On our first episode after the summer break we discuss mandatory vaccination mandates - something we have been researching before the COVID-19 pandemic began. In late 2020, we talked to former European Commissioner Vytenis Andriukaitis, who has a lot of experience with vaccine mandates.

As a commissioner, Andriukaitis campaigned for vaccination measures around Europe. But before that, as Lithuania’s minister of health, he introduced vaccine requirements for children, following a measles outbreak in 2013. But when he left for the Commission, without strong backing from the top, the legislation became stuck in parliament and was eventually repealed. Another measles outbreak followed in 2019, and vaccination became an electoral issue in Lithuania. You can read more about Lithuania’s struggle with vaccine hesitancy in our article.

We also talk to Oxford Vaccine Group researcher Samantha Vanderslott, University of Exeter Professor Jason Reifler, and Italian pediatrician Lorenza Romani.

Our reporting is supported by Journalismfund.eu, Media Lab Bayern and Alfred Toepfer Stiftung. Please subscribe to this show on Apple Podcasts, Audible, Google Podcasts, Spotify or another platform of your choice. Follow us on Facebook as @theinoculation, on Twitter as @TInoculation, and on Instagram as @the_inoculation.

Here's the transcript of the show:

Andriukaitis  0:00
I asked scientists, I will capable to develop a vaccine against stupidity.

Eva Schaper  0:10
Hi, listener. We're back for our first episode after the summer break.

Daiva Repeckaite  0:15
Yes. And today we're going to take a look at mandatory vaccination against COVID. And if it could be useful to get cases out again,

Eva Schaper  0:24
of course, and it seems like a no brainer. COVID cases arising again. Why not just make everyone take the vaccine? Welcome to Episode 12. Mandatory vaccination could backfire. We just heard from Wii tennis, Andrew Curtis, the former EU health commissioner and a former health minister in Lithuania. We talked to him late last year as the first Corona vaccines were coming available. But the idea that people would refuse to get a COVID job seemed quite ridiculous at the time. But yesterday, President Biden said he's mandating shots for 100 million Americans, including private sector employees, health care workers and federal contractors.

Daiva Repeckaite  1:12
Right and this is after other countries like France have announced similar plans. Were looked at vaccination drives against measles to see what we can learn about how useful mandatory vaccinations against COVID might be. Or if, as the SIR bones Jeremy Ward has argued, they might lead to a breakdown of trust in the medical system. We asked experts including Samantha Vander slot, a researcher at the Oxford vaccine group, if the past has any lessons about how to best implement mandatory vaccinations.

Eva Schaper  1:49
Join me Eva Schaper and my colleague dive at Red educator as we come through research to find out what you can do and what our governments can do to stop the spread of disinformation. Because we believe that knowing about disinformation is the only way to protect ourselves against it. We believe this is one of the most important fights of the future, because so much is at stake. So before we talk a bit more about mandatory vaccinations, we just want to take a minute to welcome our new listeners. Hello, and thank you for your interest. If you'd like your show, please tell your families, your co workers and your neighbours.

Daiva Repeckaite  2:30
That's right. If you know someone who might enjoy this show, just pick up your phone, you know, it's right next to you somewhere and text them the link right now.

Eva Schaper  2:40
Right, we really need your help to get the word out about our show. Okay, so let's start talking about just making people get the COVID shot. And then everything will be okay. Right?

Daiva Repeckaite  2:54
Well, I think first of all, it's important to say that in many parts of the world, there is not enough vaccine for this to even be a topic.

Eva Schaper  3:03
You know, you're right. So what we're really looking at is a first world problem.

Daiva Repeckaite  3:09
Yes, exactly.

Eva Schaper  3:10
Okay, but for those countries that have enough of the vaccine, this is really, increasingly becoming an important topic, isn't it?

Daiva Repeckaite  3:21
Right. But before we talk about mandatory vaccinations, maybe we should take a look at what the temporary means. Okay. Last year, I

Eva Schaper  3:29
talked to Alberto de blini, who researches the ethics of vaccination at the University of Oxford. And he had this actually very funny comment about what mandatory vaccination is it's not about police coming to your house with a syringe. It's usually a conditionality. So if you do X, you get Y to Blaney told us, or in the cases of the United States, if you don't do X, you might be subject to some kind of repercussions, which is I think, what is also in Biden's plans.

Daiva Repeckaite  4:05
So is this a new topic? Have any countries made vaccines mandatory in the past?

Eva Schaper  4:10
Well, again, people are really reacting quite strongly to this. But we have had mandatory vaccinations in Europe and in the United States for a long time. When we checked out the situation in Europe in December of 20 1913 of 36 European countries required certain vaccines from health care workers and nine EU countries had some form of mandatory measles vaccination for children and in the United States. According to the National Academy for State Health Policy five routine childhood vaccines are generally required for children attending childcare or school in all state what vaccines are required, though childcare in schools in the United States asked for a range Have vaccines against childhood illnesses like polio, or chickenpox or measles, mumps and rubella, which is also called the MMR vaccine?

Daiva Repeckaite  5:12
And how about the COVID vaccine? Where is that mandatory at the moment?

Eva Schaper  5:16
So in Australia, the vaccination is mandatory for high risk workers in elder care employees in quarantine hotels in Britain, also, homecare workers will have to take vaccinations from October. And what's also interesting is that English nightclubs, and other venues with large crowds are going to ask patrons to present proof of full vaccination beginning at the end of this month, so beginning at the end of September, in France, vaccinations are mandatory for health care workers. And they've also asked people to show the health pass in many social places. diver, how about in your home country in Lithuania is is anything mandatory in Lithuania?

Daiva Repeckaite  6:05
So there's a document which shows that the person has been vaccinated recovered from COVID or has recently been tested. And it's increasingly required that many places lately readiness university so that students will be required to show this document, which is called the National certificate if they want to live in in its student residence.

