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1.
BMC Public Health ; 24(1): 1514, 2024 Jun 05.
Article En | MEDLINE | ID: mdl-38840254

BACKGROUND: Mandates provide a relatively cost-effective strategy to increase vaccinate rates. Since 2014, five Australian states have implemented No Jab No Play (NJPlay) policies that require children to be fully immunised to attend early childhood education and childcare services. In Western Australia, where this study was conducted, NJNPlay legislation was enacted in 2019. While most Australian families support vaccine mandates, there are a range of complexities and unintended consequences for some families. This research explores the impact on families of the NJNPlay legislation in Western Australia (WA). METHODS: This mixed-methods study used an online parent/carer survey (n = 261) representing 427 children and in-depth interviews (n = 18) to investigate: (1) the influence of the NJNPlay legislation on decision to vaccinate; and (2) the financial and emotional impacts of NJNPlay legislation. Descriptive and bivariate tests were used to analyse the survey data and open-ended questions and interviews were analysed using reflexive thematic analysis to capture the experience and the reality of participants. RESULTS: Approximately 60% of parents intended to vaccinate their child. Parents who had decided not to vaccinate their child/ren were significantly more likely to experience financial [p < 0.001] and emotional impacts [p < 0.001], compared to those who chose to vaccinate because of the mandate. Qualitative data were divided with around half of participants supporting childhood immunisation and NJNPlay with others discussing concerns. The themes (a) belief in the importance of vaccination and ease of access, (b) individual and community protection, and (c) vaccine effectiveness, safety and alternatives help understand how parents' beliefs and access may influence vaccination uptake. Unintended impacts of NJNPlay included: (a) lack of choice, pressure and coercion to vaccinate; (b) policy and community level stigma and discrimination; (c) financial and career impacts; and (d) loss of education opportunities. CONCLUSIONS: Parents appreciation of funded immunisation programs and mandates which enhance individual and community protection was evident. However for others unintended consequences of the mandate resulted in significant social, emotional, financial and educational impacts. Long-term evidence highlights the positive impact of immunisation programs. Opinions of impacted families should be considered to alleviate mental health stressors.


Parents , Humans , Western Australia , Parents/psychology , Female , Male , Adult , Child, Preschool , Surveys and Questionnaires , Qualitative Research , Child , Vaccination/legislation & jurisprudence , Vaccination/psychology , Vaccination/statistics & numerical data , Infant , Middle Aged
2.
J Law Health ; 37(2): 127-161, 2024.
Article En | MEDLINE | ID: mdl-38833599

Humans have been a communal species since inception and continue to be so to this day. Because of this, if even a small scale of a measured population becomes severely ill, the entire remaining population and surrounding area is thrown into absolute chaos. In fact, we have seen these circumstances throughout history and in the recent COVID-19 pandemic yet, some of us have forgotten that the only way this chaos can be curbed, is by enacting a mandatory vaccination policy. Since COVID-19 however, vaccination mandates have become an uneasy topic of conversation in the United States for essentially one main reason, some U.S citizens do not like to be told what to do with their body and what to place inside it, further believing their bodily autonomy to be absolute. Data shows that this ideology recently became more widespread from an increase of mistrust of government and pharmaceutical companies, and from political beliefs and affiliations. Nevertheless, what the data also shows is that these same individuals were asserting their right to bodily autonomy against a vaccination mandate in an unduly aggressive manner, and on a very erroneous understanding of the governing jurisprudence, policies and modern scientific data surrounding said vaccination mandates and large scale disease outbreaks. This article therefore aims to provide a clear and extensive understanding of the proposition that, while bodily autonomy is favored in other aspects of life, this right can fail with respect to deadly disease outbreaks and mandatory vaccinations as there is presently no other practical or feasible alternative. Specifically, this article introduces and/or reminds the U.S. public of well-established governing case law, relevant historical and scientific information and the pertinent legislative authority surrounding vaccines, bodily autonomy, and vaccination mandates.


