A vaccination policy is a health policy adopted in order to prevent the spread of infectious disease. These policies are generally put into place by state or local governments, but may also be set by private facilities, such as workplaces or schools. Many policies have been developed and implemented since vaccines were first made widely available. The main purpose of implementing a vaccination policy is complete eradication of a disease, as was done with smallpox. This, however, can be a difficult feat to accomplish or even confirm. Many governmental public health agencies (such as the CDC or ECDC) rely on vaccination policies to create a herd immunity within their populations. Immunization advisory committees are usually responsible for providing those in leadership positions with information used to make evidence-based decisions regarding vaccines and other health policies. Vaccination policies vary from country to country, with some mandating them and others strongly recommending them. Some places only require them for people utilizing government services, like welfare or public schools. A government or facility may pay for all or part of the costs of vaccinations, such as in a national vaccination schedule, or job requirement. Cost-benefit analyses of vaccinations have shown that there is an economic incentive to implement policies, as vaccinations save the State time and money by reducing the burden preventable diseases and epidemics have on healthcare facilities and funds.
Goals
Individual and herd immunity
Vaccination policies aim to produce immunity to preventable diseases. Besides individual protection from getting ill, some vaccination policies also aim to provide the community as a whole with herd immunity. Herd immunity refers to the idea that the pathogen will have trouble spreading when a significant part of the population has immunity against it, reducing the effect an infectious disease has on society. This protects those unable to get the vaccine due to medical conditions, such as immune disorders. However, for herd immunity to be effective in a population, a majority of those who are vaccine-eligible must be vaccinated. Vaccine-preventable diseases remain a common cause of childhood mortality with an estimated three million deaths each year. Every year, vaccination prevents between two and three million deaths worldwide, across all age groups, from diphtheria, tetanus, pertussis and measles.
Eradication of diseases
With some vaccines, a goal of vaccination policies is to eradicate the disease – disappear it from Earth altogether. The World Health Organization (WHO) coordinated the effort to eradicate smallpox globally through vaccination, the last naturally occurring case of smallpox was in Somalia in 1977. Endemic measles, mumps and rubella have been eliminated through vaccination in Finland. On 14 October 2010, the UN Food and Agriculture Organization declared that rinderpest had been eradicated. The WHO is currently working to eradicate polio, which was eliminated in Africa in August 2020 and remained only in Pakistan and Afghanistan at the time.
Individual versus group goals The likely behavior of individuals when offered vaccines can be modeled economically using ideas from game theory. According to such models, individuals will attempt to minimize the risk of illness, and may seek vaccination for themselves or their children if they perceive a high threat of disease and a low risk to vaccination. However, if a vaccination program successfully reduces the disease threat, it may reduce the perceived risk of disease enough so that an individual's optimal strategy is to encourage everyone but their family to be vaccinated, or (more generally) to refuse vaccination once vaccination rates reach a certain level, even if this level is below that optimal for the community. For example, a 2003 study predicted that a bioterrorist attack using smallpox would result in conditions where voluntary vaccination would be unlikely to reach the optimum level for the U.S. as a whole, and a 2007 study predicted that severe influenza epidemics cannot be prevented by voluntary vaccination without offering certain incentives. Governments often allow exemptions to mandatory vaccinations for religious or philosophical reasons, but decreased rates of vaccination may cause loss of herd immunity, substantially increasing risks even to vaccinated individuals. However, mandatory vaccination policies raise ethical issues regarding parental rights and informed consent. Fractional dose vaccination is a strategy that trades societal benefit for individual vaccine efficacy, has proven to be effective in randomized trials in poverty diseases, and in epidemiologic models was thought to hold a significant potential for shortening the COVID-19 pandemic when vaccine supply is limited.
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