What are vaccine mandates?

Vaccine mandates are a way to compel people to get vaccinations. This could mean fining people who do not comply or excluding them from certain activities and locations, like hospitality venues or workplaces.

Several countries have introduced mandates of some type for Covid vaccines. But they are controversial, with some public health experts arguing education and persuasion should be preferred to compulsion wherever possible.

Covid passports have emerged as one way of proving Covid-19 vaccine status but are not in themselves a vaccine mandate, particularly when testing is included as an alternative.

Does the UK have Covid-19 vaccine mandates?

In general, UK politicians have argued against widespread vaccine mandate schemes often on the grounds of liberty. The UK also already has very high levels of vaccine confidence comparatively, which has led some to argue a mandate is unnecessary.

However, the UK government has amended the Health and Social Care Act 2008 to mandate covid-19 vaccination for healthcare workers:

Since November 2021, care home workers have been required to have had two doses of an approved Covid-19 vaccine (unless exempt). Care home providers can redeploy unvaccinated workers into non-frontline roles or put them on unpaid leave until they receive both doses.

From April 2022, this mandate will be extended to all frontline health and social care workers with a 12 week grace period. The mandate will also apply to other staff like porters and receptionists who may have contact with patients.

Are other countries using Covid-19 vaccine mandates?

Yes, several countries have taken a more compulsory approach than the UK, although generally with exemptions for those who cannot be vaccinated:

Indonesia was the first country to introduce a Covid-19 vaccine mandate, in February 2021. It is extensive, allowing local government or regional health agencies to fine or refuse social assistance and government services to people who do not get vaccinated. [1]

Austria is also planning to make Covid-19 vaccinations mandatory from February 2022, with means-tested fines of up to €3600 every three months for those who do not comply. It announced a stay at home order for the unvaccinated in November. [2]

The German government is planning to vote on a similar mandate in response to the spread of Omicron, most likely with fines for those who do not comply. It will soon require vaccination for workers at care homes and hospitals. In December it banned those who have not been vaccinated or recovered from bars, restaurants, theatres, cinemas, and non-essential shops, with stricter rules on household mixing for the unvaccinated as well. [3]

Greece has approved mandatory vaccination for over 60s, with a monthly €100 fine added to tax bills for those who refuse, although people who have recently recovered are exempt. [4]

Other countries have focused more narrowly on particular activities or professions:

  • Italy introduced mandatory vaccination for healthcare workers in April 2021; people who refused could be transferred to other duties or suspended without pay for up to a year. On December 15 this was extended to all school staff, police and the military. Unvaccinated adults have also been barred from entering venues such as cinemas and restaurants since 6 December. [5]
  • France has had mandatory vaccination for healthcare workers since October 2021, while New Zealand is introducing a requirement for teachers and healthcare workers. [6]
  • The US government has mandated that federal employees be vaccinated unless exempt since November 2021. It also recently mandated that workers at private companies with more than 100 employees be fully vaccinated or tested weekly, but this has been subject to repeated legal challenges and full enforcement has now been delayed until February. Different states have also taken their own approaches with some introducing mandates for employees but others banning or blocking vaccine mandates. [7]

What are the potential benefits of vaccine mandates?

Vaccine mandates aim to increase the level and/or speed of vaccination programs by incentivising people to come forward to be vaccinated, increasing the level of protection against a disease in the population. The arguments for them are generally strongest in countries where vaccine confidence is lower or when countries are facing a surge in infections and significant pressure on healthcare provision.

In some cases, evidence suggests that vaccine mandates have increased take-up. Vaccine coverage increased in France, Italy and Germany in recent years after they introduced or extended vaccine mandates for various childhood diseases, for example.

But this is not always the case. Ukraine had to end its mandatory measles and rubella campaign in 2006 after negative media response and controversy about alleged side-effects. One study comparing different countries’ approaches found no correlation between mandates and rates of childhood vaccination in the EU. [8]

Effects could also be different for Covid vaccination, with vaccine hesitancy driven in part by concerns about rapid development and long-term safety. [9] Outcomes are also context-dependent; one recent study of covid passports suggested that they increased vaccination uptake in the short term but not in countries which already had high uptake. [10]

What are the potential problems?

