=History of Vaccines |language=en|access-date=30 April 2019|archive-date=2 April 2020|archive-url=https://web.archive.org/web/20200402194734/https://www.historyofvaccines.org/index.php/content/articles/ethical-issues-and-vaccines|url-status=live}}{{cite journal |last1=Lees |first1=KA |last2=Wortley |first2=PM |last3=Coughlin |first3=SS |title=Comparison of racial/ethnic disparities in adult immunization and cancer screening. |journal=American Journal of Preventive Medicine |date=December 2005 |volume=29 |issue=5 |pages=404–11 |doi=10.1016/j.amepre.2005.08.009 |pmid=16376703 }}

There is an economic incentive to establish vaccination programs for older adults as the general population is aging due to increasing life expectancy and decreasing birth rates.{{cite journal | vauthors = Doherty TM, Connolly MP, Del Giudice G, Flamaing J, Goronzy JJ, Grubeck-Loebenstein B, Lambert PH, Maggi S, McElhaney JE, Nagai H, Schaffner W, Schmidt-Ott R, Walsh E, Di Pasquale A | title = Vaccination programs for older adults in an era of demographic change | journal = European Geriatric Medicine | volume = 9 | issue = 3 | pages = 289–300 | date = 2018 | pmid = 29887922 | pmc = 5972173 | doi = 10.1007/s41999-018-0040-8 }} Vaccinations can reduce the issues linked with both polypharmacy and antibiotic-resistant bacteria in the older demographic with comorbidities by preventing infectious diseases and decreasing the necessity of polypharmacy and antibiotics.{{cite journal | vauthors = Bonanni P, Picazo JJ, Rémy V | title = The intangible benefits of vaccination – what is the true economic value of vaccination? | journal = Journal of Market Access & Health Policy | volume = 3 | pages = 26964 | date = 12 August 2015 | pmid = 27123182 | pmc = 4802696 | doi = 10.3402/jmahp.v3.26964 }}{{cite journal | vauthors = Lipsitch M, Siber GR | title = How Can Vaccines Contribute to Solving the Antimicrobial Resistance Problem? | journal = mBio | volume = 7 | issue = 3 | date = June 2016 | pmid = 27273824 | pmc = 4959668 | doi = 10.1128/mBio.00428-16 }} One 2016 study done in Western Europe found that the estimated cost of vaccinating one person over a lifetime against 10–17 potentially debilitating pathogens would be €443–3,395 (equivalent to €{{Inflation|index=EU|value=443|start_year=2016}}–{{Inflation|index=EU|value=3395|start_year=2016|fmt=c}} in {{Inflation/year|index=EU}}).{{cite journal | vauthors = Ethgen O, Cornier M, Chriv E, Baron-Papillon F | title = The cost of vaccination throughout life: A western European overview | journal = Human Vaccines & Immunotherapeutics | volume = 12 | issue = 8 | pages = 2029–2037 | date = August 2016 | pmid = 27050111 | pmc = 4994732 | doi = 10.1080/21645515.2016.1154649 }} Another study found that if 75% of adults over 65 were vaccinated against seasonal influenza, 3.2–3.8 million cases and 35,000–52,000 influenza-related deaths could be avoided, and €438–558{{spaces}}million saved annually, solely on the European continent.{{cite journal | vauthors = Preaud E, Durand L, Macabeo B, Farkas N, Sloesen B, Palache A, Shupo F, Samson SI | title = Annual public health and economic benefits of seasonal influenza vaccination: a European estimate | journal = BMC Public Health | volume = 14 | pages = 813 | date = August 2014 | pmid = 25103091 | pmc = 4141103 | doi = 10.1186/1471-2458-14-813 | doi-access = free }}

In 2006, the World Health Organization and UNICEF created the Global Immunization Vision and Strategy (GIVS). This organization created a ten-year strategy with four main goals:{{cite web |title=Global Immunization Vision and Strategy |url=https://www.who.int/immunization/givs/en/ |website=Immunization, Vaccines and Biologicals |publisher=World Health Organization |date=1 December 2013 |access-date=24 April 2015 |archive-date=24 April 2015 |archive-url=https://web.archive.org/web/20150424112930/http://www.who.int/immunization/givs/en/}}

• to immunize more people against more diseases
• to introduce a range of newly available vaccines and technologies
• to integrate other critical health interventions with immunization
• to manage vaccination programmes within the context of global interdependence

The Global Vaccination Action Plan was created by the World Health Organization and endorsed by the World Health Assembly in 2012. The plan, which is set from 2011 to 2020, is intended to "strengthen routine immunization to meet vaccination coverage targets; accelerate control of vaccine-preventable diseases with polio eradication as the first milestone; introduce new and improved vaccines and spur research and development for the next generation of vaccines and technologies."{{cite web |url=https://www.who.int/immunization/global_vaccine_action_plan/en/ |title=Global Vaccine Action Plan 2011 – 2020 |date=5 February 2015 |access-date=24 April 2015 |publisher=World Health Organization |website=Immunization, Vaccines and Biologicals |archive-date=24 April 2015 |archive-url=https://web.archive.org/web/20150424051613/http://www.who.int/immunization/global_vaccine_action_plan/en/ |url-status=live }}

{{see also|Vaccination schedule}}

| style=padding-top:.35em | Mandatory to all ||

| style=padding-top:.35em | Mandatory to some ||

| style=padding-top:.35em | Recommended to all ||

| style=padding-top:.35em | Recommended to some ||

| style=padding-top:.35em | Neither mandatory nor recommended to anyone

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In December 2018, Argentina enacted a new vaccine policy requiring all persons who are medically able, both adults and children, to be vaccinated against specified diseases. Proof of vaccination is required to attend any level of school, file for a marriage license, and request any kind of government ID, including a passport or driver's license. The law requires the government to pay for all aspects of vaccinations and deems vaccination to be a national emergency; vaccines are exempt from internal and customs taxes.{{cite web|url=https://www.infobae.com/salud/2018/12/17/todo-lo-que-tenes-que-saber-de-la-nueva-ley-de-vacunacion-en-argentina/|title=Todo lo que hay que saber de la nueva ley de vacunación en Argentina|publisher=Infobae|first=Víctor|last=Ingrassia|date=17 December 2018|language=es|access-date=19 January 2019|archive-date=20 January 2019|archive-url=https://web.archive.org/web/20190120043027/https://www.infobae.com/salud/2018/12/17/todo-lo-que-tenes-que-saber-de-la-nueva-ley-de-vacunacion-en-argentina/|url-status=live}}{{cite web|url=https://noticias.perfil.com/2018/12/21/como-es-la-nueva-ley-de-vacunas/|title=Cómo es la nueva ley de vacunas|publisher=Noticias|first=Andrea|last=Gentil|date=21 December 2018|language=es|access-date=19 January 2019|archive-date=19 January 2019|archive-url=https://web.archive.org/web/20190119230725/https://noticias.perfil.com/2018/12/21/como-es-la-nueva-ley-de-vacunas/|url-status=live}}

{{See also|No Jab, No Pay}}

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{{#section: Vaccination schedule|Australia}}

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In an effort to boost vaccination rates in Australia, the Australian Government decided, starting on 1{{spaces}}January 2016, certain benefits (such as the universal "Family Allowance" welfare payments for parents of children) would no longer be available for conscientious objectors of vaccination. Those with medical grounds for not vaccinating continue to receive such benefits.{{cite journal |last1=Li |first1=A. |last2=Toll |first2=M. |title=Removing conscientious objection: The impact of 'No Jab No Pay' and 'No Jab No Play' vaccine policies in Australia |journal=Preventive Medicine |date=2020 |volume=145 |page=106406 |doi=10.1016/j.ypmed.2020.106406 |pmid=33388333 |s2cid=230489130 |url=https://www.sciencedirect.com/science/article/abs/pii/S0091743520304370 |access-date=13 January 2021 |archive-date=21 January 2021 |archive-url=https://web.archive.org/web/20210121214221/https://www.sciencedirect.com/science/article/abs/pii/S0091743520304370 |url-status=live |url-access=subscription }} The policy is supported by a majority of Australian parents as well as the Australian Medical Association (AMA) and Early Childhood Australia. In 2014, about 97 percent of children under seven were vaccinated, although the number of conscientious objectors to vaccination had increased by 24,000 to 39,000 in the previous decade.{{cite news |last=Peatling |first=Stephanie |name-list-style=vanc |title=Support for government push to withdraw welfare payments from anti vaccination parents |url=https://www.smh.com.au/federal-politics/political-news/support-for-government-push-to-withdraw-welfare-payments-from-anti-vaccination-parents-20150413-1mjc16.html |access-date=23 April 2015 |work=Sydney Morning Herald |department=Federal Politics |date=13 April 2015 |archive-date=17 April 2015 |archive-url=https://web.archive.org/web/20150417111614/http://www.smh.com.au/federal-politics/political-news/support-for-government-push-to-withdraw-welfare-payments-from-anti-vaccination-parents-20150413-1mjc16.html |url-status=live }}

The government began the Immunise Australia Program to increase national immunization rates.{{cite web |url=http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/about-the-program |title=About the Program |date=4 September 2014 |access-date=24 April 2015 |website=Immunise Australia Program |publisher=Australian Government, Department of Health |archive-url=https://web.archive.org/web/20150504202400/http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/about-the-program |archive-date=4 May 2015}} They fund a number of different vaccinations for certain groups of people. The intent is to encourage the most at-risk populations to get vaccinated.{{cite web |url=http://www.health.vic.gov.au/immunisation/free-vaccine.htm |title=Free vaccine Victoria – Criteria for eligibility |date=2 April 2015 |access-date=24 April 2015 |website=Health |publisher=State Government of Victoria |archive-date=27 April 2015 |archive-url=https://web.archive.org/web/20150427012433/http://www.health.vic.gov.au/immunisation/free-vaccine.htm |url-status=live }} The government maintains an immunization schedule.{{cite web |url=http://www.humanservices.gov.au/customer/enablers/medicare/australian-childhood-immunisation-register/your-childs-immunisation-schedule |title=Your child's immunisation schedule |date=20 March 2014 |access-date=24 April 2015 |website=Australian Childhood Immunisation Register for health professionals |publisher=Australian Government Department of Human Services |archive-date=16 April 2015 |archive-url=https://web.archive.org/web/20150416040621/http://www.humanservices.gov.au/customer/enablers/medicare/australian-childhood-immunisation-register/your-childs-immunisation-schedule |url-status=live }}

In most states and territories, children can consent to vaccinations if they are judged Gillick competent; normally, this applies to children aged 15 or older.{{cite web |url=https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/immunisation/consent |title=Age of Consent for Vaccinations |work=Queensland Health |publisher=Government of Queensland |date=15 December 2016 |access-date=17 March 2019 |archive-date=2 April 2019 |archive-url=https://web.archive.org/web/20190402024336/https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/immunisation/consent |url-status=live }} In South Australia, the Consent to Medical Treatment and Palliative Care Act 1995 allows children 16 and older to consent to medical treatment.{{cite news |url=https://www1.racgp.org.au/newsgp/professional/what-is-too-young-children-and-consent-for-medical |work=Royal Australian College of General Practitioners |title=Children and consent for medical treatment |first=Neelima |last=Choahan |date=20 August 2018 |access-date=17 March 2019 |archive-date=7 September 2020 |archive-url=https://web.archive.org/web/20200907165138/https://www1.racgp.org.au/newsgp/professional/what-is-too-young-children-and-consent-for-medical |url-status=live }} Additionally, children under this age can be immunized if judged capable of informed consent. In New South Wales, children can consent to medical treatment at the age of 14.

