<p class="first" id="d157943e184">Globally, infant and childhood vaccine uptake rates
are not high enough to control
vaccine preventable diseases, with outbreaks occurring even in high-income countries.
This has led a number of high-, middle-and low income countries to enact, strengthen
or contemplate mandatory infant and/or childhood immunization to try to address the
gap. Mandatory immunization that reduces or eliminates individual choice is often
controversial. There is no standard approach to mandatory immunization. What vaccines
are included, age groups covered, program flexibility and rigidity e.g. opportunities
for opting out, penalties or incentives, degree of enforcement, and whether a compensation
program for causally associated serious adverse events following immunization exists
vary widely. We present an overview of mandatory immunization with examples in two
high- and one low-income countries to illustrate variations, summarize limited outcome
data related to mandatory immunization, and suggest key elements to consider when
contemplating mandatory infant and/or child immunization. Before moving forward with
mandatory immunization, governments need to assure financial sustainability, uninterrupted
supply and equitable access to all the population. Other interventions may be more
effective and less intrusive than mandatory. If mandatory is implemented, this needs
to be tailored to fit the context and the country's culture.
</p>