ABSTRACT

Vaccinations are among the most successful preventive tools to protect collective health. In response to alarming vaccines preventable diseases (VPDs) outbreaks resurgence, decreased vaccination coverage and vaccine refusal, several European countries have recently revised their vaccination policies introducing or extending mandatory vaccinations. This review examines the health, political and ethical aspects of mandatory vaccination.

The authors first clarify terms and definitions and propose a conceptual framework of mandatory policies. Second, they describe the current status of mandatory childhood immunization programmes in Europe, assessing selected mandatory laws. Third, as the authors conduct a systematic review of the literature (retrieving from Medline 17 relevant records between 2010 and 2020), they take an analytical approach to measure the impact of mandatory vaccination policies on both VPDs control and immunization coverage, but also on population attitudes toward vaccines. 40% of European countries currently have mandatory vaccination policies; however, policies vary widely and, although there is evidence of increased vaccine uptake, their impact on informed adherence to preventive behaviors is scant.

Although mandatory vaccination policies might be needed to protect collective health in times of emergency, public health goals of VPD prevention and health promotion should primarily be pursued through health education and population empowerment.

摘要

疫苗接种是保护集体健康最成功的预防工具之一。为应对令人震惊的疫苗可预防疾病 (VPD) 暴发、疫苗接种覆盖率下降和疫苗拒绝，一些欧洲国家最近修订了其疫苗接种政策，引入或延长了强制性疫苗接种。这篇综述探讨了强制性疫苗接种的健康、政治和伦理方面的问题。

作者首先阐明了术语和定义，并提出了强制性政策的概念框架。其次，他们描述了欧洲强制性儿童免疫计划的现状，评估了选定的强制性法律。第三，当作者对文献进行系统回顾时（从 Medline 17 检索 2010 年至 2020 年的相关记录），他们采用分析方法来衡量强制性疫苗接种政策对 VPD 控制和免疫覆盖率以及对人口的影响对疫苗的态度。40%的欧洲国家目前有强制性疫苗接种政策；然而，政策差异很大，尽管有证据表明疫苗接种率有所增加，但它们对知情遵守预防行为的影响甚微。

尽管在紧急情况下可能需要强制性疫苗接种政策来保护集体健康，但 VPD 预防和健康促进的公共卫生目标应主要通过健康教育和人口赋权来实现。