When several COVID-19 vaccines were nearing completion in November 2020, Australian Prime Minister Scott Morrison announced that all international travelers who fly to Australia without proof of a COVID-19 vaccination would be required to quarantine at their own expense.{{cite news |url=https://www.news.com.au/travel/travel-updates/health-safety/pm-scott-morrison-signals-tough-new-covid19-vaccine-rules-for-international-travellers-who-fly-to-australia/news-story/ccb7e190eba5fa9a38a3d67408ab75f5 |title=PM Scott Morrison signals tough new COVID-19 vaccine rules for international travellers who fly to Australia |author=Samantha Maiden |work=News.com.au |date=25 November 2020 |access-date=25 November 2020 |archive-date=25 November 2020 |archive-url=https://web.archive.org/web/20201125130519/https://www.news.com.au/travel/travel-updates/health-safety/pm-scott-morrison-signals-tough-new-covid19-vaccine-rules-for-international-travellers-who-fly-to-australia/news-story/ccb7e190eba5fa9a38a3d67408ab75f5 |url-status=live }}

It is also lawful for workplaces in Australia to mandate vaccines. The legality of this was upheld in the Fair Work Commission case Kimber v Sapphire Coast Community Aged Care Ltd in 2021.{{Cite web |title=[2021] FWCFB 6015 |url=https://www.fwc.gov.au/documents/decisionssigned/html/2021fwcfb6015.htm |access-date=2022-07-10 |website=Fwc.gov.au |archive-date=14 July 2022 |archive-url=https://web.archive.org/web/20220714072457/https://www.fwc.gov.au/documents/decisionssigned/html/2021fwcfb6015.htm |url-status=live }}

Austrian vaccine recommendations are developed by the National Vaccination Board ({{langx|de|text=Nationales Impfgremium}}), which is part of the Federal Ministry of Social Affairs, Health, Care and Consumer Protection.{{cite web |url=https://www.sozialministerium.at/Themen/Gesundheit/Impfen/Nationales-Impfgremium.html |title=Nationales Impfgremium |language=de |access-date=1 August 2021 |archive-date=12 August 2021 |archive-url=https://web.archive.org/web/20210812120817/https://www.sozialministerium.at/Themen/Gesundheit/Impfen/Nationales-Impfgremium.html |url-status=live }}

Children aged 14 and older can be vaccinated without parental consent.{{cite news |url=https://kurier.at/wissen/gesundheit/impfung-kinder-ab-14-koennen-selbst-entscheiden/401398959 |title=Impfung: Kinder ab 14 können selbst entscheiden |language=de |date=1 June 2021 |trans-title=Vaccination: Children can decide for themselves at 14 |work=Kurier |access-date=1 August 2021 |archive-date=1 August 2021 |archive-url=https://web.archive.org/web/20210801094104/https://kurier.at/wissen/gesundheit/impfung-kinder-ab-14-koennen-selbst-entscheiden/401398959 |url-status=live }}

Vaccinating children has been mandatory in Brazil since 1975, when the federal government instituted the National Immunization Program.{{cite web |title=Programa Nacional de Imunizações - Vacinação|url=https://www.gov.br/saude/pt-br/acesso-a-informacao/acoes-e-programas/programa-nacional-de-imunizacoes-vacinacao|access-date=2021-04-21|website=Ministério da Saúde|language=pt-br|archive-date=10 November 2020|archive-url=https://web.archive.org/web/20201110071408/https://www.gov.br/saude/pt-br/acesso-a-informacao/acoes-e-programas/programa-nacional-de-imunizacoes-vacinacao|url-status=live}} The compulsory character was written into law in 1990, in the Statute of Children and Adolescents (Art. 14, Para. 1).{{cite web |title=Estatuto da Criança e do Adolescente (Lei Fed. 8069)|url=http://www.planalto.gov.br/ccivil_03/Leis/L8069.htm|url-status=live|access-date=2021-04-21|website=Planalto.gov.br|quote=Art 14, Para 1: É obrigatória a vacinação das crianças nos casos recomendados pelas autoridades sanitárias.|archive-date=7 December 2019|archive-url=https://web.archive.org/web/20191207185327/http://www.planalto.gov.br/ccivil_03/Leis/L8069.htm}} Parents in Brazil who don't take their children to be vaccinated run the risk of being fined or charged with negligence.{{cite web |title=Secom faz propaganda com frase de Bolsonaro contra obrigatoriedade da vacina [01/09/2020]|url=https://noticias.uol.com.br/ultimas-noticias/reuters/2020/09/01/secom-faz-propaganda-com-frase-de-bolsonaro-contra-obrigatoriedade-da-vacina.htm|url-status=live|access-date=2021-04-21|website=noticias.uol.com.br|language=pt-br|quote=Pais que deixarem de levar os filhos para a vacinação obrigatória correm o risco de ser multados ou processados por negligência e maus tratos.|archive-date=24 March 2021|archive-url=https://web.archive.org/web/20210324033841/https://noticias.uol.com.br/ultimas-noticias/reuters/2020/09/01/secom-faz-propaganda-com-frase-de-bolsonaro-contra-obrigatoriedade-da-vacina.htm}}

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{{#section: Vaccination schedule|Brazil}}

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Vaccination in Canada is voluntary. While vaccination is generally required to attend school in Ontario and New Brunswick, there are exemptions given to those who are opposed.{{cite news |title=Measles outbreak: The loopholes in Canada's vaccination laws |url=https://www.cbc.ca/news/health/measles-outbreak-the-loopholes-in-canada-s-vaccination-laws-1.2943583 |access-date=6 November 2019 |agency=CBC |archive-date=29 August 2019 |archive-url=https://web.archive.org/web/20190829042433/https://www.cbc.ca/news/health/measles-outbreak-the-loopholes-in-canada-s-vaccination-laws-1.2943583 |url-status=live }}

Under the mature minor doctrine, minors capable of granting informed consent can be vaccinated without parental approval.

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{{#section: Vaccination schedule|Alberta}}

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{{#section: Vaccination schedule|British Columbia}}

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{{#section: Vaccination schedule|New Brunswick}}

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{{#section: Vaccination schedule|Ontario}}

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{{#section: Vaccination schedule|Quebec}}

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China has passed the World Health Organization's (WHO) regulatory vaccine assessments, demonstrating that they adhere to international standards.{{cite journal |last1=Parry |first1=J |title=China enters the global vaccine market |journal=Bulletin of the World Health Organization |date=1 September 2014 |volume=92 |issue=9 |pages=626–627 |doi=10.2471/BLT.14.020914 |pmid=25378751 |pmc=4208573 }} The Chinese government's Expanded Program on Immunization (EPI) was created in 1978 and provides certain obligatory vaccines, named Category{{spaces}}1 vaccines, for free to all children up to 14 years of age. Initially, the vaccines consisted of Bacillus Calmette-Guérin (BCG) vaccine, oral polio vaccine (OPV), measles vaccine (MV) and diphtheria, tetanus and pertussis (DPT vaccine).{{cite journal |last1=Zheng |first1=Jingshan |last2=Zhou |first2=Yuqing |last3=Wang |first3=Huaqing |last4=Liang |first4=Xiaofeng |title=The role of the China Experts Advisory Committee on Immunization Program |journal=Vaccine |date=April 2010 |volume=28 |pages=A84–A87 |doi=10.1016/j.vaccine.2010.02.039 |pmid=20413004 |doi-access=free }} By 2007, the vaccine list was expanded to include hepatitis A, hepatitis B, Japanese encephalitis, A + C meningococcal polysaccharide, mumps, Rubella, hemorrhagic fever, anthrax, and leptospirosis.{{cite journal |last1=Fang |first1=Hai |last2=Yang |first2=Li |last3=Zhang |first3=Huyang |last4=Li |first4=Chenyang |last5=Wen |first5=Liankui |last6=Sun |first6=Li |last7=Hanson |first7=Kara |last8=Meng |first8=Qingyue |title=Strengthening health system to improve immunization for migrants in China |journal=International Journal for Equity in Health |date=1 July 2017 |volume=16 |issue=1 |pages=19 |doi=10.1186/s12939-016-0504-8 |pmid=28666442 |pmc=5493864 |doi-access=free }} Category{{spaces}}2 vaccines, such as the rabies vaccine, are private-sector, non-obligatory vaccines that are not included in neither EPI nor the government health insurance.{{cite journal |last1=Zheng |first1=Yaming |last2=Rodewald |first2=Lance |last3=Yang |first3=Juan |last4=Qin |first4=Ying |last5=Pang |first5=Mingfan |last6=Feng |first6=Luzhao |last7=Yu |first7=Hongjie |title=The landscape of vaccines in China: history, classification, supply, and price |journal=BMC Infectious Diseases |date=4 October 2018 |volume=18 |issue=1 |pages=502 |doi=10.1186/s12879-018-3422-0 |pmid=30286735 |pmc=6172750 |doi-access=free }} Due to the privatized nature of Category{{spaces}}2 vaccines, these vaccinations are associated with low coverage rates.{{cite journal |last1=Zhang |first1=Xinyi |last2=Syeda |first2=Zerin Imam |last3=Jing |first3=Zhengyue |last4=Xu |first4=Qiongqiong |last5=Sun |first5=Long |last6=Xu |first6=Lingzhong |last7=Zhou |first7=Chengchao |title=Rural-urban disparity in category II vaccination among children under five years of age: evidence from a survey in Shandong, China |journal=International Journal for Equity in Health |date=22 June 2018 |volume=17 |issue=1 |pages=87 |doi=10.1186/s12939-018-0802-4 |pmid=29929503 |pmc=6013881 |doi-access=free }}

Both the Changsheng Bio-Technology Co Ltd and the Wuhan Institute of Biological Products have been fined for selling ineffective vaccines.{{cite news|url=https://www.scmp.com/news/china/society/article/2118711/over-650000-faulty-vaccine-doses-recalled-china|title=Over 650,000 faulty vaccine doses recalled in China|date=7 November 2018|access-date=29 November 2018|publisher=South China POst|archive-date=29 November 2018|archive-url=https://web.archive.org/web/20181129142348/https://www.scmp.com/news/china/society/article/2118711/over-650000-faulty-vaccine-doses-recalled-china|url-status=live}}{{cite news|url=https://www.scmp.com/news/china/money-wealth/article/2156520/changsheng-bio-tech-vaccine-maker-behind-chinas-latest|title=Changsheng Bio-tech, the vaccine maker behind China's latest public health scare|date=23 July 2018|access-date=28 November 2018|publisher=South China Morning Post|archive-date=6 August 2018|archive-url=https://web.archive.org/web/20180806153951/https://www.scmp.com/news/china/money-wealth/article/2156520/changsheng-bio-tech-vaccine-maker-behind-chinas-latest|url-status=live}} In December 2018, China enacted new laws imposing strict controls over the production and inspection of aspects of vaccine production from research, development, and testing through production and distribution.{{cite news|url=https://www.scmp.com/news/china/policies-politics/article/2156431/chinese-premier-li-keqiang-promises-clean-vaccine|title=Chinese President Xi Jinping orders crackdown over 'appalling' vaccine scandal|date=23 July 2018|access-date=29 November 2018|publisher=South China Morning Post|archive-date=29 November 2018|archive-url=https://web.archive.org/web/20181129142403/https://www.scmp.com/news/china/policies-politics/article/2156431/chinese-premier-li-keqiang-promises-clean-vaccine|url-status=live}}{{cite web|url=https://www.scmp.com/news/china/politics/article/2179357/chinas-lawmakers-consider-strictest-rules-vaccine-industry-after|title=China's lawmakers consider 'strictest' rules on vaccine industry after scandals|publisher=South China Morning Post|first=William|last=Zheng|date=24 December 2018|access-date=19 January 2019|archive-date=26 December 2018|archive-url=https://web.archive.org/web/20181226141538/https://www.scmp.com/news/china/politics/article/2179357/chinas-lawmakers-consider-strictest-rules-vaccine-industry-after|url-status=live}}

In November 2021, Costa Rica added COVID-19 to the list of infectious diseases required to be vaccinated against. The vaccine is mandatory for children between the ages of 5 and 18.{{cite news| url = https://www.reuters.com/world/americas/costa-rica-issues-covid-19-vaccine-requirement-children-2021-11-06/| title = Costa Rica issues COVID-19 vaccine requirement for children| newspaper = Reuters| date = 6 November 2021| access-date = 27 November 2021| archive-date = 27 November 2021| archive-url = https://web.archive.org/web/20211127085251/https://www.reuters.com/world/americas/costa-rica-issues-covid-19-vaccine-requirement-children-2021-11-06/| url-status = dead}}

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{{#section: Vaccination schedule|France}}

