Vaccination policy

Malaria Clinic in Tanzania helped by SMS for Life program which organizes malaria vaccine delivery

Malaria Clinic in Tanzania helped by SMS for Life program which organizes malaria vaccine delivery

Vaccination policy refers to the health policy a government adopts in relation to vaccination. Vaccinations are voluntary in some countries and mandatory in others, as part of their public health system. Some governments pay all or part of the costs of vaccinations in a national vaccination schedule.

Goals of vaccination policies
Immunity and herd immunity
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. This protects those unable to get the vaccine due to medical conditions, such as immune disorders.

Each year, vaccination prevents between two and three million deaths, across all age groups, from diphtheria, tetanus, pertussis and measles.

The impact of immunization policy on vaccine-preventable diseases has been listed as one of the top public health achievements.

Eradication of disease

Malaria Clinic in Tanzania helped by SMS for Life program which organizes malaria vaccine delivery
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 effort to eradicate smallpox globally through vaccination, the last naturally occurring case of smallpox was in Somalia in 1977. Endemic measles, mumps and rubella have been eliminated through vaccination in Finland. The WHO has targeted polio for eradication by the year 2018.

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. 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, and a 2007 study found that severe influenza epidemics cannot be prevented by voluntary vaccination without offering certain incentives. 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. However, mandatory vaccination raises ethical issues regarding parental rights and informed consent.

Compulsory vaccination
Further information: Vaccine controversy
To eliminate the risk of disease outbreaks, at various times governments and other institutions established policies requiring vaccination. 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 Jacobson v. Massachusetts (1905) that states have the authority to require vaccination against smallpox during a smallpox epidemic. All U.S states require that children be vaccinated in order to attend school; only three states (Mississippi, West Virginia, and California) do not provide exemptions based on religious or philosophical beliefs. A few other countries also follow this practice. Compulsory vaccination greatly reduces infection rates for associated diseases. Beginning in the nineteenth century, these policies stirred resistance from a variety of groups, collectively called anti-vaccinationists, who objected on ethical, political, medical safety, religious, and other grounds. Common objections included government intervention in personal matters or that proposed vaccinations were not sufficiently safe. Many modern vaccination policies allow exemptions for people with compromised immune systems, allergies to vaccination components, or strongly held objections.

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.

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

“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 realisation 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.”
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 increases vaccination rates, and sufficient evidence that requiring vaccinations before attending child care and school does so. but insufficient evidence to assess effectiveness of requiring vaccinations as a condition for hospital and other healthcare jobs.


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