2, 3 This has already led two states (California and Louisiana) and the District of Columbia to adopt COVID-19 vaccination mandates for schoolchildren. Cross-state comparisons show that states' school-entry mandates (eg, for pertussis and measles) are effective in improving vaccination coverage among schoolchildren and greatly reduced disease outbreaks in the USA. Substantial evidence shows that vaccination mandates in the USA performed well on both dimensions of effectiveness before the COVID-19 epidemic. We distinguish both mandatory and compulsory vaccination from policies that merely require unvaccinated individuals to submit to alternative measures to prevent spreading disease to others, such as undergoing testing for disease.Įvidence for the effectiveness of vaccination mandates Compulsory vaccinations-requirements that carry civil or criminal penalties for non-compliance-are rare. Exemptions can be available on religious or philosophical grounds as legal matter, they must also be provided for valid medical contraindications. Two dimensions of effectiveness in improving uptake are relevant: (1) target-group effectiveness (the extent to which a mandate improves uptake of vaccines in the group covered by the policy) and (2) population effectiveness (the extent to which mandate policies improve vaccination coverage in the US population).īy vaccination mandate, we refer to requirements issued by government or private educational institutions or employers that condition access to an important benefit (typically school or employment) on having received a vaccine, unless an exemption applies. In this Viewpoint we consider the likely effectiveness of policies that require COVID-19 vaccines in improving vaccine uptake and reducing disease in the USA, in view of the evidence from past vaccination mandates and distinctive aspects of COVID-19. Some other objectors maintain that mandates will not be an effective policy for COVID-19 because many individuals will seek to evade them, and mandates might erode support for other public health measures such as mask wearing. Some objectors argue mandates represent undue encroachment on individual liberty. Austria's proposed mandate for adults, for example, provoked mass protests. 1 Mandates, however, are controversial in many countries. As lasting containment of COVID-19 remains elusive, many nations-from Costa Rica, to Austria, to Turkmenistan-are turning to vaccination mandates of various kinds. Many high-income countries have rapidly pivoted from hard decisions about who may receive COVID-19 vaccines, due to shortages, to equally hard decisions about who must receive them.
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