Global assessment of national mandatory vaccination policies and consequences of non-compliance

Volume 38, Issue 49 Pages 7697-7876 (17 November 2020)


Research article Open access
Global assessment of national mandatory vaccination policies and consequences of non-compliance
Katie Gravagna, Andy Becker, Robert Valeris-Chacin, Inari Mohammed, … Nicole E. Basta
Pages 7865-7873
:: Over 100 countries have a nationwide mandatory vaccination policy requiring one or more vaccines.
:: Of those, 62 countries (59%) also impose one or more penalties against individuals who do not comply.
:: Educational and financial penalties are the most common types of penalties; severity varies.
:: Most educational penalties deny school enrollment until vaccination requirements are met.
Declining vaccination coverage and increasing hesitancy is a worldwide concern. Many countries have implemented mandatory vaccination policies to promote vaccination. However, mandatory vaccination policies differ significantly by country. Beyond case studies, no comprehensive study has compared these policies or the penalties for non-compliance on a global scale.
We conducted extensive keyword, policy, and literature searches to identify mandatory national vaccination policies globally and develop a comprehensive database. A mandatory national vaccination policy was defined as a policy from a national authority that requires individuals to receive at least one vaccination based on age or to access a service. Two reviewers independently evaluated evidence for a mandate and whether non-compliance penalties were incorporated. We categorized penalties into four types, based on the nature of the penalty. These penalties impact an individual’s financial, parental rights, educational (i.e., child’s school entry and access), and liberty status. We rated the severity within each category.
Of 193 countries investigated, 54% (n = 105) had evidence of a nationwide mandate as of December 2018. The frequency, types, and severity of penalties varied widely across all regions. We found that 59% (n = 62) of countries with national mandates defined at least one penalty for non-compliance with a vaccine mandate. Among those, educational penalties (i.e., limiting a child’s entry or ongoing access to school) were the most common (69%; n = 43), with most countries with educational penalties refusing school enrollment until vaccination requirements are met (81%; n = 35).
We undertook a comprehensive assessment of national mandatory vaccination policies and identified a diversity of penalties in place to promote compliance. Our results highlight the need to critically evaluate the implementation of non-compliance penalties in order to determine their effectiveness and to define best practices for sustaining high vaccination uptake worldwide.