Vaccination policy refers to the policy a government adopts in relation to vaccination. Vaccinations are voluntary in some countries and mandatory in some countries. Some governments pay all or part of the costs of vaccinations for vaccines in a national vaccination schedule.

Goals of vaccination policies

Immunity and herd immunity

Vaccination policies aim to produce immunity to diseases. Besides individual protection from getting ill, with some vacccines vaccination policies aim also to provide herd immunity which is based on the idea that the pathogen will have trouble spreading when a significant part of the population has immunity against it.

Eradication of disease

With some vaccines, a goal of vaccination policies is to eradicate the disease - make it disappear from Earth altogether. The World Health Organization coordinated the global effort to eradicate smallpox globally. Victory is also claimed for getting rid of endemic measles, mumps and rubella in Finland. The last naturally occurring case of smallpox occurred in Somalia in 1977. In 1988, the governing body of W.H.O. targeted polio for eradication by the year 2000, but didn't succeed. The next eradication target would most likely be measles, which has declined since the introduction of measles vaccination in 1963.

Individual versus group goals

Rational individuals will attempt to minimize the risk of illness, and will seek vaccination for themselves or their children if they perceive a high threat of disease and a low risk to vaccination. 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 at coverage levels below those optimal for the community.^[1] For example, a 2003 study found 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,^[2] and a 2007 study found that severe influenza epidemics cannot be prevented by voluntary vaccination without offering certain incentives.^[3] Governments often allow exemptions to mandatory vaccination for religious or philosophical reasons, but if too many of these exemptions are granted, the resulting free rider problem may cause loss of herd immunity, substantially increasing risks even to vaccinated individuals.^[4]

Compulsory vaccination

In an attempt to eliminate the risk of outbreaks of some diseases, at various times several governments and other institutions have instituted policies requiring vaccination for all people. For example, an 1853 law required universal vaccination against smallpox in England and Wales, with fines levied on people who did not comply. In the United States, the Supreme Court ruled in the 1905 case Jacobson v. Commonwealth of Massachusetts that the state could require individuals to be vaccinated for the common good. Common contemporary U.S. vaccination policies require that children receive common vaccinations before entering school. A few other countries also have some compulsory vaccinations. Compulsory vaccination is believed to have greatly reduced the rates of some infectious diseases.^[5]

Beginning with early vaccination in the nineteenth century, these policies led to resistance from a variety of groups, collectively called anti-vaccinationists, who objected on ethical, political, medical safety, religious, and other grounds. Common objections are that compulsory vaccination represents excessive government intervention in personal matters, or that the proposed vaccinations are not sufficiently safe. Many modern vaccination policies allow exemptions for people who have compromised immune systems, allergies to the components used in vaccinations or strongly-held objections.^[5]

In 1904 in the city of Rio de Janeiro, Brazil a government program of mandatory smallpox vaccination resulted in the so-called Vaccine Revolt, several days of rioting with considerable property damage and a number of deaths.

Having compulsory vaccinations is connected with difficult policy issues where health authorities try to balance health of society and individual liberty and freedom of expression:

"Vaccination is unique among de facto mandatory requirements in the modern era, requiring individuals to accept the injection of a 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 realization 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." BMJ

Vaccination policy in U.S.

States in the U.S. mandate immunization, or obtaining exemption, before children enroll in public school. Exemptions are typically for people who have compromised immune systems, allergies to the components used in vaccinations, or strongly-held objections. All states but West Virginia and Mississippi allow religious exemptions, and twenty states allow parents to cite personal or philosophical objections. Organizations opposed to mandatory vaccines publicize exemption procedures. Some parents falsely claim religious beliefs to get vaccination exemptions.^[6]

If the child is put at significant risk of harm (such as during an epidemic) the American Academy of Pediatrics considers parental refusal of immunization a form of medical neglect and suggests that state agencies become involved.^[7]

See Vaccination schedule for the vaccination schedule used in U.S.

Immunizations are often compulsory for military enlistment in the U.S.^[8]

References