COVID-19 , Mandatory Programs , Personal Autonomy , Vaccination , Humans , Mandatory Programs/legislation & jurisprudence , COVID-19/prevention & control , COVID-19/epidemiology , United States , Vaccination/legislation & jurisprudence , COVID-19 Vaccines/administration & dosage , SARS-CoV-2
4.
J Law Med Ethics ; 52(1): 52-61, 2024.
Article En | MEDLINE | ID: mdl-38818609

This paper challenges historically preconceived notions surrounding a minor's ability to make medical decisions, arguing that federal health law should be reformed to allow minors with capacity as young as age 12 to consent to their own Centers for Diseases Control and Prevention (CDC)-approved COVID-19 vaccinations. This proposal aligns with and expands upon current exceptions to limitations on adolescent decision-making. This analysis reviews the historic and current anti-vaccination sentiment, examines legal precedence and rationale, outlines supporting ethical arguments regarding adolescent decision-making, and offers rebuttals to anticipated ethical counterarguments.


COVID-19 Vaccines , COVID-19 , Informed Consent By Minors , Humans , Adolescent , United States , Child , COVID-19/prevention & control , Informed Consent By Minors/legislation & jurisprudence , Informed Consent By Minors/ethics , Vaccination/legislation & jurisprudence , Vaccination/ethics , Informed Consent/legislation & jurisprudence , Minors/legislation & jurisprudence , Centers for Disease Control and Prevention, U.S. , SARS-CoV-2 , Decision Making
5.
J Law Med Ethics ; 52(1): 62-64, 2024.
Article En | MEDLINE | ID: mdl-38818597

Policies allowing some minors to consent to receive recommended vaccines are ethically defensible. However, a policy change at the federal level expanding minor consent for vaccinations nationwide risks triggering a political backlash. Such a move may be perceived as infringing on the rights of parents to make decisions about their children's health care. In the current post-COVID environment of heightened anti-vaccination activism, changes to minor consent laws may be unadvisable, and policy makers should proceed with caution.


Vaccination , Adolescent , Child , Humans , Anti-Vaccination Movement , COVID-19/prevention & control , Health Policy/legislation & jurisprudence , Informed Consent/legislation & jurisprudence , Informed Consent/ethics , Informed Consent By Minors/legislation & jurisprudence , Informed Consent By Minors/ethics , Minors/legislation & jurisprudence , Politics , United States , Vaccination/ethics , Vaccination/legislation & jurisprudence
6.
Cad Saude Publica ; 40(4): e00086823, 2024.
Article En | MEDLINE | ID: mdl-38695454

The aim was to analyze the perception of Brazilian federal judges on the implications of COVID-19 vaccination. A study was carried out with Brazilian federal judges, who received a survey designed with multiple-choice questions on COVID-19 vaccination, covering topics such as its mandatory aspect, the application of coercive measures, hesitation to vaccinate, priority groups, the duties of Brazilian Health Regulatory Agency (Anvisa, acronym in Portuguese), the role of the Judiciary branch, and immunity passports. A total of 254 out of 1,300 federal judges from all states responded to the survey. Most respondents have a Bachelor's degree or a specialization (59.1%) and have been judges for more than 10 years (63.8%). A great majority of the judges (87.7%) agree with vaccine mandates for adults and for children and adolescents (66.1%). Over 75% of judges believe that all levels of government can impose sanctions on those who refuse to get vaccinated. The judges trust vaccination 93% of the time, 56.1% reject anti-vaccination movements, and 75.2% believe that Anvisa duties should be respected. The Judiciary branch actions concerning the COVID-19 pandemic are approved by 62.6% of judges, and 88.2% support immunity passports. There is a direct connection among mandatory vaccination, trust in the vaccine, and the adoption of immunity passports. Most federal judges agree with vaccine mandates for children and adults, support the application of sanctions for vaccination refusal, disapprove of anti-vaccination movements, agree with Anvisa's duties, and support judicial intervention in relation to the COVID-19 pandemic.