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In France, the High Council of Public Health is in charge of proposing vaccine recommendations to the Minister of Health. Each year, immunization recommendations for both the general population and specific groups are published by the Institute of Epidemiology and Surveillance.{{cite journal |last1=Loulergue |first1=Pierre |name-list-style=vanc |title=Survey of Vaccination Policies in French Healthcare Institutions |volume=42 |issue=4 |pages=161–6 |journal=Médecine et Maladies Infectieuses |url=http://www.vhpb.org/files/html/Meetings_and_publications/Presentations/BARS34.pdf |pmid=22516534 |year=2012 |doi=10.1016/j.medmal.2011.11.003 |access-date=5 August 2018 |archive-date=27 August 2018 |archive-url=https://web.archive.org/web/20180827014007/http://www.vhpb.org/files/html/Meetings_and_publications/Presentations/BARS34.pdf |url-status=live }} Since some hospitals are granted additional freedoms, there are two key people responsible for vaccine policy within hospitals: the Operational physician (OP), and the Head of the hospital infection and prevention committee (HIPC). Mandatory immunization policies on BCG, diphtheria, tetanus, and poliomyelitis began in the 1950s and policies on Hepatitis B began in 1991. Recommended but not mandatory suggestions on influenza, pertussis, varicella, and measles began in 2000, 2004, 2004, and 2005, respectively. According to the 2013 INPES Peretti-Watel health barometer, between 2005 and 2010, the percentage of French people between 18 and 75 years old in favor of vaccination dropped from 90% to 60%.{{Citation needed|date=November 2018}}

Since 2009, France has recommended meningococcus C vaccination for infants 1–2 years old, with a catch up dosage up to 25 years later. French insurance companies have reimbursed this vaccine since January 2010, at which point coverage levels were 32.3% for children 1–2 years and 21.3% for teenagers 14–16 years old.{{cite journal | vauthors = Stahl JP, Cohen R, Denis F, Gaudelus J, Lery T, Lepetit H, Martinot A | title = Vaccination against meningococcus C. vaccinal coverage in the French target population | journal = Médecine et Maladies Infectieuses | volume = 43 | issue = 2 | pages = 75–80 | date = February 2013 | pmid = 23428390 | doi = 10.1016/j.medmal.2013.01.001 }} In 2012, the French government and the Institut de veille sanitaire launched a 5-year national program to improve vaccination policy. The program simplified guidelines, facilitated access to vaccination, and invested in vaccine research.{{cite journal | vauthors = Loulergue P, Floret D, Launay O | title = Strategies for decision-making on vaccine use: the French experience | journal = Expert Review of Vaccines | volume = 14 | issue = 7 | pages = 917–22 | date = July 2015 | pmid = 25913015 | doi = 10.1586/14760584.2015.1035650 | s2cid = 19850490 }} In 2014, fueled by rare health-related scandals, mistrust of vaccines became a common topic in the French public debate on health.{{cite web|last1=Rouillon|first1=Etienne|name-list-style=vanc|title=Charges Against French Parents Stir Mandatory Vaccination Debate|url=https://www.vice.com/en/article/charges-against-french-parents-stir-mandatory-vaccination-debate/|website=VICE NEWS|access-date=10 March 2016|date=10 October 2014|archive-date=25 June 2016|archive-url=https://web.archive.org/web/20160625074709/https://news.vice.com/article/charges-against-french-parents-stir-mandatory-vaccination-debate|url-status=live}} According to a French radio station, as of 2014, three to five percent of kids in France were not given the mandatory vaccines. Some families may avoid requirements by finding a doctor willing to forge a vaccination certificate, a solution which numerous French forums confirm. However, the French State considers "vaccine refusal" a form of child abuse. In some instances, parental vaccine refusals may result in criminal trials. France's 2010 creation of the Question Prioritaire Constitutionelle (QPC) allows lower courts to refer constitutional questions to the highest court in the relevant hierarchy.{{cite web|last1=Reiss|first1=Dorit Rubinstein|name-list-style=vanc|title=Freedom To Ignore French Vaccination Program – A Court Case.|website=Skeptical Raptor|url=http://www.skepticalraptor.com/skepticalraptorblog.php/freedom-vaccinate-france-a-court-case/|access-date=10 March 2016|date=8 January 2016|archive-date=3 March 2016|archive-url=https://web.archive.org/web/20160303111313/http://www.skepticalraptor.com/skepticalraptorblog.php/freedom-vaccinate-france-a-court-case/|url-status=live}} Therefore, criminal trials based on vaccine refusals may be referred to the Cour de Cassation, which will then certify whether the case meets certain criteria.

In May 2015, France updated its vaccination policies on diphtheria, tetanus, acellular pertussis, polio, Haemophilus influenzae b infections, and hepatitis B for premature infants. As of 2015, while failure to vaccinate is not necessarily illegal, a parent's right to refuse to vaccinate his or her child is technically a constitutional matter. Additionally, children in France cannot enter schools without proof of vaccination against diphtheria, tetanus, and polio.{{cite news|last1=Greenhouse|first1=Emily|name-list-style=vanc|title=How France Is Handling Its Own Vaccine Debate|newspaper=Bloomberg.com |date=4 February 2015 |publisher=Bloomberg|url=https://www.bloomberg.com/politics/articles/2015-02-04/how-france-is-handling-its-own-vaccine-debate|access-date=21 April 2021|archive-date=20 April 2021|archive-url=https://web.archive.org/web/20210420223101/https://www.bloomberg.com/|url-status=live}} French Health Minister, Marisol Touraine, finds vaccinations "absolutely fundamental to avoid disease," and has pushed to have trained pharmacists and doctors administer vaccinations. Most recently, the Prime Minister's 2015–2017 roadmap for the "multi-annual social inclusion and anti-poverty plan" includes free vaccinations in certain public facilities.{{cite web|title="The Fight against Poverty: "The Challenge Is to Preserve Our Social Model and Its Underlying Values""|url=http://Gouvernement.fr|publisher=General Assembly on Social Work|access-date=21 April 2021|archive-date=20 April 2021|archive-url=https://web.archive.org/web/20210420195318/https://www.gouvernement.fr/|url-status=live}} Vaccinations within the immunization schedule are given for free at immunization services within the public sector. When given in private medical practices they are reimbursed at 65%.

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{{#section: Vaccination schedule|Germany}}

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In Germany, the Standing Committee on Vaccination (STIKO) is the federal commission responsible for recommending an immunization schedule. The Robert Koch Institute in Berlin (RKI) compiles data of immunization status upon the entry of children at school, and measures vaccine coverage of Germany at a national level.{{cite web|title=Germany|url=http://venice.cineca.org/documents/germany_ip.pdf|website=Vaccination European New Integrated Collaboration Effort|publisher=Venice III|access-date=18 April 2016|archive-date=5 January 2017|archive-url=https://web.archive.org/web/20170105235556/http://venice.cineca.org/documents/germany_ip.pdf|url-status=live}} Founded in 1972, the STIKO is composed of 12–18 volunteers, appointed members by the Federal Ministry for Health for 3-year terms.{{cite web|title=The German Standing Committee of Vaccination|url=http://www.rki.de/EN/Content/infections/Vaccination/Vaccination_node.html|publisher=Robert Koch Institut|access-date=18 April 2016|archive-date=3 April 2016|archive-url=https://web.archive.org/web/20160403190225/http://www.rki.de/EN/Content/infections/Vaccination/Vaccination_node.html|url-status=live}} Members include experts from many scientific disciplines and public health fields and professionals with extensive experience on vaccination. The independent advisory group meets biannually to address issues pertaining to preventable infectious diseases.{{cite web|title=Vaccinations|url=http://www.english.g-ba.de/special-topics/vaccinations/|website=G-BA|publisher=Bermeinsamer Bundesausschuss|access-date=15 March 2016|archive-date=22 April 2016|archive-url=https://web.archive.org/web/20160422104130/http://www.english.g-ba.de/special-topics/vaccinations/|url-status=live}} Although the STIKO makes recommendations, immunization in Germany is voluntary and there are no official government recommendations. German Federal States typically follow the Standing Vaccination Committee's recommendations minimally, although each state can make recommendations for their geographic jurisdiction that extends beyond the recommended list. In addition to the proposed immunization schedule for children and adults, the STIKO recommends vaccinations for occupational groups, police, travelers, and other at risk groups.

Vaccinations recommendations that are issued must be in accordance with the Protection Against Infection Act ({{ill|Infektionsschutzgesetz|de|vertical-align=sup}}), which regulates the prevention of infectious diseases in humans.{{cite journal |last1=Kerwat |first1=Klaus |last2=Just |first2=Martin |last3=Wulf |first3=Hinnerk |title=Krankenhaushygiene – Das Infektionsschutzgesetz |trans-title=The German Protection against Infection Act (Infektionsschutzgesetz (IfSG)) |language=de|journal=Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie |date=5 March 2009 |volume=44 |issue=3 |pages=182–183 |doi=10.1055/s-0029-1215548 |pmid=19266418 |s2cid=206294740 }} If a vaccination is recommended because of occupational risks, it must adhere to the Occupational Safety and Health Act involving Biological Agents.{{cite web|title=Recommendations of the Standing Committee on Vaccinations STIKO at the Robert Koch Institute|url=http://www.rki.de/EN/Content/infections/Vaccination/recommandations/34_2015_engl.pdf?__blob=publicationFile|website=Epidemiologisches Bulletin|publisher=Robert Koch Institute|access-date=18 April 2016|archive-date=22 May 2016|archive-url=https://web.archive.org/web/20160522224923/http://www.rki.de/EN/Content/infections/Vaccination/recommandations/34_2015_engl.pdf?__blob=publicationFile|url-status=live}} Criteria for the recommendation include disease burden, efficacy and effectiveness, safety, feasibility of program implementation, cost-effectiveness evaluation, clinical trial results, and equity in access to the vaccine. In the event of vaccination-related injuries, federal states are responsible for monetary compensation. Germany's central government does not finance childhood immunizations, so 90% of vaccines are administered in a private physician's office and paid for through insurance. The other 10% of vaccines are provided by the states in public health clinics, schools, or day care centers by local immunization programs. Physician responsibilities concerning immunization include beginning infancy vaccination, administering booster vaccinations, maintaining medical and vaccination history, and giving information and recommendations concerning vaccines.

Children aged 15 and over can legally consent to being vaccinated, even if their parents expressly object, provided the child gives the impression of being mature, informed, and capable of understanding the risks and benefits of their decision.{{cite web |url=https://www.aekno.de/page.asp?pageId=17342&noredir=True |title=Einwilligung in die ärztliche Behandlung von Kindern und Jugendlichen |trans-title=Consent in the medical treatment of children and youth |date=27 November 2017 |first1=Dirk |last1=Schulenburg |first2=Katharina |last2=Eibl |access-date=12 March 2019 |work=Rheinisches Ärzteblatt |language=de }}{{Dead link|date=June 2022 |bot=InternetArchiveBot |fix-attempted=yes }}{{cite web |url=https://www.medical-tribune.de/praxis-und-wirtschaft/artikel/juristische-fallen-beim-impfen-aufklaerung-und-einwilligung/ |date=10 July 2013 |first=Birgit |last=Maronde |name-list-style=vanc |trans-title=Legal Pitfalls with Vaccination: Informing and Consenting |title=Juristische Fallen beim Impfen: Aufklärung und Einwilligung |language=de |work=Medical Tribune |publisher=Süddeutscher Verlag |access-date=12 March 2019 |archive-date=12 November 2020 |archive-url=https://web.archive.org/web/20201112031829/https://www.medical-tribune.de/praxis-und-wirtschaft/artikel/juristische-fallen-beim-impfen-aufklaerung-und-einwilligung/ |url-status=live }}

Beginning in March 2020, Germany made the measles vaccine compulsory for all children attending school or day care, as well persons employed at schools, day cares, and medical or community facilities.{{cite web |url=https://www.dw.com/en/germany-makes-measles-vaccination-compulsory/a-51243094 |title=Germany makes measles vaccination compulsory |date=14 November 2019 |access-date=1 December 2021 |first=Kate |last=Brady |website=Deutsche Welle |archive-date=29 November 2021 |archive-url=https://web.archive.org/web/20211129214845/https://www.dw.com/en/germany-makes-measles-vaccination-compulsory/a-51243094 |url-status=live }}

As of January 2022, COVID-19-vaccination is mandatory for staff and students of secondary and tertiary education, employees in all arms of government, health workers, security personnel, and commercial drivers.

