As countries struggle to contain the COVID-19 pandemic, vaccination uptake is a public health priority now more than ever. Efforts to increase vaccinations vary greatly around the globe. A new McGill-led study comparing policies around the world finds broad implementation of mandatory vaccination mandates. However, the penalties for failing to vaccinate differ significantly by country, ranging from fines to jail time.

"Achieving and maintaining high vaccination coverage globally is critical. The COVID-19 pandemic has shown just how challenging infectious disease control is when vaccination is not possible. There are many other vaccine-preventable diseases, yet vaccine uptake is not high enough to prevent outbreaks in many countries," says Dr. Nicole Basta, an associate professor in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University.

The study, published in Vaccine, assesses national mandatory vaccination policies from all UN-recognized countries worldwide. "The use of vaccination programs is one of the most cost-effective and successful tools for public health. Especially in a pandemic, high vaccination coverage on a global scale is important," says lead author Katie Gravagna, a Master's student in epidemiology studying under the supervision of Associate Professor Basta.

Variations in penalties for non-compliance

Researchers found that 105 out of the 193 countries (54%) studied had evidence of a national mandatory vaccination policy that required at least one vaccine. Of those, 62 countries (59%) also have one or more penalties that can be imposed on individuals who do not comply. The frequency, types, and severity of penalties for failing to comply with mandatory vaccination varied widely across all regions from relatively minor penalties like small one-time fines to jail time.

Educational and financial penalties were the most common. Most educational penalties deny school enrollment until vaccination requirements have been met. Of the 32 countries with financial penalties, 53% have one-time fines of less than $1,000 USD. More severe penalties entailed jail time—a possibility in 12 countries, seven of which include less than six months of jail time. Italy's mandatory vaccination policy had among the most severe penalties, with violations potentially resulting in the temporary loss of parental rights.

"Our findings set the stage for the most important next step: determining whether these mandatory vaccination policies and the penalties that countries use to promote adherence are effective, beneficial, or harmful in deterring non-compliance. These comparative studies are important because we need to define best practices for sustaining high vaccination uptake worldwide," says Basta.

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