European Countries Move to Expand, Enforce Vaccine Mandates

by Ariana Rawls Fine and Barbara Loe Fisher

Published February 6, 2018 | Law, International

Story Highlights

Vaccine requirements, exemptions, severity of fines and repercussions for vaccine refusal are as varied across Europe as the countries themselves.
Until recently, most European countries mandated few vaccines but, in the past few years Italy, France, Romania and other countries have moved to expand vaccine mandates and punish families who do not comply.
With the objective of increasing childhood vaccination rates by compelling parents to give their children multiple vaccines recommended and promoted by the WHO, international medical and vaccine trade organizations, and national health care plans, it is expected that public health officials in other countries will urge legislators to pass similar legislation.

A number of countries—namely Italy, France and Romania—have passed legislation to expand vaccine mandates and punish families refusing to comply. Others, such as the U.K., do not have compulsory vaccination laws but parents are facing more pressure and disapproval from physicians and government health officials for questioning or declining to use every recommended vaccine. Mandatory use of more vaccines and stricter enforcement of vaccine laws in European countries is coinciding with growing public distrust of vaccine safety as governments move to enforce recommendations by the World Health Organization, medical and vaccine trade organizations and national health care plans.¹ ² ³ ⁴ ⁵
Compulsory vaccination was abandoned in Britain in the Victorian era after smallpox vaccine mandates, which included fines and imprisonment for parents who refused to comply, were met with massive public protests.⁶ The subject of mandating vaccines resurfaced and created a contentious debate in June 2017 at a British Medical Association’s annual representatives conference that resulted in a motion to examine the pros and cons of making childhood immunizations mandatory and how it could be achieved in the U.K.⁷

Voluntary Vaccination Programs in Europe Yield High Vaccine Uptake

Historically, most European countries have preferred to strongly recommend vaccination rather than instituting mass, mandatory vaccination programs for their populations. A 2012 Eurosurveillance report analyzed vaccination programs in 27 E.U. countries plus Norway and Iceland found that more than half had no compulsory vaccination laws, while 14 mandated at least one vaccine. A key finding was that “compliance with many [vaccination] programmes in Europe is high using only recommendations.”⁸
A 2016 ASSET analysis published by Science in Society and co-funded by the European Union, once again did not find evidence of a relationship between national mandatory vaccination policies and increased vaccine uptake in European countries. The analysis found that, “countries where a vaccination is mandatory do not usually reach better coverage than neighbor or similar countries where there is no legal obligation.”⁹ A Council Recommendation on Strengthened Cooperation against Vaccine Preventable Diseases proposal is scheduled to be adopted in mid-2018 and reportedly public comment will be taken until March 2018.

Waning Confidence in Vaccination

A global survey of people living in 67 countries was published in July 2016 and offered further insight into public confidence about vaccination.¹⁰ The report, which was authored by doctors in the U.K., France and Singapore, looked at the perceptions of more than 65,000 people across the world on the importance, safety, and effectiveness of vaccines and whether vaccination was compatible with personal religious beliefs. They found that seven of the 10 least confident nations were in Europe, including France, Bosnia and Herzegovina.
An earlier 2015 study published by the European Centre for Disease Prevention and Control revealed that there is growing vaccine hesitancy and concern about vaccine safety among healthcare workers and their patients in Europe. Researchers reported that healthcare workers had “significant mistrust of pharmaceutical companies who not only had financial interests but also did not communicate sufficient information about side effects and tried to exert pressure on doctors.”

Italy Mandates 10 Vaccines Despite Massive Public Protests

In the summer of 2017, the biggest public demonstrations against forced vaccination held in Europe since the mid-1800s were held in Italy.¹¹ Tens of thousands of Italians of all ages marched in Rome, Florence, Milan, Bologna, Turin, Cagliani and other cities protesting in opposition.¹² They marched in opposition to a May 19 decree endorsed by the government’s Health Minister and President mandating that school children receive multiple doses of 12 vaccines or be prohibited from attending school.
Despite public opposition, Italy’s parliament voted on July 28, 2017 to make 10 vaccinations mandatory for children under the age of 16.¹³ Parents are required to show proof of vaccination for the child to go to school or they must pay a noncompliance fine of approximately $600 USD. Philosophical exemptions are not allowed under the new law. In addition, a government operated vaccine tracking system with a national digital registry will merge the databases of 19 regions and two provinces. There continues to be strong public opposition and advocates for voluntary vaccination hope for change with the upcoming March 2018 elections. Two Italian political parties have pledged to get rid of the mandatory vaccination law.¹⁴