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{{#section: Vaccination schedule|India}}

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In the Republic of Ireland, childhood vaccination (up to age 16) requires the consent of the parents. The Department of Health strongly recommend vaccinations.{{cite web |url=http://www.citizensinformation.ie/en/health/children_s_health/immunisations_for_children.html |title=Immunisations for children and young people |date=16 September 2014 |access-date=24 April 2015 |website=Citizens Information |publisher=Citizens Information Board, Republic of Ireland |archive-date=1 May 2015 |archive-url=https://web.archive.org/web/20150501203021/http://www.citizensinformation.ie/en/health/children_s_health/immunisations_for_children.html}}

{{main|Health_in_Italy#Vaccination}}

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{{#section: Vaccination schedule|Italy}}

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As aging populations in Italy bring a rising burden of age-related disease, the Italian vaccination system remains complex.{{cite web|last1=Webicine Journalists|title=Italy Embraces 'life-course Immunisation |url=http://www.vaccinestoday.eu/vaccines/italy-embraces-life-course-immunisation/|website=Vaccines Today|publisher=EFPIA|access-date=10 March 2016|date=19 December 2014|archive-date=27 April 2016|archive-url=https://web.archive.org/web/20160427075518/http://www.vaccinestoday.eu/vaccines/italy-embraces-life-course-immunisation/|url-status=live}} The fact that services and decisions are delivered by 21 separate regional authorities creates many variations in Italian vaccine policy. There is a National committee on immunizations that updates the national recommended immunization schedule, with input from the ministry of health representatives, regional health authorities, national institute of health, and other scientific societies.{{cite web|title=Ministero Della Salute|url=http://www.salute.gov.it|publisher=Italian Ministry of Health|access-date=10 March 2016|archive-date=26 April 2011|archive-url=https://web.archive.org/web/20110426023941/http://www.salute.gov.it/|url-status=live}} Regions may add more scheduled vaccinations, but cannot exempt citizens from nationally mandated or recommended ones. For instance, a nationwide plan for eliminating measles and rubella began in 2001. Certain vaccinations in Italy are based on findings from the National Centre for Epidemiology, Surveillance and Health Promotion are also used to determine miscellaneous vaccination mandates.

Childhood vaccinations included in national schedules are guaranteed free of charge for all Italian children and foreign children who live in the country. Estimated insurance coverage for the required three doses of HBV-Hib-IPV vaccines is at least 95% when the child is two years old. Influenza is the only nationally necessary vaccine for adults, and is administered by general practitioners. To mitigate some public concerns, Italy currently has a national vaccine injury compensation program. Essentially, those who are ill or damaged by mandatory and recommended vaccinations may receive funding from the government as compensation. A 2010 evaluation of vaccine coverage, which covered the 2008 birth cohort, showed a slight decline in immunization insurance coverage rates of diphtheria, hepatitis B, polio, and tetanus after those specific vaccinations had been made mandatory.{{cite journal |last1=Haverkate |first1=M. |last2=d'Ancona |first2=F. |last3=Giambi |first3=C. |last4=Johansen |first4=K. |last5=Lopalco |first5=P. L. |last6=Cozza |first6=V. |last7=Appelgren |first7=E. |collaboration=Venice Project Gat Collective |year=2012 |title=Mandatory And Recommended Vaccination In The EU, Iceland And Norway: Results Of The Venice 2010 Survey On The Ways Of Implementing National Vaccination Programmes |journal=Eurosurveillance|volume=17|issue=22|doi=10.2807/ese.17.22.20183-en|pmid=22687916|doi-access=free}} However, vaccination levels continued to pass the Italian government's goal of 95% outreach.

Aiming to integrate immunization strategies across the country and equitize access to disease prevention, the Italian Ministry of Health issued the National Immunization Prevention Plan (Piano Nazionale Prevenzione Vaccinale) in 2012. This plan for 2012–2014 introduced an institutional "life course" approach to vaccination to complement the Italian health policy agenda.{{cite journal | vauthors = Bonanni P, Ferro A, Guerra R, Iannazzo S, Odone A, Pompa MG, Rizzuto E, Signorelli C | title = Vaccine coverage in Italy and assessment of the 2012–2014 National Immunization Prevention Plan | journal = Epidemiologia e Prevenzione | volume = 39 | issue = 4 Suppl 1 | pages = 146–58 | date = July 2013 | pmid = 26499433 }} HPV vaccine coverage increased well, and pneumococcal vaccine and meningococcal C vaccines faced positive public reception. However, both infant vaccine coverage rates and influenza immunization in the elderly have been decreasing. A 2015 government plan in Italy aimed to boost vaccination rates and introduce a series of new vaccines, triggering protests among public health professionals.{{cite web|last1=Margottini|first1=Laura|name-list-style=vanc|title=New Vaccination Strategy Stirs Controversy in Italy.|url=https://www.science.org/content/article/new-vaccination-strategy-stirs-controversy-italy|website=Science Insider|publisher=American Association for the Advancement of Science|access-date=10 March 2016|date=7 December 2015|archive-date=8 March 2016|archive-url=https://web.archive.org/web/20160308090124/http://www.sciencemag.org/news/2015/12/new-vaccination-strategy-stirs-controversy-italy|url-status=live}} Partially in response to the statistic that less than 86% of Italian children receive the measles shot, the National Vaccination Plan for 2016–18 (PNPV) increased vaccination requirements. For instance, nationwide varicella shots would be required for newborns. Under this plan, government spending on vaccines would double to €620{{spaces}}million annually, and children could be barred from attending school without proving vaccination. Although these implementations would make Italy a European frontrunner in vaccination, some experts questioned the need for several of the vaccines, and some physicians worried about the potential punishment they may face if they do not comply with the proposed regulations.

There were 5,000 cases of measles in 2017, up from 870 in 2016. This rise accounted for 29% of all those in the European Union.{{Citation needed|date=July 2022}} The law compelling children to have ten vaccinations to enroll at state schools came into effect in March 2018 but in August 2018 the Five Star Movement pushed legislation through the Italian Senate abolishing it. It did not pass the Chamber of Deputies but parents did not have to provide schools with a doctor's note to show their children have been vaccinated.{{cite news |title=Italy Senate overturns mandatory vaccination law |url=https://www.ft.com/content/afd472be-996c-11e8-9702-5946bae86e6d?emailId=5b6873a4a1ccf60004083fa6 |access-date=17 September 2018 |publisher=Financial Times |date=6 August 2018 |archive-date=17 September 2018 |archive-url=https://web.archive.org/web/20180917143438/https://www.ft.com/content/afd472be-996c-11e8-9702-5946bae86e6d?emailId=5b6873a4a1ccf60004083fa6 |url-status=live }} By November 2018, the government had changed its stance because of the "measles emergency" and decided to uphold the obligation for children up to the age of 16, teachers and health professionals to be vaccinated. A midwife working at a hospital in central Italy was terminated for refusing vaccination.{{cite news |title=Italy's populist coalition renounces anti-vaccination stance amid measles 'emergency' |url=https://www.telegraph.co.uk/news/2018/11/15/italys-populist-coalition-renounces-anti-vaccination-stance/ |access-date=22 December 2018 |publisher=Telegraph |date=15 November 2018 |archive-date=22 December 2018 |archive-url=https://web.archive.org/web/20181222173439/https://www.telegraph.co.uk/news/2018/11/15/italys-populist-coalition-renounces-anti-vaccination-stance/ |url-status=live }}

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{{#section: Vaccination schedule|Japan}}

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In Japan, there are three types of vaccination practices: Routine (scheduled); Temporary (ad-hoc); and Non-legal.{{cite web |url=http://www.japaneselawtranslation.go.jp/law/detail/?id=2964&vm=04&re=01&new=1 |title=予防接種法 (法令番号：昭和二十三年法律第六十八号); Immunization Act (Law number: Act No. 68 of 1948) |publisher=Ministry of Justice (Japan) |website=Japanese Law Translation (日本法令外国語訳データベースシステム) |date=7 November 2016 |access-date=24 February 2020 |type=The translated law from Japanese to English is the latest version as of February 2020, followed by 平成二十五年法律第百三号 改正 (Amendment of Act No. 103 of 2013)}}{{Dead link|date=July 2023 |bot=InternetArchiveBot |fix-attempted=yes }}{{cite web |url=https://elaws.e-gov.go.jp/search/elawsSearch/elaws_search/lsg0500/detail?openerCode=1&lawId=323CO0000000197#1 |title=予防接種法施行令（昭和二十三年政令第百九十七号）第1条: 政令で定めるＡ類疾病、第1条の2: 政令で定めるＢ類疾病、第1条の3: 市町村長が予防接種を行う疾病及びその対象者 |trans-title=Immunization Act Implementation Order (Law number: Order No. 197 of 1948) {{!}} Article 1: Category A diseases under the Order; Article 1–2: Category B diseases under the Order; Article 1–3: vaccine recipients and vaccination schedule under city mayors' initiatives |date=30 March 2018 |website=e-Gov Law Database |access-date=24 February 2020 |publisher=Administrative Management Bureau, the Ministry of Internal Affairs and Communications |quote=平成三十年政令第百六号改正、2018年4月1日施行分 (version information: Amendment of Order No. 106 of 2018) |language=ja |archive-date=21 April 2021 |archive-url=https://web.archive.org/web/20210421083617/https://elaws.e-gov.go.jp/document?lawid=323CO0000000197#1 |url-status=live }}{{cite journal |url=https://www.jpeds.or.jp/uploads/files/VIS_02teikisesshu.ninisesshu.pdf |title=定期接種と任意接種のワクチン |trans-title=Scheduled and non-legal vaccination |journal=日本小児科学会の「知っておきたいわくちん情報」 |issue=2 |publisher=公益社団法人 日本小児科学会 (Japan Pedriatric Society) |year=2018 |access-date=26 February 2020 |archive-date=28 May 2018 |archive-url=https://web.archive.org/web/20180528215649/http://www.jpeds.or.jp/uploads/files/VIS_02teikisesshu.ninisesshu.pdf |url-status=live }} Infections of the first two types are defined by {{ill|Immunization Act (Japan)|lt=Immunization Act|ja|予防接種法}} ({{Langx|ja|予防接種法}}) and its related {{ill|Cabinet order (Japan)|lt=cabinet order|ja|政令}} ({{Langx|ja|予防接種法施行令}}). As of January 2020, sixteen infections in total are on the legal lists{{snd}}fourteen are Category{{spaces}}A diseases (vaccination is not mandatory but recommended to prevent pandemic), and two are Category{{spaces}}B (not even recommended and only for a personal care purpose).

Compared to the global standard, Japanese vaccination policy is sometimes described by medical experts as the "Vaccine Gap."{{cite journal |url=https://www.igaku-shoin.co.jp/paperDetail.do?id=PA03058_02 |title=過去・現在・未来で読み解く，日本の予防接種制度 |trans-title=Vaccine policy in Japan – past, present and future |author1=齋藤昭彦 (Akihiko Saito, Professor at Graduate School of Medical and Dental Sciences, Niigata University) |journal=週刊医学界新聞 |issue=3058 |publisher=Igaku-Shoin Ltd. |date=6 January 2014 |language=ja |access-date=26 February 2020 |archive-date=25 January 2020 |archive-url=https://web.archive.org/web/20200125024504/http://www.igaku-shoin.co.jp/paperDetail.do?id=PA03058_02 |url-status=live }}{{cite journal |title=日本のワクチン政策の変遷 |trans-title=History of vaccination policy in Japan |journal=The Value of VACCINE |issue=改訂版 (revised version) |url=http://www.phrma-jp.org/wordpress/wp-content/uploads/old/library/the_value_of_vaccine/the_value_of_vaccine04.pdf |publisher=Pharmaceutical Research and Manufacturers of America (PhRMA) |pages=14–19 |year=2014 |language=ja |access-date=26 February 2020 |archive-date=4 October 2020 |archive-url=https://web.archive.org/web/20201004123121/http://www.phrma-jp.org/wordpress/wp-content/uploads/old/library/the_value_of_vaccine/the_value_of_vaccine04.pdf |url-status=live }} For instance, Japan is the only developed country that does not list mumps on the vaccine schedule. It's also noted that the government approval for new combination vaccines usually takes longer than other developed countries, such as the United States.

