Intended for healthcare professionals

Letters Case for mandatory vaccination

Debating the future of mandatory vaccination

BMJ 2017; 358 doi: (Published 07 September 2017) Cite this as: BMJ 2017;358:j4100
  1. Emma Cave, professor of healthcare law
  1. Durham Law School, Palatine Centre, Durham University, Durham DH1 3LE, UK
  1. emma.cave{at}

Mandatory vaccination should be debated before an epidemic or public health emergency to assure that public health law is graduated and proportionate.1

Mandated vaccination of children is not currently warranted in light of the current levels of herd immunity. Important historical lessons on the efficacy of legal mandate flow from the vaccination acts of the 19th century. A more moderate approach was recommended in Lord Herschell’s 1896 royal commission and reflected in the Vaccination Act 1898.

The issue of avoidable harm applies to both vaccinated and unvaccinated people, especially in light of the June 2017 ruling of the European Court of Justice that circumstantial evidence, such as the timing of the onset of disease, can support the link between vaccination and subsequent disease.2

Two matters might tip the balance in favour of enhanced measures of compulsion.3 One is development of child welfare arguments. This focuses on the best interests of the child rather than the public interest in herd immunity. Courts in England and Wales already favour vaccination in cases of parental dispute, even (in one case) if the adolescent children object. The other is a fall in vaccine uptake or rise in infection. The spectre of epidemics and pandemics can warrant emergency measures and threaten the proportionality of the response (and civil liberties).

It is good to see the BMA debate these matters.1 The debate should extend beyond what is appropriate today to encompass the circumstances in which degrees of compulsion would be defensible.


  • Competing interests: None declared.

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