[Dictatorship, Health and Propaganda: The National Immunization Program (PNI) and the media campaign for compulsory vaccination]. / Ditadura, Saúde e Propaganda: O Programa Nacional de Imunização (PNI) e a campanha midiática de vacinação obrigatória.

This article analyzes the films produced and broadcast between 1976 and 1978 by the National Agency and the Public Relations Office (ARP) for the campaign to publicize the mandatory vaccination that was instituted by the National Immunization Plan (PNI), created in 1975 and regulated by Decree No. 78,231 of August 12, 1976. The objective is to understand the narrative constructed through images and speeches aimed at convincing the population to make vaccination a culturally accepted practice. To achieve this, we examine the legislation on the subject during the period under analysis, namely the civil-military dictatorship. The dictatorial regime is approached based on the conceptual aspects that guide the analysis of the appropriation of health campaigns as propaganda and investments in a private and curative health model. We can therefore conclude that the initiative to create the PNI is a hiatus in this process of privatizing health, since it is not an action guided by the dictatorship's responsibility for the health of the population, but an action that involved the management of multiple actors in the health field, and which was embraced by the regime because it was a process directly linked to interests connected to the country's conservative modernization project.

Este artigo analisa os filmes produzidos e veiculados, entre 1976 e 1978, pela Agência Nacional e pela Assessoria de Relações Públicas (ARP) para a campanha de divulgação da vacinação obrigatória que foi instituída pelo Plano Nacional de Imunizações (PNI), criado em 1975, e regulamentado pelo Decreto nº 78.231, de 12 de agosto de 1976. O objetivo é compreender a narrativa construída através de imagens e discursos visando tornar a vacina uma prática culturalmente aceita. Para isso, recorre-se à legislação que versa sobre o tema no período analisado, qual seja na ditadura civil-militar. O regime ditatorial é abordado a partir dos aspectos conceituais que orientam as análises sobre a apropriação das campanhas de saúde como propaganda e dos investimentos em um modelo de saúde privada e curativista. Conclui-se, assim, que a iniciativa de criação do PNI trata-se de um hiato nesse processo de privatização da saúde, já que não é uma ação orientada pela responsabilidade da ditadura para com a saúde da população, mas sim, uma ação que envolveu a gerência de múltiplos atores do campo da saúde, e que foi encampada pelo regime por se tratar de um processo diretamente atrelado a interesses ligados ao projeto de modernização conservadora do país.

Possible counter-intuitive impact of local vaccine mandates for vaccine-preventable infectious diseases.

We modeled the impact of local vaccine mandates on the spread of vaccine-preventable infectious diseases, which in the absence of vaccines will mainly affect children. Examples of such diseases are measles, rubella, mumps, and pertussis. To model the spread of the pathogen, we used a stochastic SIR (susceptible, infectious, recovered) model with two levels of mixing in a closed population, often referred to as the household model. In this model, individuals make local contacts within a specific small subgroup of the population (e.g., within a household or a school class), while they also make global contacts with random people in the population at a much lower rate than the rate of local contacts. We considered what would happen if schools were given freedom to impose vaccine mandates on all of their pupils, except for the pupils that were exempt from vaccination because of medical reasons. We investigated first how such a mandate affected the probability of an outbreak of a disease. Furthermore, we focused on the probability that a pupil that was medically exempt from vaccination, would get infected during an outbreak. We showed that if the population vaccine coverage was close to the herd-immunity level, then both probabilities may increase if local vaccine mandates were implemented. This was caused by unvaccinated pupils possibly being moved to schools without mandates.

Newspaper Representation of Mandatory Vaccination Against COVID-19 for Healthcare Workers in England: A Qualitative Framing Analysis.