One reason behind the vaccine gap is that the government was sued several times for negligence of duty of care and for malpractice liabilities throughout the vaccination history.{{cite journal |title=判例研究 : 予防接種禍事件 |trans-title=Case study: The class action against vaccination malpractices |author1=高木武 (Takeshi Takagi) |journal=東洋法学 |trans-journal=Toyo Law Review |volume=29 |issue=2 |pages=71–76 |publisher=Toyo University |year=1986 |url=http://id.nii.ac.jp/1060/00003620/ |language=ja}}{{cite journal |url=https://www.pmrj.jp/publications/02/pmdrs_column/pmdrs_column_76-47_04.pdf |title=薬事温故知新 第76回 ジフテリア予防接種禍事件 |trans-title=Lesson Learned from the diphtheria vaccine lawsuit (Column series 76) |publisher=Pharmaceutical and Medical Device Regulatory Science Society of Japan (PMRJ) |journal=医薬品医療機器レギュラトリーサイエンス |author1=土井脩 (Osamu Doi, President of PMRJ) |volume=47 |issue=4 |pages=284–285 |year=2016 |access-date=26 February 2020 |archive-date=13 November 2020 |archive-url=https://web.archive.org/web/20201113101110/https://www.pmrj.jp/publications/02/pmdrs_column/pmdrs_column_76-47_04.pdf |url-status=live }} The lawsuit risks, particularly the 1992 Tokyo High Court's ruling on the MMR vaccine class action, impacted on law amendment. Vaccination is no longer mandatory as of 1994.{{cite journal |last1=Reichert |first1=Thomas A. |last2=Sugaya |first2=Norio |last3=Fedson |first3=David S. |last4=Glezen |first4=W. Paul |last5=Simonsen |first5=Lone |last6=Tashiro |first6=Masato |title=The Japanese Experience with Vaccinating Schoolchildren against Influenza |journal=New England Journal of Medicine |date=22 March 2001 |volume=344 |issue=12 |pages=889–896 |doi=10.1056/NEJM200103223441204|pmid=11259722|doi-access=free }} As a result, vaccination rate declined in Japan. The rate of flu vaccination, for example, was 67.9% among schoolchildren in 1979 but dropped down to approximately 20% in 1998–1999. With the rapidly aging society issue, the decline among schoolchildren hit the elderly generation. In 1998–1999 season, deadly flu outbreak spread widely in nursing homes for the elderly as well as inpatients wards. The outbreak was followed by the 2001 amendment of Immunization Act to add flu vaccination for the elderly. As of February 2020, flu vaccination under the Act is in Category{{spaces}}B (for a personal care purpose) only for the elderly. However, historical data sets suggest that flu vaccination for schoolchildren is also the key to take care of the elderly.{{cite journal |url=http://journal.kansensho.or.jp/Disp?pdf=0760010009.pdf |title=インフルエンザワクチンの過去，現在，未来 |trans-title=Influenza of the past, present and future |journal=感染症学雑誌 (The Journal of the Japanese Association for Infectious Diseases) |volume=76 |issue=1 |year=2002 |author1=菅谷憲夫 (Norio Sugaya, pediatrician at Nihon Koukan Hospital) |pages=9–10 |access-date=26 February 2020 |archive-date=5 August 2020 |archive-url=https://web.archive.org/web/20200805035805/http://journal.kansensho.or.jp/Disp?pdf=0760010009.pdf |url-status=live }}

In addition to legal and social risk concerns, an issue of the decision-making process underlies the vaccine gap. Unlike the Advisory Committee on Immunization Practices (ACIP) in the United States, a centralized permanent advisory committee for vaccination policy was not organized in Japan until 2009, when a deadly flu outbreak struck the nation. Since the committee kick-off, however, the vaccine gap has been gradually improved.{{cite journal |url=http://www.ipss.go.jp/syoushika/bunken/data/pdf/kai192.pdf |title=特集:予防接種の国際比較 |trans-title=Global comparative study for vaccination |journal=海外社会保障研究 |date=Autumn 2015 |issue=192 |publisher=National Institute of Population and Social Security Research (IPSS) |author1=加藤智章 (Tomoaki Kato, preface at p.4-) |author2=齋藤昭彦 (Akihiko Saito, about the United States at p.6-) |author3=中村安秀 (Yasuhide Nakamura, about developing countries at p.20-) |author4=松本勝明 (Katsuaki Matsumoto, about Germany at p.25-) |author5=福士由紀 (Yuki Fukushi, about China at p.30-) |access-date=26 February 2020 |archive-date=26 February 2020 |archive-url=https://web.archive.org/web/20200226022836/http://www.ipss.go.jp/syoushika/bunken/data/pdf/kai192.pdf |url-status=live}}

According to a 2011 publication in CMAJ:{{cite journal |vauthors=Walkinshaw E |title=Mandatory vaccinations: The international landscape |journal=CMAJ |volume=183 |issue=16 |pages=E1167–8 |date=November 2011 |pmid=21989473 |doi=10.1503/cmaj.109-3993 |pmc=3216445}} The notion of "mandatory" in Latvia differs from that of other nations. Latvia appears unique in that it compels health care providers to obtain the signatures of those who decline vaccination. Individuals have the right to refuse a vaccination, but if they do so, health providers have a duty to explain the health consequences.

Vaccines that are not mandatory are not publicly funded, so the cost for those must be borne by parents or employers, she adds. Funded vaccinations include tuberculosis, diphtheria, measles, hepatitis B, human papillomavirus for 12-year-old girls, and tick-borne encephalitis until age 18 in endemic areas and for orphans.

Beginning at age 14, minors can consent to vaccination in Latvia without parental permission.{{cite news |url=https://bnn-news.com/latvia-to-commence-covid-19-vaccination-of-12-to15-year-olds-2-june-225367 |title=Latvia to commence Covid-19 vaccination of 12 to15-year-olds 2 June |work=Baltic News Network |date=1 June 2021 |access-date=2 August 2021 |archive-date=2 August 2021 |archive-url=https://web.archive.org/web/20210802103601/https://bnn-news.com/latvia-to-commence-covid-19-vaccination-of-12-to15-year-olds-2-june-225367 |url-status=live }}

COVID-19 vaccination is mandatory for health workers, journalists, and other frontline staff starting 20 December 2021.

In Malaysia, mass vaccination is practised in public schools. The vaccines may be administered by a school nurse or a team of other medical staff from outside the school. All the children in a given school year are vaccinated as a cohort. For example, children may receive the oral polio vaccine in Year One of primary school (about six or seven years of age), the BCG in Year Six, and the MMR in Form Three of secondary school. Therefore, most people have received their core vaccines by the time they finish secondary school.{{cite report |title=School Immunization Programme in Malaysia – 24 February to 4 March 2008 |url=https://www.who.int/immunization/programmes_systems/policies_strategies/Malaysia-school-immunization.pdf?ua=1 |first1=Sigrun |last1=Roesel |first2=Kaushik |last2=Banerjee |name-list-style=vanc |publisher=World Health Organization |date= |access-date=5 October 2020 |archive-url=https://web.archive.org/web/20200617210018/https://www.who.int/immunization/programmes_systems/policies_strategies/Malaysia-school-immunization.pdf?ua=1 |archive-date=17 June 2020 |url-status=live}}

{{main|Vaccination in Mexico}}

Mexico has a multi-year program for immunisation of children.{{cite web |last1=Organization |first1=WHO {{!}} World Health |title=WHO : Immunization Country Profile |url=https://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=MEX&commit=OK |website=apps.who.int |access-date=2 April 2021 |language=en |archive-date=6 September 2021 |archive-url=https://web.archive.org/web/20210906023748/https://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=MEX&commit=OK |url-status=live }} The immunisation of children is fully covered by the government. Mexico has an adverse events committee to monitor the adverse effects of vaccination as well as a standing technical advisory group on immunization.

The recommended vaccine schedule for children in Mexico contains vaccinations against 16 vaccine-preventable diseases.{{cite web |title=Binational vaccine schedule Mexico-USA |url=http://www.sdiz.org/documents/schedules/11_binational-schedule-pr.pdf |access-date=2 April 2021 |archive-date=12 September 2021 |archive-url=https://web.archive.org/web/20210912155534/http://www.sdiz.org/documents/schedules/11_binational-schedule-pr.pdf |url-status=live }} Vaccine doses administered in Mexico are usually valid in the United States. The immunization schedule for children in Mexico is as follows:

In addition, Vitamin A is offered to all children of one year of age enrolled in nurseries or children's rooms.

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{{#section: Vaccination schedule|New Zealand}}

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Minors aged 16 and older may consent to vaccination without parental approval.{{cite news |url=https://www.nzherald.co.nz/nz/covid-19-coronavirus-vaccine-for-teens-to-be-delivered-at-schools-parents-urged-to-discuss-with-kids/OQZJHKG54ZRJZSVMIFT262DHMQ/ |title=Covid 19 coronavirus: Vaccine for teens to be delivered at schools, parents urged to discuss with kids |date=21 June 2021 |work=The New Zealand Herald |access-date=2 August 2021 |archive-date=2 August 2021 |archive-url=https://web.archive.org/web/20210802103946/https://www.nzherald.co.nz/nz/covid-19-coronavirus-vaccine-for-teens-to-be-delivered-at-schools-parents-urged-to-discuss-with-kids/OQZJHKG54ZRJZSVMIFT262DHMQ/ |url-status=live }}

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{{#section: Vaccination schedule|Nigeria}}

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In Nigeria, the Expanded Programme on Immunization (EPI), was introduced in 1978 to provide free immunization against polio, measles, diphtheria, whooping cough, tuberculosis, and yellow fever to Nigerian children less than two years old. This free immunization can be obtained at any primary healthcare provider in the country. The vaccines are usually administered by a government health care worker. They also conduct routine vaccination visits in schools where all the children in a given school are vaccinated.

Facing numerous minor polio epidemics, the Pakistani government has now ruled that polio vaccination is mandatory and indisputable. In a statement from Pakistani Police Commissioner Riaz Khan Mehsud, "There is no mercy, we have decided to deal with the refusal cases with iron hands. Anyone who refuses [the vaccine] will be sent to jail."{{cite news |url=https://www.bbc.com/news/world-asia-31703835|title=Pakistan arrests parents for refusing polio vaccine|work=BBC News |date=2 March 2015|access-date=14 August 2021|archive-date=14 August 2021|archive-url=https://web.archive.org/web/20210814070747/https://www.bbc.com/news/world-asia-31703835|url-status=live}}

COVID-19 vaccination may become mandatory for government employees. Unvaccinated employees may be forced to take unpaid leave.{{cite web |url=https://www.tvn-2.com/nacionales/Cortizo-funcionarios-absolutamente-derecho-vacunados_0_5920657920.html|title=Vacunación en Panamá: Cortizo dice que analizan enviar de licencia sin sueldo a funcionarios no vacunados|date=13 August 2021|website=TVN|access-date=14 August 2021|archive-date=14 August 2021|archive-url=https://web.archive.org/web/20210814065329/https://www.tvn-2.com/nacionales/Cortizo-funcionarios-absolutamente-derecho-vacunados_0_5920657920.html|url-status=live}}{{cite web |url=https://www.telemetro.com/nacionales/presidente-cortizo-evalua-licencia-sueldo-funcionarios-no-vacunados-n5325044|title=Presidente Cortizo evalúa licencia sin sueldo para funcionarios no vacunados|website=Telemetro.com|date=14 August 2021 |access-date=14 August 2021|archive-date=14 August 2021|archive-url=https://web.archive.org/web/20210814065336/https://www.telemetro.com/nacionales/presidente-cortizo-evalua-licencia-sueldo-funcionarios-no-vacunados-n5325044|url-status=live}} Having completed the vaccine schedule for schoolchildren up to the child's age, is required for access to the government's main scholarship program.{{Cite web|date=2021-03-01|title=¿Qué alumnos tienen derecho al PASE-U? - IFARHU|url=https://www.ifarhu.gob.pa/sp_faq/alumnos-tienen-derecho-al-pase-u/|access-date=2022-07-21|archive-url=https://web.archive.org/web/20210301222337/https://www.ifarhu.gob.pa/sp_faq/alumnos-tienen-derecho-al-pase-u/ |archive-date=1 March 2021 }}

