Strengthening health security through routine vaccination policy: A comprehensive analysis of childhood vaccination laws across 194 countries
Vaccine 54 (2025) 127121 https://doi.org/10.1016/j.vaccine.2025.127121
Ciara M. Weets , Rory Wilson, Heather Swadley, Rebecca Katz
Background: Vaccine preventable diseases (VPD) present a resurgent threat to global health security and jeopardize decades of advancements in public health and economic development. Since 1974, childhood vaccinations are estimated to have prevented 154 million deaths from VPD, yet recent declines in routine vaccination rates highlight the global population’s growing vulnerability to these diseases. When paired with appropriate access to healthcare and trusted information, evidence informed enforceable policies have demonstrably improved childhood vaccination rates in countries that have recently implemented more stringent laws on routine vaccination. Here we comprehensively map and describe the current legal environment for childhood vaccination.
Methods: We conducted a comprehensive analysis of the childhood vaccination-related policies in 194 countries. Policies were systematically identified, collated, and categorized into a publicly available tool.
Results: A total of 106 countries have legally-enforceable policies requiring vaccination for at least one disease. We found that vaccines against diphtheria, measles, and tetanus were the most universally mandated, while vaccines against COVID-19 and Japanese Encephalitis were mandated by the fewest countries. In 91 countries, childhood vaccination requirements are enforced through either legal sanctions, such as monetary fines or incarceration, through exclusion from congregate settings, or through some combination of the two.
Conclusion: Analyses of the efficacy of childhood vaccination laws are predicated upon a comprehensive mapping of the current legal landscape related to routine immunization. Public health officials and researchers with an interest in increasing routine childhood vaccination rates in their country must know what characteristics of policy have been effective across various contexts. Our mapping of legally-enforceable childhood vaccination policies is foundational for assessing current vulnerabilities to vaccine-preventable diseases and future policy analyses.
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