In 2021, vaccination against COVID-19 became mandatory for healthcare workers in England. The media coverage of the mandate was extensive and became an issue of public interest. This study aimed to understand the United Kingdom (UK) debate on mandatory COVID-19 vaccination through a framing analysis of UK media coverage. Articles written between November 2021 and April 2022 were identified from UK national newspapers: The Daily (and Sunday) Telegraph, the Times (and Sunday Times), the Guardian (and the Observer), the Independent, the Daily Mail (and Mail on Sunday), the Daily Mirror, the Daily Express, and the Sun. Articles were selected using eligibility criteria before framing analysis was undertaken. The sample included 204 articles. Safe Staffing, Treatment of Staff, Change in Covid Context, and Protect Patient Safety were identified as frames used to stimulate debate on the mandatory vaccination policy. Such frames established three broader concepts in the media: civil liberty theory, duty-based ethics, and social-vulnerability theory. This study analyzed how mandatory COVID-19 vaccination for healthcare workers in England was framed in the UK national media. The broader concepts built in the media heightened debate on the policy, creating a voluminous amount of coverage and criticism that may have played a role in the mandate's reversal.

Challenging Pandemic Law: From Vaccine Mandates to Judicial Review of Vaccine Approvals.

Over recent years, dozens of legal challenges have been instituted in response to government action during the COVID-19 pandemic. While public health orders have been challenged on several grounds, few cases have succeeded. Fewer cases still have called into question decisions made by the Therapeutic Goods Administration (TGA) to approve the COVID-19 vaccines. This section provides a brief update on one recent, partially successful COVID-19 health directions case before examining two applications in the Federal Court of Australia seeking judicial review of the TGA's approval of the COVID-19 vaccines. The section argues that, while both TGA applications were dismissed for lack of standing, they illustrate how and why third parties will ordinarily not be entitled to challenge administrative decisions about therapeutic goods.

Some issues of compulsory vaccination of adults.

Legal regulation, whether we want it or not, plays a role in protecting and promoting individual and public health. This also applies to legislation involving vaccination, especially compulsory vaccination. It is appropriate that legislation should not create barriers to the provision of health care. Where there is legal ambiguity, problems can arise that make the provision of health care more difficult, as we have seen, for example, in the context of the COVID pandemic. Furthermore, in the case of compulsory vaccination, there is a conflict between fundamental rights and freedoms. On the one hand, the right to the protection of personal freedom and bodily integrity, and on the other, the right to life and health. Most compulsory vaccinations concern children. As far as adult vaccination is concerned, this mainly includes compulsory vaccination of medical and social staff caring for patients and operating at biological risk, as well as patient groups also at risk of serious infectious disease. For these reasons, it is essential that the legislation is such that it does not impose a burden where it is not necessary and, on the contrary, allows for optimal protection of persons at biological risk.

The Compatibility of Mandatory Vaccination with the European Convention on Human Rights: Implications for a National Vaccination Policy.

This contribution examines the compatibility of mandatory vaccination with the European Convention on Human Rights (ECHR) through an analysis of the relevant ECHR rights and related case law of the European Court of Human Rights (ECtHR). By focusing on Article 8 (Right to Private Life), Article 2 (Right to Life) and Article 9 (Freedom of Thought, Conscience and Religion) ECHR, we formulate conditions under which mandatory vaccination legislation is justified. With that, this analysis aims to provide national legislators with guidance on responsible legislative policy. Additionally, this article discusses the legal framework underlying the Dutch vaccination policy, including developments therein since COVID-19. Furthermore, the role of the European Union in the context of vaccination is briefly discussed. The importance of an extensive societal and parliamentary debate before implementing a mandatory vaccination policy is stressed, as is the need for proportionality in enforcement.

Did the health care vaccine mandate work? An evaluation of the impact of the COVID-19 vaccine mandate on vaccine uptake and infection risk in a large cohort of Canadian health care workers.