As of 2019, immunization is voluntary in Russia.{{cite web |last1= Grigoryan |first1= Astghik |title= Russia: Government Expanding Vaccination for Measles Amid Outbreak in Neighboring Countries {{!}} Global Legal Monitor |url= https://www.loc.gov/law/foreign-news/article/russia-government-expanding-vaccination-for-measles-amid-outbreak-in-neighboring-countries/ |website= www.loc.gov |access-date= 6 November 2019 |date= 9 May 2019 |archive-date= 20 February 2020 |archive-url= https://web.archive.org/web/20200220201409/http://www.loc.gov/law/foreign-news/article/russia-government-expanding-vaccination-for-measles-amid-outbreak-in-neighboring-countries/ |url-status= live }} In May 2021, Russian President Vladimir Putin said that mandating COVID-19 vaccines would be "impractical and impossible."{{cite web |title=Putin Rules Out Mandatory Vaccinations|date=27 May 2021 |url=https://www.themoscowtimes.com/2021/05/27/putin-rules-out-mandatory-vaccinations-a74021|url-status=live|access-date=12 June 2021|archive-date=12 June 2021|archive-url=https://web.archive.org/web/20210612164103/https://www.themoscowtimes.com/2021/05/27/putin-rules-out-mandatory-vaccinations-a74021}}

In the wake of a declared measles epidemic, Samoan authorities made vaccination against measles compulsory in November 2019.{{cite news

|title = Samoa makes measles vaccinations compulsory after outbreak kills 32

|url = https://www.abc.net.au/news/2019-11-26/samoa-measles-emergency-claims-32-lives-as-death-toll-rises/11738138

|department = Pacific Beat

|work = ABC News

|publisher = Australian Broadcasting Corporation

|date = 26 November 2019

|access-date = 5 December 2019

|quote = Authorities have made measles vaccinations compulsory under law and publicly warned people against discouraging others from receiving vaccinations.

|archive-date = 2 December 2019

|archive-url = https://web.archive.org/web/20191202185746/https://www.abc.net.au/news/2019-11-26/samoa-measles-emergency-claims-32-lives-as-death-toll-rises/11738138

|url-status = live

}}

According to a 2011 publication in CMAJ: Slovenia has one of the world's most aggressive and comprehensive vaccination programs. Its program is mandatory for nine designated diseases. Within the first three months of life, infants must be vaccinated for tuberculosis, tetanus, polio, pertussis, and Haemophilus influenza type B. Within 18 months, vaccines are required for measles, mumps, and rubella, and finally, before a child starts school, the child must be vaccinated for hepatitis B. While a medical exemption request can be submitted to a committee, such an application for reasons of religion or conscience would not be acceptable. Failure to comply results in a fine and compliance rates top 95%, Kraigher says, adding that for nonmandatory vaccines, such as the one for human papillomavirus, coverage is below 50%.

Mandatory vaccination against measles was introduced in 1968 and since 1978, all children receive two doses of vaccine with a compliance rate of more than 95%.{{cite conference |title=Mandatory measles vaccination – are healthcare workers really safe? |author1=Mrvic T |author2=Petrovec M |author3=Breskvar M |author4=Zupanc TL |author5=Logar M |conference=22nd European Congress of Clinical Microbiology and Infectious Diseases |date=31 March 2012 |access-date=24 April 2015 |location=London |url=http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=145466&XNSPRACHE_ID=2&XNKONGRESS_ID=161&XNMASKEN_ID=900 |archive-date=21 October 2013 |archive-url=https://web.archive.org/web/20131021150922/http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=145466&XNSPRACHE_ID=2&XNKONGRESS_ID=161&XNMASKEN_ID=900 |url-status=live }} For TBE, the vaccination rate in 2007 was estimated to be 12.4% of the general population in 2007. For comparison, in neighboring Austria, 87% of the population is vaccinated against TBE.{{cite web |url=http://www.isw-tbe.info/Kontext/WebService/SecureFileAccess.aspx?fileguid=%7Be8c06e91-bdf7-4698-813a-e51b38784846%7D |title=Success of the vaccination campaign in Slovenia |author=Irena Grmek Kosnik |publisher=International Scientific Working Group on Tick-Borne Encephalitis |format=PDF of slidedeck |date=2012 |access-date=24 April 2015 |archive-date=24 April 2015 |archive-url=https://web.archive.org/web/20150424025427/http://www.isw-tbe.info/Kontext/WebService/SecureFileAccess.aspx?fileguid=%7Be8c06e91-bdf7-4698-813a-e51b38784846%7D |url-status=live }}

In South Africa vaccination is voluntary.{{cite web |last1=Nel |first1=Michelle |title=The great vaccination debate |url=https://mg.co.za/article/2005-05-13-the-great-vaccination-debate |website=The M&G Online |date=12 May 2005 |access-date=6 November 2019 |language=en |archive-date=6 November 2019 |archive-url=https://web.archive.org/web/20191106063559/https://mg.co.za/article/2005-05-13-the-great-vaccination-debate |url-status=live }}

The South African Vaccination and Immunisation Centre (SAVIC) began in 2003 as an alliance between the South African Department of Health, vaccine industry, academic institutions, and other stakeholders.{{cite web |url=http://www.savic.ac.za/index.php?option=com_k2&view=item&layout=item&id=95&Itemid=278|title=South African Vaccination & Immunisation Centre (SAVIC)|date=14 August 2017|archive-url=https://web.archive.org/web/20170814023408/http://www.savic.ac.za/index.php?option=com_k2&view=item&layout=item&id=95&Itemid=278|archive-date=14 August 2017}} SAVIC works with the WHO and the South African National Department of Health to educate, research, provide technical support, and advocate for country-wide vaccinations.

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{{#section: Vaccination schedule|Spain}}

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Spain's 19 autonomous communities, consisting of 17 Regions and two cities, follow health policies established by the Inter-Territorial Health Council that was formed by the National and Regional Ministries of Health.{{cite web|last1=Delgado|first1=Sinesio|name-list-style=vanc|title=Spain|url=http://venice.cineca.org/documents/spain_ip.pdf|website=Instituto De Salud Carlos III|publisher=Centro Nacional De Epidemiologia|access-date=15 March 2016|archive-date=4 August 2016|archive-url=https://web.archive.org/web/20160804021628/http://venice.cineca.org/documents/spain_ip.pdf|url-status=live}} This Inter-Territorial Council is composed of representatives from each region and meets to discuss health related issues spanning across Spain. The Institute of Health Carlos{{spaces}}III (ISCIIII) is a public research institute that manages biomedical research for the advancement of health sciences and disease preventions.{{cite web|title=Functions|url=http://www.eng.isciii.es/|website=Instituto De Salud Carlos III|publisher=Gobierno de España, Minesterio de Economia y Competitividad|access-date=15 March 2016|archive-date=28 April 2016|archive-url=https://web.archive.org/web/20160428003901/http://www.eng.isciii.es/|url-status=live}} The ISCIII may suggest the introduction of new vaccines into Spain's Recommended Health Schedule and is under direct control of the Ministry of Health. Although the Ministry of Health is responsible for the oversight of health care services, the policy of devolution divides responsibilities among local agencies, including health planning and programing, fiscal duties, and direct management of health services. This decentralization proposes difficulties in collecting information at the national level.{{cite journal |author1=Ricciardi GW |author2=Toumi M |author3=Weil-Olivier C |author4=Ruitenberg EJ |author5=Dankó D |author6=Duru G |author7=Picazo J |author8=Zöllner Y |author9=Poland G |author10=Drummond M |title=Comparison of NITAG policies and working processes in selected developed countries |journal=Vaccine |volume=33 |issue=1 |pages=3–11 |date=January 2015 |pmid=25258100 |doi=10.1016/j.vaccine.2014.09.023 |doi-access=free}} The Inter-Territorial Council's Commission on Public Health works to establish health care policies according to recommendations by technical working groups via letters, meetings, and conferences. The Technical Working Group on Vaccines review data on vaccine preventable diseases and proposes recommendations for policies. No additional groups outside the government propose recommendations. Recommendations must be approved by the Commission of Public Health and then by the Inter-Territorial Council, at which point they are incorporated into the National Immunization Schedule.

The Spanish Association of Pediatrics, in conjunction with the Spanish Medicines Agency, outlines specifications for vaccination schedules and policies and provides a history of vaccination policies implemented in the past, as well as legislature pertaining to the public currently. Spain's Constitution does not mandate vaccination, so it is voluntary unless authorities require compulsory vaccination in the case of epidemics.{{cite web|title=CALENDARIOS DE VACUNACIÓN EN ESPAÑA|url=http://vacunasaep.org/documentos/manual/cap-7|website=Vaccination ASP|publisher=Asociacíon Españada de Pediatría, Comité Asesor de Vacunas|access-date=15 March 2016|archive-date=25 March 2016|archive-url=https://web.archive.org/web/20160325024136/http://vacunasaep.org/documentos/manual/cap-7|url-status=live}} In 1921, vaccination became mandatory for smallpox, and in 1944 the Bases Health Act mandated compulsory vaccination for diphtheria and smallpox, but was suspended in 1979 after the elimination of the threat of an epidemic. The first systematic immunization schedule for the provinces of Spain was established in 1975 and has continuously been updated by each autonomous community in regard to doses at certain ages and recommendation of additional vaccine not proposed in the schedule.

The 2015 schedule proposed the newest change with the inclusion of pneumococcal vaccine for children under 12 months. For 2016, the schedule plans to propose a vaccine against varicella in children at 12–15 months and 3–4 years. Furthermore, the General Health Law of 1986 echoes Article 40.2 from the Constitution guaranteeing the right to the protection of health, and states employers must provide vaccines to workers if they are at risk of exposure.{{cite web|title=Occupational Health Regulations|url=http://www.msssi.gob.es/ciudadanos/saludAmbLaboral/saludLaboral/normativa.htm#leyGralSanidad|website=Ministry of Health, Social Services, and Equality|publisher=Ministry of Health|access-date=15 March 2016|archive-date=3 March 2016|archive-url=https://web.archive.org/web/20160303190459/http://www.msssi.gob.es/ciudadanos/saludAmbLaboral/saludLaboral/normativa.htm#leyGralSanidad|url-status=live}} Due to vaccination coverage in each Community, there is little anti-vaccine activity or opposition to the current schedule, and no organized groups against vaccines. The universal public health care provides coverage for all residents, while central and regional support programs extend coverage to immigrant populations. However, no national funds are granted to the Communities for vaccine purchases. Vaccines are financed from taxes, and paid in full by the Community government. Law 21 in Article 2.6 establishes the need for proper clinical documentation and informed consent by the patient, although written informed consent is not mandated in the verbal request of a vaccine for a minor.{{cite web|title=Immunisation Schedules in Spain|url=http://vacunasaep.org/documentos/manual/cap-44-1|website=Vaccination ASP|publisher=Asociacíon Españada De Pediatría, Comité Asesor De Vacunas|access-date=15 March 2016|archive-date=9 April 2016|archive-url=https://web.archive.org/web/20160409012431/http://vacunasaep.org/documentos/manual/cap-44-1|url-status=live}} The autonomous regions collect data, from either electronic registries or written physician charts, to calculate immunization coverage.