Romania and Slovenia Take Hardline Position

A mandatory vaccination law was proposed in Romania in the fall of 2017, which sparked large public protests and debates. One proposal that was particularly alarming was that parents, who refuse vaccinations for their children, could be charged with child abuse and possibly murder if their child experiences injury, health damage or death from a disease for which there is a vaccine available.¹⁵ Under legislation adopted in August 2017 by one legislative branch of government, Romanian parents would be required to show vaccination records in order for their children to go to school. Proposed fines for vaccine refusal, which were attached to the October 2017 version of the bill, can be up to nearly $3,000 USD. In addition, it is assumed that informed consent is given when compulsory vaccinations are administered to children. However, the proposed law’s implementation date has not yet been set, and Romania’s Chamber of Deputies still needs to vote on the bill.
Another country with strict mandatory vaccination policies is Slovenia, which requires children to receive nine vaccinations and strongly recommends pneumococcal and HPV vaccinations. Although medical exemptions are allowed, philosophical and religious exemptions are not allowed and failure to comply will result in a fine. All medical exemption applications need to be approved by a Ministry of Health commission and then by the health minister; however, a child’s vaccination status is considered private and schools cannot require a child be vaccinated to attend.

France Adds Eight Vaccines Over Public Opposition

In France, eight more childhood vaccines where added last year to the previous mandatory list of three (polio, tetanus and diphtheria) for children born on or after January 1, 2018.¹⁶ Entry to preschool, schools and children’s camps will be dependent on being up-to-date with the mandated vaccinations and booster shots.
But there has been an increasing amount of public resistance from citizens and physicians in France, who have increasingly lost trust in the safety of vaccines.¹⁷ On June 21, 2017, the Court of Justice of the European Union ruled in a compensation case involving a French man who sued Sanofi Pasteur for design defect after a hepatitis B vaccine left him with multiple sclerosis. The court ruled that E.U. laws do not stop courts from considering “serious, specific and consistent” circumstantial evidence along with “scientific” evidence and that lawsuit will proceed.¹⁸ There was public opposition to hepatitis B vaccine mandates in France in the 1990s and, additionally, there have been lawsuits against Merck for Gardasil vaccine injuries suffered by young girls in France.¹⁹

Germany Requires Kindergarten Reporting

In June 2017, Germany instituted a requirement that kindergartens notify government health authorities if parents do not present proof they have participated in “vaccination counseling” with their physician. Non-compliance can result in expulsion of their children from school. The policy for the previous three years had required parents to submit proof of counseling but had not requested schools to report parents for non-compliance. Although the law required more strict enforcement of physician counseling on vaccination, legislators did not make vaccination compulsory in Germany last year.

Finland Targets Health Care Workers

Meanwhile, in Finland, disease control has been more front and center as a new law will go into effect in March 2018 requiring employees working in the social and health fields be vaccinated against influenza, measles, varicella and pertussis. This includes those working with vulnerable populations, including young children, the elderly and medically high-risk people. The employee can be terminated for vaccine refusal if the employer is unable to offer another non-public contact position.²⁰ A new parliamentary group has been solely created to advertise and legislatively promote vaccination.²¹ Finland already has a high vaccination rate despite no mandatory vaccination laws for children and the general population.

Vaccine Laws Vary from Country to Country

Elsewhere in Europe, only those working in state institutions and those administering vaccines are required to be vaccinated in Latvia. That being said, individuals need to attend an education session with a health care provider and sign a refusal form if they choose not to get the recommended doses. The country has a high rate of vaccination at well over 90 percent.

Belgium has implemented a mandatory polio vaccine law since 1966 but the country is divided when it comes to vaccination policies and requirements. The Belgian National Bureau for Childbirth and Childhood requires not only polio vaccine, but also proof of diphtheria and pertussis vaccinations for attendance at French-speaking preschools and childcare centers.

The Ukraine government requires that parents provide a certificate of immunization for their children to attend school. Yet, the country is experiencing a high level of distrust with a 2012 UNICEF survey showing that close to 30 percent of parents were against vaccinations.

Sweden is experiencing resistance from citizens similar to other European countries. There was public opposition to a Swedish Parliament Social Committee Report that was presented in May 2017 with several motions related to compulsory vaccinations.²² In addition to calling for the country’s vaccine program to be made compulsory, the report called for adding influenza and HPV vaccines to the childhood vaccine schedule. The committee and the parliament both rejected the proposals.

Looking beyond Europe’s borders, Australia’s “no jab, no play” and “no jab, no pay” policies have taken a hard line against parents with children, who have not received all government recommended vaccines. Not only are unvaccinated children not allowed to attend daycare or preschools, but the directors of daycare and preschool facilities are fined more than $4,000 USD if unvaccinated children are enrolled. In addition, the parents are deemed ineligible for government payment benefits for child care.
Vaccine requirements, exemptions, severity of fines and repercussions for vaccine refusal are as varied across Europe as the countries themselves. With the objective of increasing childhood vaccination rates by compelling parents to give their children multiple vaccines recommended and promoted by public health officials, as well as multi-national medical and vaccine trade organizations, it is expected that other countries in Europe and around the world will introduce more vaccine mandates even as public confidence in vaccine safety declines and public protests opposing forced vaccination laws continue.

References:

Templeton Times

Wednesday, February 7, 2018