BACKGROUND: We aimed to evaluate the impact of health care vaccine mandates on vaccine uptake and infection risk in a cohort of Canadian health care workers (HCWs). METHODS: We conduct interrupted time series analysis through a regression discontinuity in time approach to estimate the immediate and delayed impact of the mandate. Multilevel mixed effect modeling fitted with restricted maximum likelihood was used to estimate impact on infection risk. RESULTS: The immediate and sustained effects of the mandate was a 0.19% (P < .05) and a 0.012% (P < .05) increase in the daily proportion of unvaccinated HCWs getting their first dose, respectively. An additional 623 (95% confidence interval: 613-667) HCWs received first doses compared to the predicted uptake absent the mandate. Adjusted test positivity declined by 0.053% (95% confidence interval: 0.035%, 0.069) for every additional day the mandate was in effect. DISCUSSION: Our results indicate that the mandate was associated with significant increases in vaccine uptake and infection risk reduction in the cohort. CONCLUSIONS: Given the benefit that vaccination could bring to HCWs, understanding strategies to enhance uptake is crucial for bolstering health system resilience, but steps must be taken to avert approaches that sacrifice trust, foster animosity, or exacerbate staffing constraints for short-term results.

Compulsory vaccination of children - medical and legal problems.

Regarding the vaccination of children, it can be said that there are basically three vaccination policies in the world, one of which is usually used in particular country depending on the national legislation. These are the mandatory vaccination policy, mandatory vaccination policy for school entry and recommended vaccination policy. The mandatory vaccination policy and the mandatory vaccination policy for school entry face obstacles consisting of conflicts between fundamental human rights and freedoms. This is, for example, a conflict between the right to health and the right to life on the one hand and the right to protect the inviolability of the person and body integrity or the right to personal freedom, freedom of movement, residence, etc., on the other. Another issue is the right to undisrupted school attendance, based on both compulsory schooling and the right to education. This article looks at different approaches to the vaccination of children in different countries. It provides an illustrative comparison of approaches to vaccination of children in selected countries. It is obvious that the essential problems with organizing and ensuring the vaccination of children are and will be associated with the indicated conflicts of fundamental human rights. It is therefore necessary to search and try to find the optimal policy for undergoing the necessary vaccinations and thereby creating herd immunity, of course for those infectious diseases where this is possible. These efforts are necessary for sufficiently effective protection of individual and public health.

US state vaccine mandates did not influence COVID-19 vaccination rates but reduced uptake of COVID-19 boosters and flu vaccines compared to bans on vaccine restrictions.

During the COVID-19 pandemic, some US states mandated vaccination for certain citizens. We used state-level data from the CDC to test whether vaccine mandates predicted changes in COVID-19 vaccine uptake, as well as related voluntary behaviors involving COVID-19 boosters and seasonal influenza vaccines. Results showed that COVID-19 vaccine adoption did not significantly change in the weeks before and after states implemented vaccine mandates, suggesting that mandates did not directly impact COVID-19 vaccination. Compared to states that banned vaccine restrictions, however, states with mandates had lower levels of COVID-19 booster adoption as well as adult and child flu vaccination, especially when residents initially were less likely to vaccinate for COVID-19. This research supports the notion that governmental restrictions in the form of vaccination mandates can have unintended negative consequences, not necessarily by reducing uptake of the mandated vaccine, but by reducing adoption of other voluntary vaccines.

Medical exemptions to mandatory vaccinations: The state of play in Australia and a pressure point to watch.

Australia's mandatory vaccination policies have historically allowed for non-medical exemptions (NMEs), but this changed in 2016 when the Federal Government discontinued NMEs for childhood vaccination requirements. Australian states introduced further mandatory vaccination policies during the COVID-19 pandemic for a range of occupations including healthcare workers (HCWs). There is global evidence to suggest that medical exemptions (MEs) increase following the discontinuation of NMEs; the new swathe of COVID-19 mandatory vaccination policies likely also placed further pressure on ME systems in many jurisdictions. This paper examines the state of play of mandatory vaccination and ME policies in Australia by outlining the structure and operation of these policies for childhood vaccines, then for COVID-19, with a case study of HCW mandates. Next, the paper explores HCWs' experiences in providing vaccine exemptions to patients (and MEs in particular). Finally, the paper synthesizes existing literature and reflects on the challenges of MEs as a pressure point for people who do not want to vaccinate and for the clinicians who care for them, proposing areas for future research and action.

Vaccine mandates for prospective versus existing employees: reply to Smith.