The Swiss vaccination schedule and recommendations are developed by the Federal Vaccination Commission and the Federal Office of Public Health in collaboration with the cantons.{{cite web |url=https://www.bag.admin.ch/bag/en/home/gesund-leben/gesundheitsfoerderung-und-praevention/impfungen-prophylaxe.html |title=Vaccinations and prevention |work=admin.ch |access-date=2 August 2021 |archive-date=23 July 2021 |archive-url=https://web.archive.org/web/20210723113808/https://www.bag.admin.ch/bag/en/home/gesund-leben/gesundheitsfoerderung-und-praevention/impfungen-prophylaxe.html |url-status=live }}

Minors aged 12 and older may consent to immunization with the Pfizer–BioNTech COVID-19 vaccine without parental approval.{{cite web |url=https://www.thelocal.com/20210608/children-as-young-as-12-can-be-vaccinated-without-parental-consent-from-july-in-switzerland/ |title=Covid-19: Switzerland to allow children over 12 to be vaccinated without parental consent |date=8 June 2021 |work=The Local |access-date=2 August 2021 |archive-date=2 August 2021 |archive-url=https://web.archive.org/web/20210802114508/https://www.thelocal.com/20210608/children-as-young-as-12-can-be-vaccinated-without-parental-consent-from-july-in-switzerland/ |url-status=live }}

According to the World Health Organization vaccination coverage in Tanzania was more than 90% in 2012.{{cite web|author=WHO|title=Global Health Observatory Data Repository-Immunization|url=http://apps.who.int/gho/data/node.main.A824?lang=en|access-date=3 September 2014|archive-date=25 October 2014|archive-url=https://web.archive.org/web/20141025073050/http://apps.who.int/gho/data/node.main.A824?lang=en|url-status=live}} An Electronic Immunisation Register has been established, which permits online access to the medical records of mothers and infants, enabling vaccination teams in remote areas to operate more effectively, especially with nomadic people. It also helps to coordinate stock levels and order new supplies.{{cite news |title=Good data saves lives |url=http://gotlife.gavi.org/features/good-data-saves-lives/ |access-date=28 November 2018 |publisher=Gavi |date=2018 |archive-date=28 November 2018 |archive-url=https://web.archive.org/web/20181128164526/http://gotlife.gavi.org/features/good-data-saves-lives/ |url-status=live }}

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{{#section: Vaccination schedule|UK}}

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In the United Kingdom, the purchase and distribution of vaccines is managed centrally, and recommended vaccines are provided for free by the NHS.{{cite journal |author1=Freed GL |title=Vaccine policies across the pond: looking at the U.K. and U.S. systems |journal=Health Affairs |volume=24 |issue=3 |pages=755–7 |year=2005 |pmid=15886170 |doi=10.1377/hlthaff.24.3.755 |doi-access=}} In the UK, no laws require vaccination of schoolchildren.

Children aged 16 and 17 can consent to immunizations without parental consent.{{cite web |url=https://www.nhs.uk/conditions/consent-to-treatment/children/ |title=Children and young people: Consent to treatment |date=3 March 2016 |access-date=16 March 2019 |work=National Health Service |via=nhs.uk |archive-date=31 January 2019 |archive-url=https://web.archive.org/web/20190131122435/https://www.nhs.uk/conditions/consent-to-treatment/children/ |url-status=live }} Under the Gillick test, children under 16 can consent to vaccination over parental objections if they demonstrate a mature understanding of the ramifications of the procedure.{{cite journal |title=What is Gillick competence? |date=30 November 2015 |doi=10.1080/21645515.2015.1091548 |pmid=26619366 |pmc=4962726 |journal=Human Vaccines & Immunotherapeutics |volume=12 |issue=1 |pages=244–247 |first=Richard |last=Griffith}}

{{main|Vaccination policy in the United States}}

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{{#section: Vaccination schedule|USA}}

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In the United States, the Advisory Committee on Immunization Practices makes scientific recommendations regarding vaccines and vaccination schedules{{cite journal |last1=Smith |first1=Jean Clare |title=The Structure, Role, and Procedures of the U.S. Advisory Committee on Immunization Practices (ACIP) |journal=Vaccine |date=19 April 2010 |volume=28 |issue=1 |pages=A68–A75 |doi=10.1016/j.vaccine.2010.02.037 |pmid=20413002|doi-access=free}} that the federal government, state governments, and private health insurance companies generally follow.{{cite book |first1=Brian Dean |last1=Abramson |title=Vaccine, Vaccination, and Immunization Law |publisher=Bloomberg Law |year=2019 |section=5 |pages=13}} See Vaccination schedule for the schedule recommended in the United States.

As of 2025, all states in the U.S. except for Idaho{{Cite web |last=Pfannenstiel |first=Kyle |date=2025-04-04 |title=Responding to governor’s veto, Idaho Legislature passes new ‘medical freedom’ bill • Idaho Capital Sun |url=https://idahocapitalsun.com/2025/04/04/responding-to-governors-veto-idaho-legislature-passes-new-medical-freedom-bill/ |access-date=2025-04-08 |website=Idaho Capital Sun |language=en-US}}{{Cite web |title=Idaho's 'Medical Freedom' Law Bans School, Business Vaccine Mandates |url=https://kffhealthnews.org/morning-breakout/idahos-medical-freedom-law-bans-school-business-vaccine-mandates/ |access-date=2025-04-12 |website=KFF Health News |language=en-US}}{{Cite web |last=Goldman |first=Maya |date=2025-04-09 |title=Idaho restricts vaccine mandates |url=https://www.axios.com/2025/04/09/idaho-restricts-vaccine-mandates |access-date=2025-04-12 |website=Axios |language=en}} mandate immunizations for children to enroll in public school, but various exemptions are available depending on the state. All states have exemptions for people who have medical contraindications to vaccines, all states except for California, Maine, Mississippi, and New York allow religious exemptions,{{Cite web |date=2025-01-14 |title=West Virginia governor axes DEI and enacts vaccine exemptions on first full day in office |url=https://apnews.com/article/west-virginia-governor-religious-vaccine-exemptions-dei-8665e89daf101e42cc372de56d699c38 |access-date=2025-04-08 |website=AP News |language=en}}{{cite web |title=Measles Outbreak: N.Y. Eliminates Religious Exemptions for Vaccinations |url=https://www.nytimes.com/2019/06/13/nyregion/measles-vaccinations-new-york.html |work=The New York Times |archive-url=https://web.archive.org/web/20190614101156/https://www.nytimes.com/2019/06/13/nyregion/measles-vaccinations-new-york.html |archive-date=14 June 2019 |date=13 June 2019 |url-status=live}} and sixteen states allow parents to cite personal, conscientious, philosophical, or other objections.{{cite web|title=States with Religious and Philosophical Exemptions from School Immunization Requirements|url=http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx|website=National Conference of State Legislatures|access-date=1 July 2015|archive-date=18 June 2015|archive-url=https://web.archive.org/web/20150618145345/http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx|url-status=live}}

An increasing number of parents are using religious and philosophical exemptions: researchers have cited this increased use of exemptions as contributing to loss of herd immunity within these communities, and hence an increasing number of disease outbreaks.{{cite journal |author1=Ciolli A |title=Mandatory school vaccinations: the role of tort law |journal=The Yale Journal of Biology and Medicine |volume=81 |issue=3 |pages=129–37 |date=September 2008 |pmid=18827888 |pmc=2553651}}{{cite journal |author1=May T |author2=Silverman RD |title='Clustering of exemptions' as a collective action threat to herd immunity |journal=Vaccine |volume=21 |issue=11–12 |pages=1048–51 |date=March 2003 |pmid=12559778 |doi=10.1016/S0264-410X(02)00627-8 |hdl=1805/6156 |hdl-access=free}}{{cite book |doi=10.1145/2559206.2581332 |chapter=Viz Com |title=Proceedings of the extended abstracts of the 32nd annual ACM conference on Human factors in computing systems – CHI EA '14 |pages=1705–1710 |year=2014 |last1=Faiola |first1=Anthony |last2=Srinivas |first2=Preethi |last3=Karanam |first3=Yamini |last4=Chartash |first4=David |last5=Doebbeling |first5=Bradley |isbn=978-1-4503-2474-8 |hdl=1805/6156 |s2cid=18498065}}

Of the 49 states with existing immunization requirements for public school, all of them require DTaP (diphtheria-tetanus-pertussis), MMR (measles-mumps-rubella), Polio, Tdap (tetanus-diphtheria-pertussis; secondary school only) and Varicella (chickenpox) vaccines for school attendance. Additionally, 46 states require the Hepatitis B vaccine, 34 states require the Meningococcal vaccine, and 18 require the Hepatitis A vaccine; Rhode Island, Virginia, and Hawaii also require the HPV vaccine (human papillomavirus; secondary school only).{{Cite web |date=2024-07-11 |title=State Vaccine-Specific Requirements |url=https://www.immunize.org/official-guidance/state-policies/requirements/ |access-date=2025-05-29 |website=Immunize.org |language=en-US}}

The American Academy of Pediatrics (AAP) advises physicians to respect the refusal of parents to vaccinate their child after adequate discussion, unless the child is put at significant risk of harm (e.g., during an epidemic, or after a deep and contaminated puncture wound). Under such circumstances, the AAP states that parental refusal of immunization constitutes a form of medical neglect and should be reported to state child protective services agencies.{{cite journal |author1=Diekema DS |title=Responding to parental refusals of immunization of children |journal=Pediatrics |volume=115 |issue=5 |pages=1428–31 |date=May 2005 |pmid=15867060 |doi=10.1542/peds.2005-0316 |doi-access=}} Several states allow minors to legally consent to vaccination over parental objections under the mature minor doctrine.

Immunizations are compulsory for military enlistment in the U.S.{{cite journal |last1=Grabenstein |first1=John D. |last2=Pittman |first2=Phillip R. |last3=Greenwood |first3=John T. |last4=Engler |first4=Renata J. M. |title=Immunization to Protect the US Armed Forces: Heritage, Current Practice, and Prospects |journal=Epidemiologic Reviews |date=2006 |volume=28 |issue=1 |pages=3–26 |doi=10.1093/epirev/mxj003 |pmid=16763072|doi-access=free}}{{cite web | author= United States Department of Defense | title= MilVax homepage | url= http://www.vaccines.army.mil/default.aspx | access-date= 25 July 2007 | author-link= United States Department of Defense | archive-date= 6 July 2007 | archive-url= https://web.archive.org/web/20070706043213/http://www.vaccines.army.mil/default.aspx | url-status= dead }} However, exceptions exist, but may be determined by an uneven process. The suppression of religious exemptions to the military COVID-19 vaccination mandate was successfully proven by members of the Air Force and overturned in the Sixth Circuit federal court of appeals in September 2022, when evidence was presented that more than 99% of requests for religious exceptions were systematically denied approval, though other kinds of exemption requests were more often granted.{{Cite web |last=Morgan |first=Ryan |date=2022-07-14 |title=US judge blocks Air Force from kicking out, punishing thousands of unvaccinated troops |url=https://americanmilitarynews.com/2022/07/us-judge-blocks-air-force-from-kicking-out-punishing-thousands-of-unvaccinated-troops/ |access-date=2022-09-15 |website=American Military News |language=en-US |archive-date=15 September 2022 |archive-url=https://web.archive.org/web/20220915220424/https://americanmilitarynews.com/2022/07/us-judge-blocks-air-force-from-kicking-out-punishing-thousands-of-unvaccinated-troops/ |url-status=live }}{{Cite web |title=Doster v. Kendall, No. 22-3702 (6th Cir. 2022) |url=https://law.justia.com/cases/federal/appellate-courts/ca6/22-3702/22-3702-2022-09-09.html |access-date=2022-09-15 |website=Justia Law |language=en |archive-date=15 September 2022 |archive-url=https://web.archive.org/web/20220915195743/https://law.justia.com/cases/federal/appellate-courts/ca6/22-3702/22-3702-2022-09-09.html |url-status=live }} The judge had previously awarded class action status to the case, extending the suit to cover an estimated more than 12,000 joint plaintiffs.

