Charting mandatory vaccination policies worldwide

Abstract Background Mandatory vaccination is becoming an increasingly important policy intervention for governments trying to address low vaccination rates. However, the evidence about which countries have mandatory vaccination policy worldwide and discussions surrounding their impact has largely been limited to high-income countries. While many recent publications discuss the issue, none provide a comprehensive list. This is an obvious gap in the discussion about the merits of introducing mandatory vaccination into countries. Methods We draw on extensive desk-based research analysing a mixture of sources, including national, regional, and international vaccination policy reports, international health institution websites, ministry of health websites, and media reports. We supplemented this material by contacting a variety of health authorities, such as PAHO and the WHO as well as country's ministries of health. Results We have compiled the first comprehensive list of vaccination policies worldwide, covering 149 countries. This list indicates whether a country has a mandatory vaccination policy and the strictness of the mandate on a scale ranging across four levels. We provide an overview of the state of mandatory vaccination across different countries, set out the general trends and issues, and engage into a discussion about why, how, and where mandatory vaccination is put in place. We also provide several case studies, which highlight the limitations of vaccine mandates because other factors such as exemptions, penalties or enforcement play an important role in their actual effect on immunisation rates. Conclusions Our key finding is that the majority of low- and middle- income countries have mandatory vaccination policies but low vaccination rates because of problems with vaccine supply, delivery, and access.