Vaccination policy refers to the policy a government practices in relation to vaccination. Vaccinations are voluntary in some countries and mandatory in some countries. Some governments pay all or part of the costs of vaccinations for vaccines in a national vaccination schedule.
Goals of vaccination policies
Immunity and herd immunity
Vaccination policies aim to produce immunity to diseases. Besides individual protection from getting ill, with some vacccines vaccination policies aim also to provide herd immunity which is based on the idea that the pathogen will have trouble spreading when a significant part of the population has immunity against it.
Eradication of disease
With some vaccines, a goal of vaccination policies is to eradicate the disease - make it disappear from Earth altogether. Victory is claimed for smallpox globally and getting rid of endemic measles, mumps and rubella in Finland. The World Health Organization coordinated the global effort to eradicate this disease. The last naturally occurring case of smallpox occurred in Somalia in 1977. In 1988, the governing body of W.H.O. targeted polio for eradication by the year 2000, but didn't succeed. The next eradication target would most likely be measles, which has declined since the introduction of measles vaccination in 1963.
Compulsory vaccination as vaccinaton policy
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In an attempt to eliminate the risk of outbreaks of some diseases, at various times several governments and other institutions have instituted policies requiring vaccination for all people. For example, an 1853 law required universal vaccination against smallpox in England and Wales, with fines levied on people who did not comply. In the United States, the Supreme Court ruled in the 1905 case Jacobson v. Commonwealth of Massachusetts that the state could require individuals to be vaccinated for the common good. Common contemporary U.S. vaccination policies require that children receive common vaccinations before entering school. A few other countries also have some compulsory vaccinations. Compulsory vaccination is believed to have greatly reduced the rates of some infectious diseases.
Beginning with early vaccination in the nineteenth century, these policies led to resistance from a variety of groups, collectively called anti-vaccinationists, who objected on ethical, political, medical safety, religious, and other grounds. Common objections are that compulsory vaccination represents excessive government intervention in personal matters, or that the proposed vaccinations are not sufficiently safe. Many modern vaccination policies allow exemptions for people who have compromised immune systems, allergies to the components used in vaccinations or strongly-held objections.
In 1904 in the city of Rio de Janeiro, Brazil a government program of mandatory smallpox vaccination resulted in the so-called Vaccine Revolt, several days of rioting with considerable property damage and a number of deaths.
Having compulsory vaccinations is connected with difficult policy issues where health authorities try to balance health of society and individual liberty and freedom of expression:
"Vaccination is unique among de facto mandatory requirements in the modern era, requiring individuals to accept the injection of a medicine or medicinal agent into their bodies, and it has provoked a spirited opposition. This opposition began with the first vaccinations, has not ceased, and probably never will. From this realization arises a difficult issue: how should the mainstream medical authorities approach the anti-vaccination movement? A passive reaction could be construed as endangering the health of society, whereas a heavy handed approach can threaten the values of individual liberty and freedom of expression that we cherish." BMJ
Most states in the U.S. mandate immunization, or obtaining exemption, before enrollment in public school. Exemptions are typically for people who have compromised immune systems, allergies to the components used in vaccinations, or strongly-held objections. Under occasional circumstances, the American Academy of Pediatrics considers parental refusal of immunization a form of child abuse and neglect.
Organizations opposed to mandatory vaccines often publicize the procedure for obtaining exemption.
Immunizations are often compulsory for military enlistment in the U.S.
Vaccination policy in U.S.
United States of America has mandatory vaccinations ar the state level - all states have laws requiring children to be vaccinated according to CDC schedules as a requisite for attending school. In practice there are religous and/or philosophical exemptions in all states.
See Vaccination schedule for the vaccination schedule used in U.S.
U.S. vaccinations and school attendance
A significant number of vaccinations may be a requirement for school admission at various grades. This requirement exists primarily to reduce the number of diseases which are transmissible in the classroom, not as a comprehensive list of the vaccinations which may be appropriate for any given child. As a result, a school may require a vaccination for highly contagious diseases like HIB and chicken pox, which can cause significant school disruption during outbreaks, but is less likely to require vaccination against Hepatitis B, which is strictly a bloodborne pathogen and which cannot be caught through the kind of casual contact one encounters in a classroom. In the US, individual states have varying exemptions to compulsory vaccination that parents may claim for religious, ethical, or medical reasons.
- Salmon, Daniel A et al. (2006) Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future. The Lancet 367(9508):436-442.
- United States Department of Defense. "MilVax homepage". Retrieved 2007-07-25.