All vaccines recommended by the U.S. government for its citizens are required for green card applicants.{{cite web|url=http://www.uscis.gov/i-693|title=Report of Medical Examination and Vaccination Record|work=USCIS|access-date=6 March 2015|archive-date=4 March 2015|archive-url=https://web.archive.org/web/20150304120850/http://www.uscis.gov/i-693|url-status=live}} This requirement stirred controversy over related costs when, in July 2008, it was applied to the HPV vaccine. In addition, the 13 other required vaccines prevent highly contagious diseases communicable through the respiratory route, while HPV is spread only through sexual contact.{{cite news |title=Gardasil requirement for immigrants stirs backlash |url=https://www.wsj.com/articles/SB122282354408892791 |date=1 October 2008 |access-date=18 January 2009 |author=Jordan M |work=The Wall Street Journal |archive-date=18 December 2014 |archive-url=https://web.archive.org/web/20141218185826/http://www.wsj.com/articles/SB122282354408892791 |url-status=live }} In November 2009, this requirement was canceled.{{cite web|url=https://www.nbcnews.com/id/33973646/ns/health-health_care/t/hpv-vaccine-no-longer-required-green-cards/|title=HPV vaccine no longer required for green cards|date=17 November 2009|website=NBC News|access-date=17 April 2020|archive-date=27 November 2019|archive-url=https://web.archive.org/web/20191127162707/http://www.nbcnews.com/id/33973646/ns/health-health_care/t/hpv-vaccine-no-longer-required-green-cards/#.WZH6o3eGOV4|url-status=dead}}

Though the federal guidelines do not require written consent to receive a vaccination, they do require doctors give the recipients or legal representatives a Vaccine Information Statement (VIS). Specific informed consent laws are made by the states.{{cite web |url=https://www.cdc.gov/vaccines/hcp/vis/about/facts-vis.html|title=Vaccine Information Statement {{!}} Facts About VISs {{!}} CDC|date=3 April 2019|website=Cdc.gov|language=en-us|access-date=30 April 2019|archive-date=28 April 2019|archive-url=https://web.archive.org/web/20190428173107/https://www.cdc.gov/vaccines/hcp/vis/about/facts-vis.html|url-status=live}}

The United States has a long history of school vaccination requirements. The first school vaccination requirement was enacted in the 1850s in Massachusetts to prevent the spread of smallpox.{{cite journal | vauthors = McAllister-Grum K | title = Pigments and Vaccines: Evaluating the Constitutionality of Targeting Melanin Groups for Mandatory Vaccination | journal = The Journal of Legal Medicine | volume = 37 | issue = 1–2 | pages = 217–247 | year = 2017 | pmid = 28910223 | doi = 10.1080/01947648.2017.1303288 | s2cid = 205505188}} The school vaccination requirement was put in place after the compulsory school attendance law caused a rapid increase in the number of children in public schools, increasing the risk of smallpox outbreaks. The early movement towards school vaccination laws began at the local level including counties, cities, and boards of education. By 1827, Boston had become the first city to mandate that all children entering public schools show proof of vaccination.{{cite journal | vauthors = Hodge JG, Gostin LO | title = School vaccination requirements: historical, social, and legal perspectives | journal = Kentucky Law Journal | volume = 90 | issue = 4 | pages = 831–90 | year = 2001 | pmid = 15868682}} In addition, in 1855 the Massachusetts General Court had established its own statewide vaccination requirements for all students entering school, this influenced other states to implement similar statewide vaccination laws in schools as seen in New York in 1862, Connecticut in 1872, Pennsylvania in 1895, and later the Midwest, South, and the Western United States. By 1963, 20 states had school vaccination laws.

These vaccination laws resulted in political debates throughout the United States, as those opposed to vaccination sought to repeal local policies and state laws.{{cite journal |last1=Tolley |first1=Kim |title=School Vaccination Wars |journal=History of Education Quarterly |date=May 2019 |volume=59 |issue=2 |pages=161–194 |doi=10.1017/heq.2019.3|doi-access= |s2cid=151030120 }} An example of this political controversy occurred in 1893, in Chicago, where less than ten percent of the children were vaccinated, despite the twelve-year-old state law. Resistance was seen at the local level of the school district as some local school boards and superintendents opposed the state vaccination laws, leading the state board health inspectors to examine vaccination policies in schools. Resistance proceeded during the mid-1900s and in 1977 a nationwide Childhood Immunization Initiative was developed with the goal of increasing vaccination rates among children to ninety percent by 1979. During the two-year period of observation, the initiative reviewed the immunization records of more than 28 million children and vaccinated children who had not received the recommended vaccines.{{cite journal|last=Malone|first=Kevin M|author2=Hinman, Alan R |title=The Public Health Imperative and Individual Rights|journal=Law in Public Health Practice|year=2003|pages=262–84}}

In 1922, the constitutionality of childhood vaccination was examined in the Supreme Court case Zucht v. King. The court decided that a school could deny admission to children who failed to provide a certification of vaccination for the protection of the public health. In 1987, there was a measles epidemic in Maricopa County, Arizona, and Maricopa County Health Department v. Harmon examined the arguments of an individual's right to education over the state's need to protect against the spread of disease. The court decided that it is prudent to take action to combat the spread of disease by denying unvaccinated children a place in school until the risk for the spread of measles had passed.

Schools in the United States require an updated immunization record for all incoming and returning students. While all states require an immunization record, this does not mean all students must get vaccinated. Exemptions are determined at a state level. In the United States, exemptions take one of three forms: medical, in which a vaccine is contraindicated because of a component ingredient allergy or existing medical condition; religious; and personal philosophical opposition.

Until 2015, only Mississippi and West Virginia did not permit religious exemptions.{{cite web |author=Horowitz, Julia |date=30 June 2015 |title=California governor signs strict school vaccine legislation |url=https://www.msn.com/en-us/news/us/california-governor-signs-strict-school-vaccine-legislation/ar-AAcm68T?ocid=ansnewsap11 |url-status=live |archive-url=https://web.archive.org/web/20150703005903/http://www.msn.com/en-us/news/us/california-governor-signs-strict-school-vaccine-legislation/ar-AAcm68T?ocid=ansnewsap11 |archive-date=3 July 2015 |access-date=30 June 2015 |publisher=Associated Press}} However, this changed after California removed personal and religious exemptions with the passage of California Senate Bill 277. This is the first time an immunization exemption was removed by a state legislature. The bill was prompted by the 2014 Disneyland measles outbreak and low levels of vaccination in pockets of California, with some schools having vaccination rates below 60%. Despite the bill receiving support by the California Medical Association, as well as by the American Academy of Pediatrics' California affiliate, opposition to the bill had been characterized as "possibly the most strident outpouring of political dissent in recent memory."{{Cite web |last=Whitman |first=Elizabeth |date=2015-05-20 |title=For California Anti-Vaxxers, A Long Shot |url=https://www.ibtimes.com/california-vaccine-bill-sb-277-ban-personal-exemptions-sparks-counter-movement-1931383 |access-date=2025-04-08 |website=International Business Times |language=en-US}} After the 2019 measles outbreak, the state legislatures of New York (2019), Maine (2019, upheld by voters in a 2020 referendum), and Connecticut (2021) removed their religious exemptions.

Throughout the 2020s, some states have loosened their immunization policies for schools. In July 2023, Mississippi started recognizing religious exemptions at the order of a judge,{{Cite web |date=2023-07-14 |title=Mississippi, under judge's order, starts allowing religious exemptions for childhood vaccinations |url=https://apnews.com/article/mississippi-vaccines-religion-747269fe3edcc20530a9aa17e6ad1a3b |access-date=2025-04-08 |website=AP News |language=en}} and in January 2025, West Virginia governor Patrick Morrisey issued an executive order allowing religious exemptions in the state.{{Cite web |date=2025-01-14 |title=West Virginia governor axes DEI and enacts vaccine exemptions on first full day in office |url=https://apnews.com/article/west-virginia-governor-religious-vaccine-exemptions-dei-8665e89daf101e42cc372de56d699c38 |access-date=2025-04-08 |website=AP News |language=en}} In April 2025, Idaho became the first and only state to remove immunization requirements for schools after the passage of Senate Bill 1210.{{Cite web |last=Pfannenstiel |first=Kyle |date=2025-04-04 |title=Responding to governor’s veto, Idaho Legislature passes new ‘medical freedom’ bill • Idaho Capital Sun |url=https://idahocapitalsun.com/2025/04/04/responding-to-governors-veto-idaho-legislature-passes-new-medical-freedom-bill/ |access-date=2025-04-08 |website=Idaho Capital Sun |language=en-US}}

Research studies have found a correlation between the rise of vaccine-preventable diseases and non-medical exemptions from school vaccination requirements,{{cite journal |last1=Goldstein |first1=N. D. |last2=Purtle |first2=J. |last3=Suder |first3=J.S. |date=18 November 2019 |title=Association of Vaccine-Preventable Disease Incidence With Proposed State Vaccine Exemption Legislation |journal=JAMA Pediatrics |volume=174 |issue=1 |pages=88–89 |doi=10.1001/jamapediatrics.2019.4365 |pmc=6865316 |pmid=31738369}}{{cite journal |last1=Wang |first1=Eileen |last2=Clymer |first2=Jessica |last3=Davis-Hayes |first3=Cecilia |last4=Buttenheim |first4=Alison |year=2014 |title=Nonmedical Exemptions From School Immunization Requirements: A Systematic Review |journal=American Journal of Public Health |volume=104 |issue=11 |pages=62–84 |doi=10.2105/AJPH.2014.302190 |pmc=4202987 |pmid=25211732}} however, mandatory vaccination requirements for attending public schools have received criticism. Parents say that vaccine mandates to attend public schools prevent one's right to choose, especially if the vaccinations could be harmful.{{cite web|url=http://www.ncsl.org/research/health/immunizations-policy-issues-overview.aspx|title=Is it bad policy?|publisher=NCSL|date=17 January 2019|access-date=9 February 2018|archive-date=2 April 2020|archive-url=https://web.archive.org/web/20200402194725/http://www.ncsl.org/research/health/immunizations-policy-issues-overview.aspx|url-status=live}} Some people believe being forced to get a vaccination could cause trauma, and may lead to not seeking medical care/attention ever again.{{cite journal | author = Cantor, Julie D | year = 2019| title = Mandatory Measles Vaccination in New York City – Reflections on a Bold Experiment | journal = New England Journal of Medicine | volume = 381 | issue = 2| pages = 101–103 | doi = 10.1056/NEJMp1905941 | pmid = 31167046| doi-access = free }} In the constitutional law, some states have the liberty to withdraw to public health regulations, which includes mandatory vaccination laws that threaten fines. Certain laws are being looked at for immunization requirements, and are trying to be changed, but cannot succeed due to legal challenges.{{cite journal | author = Barraza, Leila | display-authors = etal | year = 2017| title = The Latest in Vaccine Policies: Selected Issues in School Vaccinations, Healthcare Worker Vaccinations, and Pharmacist Vaccination Authority Laws | journal = Journal of Law, Medicine & Ethics | volume = 45 | issue = 1_suppl| pages = 16–19 | doi = 10.1177/1073110517703307 | pmid = 28661302 | pmc = 5503112 }} After California removed non-medical exemptions for school entrance, lawsuits were filed arguing for the right for children to attend school regardless of their vaccination history, and to suspend the bill's implementation altogether. However, all such lawsuits ultimately failed.{{cite web |url=https://www.sfchronicle.com/health/article/California-s-mandatory-vaccination-law-survives-13047905.php|title=California's mandatory-vaccination law survives court test|date=4 July 2018|website=SFChronicle.com|access-date=16 November 2019|archive-date=27 October 2019|archive-url=https://web.archive.org/web/20191027134010/https://www.sfchronicle.com/health/article/California-s-mandatory-vaccination-law-survives-13047905.php|url-status=live}}

As of 2022, 300 American colleges and universities mandate that their students receive a COVID-19 booster.{{cite web|url=https://www.bestcolleges.com/news/2021/12/14/what-colleges-require-covid-vaccine-booster-omicron/|title=These Are the Colleges Requiring Vaccine Boosters Now|date=September 15, 2022|access-date=16 December 2022|archive-date=16 December 2022|archive-url=https://web.archive.org/web/20221216194338/https://www.bestcolleges.com/news/2021/12/14/what-colleges-require-covid-vaccine-booster-omicron/|url-status=live}} A study in the Journal of Medical Ethics concludes that the cost of these mandates likely outweigh the benefits.{{cite web|url=https://jme.bmj.com/content/medethics/early/2022/12/05/jme-2022-108449.full.pdf/|title=COVID-19 vaccine boosters for young adults: a risk benefit assessment and ethical analysis of mandate policies at universities|date=September 23, 2022|access-date=16 December 2022|archive-date=16 December 2022|archive-url=https://web.archive.org/web/20221216194339/https://jme.bmj.com/content/medethics/early/2022/12/05/jme-2022-108449.full.pdf/|url-status=live}} For example, to prevent one COVID hospitalization over a 6-month period, 31,000 to 42,000 adults in that age group would have to get a third mRNA booster; and those boosters will result in at least 18 "serious adverse events" (SAEs) for that single prevented hospitalization.

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• World Immunization Week
• Vaccination requirements for international travel

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Policy, Vaccination

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