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Why mandatory vaccination is nothing new

Inoculation gave way to more sophisticated vaccination once the English doctor Edward Jenner developed a smallpox vaccine in 1796. Mandatory vaccination began just a few years later. In 1806, Elisa Bonaparte, the ruler of Lucca and Piombino in present-day Italy (and sister to Napoleon), mandated the vaccination of newborn babies and adults.

Another milestone occurred in 1853, when the Compulsory Vaccination Act required infants in England and Wales to be vaccinated against smallpox.

Though some vaccines, like for polio, were initially popular, one noticeable pattern is the public getting used to a particular vaccine requirement over time, then some people getting spooked by a novel vaccine.

“The United States has had vaccination mandates in place since the late 1970s,” says Lee Hampton, a paediatrician and medical epidemiologist with Gavi, the Vaccine Alliance. And Italy requires children to be vaccinated against a range of pathogens, such as hepatitis B, diphtheria, pertussis, poliovirus, tetanus, Haemophilus influenzae type b, measles, mumps, rubella and varicella.

According to Hampton, “the mandates themselves… hadn’t really caused any issues. What has caused changes over time in those types of contexts is when what’s being mandated changes.” This pattern has been seen, for example, with new requirements for vaccination against hepatitis B, anthrax and of course now Covid-19.

Vaccination is now required in some cases for school attendance (for example, against hepatitis B in Slovenia), for organ transplants (some parts of the UK require them for kidney transplants) – and in one extreme case in Italy, to retain custody of children. Penalties for non-compliance are most often educational or financial.

Vaccine mandates are especially common in high-income countries, according to Hampton. There also tends to be a link to the style of government, where “the more authoritarian the government, the more likely it is to have vaccination mandates”. This may not be surprising, because it’s easier for this style of government to impose new rules, including those in the public interest (in the case of vaccines).

For instance, The Gambia mandated childhood immunisations in 2007, during a period of authoritarian rule (and following a drop in immunisation coverage). However, mandatory vaccination is also common in democratic countries in emergency situations, such as during pandemics – the US state of New York imposed mandatory flu vaccines on healthcare workers temporarily during the swine flu pandemic in 2009.

The legacies of “conscientious objection”

Over the centuries, some objections have arisen over the components used to make vaccines. Certain vaccines include tiny amounts of animal products, like squalene, an oil from shark livers. The polio vaccine previously used cells from monkey kidneys. These types of ingredients have led to some vegetarian opposition.