Vaccine mandates raise ethical questions; some consider them an unacceptable infringement of individual liberty regardless of potential public health benefits. Where vaccine hesitancy varies between different groups there is also the risk that vaccine mandates could exacerbate existing inequalities. [11]

There are concerns around whether mandates might reduce public trust in government, undermining support for vaccination and other public health measures and proving counterproductive in the long term. [12] Ukraine’s experience shows that public response to mandates can be an issue, and there have reportedly been some protests in response to recent attempts to introduce covid-19 vaccine mandates. [13]

When it comes to mandates on healthcare workers there is also the potential impact on healthcare provision if a signification number of staff refuse to be vaccinated. However, it is still unclear how much of an issue this will be. Although unions and providers in the UK have warned that there could be a major impact on staffing in some areas, the French health minister stated in October 2021 that only 0.6% of healthcare staff were still unvaccinated and could be suspended after France brought in its mandate. [14]

The WHO has argued that vaccine mandates could be a proportionate policy response, but should be a last resort, used only if other policy interventions, like public education, have failed, and where they would have unequivocal public health benefits. [15] Jeremy Farrar, Director of Wellcome Trust, similarly argued at a recent Institute for Government event for example: “…the UK has had such remarkable vaccine uptake compared to essentially every other country because prior to the pandemic the UK actually had very good high levels of population trust in vaccines… in the UK we would be much better advised to explain…. [and] use the systems we have in place and persuade people rather than coerce people”.

To determine whether vaccine mandates could be a proportionate policy response in the UK the government might need to consider how much pressure Covid was putting on healthcare services at the time, the number of people vaccinated, the likely impact in terms of increasing uptake, the level of pre-existing immunity (from infection as well as vaccination), vaccine supply and efficacy, and the success or otherwise of other attempts to incentivise vaccination. [16]

Are vaccine mandates a new idea?

Vaccine mandates have been used by governments since the 18th century. Smallpox vaccination was made compulsory for infants in England and Wales in 1853, provoking some resistance. Exemption on grounds of conscientious objection was introduced in 1898 and made easier to access in 1907, which was followed by a fall in vaccination rates. The Vaccination Acts were repealed by the National Health Service Acts in 1946 and 1947, in part for administrative reasons but also because a model focused on education and persuasion rather than compulsion for diphtheria vaccination had proved successful. [17]

Vaccine mandates have also been used more recently. Several European countries introduced or extended vaccine mandates in recent years in response to disease outbreaks. France, for example, made 11 childhood vaccines mandatory in 2017, with fines and possible prison sentences for non-compliance. [18]

While vaccine mandates have been around a long time, they have more often been used in relation to childhood vaccinations – their use for adults has expanded during the Covid pandemic.

Are vaccine mandates likely to be used more widely in the UK in future?

The UK government has moved ahead with vaccine mandates for healthcare workers but backed away from imposing a vaccine mandate for access to some venues when it decided to allow testing to be included in its Plan B covid passport scheme.

The prime minister stated when announcing Plan B that although he did not want Britain to be a “society and a culture where we force people to get vaccinated” if vaccines worked against the Omicron variant then there would come a point when "we are going to have to have a conversation about ways in which we deal with this pandemic".

But this does not appear to have been a concrete proposal for moving towards the more compulsory approach of other countries. Health secretary Sajid Javid has dismissed the idea of mandatory vaccination, stating that "if you’re talking about universal mandatory vaccination, I think ethically it is wrong” and that it “just wouldn’t work, being vaccinated has to be a positive decision". Labour has also stated its opposition to compulsory schemes. [19]

What seems more plausible is debate over whether Covid passport schemes, if they are seen as successful and gain wider support, should be extended beyond large events to other venues.

