Vaccination Mandates Tied to Higher Rates of Immunization in European Countries

European countries that legally mandate vaccinations for measles and pertussis showed higher vaccination rates, especially in countries that imposed financial penalties for failure to comply, according to a study published in the February 2020 Pediatrics. The study, "Mandatory Vaccination in Europe," (published online Jan. 13) examined the associations between vaccination mandate policies and vaccination coverage in 29 European countries, where laws vary. Researchers examined data from the European Centers for Disease Control and Prevention and the World Health Organization, collecting vaccination rates for 2006-2015 for measles and from 2006-2016 for pertussis. Seven of the 29 countries mandate vaccination, and among those with mandates, only two - the Czech Republic and Latvia --offered processes to acquire a nonmedical vaccination exemption. Mandatory vaccination was associated with 3.71 (95% confidence interval: 1.68 to 5.74) percentage points higher prevalence of measles vaccination and 2.14 (95% confidence interval: 0.13 to 4.15) percentage points higher of pertussis vaccination compared with countries that did not mandate immunization. The measles incidence was lower in countries with mandatory vaccination without nonmedical exemptions, while pertussis incidence was unaffected. Countries that imposed the highest financial penalties for failing to follow vaccination requirements showed higher vaccination rates. Recent measles outbreaks have been the main drivers of policy changes in Europe. The study supports the mandatory vaccination and financial penalties to ensure high vaccination rates but calls for careful surveillance of the impact on vaccine acceptance and disease outcomes.

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