COVID-19 Vaccines , COVID-19 , Vaccination , Humans , Brazil , COVID-19/prevention & control , Vaccination/legislation & jurisprudence , Adult , Female , Male , Surveys and Questionnaires , SARS-CoV-2 , Vaccination Hesitancy , Middle Aged , Federal Government , Pandemics/prevention & control
7.
Eur J Health Law ; 31(3): 285-311, 2024 Apr 30.
Article En | MEDLINE | ID: mdl-38704150

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.


European Union , Health Policy , Human Rights , Mandatory Programs , Vaccination , Humans , Human Rights/legislation & jurisprudence , Mandatory Programs/legislation & jurisprudence , Vaccination/legislation & jurisprudence , Health Policy/legislation & jurisprudence , COVID-19/prevention & control , Netherlands , Mandatory Vaccination
8.
Perspect Biol Med ; 67(1): 96-113, 2024.
Article En | MEDLINE | ID: mdl-38662066

This essay explores a more inclusive and equitable interpretation of "religion" within the context of religious vaccine exemptions. The existing literature critiques the prevalent interpretation of the meaning of religion in religious exemption cases, but frequently overlooks the importance of incorporating the concept of "lived religion." This essay introduces the concept of lived religion from religious studies, elucidates why this lived religion approach is crucial for redefining "religion," and illustrates its application in the domain of religious vaccine exemptions. The author contends that broadening the meaning of religion by employing the concept of lived religion would promote a more inclusive and equitable implementation of religious vaccine exemptions.


Religion and Medicine , Humans , Religion , Vaccination/psychology , Vaccination/legislation & jurisprudence , Vaccines , Vaccination Refusal/psychology
10.
JAMA ; 330(7): 589-590, 2023 08 15.
Article En | MEDLINE | ID: mdl-37486681

This Viewpoint discusses how federal vaccine requirements have helped thwart vaccine-preventable diseases as well as how growing public resistance to vaccines and judicial and legislative limits to vaccination mandates may change that.


Immunization Programs , Mandatory Programs , Public Health , Vaccination , Vaccines , Immunization Programs/legislation & jurisprudence , Immunization Programs/methods , Mandatory Programs/legislation & jurisprudence , Public Health/legislation & jurisprudence , Public Health/methods , Vaccination/legislation & jurisprudence , Vaccination/methods , Vaccines/therapeutic use
13.
West J Emerg Med ; 23(4): 570-578, 2022 Jul 11.
Article En | MEDLINE | ID: mdl-35980411

INTRODUCTION: Unvaccinated emergency medical services (EMS) personnel are at increased risk of contracting coronavirus disease 2019 (COVID-19) and potentially transmitting the virus to their families, coworkers, and patients. Effective vaccines for the severe acute respiratory syndrome coronavirus 2 virus exist; however, vaccination rates among EMS professionals remain largely unknown. Consequently, we sought to document vaccination rates of EMS professionals and identify predictors of vaccination uptake. METHODS: We conducted a cross-sectional survey of North Carolina EMS professionals after the COVID-19 vaccines were widely available. The survey assessed vaccination status as well as beliefs regarding COVID-19 illness and vaccine effectiveness. Prediction of vaccine uptake was modeled using logistic regression. RESULTS: A total of 860 EMS professionals completed the survey, of whom 74.7% reported receiving the COVID-19 vaccination. Most respondents believed that COVID-19 is a serious threat to the population, that they are personally at higher risk of infection, that vaccine side effects are outweighed by illness prevention, and the vaccine is safe and effective. Despite this, only 18.7% supported mandatory vaccination for EMS professionals. Statistically significant differences were observed between the vaccinated and unvaccinated groups regarding vaccine safety and effectiveness, recall of employer vaccine recommendation, perceived risk of infection, degree of threat to the population, and trust in government to take actions to limit the spread of disease. Unvaccinated respondents cited reasons such as belief in personal health and natural immunity as protectors against infection, concerns about vaccine safety and effectiveness, inadequate vaccine knowledge, and lack of an employer mandate for declining the vaccine. Predictors of vaccination included belief in vaccine safety (odds ratio [OR] 5.5, P=<0.001) and effectiveness (OR 4.6, P=<0.001); importance of vaccination to protect patients (OR 15.5, P=<0.001); perceived personal risk of infection (OR 1.8, P=0.04); previous receipt of influenza vaccine (OR 2.5, P=0.003); and sufficient knowledge to make an informed decision about vaccination (OR 2.4, P=0.024). CONCLUSION: In this survey of EMS professionals, over a quarter remained unvaccinated for COVID-19. Given the identified predictors of vaccine acceptance, EMS systems should focus on countering misinformation through employee educational campaigns as well as on developing policies regarding workforce immunization requirements.


