Salmon Daniel A, Teret Stephen P, MacIntyre C Raina, Salisbury David, Burgess Margaret A, Halsey Neal A
Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, FL 32608, USA.
Lancet. 2006 Feb 4;367(9508):436-42. doi: 10.1016/S0140-6736(06)68144-0.
Compulsory vaccination has contributed to the success of immunisation programmes in the USA and Australia, yet the benefits from compulsory vaccination are not universally recognised. Some people--experts and the public alike--believe that the benefits of compulsory vaccination are outweighed by the associated ethical problems. A review of vaccination legislation in the UK, Australia, and the USA raises four main points. First, compulsory vaccination may be effective in preventing disease outbreaks, reaching and sustaining high immunisation coverage rates, and expediting the introduction of new vaccines. Second, to be effective, compulsory programmes must have a reliable supply of safe and effective vaccines and most people must be willing to be vaccinated. Third, allowance of exemptions to compulsory vaccination may limit public backlash. Finally, compulsory vaccination may increase the burden on governments to ensure the safety of vaccines. Nevertheless, although compulsory immunisation can be very effective, it might not be acceptable in some countries where high coverage has been achieved through other approaches or efforts, such as in Sweden, Norway, Denmark, the Netherlands, and the UK. These factors should be considered when compulsory vaccinations are being introduced or immunisation laws refined. Lessons learned from compulsory vaccination could be useful to other public-health programmes.
强制接种疫苗对美国和澳大利亚免疫规划的成功起到了推动作用，然而强制接种疫苗的益处并未得到普遍认可。一些人——包括专家和公众——认为，强制接种疫苗的益处被相关的伦理问题所抵消。对英国、澳大利亚和美国疫苗接种立法的审查提出了四个要点。第一，强制接种疫苗可能在预防疾病爆发、实现并维持高免疫覆盖率以及加速新疫苗的引进方面有效。第二，要想有效，强制接种计划必须有安全有效的疫苗可靠供应，并且大多数人必须愿意接种。第三，允许对强制接种疫苗有豁免可能会减少公众的强烈反对。最后，强制接种疫苗可能会增加政府确保疫苗安全的负担。尽管如此，虽然强制免疫可能非常有效，但在一些通过其他途径或努力已实现高覆盖率的国家，如瑞典、挪威、丹麦、荷兰和英国，强制免疫可能并不被接受。在引入强制接种疫苗或完善免疫法时应考虑这些因素。从强制接种疫苗中吸取的经验教训可能对其他公共卫生项目有用。
