Intended for healthcare professionals

Head To Head Head to Head

Should measles vaccination be compulsory?

BMJ 2019; 365 doi: (Published 05 June 2019) Cite this as: BMJ 2019;365:l2359
  1. Eleanor Draeger, sexual health doctor and medical writer1,
  2. Helen E Bedford, professor of children’s health2,
  3. David A C Elliman, consultant paediatrician3
  1. 1Gravesend
  2. 2UCL Great Ormond Street Institute of Child Health, London
  3. 3Great Ormond Street Hospital, London
  1. Correspondence to: E Draeger elsdraeger{at}, David A C Elliman david.elliman{at}
    Follow Eleanor Draeger on Twitter: @elsdraeger

Making MMR vaccination mandatory would still allow parents to choose not to vaccinate their children while protecting those attending schools or nurseries, says Eleanor Draeger. But Helen Bedford and David Elliman worry that such a step might lead to unintended consequences and recommend exploring potential obstacles to vaccine uptake first

Yes—Eleanor Draeger

Unicef published a sobering report on vaccination in 2018,1 and in April 2019 it showed that an estimated 169 million children had missed out on a first dose of the measles vaccine from 2010 to 2017—21.1 million children a year on average, which includes more than 500 000 children in the UK alone.12

The latest report on uptake of the measles, mumps, and rubella (MMR) vaccine in the UK is 94.9% for the first dose, but this drops to 87.2% for the second dose,3 which falls short of the 95% needed to produce herd immunity. If vaccination rates continue to decline we run the risk of measles becoming endemic again.

Above and beyond free access to government recommended vaccines, which we already have in the UK, there are many ways to increase vaccination rates. These broadly fit into three categories: education (including communication and public engagement), incentives, and legislation.4 Education is the most widely practised, but legitimate online sources on vaccination must compete with fake news and “antivax” rhetoric. An online study in 2010 found that viewing a website criticising vaccines for five to 10 minutes increased people’s perception of risk from vaccinations and decreased the intention to vaccinate.5

Punitive policies

In Europe, vaccination is compulsory for at least one childhood disease in 11 countries, nine of which include measles. Italy increased its number of compulsory vaccinations from four to 10 in July 2017, …

View Full Text

Log in

Log in through your institution


* For online subscription