COVID-19 Vaccines , COVID-19 , Emergency Medical Services , Health Personnel , Vaccination , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/supply & distribution , Cross-Sectional Studies , Decision Making , Health Personnel/psychology , Health Personnel/statistics & numerical data , Health Surveys , Humans , Influenza Vaccines/administration & dosage , North Carolina , Occupational Health , Patient Safety , Vaccination/legislation & jurisprudence , Vaccination/psychology , Vaccination/statistics & numerical data
14.
J UOEH ; 44(2): 177-184, 2022.
Article Ja | MEDLINE | ID: mdl-35660683

Several types of SARS-Cov-2 vaccine have been quickly developed and officially approved for emergency use in accordance with the Pharmaceutical Act. Mass vaccination in workplaces in Japan was subsequently promoted, targeting health care workers and senior citizens. We overviewed the pathophysiology of COVID-19 and reviewed reports containing fatal outcomes, compensation programs, and remedial measures for health damage after vaccinations, in relation to their relevant legislations. The Immunization Act was amended prior to the mass vaccination to authorize the indemnity agreement between the government and pharmaceutical companies to compensate for losses based on health damages after vaccination. Pursuant to the Civil Code and the State Redress Act, employers reserve the right to obtain reimbursement when they are liable to pay compensation for damages inflicted on a third party. There are no provisions to exclude healthcare workers and occupational health staff who participated in practical procedures from lawsuits and liability. We propose legislative reformation and careful contracts with responsible organizations concerned with emergency vaccinations in order to confront forthcoming new or re-emerging infections beyond this pandemic.


COVID-19 Vaccines , Vaccination , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , Humans , Japan , Vaccination/adverse effects , Vaccination/legislation & jurisprudence , Workers' Compensation , Workplace
15.
Vaccine ; 40(26): 3540-3545, 2022 06 09.
Article En | MEDLINE | ID: mdl-35581098

School-based vaccine mandates improve vaccination coverage in children. We conducted a cross-sectional survey of parents in New York City (NYC) in November 2021 to measure acceptability of COVID-19 vaccine mandates for students, and for teachers and school staff. Random address-based sampling was used to recruit parents of children 5-11 years of age. Among 2,506 parents surveyed, 44.3% supported school-based vaccine mandates for students and 69.1% supported mandates for teachers and school staff. Asian parents, male parents, those with higher income, college education, those voting for the 2021 Democratic mayoral candidate and parents from Manhattan were most likely to support vaccine mandates for students. Among all parents, 25.1% said they would not vaccinate their child if required. Our data show only modest support for school-based COVID-19 vaccine mandates for children despite their importance in improving vaccination coverage.


COVID-19 Vaccines , Mandatory Programs , Parents , Vaccination , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , New York City/epidemiology , Parents/psychology , Schools , Vaccination/legislation & jurisprudence
16.
BMJ Glob Health ; 7(5)2022 05.
Article En | MEDLINE | ID: mdl-35618306