 

 

  1. www.reuters.com/article/health-coronavirus-indonesia-vaccines-idUSL4N2KO1ZD
  2. www.theguardian.com/world/2021/nov/19/austria-plans-compulsory-covid-vaccination-for-all; www.theguardian.com/world/2021/nov/19/austrians-queue-for-covid-jabs-as-unvaccinated-told-to-stay-home; www.reuters.com/world/europe/austria-announce-details-planned-covid-19-vaccine-mandate-2021-12-09/  
  3. www.ft.com/content/8fae9488-a66a-4cf3-ba48-49928ceea7f6;  www.nytimes.com/2021/12/10/world/europe/vaccine-mandates-civil-liberties.html
  4. www.independent.co.uk/news/greece-parties-kyriakos-mitsotakis-athens-b1968058.html
  5. www.bmj.com/content/373/bmj.n905; www.reuters.com/world/europe/italy-restrict-access-unvaccinated-indoor-venues-sources-2021-11-24/
  6. www.service-public.fr/particuliers/actualites/A15106; www.reuters.com/world/asia-pacific/new-zealand-reports-fall-local-covid-19-cases-all-auckland-2021-10-11/
  7. www.whitehouse.gov/omb/briefing-room/2021/11/24/update-on-implementation-of-covid-19-vaccination-requirement-for-federal-employe… www.bbc.co.uk/news/world-us-canada-59708304; www.reuters.com/legal/government/challengers-ask-us-supreme-court-block-biden-vaccine-mandate-businesses-2021-12-20/; www.nytimes.com/2021/12/20/business/company-vaccine-mandates-biden.html; www.nytimes.com/interactive/2021/12/18/us/vaccine-mandate-states.html
  8. https://theconversation.com/greece-to-make-covid-vaccines-mandatory-for-over-60s-but-do-vaccine-mandates-work-172672; www.ncbi.nlm.nih.gov/pmc/articles/PMC6607737/; www.ncbi.nlm.nih.gov/pmc/articles/PMC6607743/; www.asset-scienceinsociety.eu/reports/page1.html
  9. https://theconversation.com/why-the-uk-shouldnt-introduce-mandatory-covid-vaccination-173179
  10. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1027643/S1401_University_of_Oxfo…
  11. https://apps.who.int/iris/rest/bitstreams/1342697/retrieve
  12. https://apps.who.int/iris/rest/bitstreams/1342697/retrieve
  13. https://theconversation.com/greece-to-make-covid-vaccines-mandatory-for-over-60s-but-do-vaccine-mandates-work-172672; www.theguardian.com/world/2021/dec/11/tens-of-thousands-protest-against-compulsory-covid-jabs-in-austria; www.aljazeera.com/news/2021/12/5/protesters-against-vaccine-mandate-in-belgium-clash-with-police; www.france24.com/en/europe/20211126-france-postpones-vaccine-mandate-after-violent-unrest-in-martinique-and-guadeloupe
  14. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1032203/making-vaccination-a-con… www.theguardian.com/society/2021/dec/20/england-hospital-units-may-close-as-staff-revolt-over-jab-mandate-says-nhs-leader; www.bmj.com/content/374/bmj.n2318; www.francetvinfo.fr/sante/maladie/coronavirus/video-covid-19-aux-alentours-de-15-000-soignants-ne-se-sont-pas-fait-vacciner-esti… www.bmj.com/content/375/bmj.n2670
  15. https://unric.org/en/who-mandatory-vaccinations-are-a-last-resort/; https://apps.who.int/iris/rest/bitstreams/1342697/retrieve
  16. https://apps.who.int/iris/rest/bitstreams/1342697/retrieve; https://theconversation.com/why-the-uk-shouldnt-introduce-mandatory-covid-vaccination-173179; www.theguardian.com/world/2021/dec/03/do-covid-vaccine-mandates-work
  17. www.ncbi.nlm.nih.gov/books/NBK545998/
  18. www.bbc.com/future/article/20211029-why-mandatory-vaccination-is-nothing-new; https://theconversation.com/greece-to-make-covid-vaccines-mandatory-for-over-60s-but-do-vaccine-mandates-work-172672
  19. https://news.sky.com/story/covid-19-downing-street-seeks-to-play-down-significance-of-boris-johnsons-mandatory-jabs-comment-1249… www.independent.co.uk/news/uk/politics/covid-vaccination-compulsory-austria-b1961669.html
Update date: 
Thursday, December 23, 2021

Original source – The Institute for Government

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