Employment-based vaccine mandates have worse consequences for existing than prospective employees. Prospective employees are not yet dependent on a particular employment arrangement, so they are better positioned to respond to such mandates. Yet despite this asymmetry in consequences, Smith argues that if vaccine mandates are justified for prospective employees, they are similarly justified for existing employees. This paper responds to Smith's argument. First, Smith holds that bona fide occupational requirements are actions that are necessary for the safe and effective completion of one's job. As such, they apply to existing and prospective employees alike. However, I argue that the existence of effective alternative interventions precludes vaccination from being considered a bona fide occupational requirement under current circumstances. Second, Smith holds that if a requirement is justified for prospective employees, it is justified for existing employees, despite the asymmetry in consequences. However, I argue that since vaccination is not a bona fide requirement, the asymmetry in the harms of mandates experienced by prospective versus existing employees entails an asymmetry in the justification required to mandate vaccination for each group. As such, vaccination can be considered a requirement for prospective employees while not being required for existing employees.

Compulsory Vaccination Coverage in 12 Sub-Saharan African Countries Two Years Following the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is a global threat, challenging health services' provision and utilization. This study aimed to assess compulsory vaccination coverage in 12 Sub-Saharan African countries two years following the COVID-19 pandemic using the Health Belief Model. A cross-sectional survey was conducted from November 1 to December 15, 2022. Multivariate logistic regression was conducted to identify the determinants of vaccination coverage. Among the 5032 respondents, 73.1% reported that their children received compulsory vaccination. The lowest coverage was observed in Ghana (36.5%), while the highest was in Burkina Faso and Congo (92.0%). Factors associated with non-vaccination included older mothers (adjusted odds ratio (AOR) = 1.04, 95%CI: 1.03-1.05), lower mothers' education, older children (AOR = 0.76, 95%CI: 0.60-0.96), children with chronic illnesses (AOR = 0.55, 95%CI: 0.45-0.66), and difficult accessibility to healthcare facilities (AOR = 11.27, 95%CI: 9.48-13.44). Low perceived risk, in which non-vaccinated children were believed to be at no higher risk for infectious diseases and the disease severity would not worsen among non-vaccinated children, increased the likelihood of non-vaccination (AOR = 2.29, 95%CI: 1.75-2.99 and AOR = 2.12, 95%CI: 1.64-2.73, respectively). Perceiving vaccines as unnecessary, and needless for breastfed babies increased the probability of non-vaccination (AOR = 1.38, 95%CI: 1.10-1.73 and AOR = 1.69, 95%CI: 1.31-2.19, respectively). Higher odds of non-vaccination were found when the provision of vaccine information did not motivate parents to vaccinate their children (AOR = 4.29, 95%CI: 3.15-5.85). Conversely, believing that vaccines were safe for children decreased the odds of non-vaccination (AOR = 0.72, 95%CI: 0.58-0.88). Parental perceptions and concerns should be considered in interventions aiming to increase compulsory vaccine acceptance and coverage.

Effectiveness of COVID-19 vaccine mandates in raising vaccination rates among the elderly and general population in Europe: Controlled interrupted time series analysis.

BACKGROUND: During the COVID-19 pandemic, three European countries (Austria, Greece, Italy) announced and/or implemented mandatory COVID-19 vaccination for high-risk groups in the general population. Besides the ethical justification for this policy, it is important to assess and quantify the effectiveness of the mandate in raising vaccination rates. METHODS: Controlled interrupted time series analysis of first-dose vaccination rates in the targeted age groups (Greece: ≥60 years; Italy: ≥50 years) relative to a control group (Greece: 50-59 years; Italy: 25-49 years) between week 35/2021 and week 50/2022. For Austria an uncontrolled analysis was performed, as the vaccine mandate targeted all adults ≥18 years. RESULTS: Announcement of mandatory vaccination substantially increased vaccination rates in the targeted age groups compared to control in both Greece (RR = 4.36, 95 % CI: 3.57-5.32) and Italy (RR = 2.90, 95 % CI: 2.37-3.56), an effect which persisted throughout the study period. There were 176,428 (95 % CI: 164,097-187,226) mandate-attributable first-dose vaccinations in Greece and 316,192 (95 % CI: 282,467-346,678) in Italy, most of which occurred before the mandate came into effect. In Austria no discernible increase in vaccination rates was observed after the announcement of mandatory vaccination. At the end of the study period, 9.5 % of ≥60 year-olds in Greece, 4.9 % of ≥50 year-olds in Italy and 13.8 % of ≥18 year-olds in Austria remained unvaccinated. CONCLUSIONS: In Greece and Italy - though not in Austria - simple announcement of a vaccine mandate rapidly increased COVID-19 vaccination rates in the targeted age groups, without fully closing the vaccination gap. Mandatory vaccination appears to effectively target complacency but not vaccine hesitancy, and its public health benefits need to be weighted against possible detrimental effects on confidence and trust.