Vaccination policies have shifted dramatically during COVID-19 with the rapid emergence of population-wide vaccine mandates, domestic vaccine passports and differential restrictions based on vaccination status. While these policies have prompted ethical, scientific, practical, legal and political debate, there has been limited evaluation of their potential unintended consequences. Here, we outline a comprehensive set of hypotheses for why these policies may ultimately be counterproductive and harmful. Our framework considers four domains: (1) behavioural psychology, (2) politics and law, (3) socioeconomics, and (4) the integrity of science and public health. While current vaccines appear to have had a significant impact on decreasing COVID-19-related morbidity and mortality burdens, we argue that current mandatory vaccine policies are scientifically questionable and are likely to cause more societal harm than good. Restricting people's access to work, education, public transport and social life based on COVID-19 vaccination status impinges on human rights, promotes stigma and social polarisation, and adversely affects health and well-being. Current policies may lead to a widening of health and economic inequalities, detrimental long-term impacts on trust in government and scientific institutions, and reduce the uptake of future public health measures, including COVID-19 vaccines as well as routine immunisations. Mandating vaccination is one of the most powerful interventions in public health and should be used sparingly and carefully to uphold ethical norms and trust in institutions. We argue that current COVID-19 vaccine policies should be re-evaluated in light of the negative consequences that we outline. Leveraging empowering strategies based on trust and public consultation, and improving healthcare services and infrastructure, represent a more sustainable approach to optimising COVID-19 vaccination programmes and, more broadly, the health and well-being of the public.


COVID-19 Vaccines , COVID-19 , Health Policy , Vaccination , COVID-19/prevention & control , Humans , Vaccination/legislation & jurisprudence
19.
JAMA Netw Open ; 5(2): e2146467, 2022 02 01.
Article En | MEDLINE | ID: mdl-35107573

Introduction: In 2015, California passed Senate Bill No. 277 (SB 277) and became the first state in more than 30 years to eliminate nonmedical exemptions to mandatory childhood immunizations for school entry. One concern that emerged was that the law created an incentive for parents to remove children from brick-and-mortar schools to bypass the immunization requirements. Objective: To assess the trends in homeschooling rates after the elimination of nonmedical exemptions to the requirement of childhood immunizations for school entry. Design, Setting, and Participants: This preintervention-postintervention cross-sectional study calculated homeschooling rates as the number of students in kindergarten through grade 8 (K-8) enrolled through each of California's 3 homeschooling mechanisms (independent study program, private school affidavit, and private school satellite program) divided by all K-8 students enrolled in the same academic year. Data on homeschooling rates were obtained from the California Department of Education. Interrupted time series analyses were conducted using a linear regression model in which the outcome variable was the percentage of students enrolled in a homeschool program before and after SB 277. Data were collected and analyzed from October 3, 2012, to October 2, 2019. Intervention: Passage of SB 277, which eliminated nonmedical exemptions to childhood immunizations for school entry. Main Outcomes and Measures: Homeschooling rates for K-8 students. Results: Among the students included in the analysis, the homeschooling enrollment for K-8 students in California increased from 35 122 students (0.8%) during the 2012-2013 school year to 86 574 students (1.9%) during the 2019-2020 school year; however, the implementation of SB 277 was not associated with an increase in the percentage of students enrolled in homeschooling programs in California beyond the secular trend. The increase in homeschooling was greatest for the lower grade levels: kindergarten homeschooling enrollment increased from 2068 students (0.4%) in the 2012-2013 school year to 10 553 students (1.9%) in the 2019-2020 school year, whereas the grade 8 homeschool enrollment rate increased from 5146 students (1.0%) in the 2012-2013 school year to 10 485 students (2.0%) in the 2019-2020 school year. Independent study programs accounted for 20 149 students (45.3%) of homeschooling enrollment, private school affidavits accounted for 19 333 students (43.5%), and private school satellite programs accounted for 4935 students (11.1%) during the 2015-2016 school year. Conclusions and Relevance: The findings of this study suggest that legislative action to limit nonmedical exemptions for compulsory vaccination for school entry is not associated with removal of students from classroom-based instruction in brick-and-mortar institutions.


Health Policy/trends , Schools/legislation & jurisprudence , Schools/statistics & numerical data , Schools/trends , Vaccination/legislation & jurisprudence , Vaccination/statistics & numerical data , Vaccination/trends , Adolescent , California , Child , Cross-Sectional Studies , Female , Forecasting , Health Policy/legislation & jurisprudence , Humans , Male
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