Intended for healthcare professionals

Head To Head

Should childhood vaccination be mandatory? No

BMJ 2012; 344 doi: (Published 15 May 2012) Cite this as: BMJ 2012;344:e2435
  1. David M Salisbury, director of immunisation
  1. 1Department of Health, London SE1 8UG, UK
  1. david.salisbury{at}

Paul Offit (doi:10.1136/bmj.e2434) believes that mandatory vaccination is needed to protect vulnerable people from infection, but David Salisbury argues that there are more workable ways to ensure high uptake

Mandatory vaccination in the UK was attempted first in the 19th century.1 The legislation was ineffective, discriminated in favour of those able to use the exemptions, and was divisive; it fostered substantial anti-vaccine sentiment and was counterproductive. Attempts to impose compulsion today would undoubtedly be challenged in terms of autonomy, inappropriate intrusion of the state, availability of choice, and parental rights and responsibilities. Bolstered by access to information, its unacceptability to the public would be likely to have the same consequences.

Two questions need to be answered: do we need mandatory vaccination and are there examples of it being beneficial?

Compulsion is unnecessary

I presume that the purpose of mandatory vaccination is to raise coverage. If coverage is sufficiently high, compulsion is not needed. If coverage were not adequately high, other interventions are more likely to be successful than compulsion. We have reasonable ideas of what “sufficiently high” means: polio outbreaks do not occur when coverage is consistently above 80% in …

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