Ethics of college vaccine mandates, using reasonable comparisons.

In the paper 'COVID-19 vaccine boosters for young adults: a risk-benefit assessment and ethical analysis of mandate policies at universities,' Bardosh et al argued that college mandates of the COVID-19 booster vaccine are unethical. The authors came to this conclusion by performing three different sets of comparisons of benefits versus risks using referenced data and argued that the harm outweighs the risk in all three cases. In this response article, we argue that the authors frame their arguments by comparing values that are not scientifically or reasonably comparable and that the authors used values that represent grossly different risk profiles and grouped them into a set of figures to create an illusion of fair comparisons. We argue that absent the falsely skewed portrayals of a higher level of risk over benefit in their misrepresented figures, the five ethical arguments they presented completely fall apart.

The Double Democratic Bind: Challenges to Enacting Mandates and Combating Misinformation.

CONTEXT: Wealthy countries vary considerably in terms of how well they have been able to inoculate their populations against COVID-19. In particular, democracies have been constrained in their abilities to implement vaccine mandates, given enshrined protections of civil liberties and individual freedom in such regimes. While scholars have begun addressing the democratic constraint on vaccine mandates, less attention has been paid to the additional challenges democracies face in constraining the spread of vaccine misinformation-particularly misinformation that spreads online. METHODS: This study combines large-N cross-country analysis with a case study of Germany to illustrate the "double bind" that democracies face when it comes to containing both the spread of disease and the spread of misinformation through social media. FINDINGS: The cross-national analysis confirms that democracies have been less likely to enact vaccine mandates, and they have also been relatively more hesitant to restrict what people can see and share online. The case study of Germany highlights the normative and the procedural constraints underlying such decisions. CONCLUSIONS: These findings show that resources are often not the binding constraint on effective disease control, raising questions regarding the ability of high-income democracies to respond effectively to future public health emergencies.

COVID-19 Vaccine Mandates and Vaccine Hesitancy among Black People in Canada.

OBJECTIVES: COVID-19 vaccine mandates increased vaccination rates globally. Implemented as a one-size-fits-all policy, these mandates have unintended harmful consequences for many, including Black Canadians. This article reports findings on the interconnectedness of vaccine mandates and vaccine hesitancy by describing a range of responses to mandatory COVID-19 vaccination policies among Black people in Canada. METHODS: Using qualitative research methods, semi-structured interviews with 36 Black people living in Canada aged 18 years and over across 6 provinces in Canada were conducted. Participants were selected across intersectional categories including migration status, income, religion, education, sex, and Black ethnicity. Thematic analysis informed the identification of key themes using Foucauldian notions of biopower and governmentality. RESULTS: Our results show how the power relations present in the ways many Black people actualize vaccine intentions. Two main themes were identified: acceptance of the COVID-19 vaccine in the context of governmentality and resistance to vaccine mandates driven by oppression, mistrust, and religion. CONCLUSION: COVID-19 vaccine mandates may have reinforced mistrust of the government and decreased confidence in the COVID-19 vaccine. Policy makers need to consider non-discriminatory public health policies and monitor how these policies are implemented over time and across multiple sectors to better understand vaccine hesitancy.