Eva Schaper  6:24
So even though this looks like this is something really new, I think we want to remember that vaccine hesitancy has been around for a very long time.

Daiva Repeckaite  6:35
Yes. And former commissioner Andrew crisis has been dealing with it for years. And this is what he told us.

Andriukaitis  6:41
How can we address issues related to vaccine hesitancy but please keep in mind that we have this very old phenomenon is just from the beginning, when Dr. General discovered vaccines immediately, he was surrounded by by a scare mongers by missing interpretations, because it is in our human nature, we all have to feed, as you see, it needs a lot of obstacles. Maybe it is, you know, maybe this also belongs to our behavioural issues. You know, Miss Lilly, that's a vaccine densities today's phenomenon is riddled with anomalies, right? The old one is, of course, you can see many, many reasons why it but step by step in development of new technologies and possibilities to have more effective vaccines and to help more effective vaccine safety systems

Eva Schaper  7:45
and more thorough assessment, which doesn't matter. Some part of society is facing doubts, because also you can see new phenomena, interest in science is going down. We've been seeing in France and now in the United States that health care workers and unions are really bristling at these new plans. They've I think we also had something really similar in Lithuania, your home country. I think there was a very large outbreak of the measles in 2019. That led to some resistance to vaccination. Is that right? Am I remembering that correctly?

Daiva Repeckaite  8:27
Yes. But even then the country's institutions could not pass long planned measures to introduce a mandatory measles vaccination. Right. So it started in 2011 when the country's MMR vaccination rate slipped under the level needed for her immunity.

Eva Schaper  8:44
Okay, right. Let's just remember that MMR is the shorthand for the measles, mumps and rubella vaccination. And herd immunity is the percentage of people who have to be vaccinated to protect the unvaccinated members of any community. So for measles, I think it's about 95%, isn't it?

Daiva Repeckaite  9:04
That's what experts say. So, an outbreak in Lithuania erupted in 2013 when mutandis andriukaitis, who were heard earlier was the Minister of Health, and he responded with an order to make entry to kindergartens conditional on vaccination certificates Three years later, so from 2016 but the parliament never changed the laws to enable the mandatory measures for parliament members from three different opposition parties at the time, took the issue to court, which declared the vaccination requirement unconstitutional. After the national election in 2016, the new ruling party, the left of centre farmers and greens union shank mandatory vaccinations and the government vowed to improve education on the benefits of vaccination instead. This became a hot topic again during the run up to the 2020 Lithuanian election amid the covid 19 pandemic. Mandatory vaccine nation yes or no became a question on TV debates and then candidate surveys. And the farmers and greens were pressured from the right and from the left to consider mandatory measures. Some opposition parties though, started exploring vaccine scepticism as their political stance

Eva Schaper  10:18
so diverse. So the resistance to the measles vaccination, there was really a lot of political back and forth around it. Has it changed the political landscape in Lithuania in any way?

Daiva Repeckaite  10:31
Well, a number of politicians have tried to tap into the social media panic surrounding vaccination. There still seems speaking at rallies,

Eva Schaper  10:40
still in recent times are also examples of the success of mandatory vaccinations. For example, Italy after a number of measles outbreaks made inoculation a prerequisite for attending daycare kindergarten. That's why while we did see a rise in vaccination rates to the level needed to secure herd immunity, it's always remained a subject of political debate.

Daiva Repeckaite  11:04
I talked to an Italian paediatrician and asked her what she thought

Lorenza  11:08
when I started to do medicine. We did not have any more cases of measles. So was the measles was just something that was written on books, but was impossible to see their disease. Four years ago when I was I was still a trainee in paediatrics. I remember the hospital became full, completely full of children with with measles.

Daiva Repeckaite  11:36
This is the Italian paediatrician Lorenzo Romani. Looking back, she thinks that introducing mandatory measures to control measles in 2017 was an important stopgap measure to control the crisis. She noticed that people who had previously not given much thought to vaccination just did what was required. We also talked to Samantha vandersloot, who researches vaccine hesitancy at the Oxford vaccine group. She recently published a paper on mandatory childhood vaccination policies worldwide. When we spoke to her, we wanted to know if there was a situation that is comparable to the one we have now.

Vanderslott  12:11
I think governments will be considering whether they they put in mandatory policies or no particular policies for certain groups, so healthcare workers, and private companies also are getting into this area by talking about making vaccination mandatory for air travel, and possibly also save markets or other kind of events. might be considering mandatory vaccinations. So it's something that will have to be considered by governments, even if they're not implementing a policy themselves, I suppose in terms of it backfire in the strongest examples, and maybe earlier in a couple of centuries ago. So it might not be the best example see us. And then I think the compulsory vaccination policies in Europe have been quite complex in the reasons and yeah, intricacies of the law and policy. So during parallels there might be also a bit tricky. I think, with the example with France. There have been signs that making making recommended vaccines compulsory when we already had one. DTP was was more a case of clarifying the law or clarifying the policy position. So yeah, the research on that has been that the recommended vaccines weren't seen as important as as that compulsory one. So yeah, it's quite early to look at effects. But that's that's some of the research findings. And I think with Italy, you see some kind of similar things in that, even though vaccines were compulsory, the different regions had some autonomy and how they were implementing that and enforcing that. And then there was a slight regression, I think, yeah, one one reason you probably know about this, Veneto and a change of law in education policy, saying that you're not going to be refusing school entry and then that that led to some slight confused reactions about whether vaccines were mandatory or not. So having a law of making the vaccines mandatory was was maybe just enforcing a position that was already being held. I suppose the German example of choosing one vaccine for for measles. Making that compulsory for school entry into healthcare. That's probably one that you can draw more parallels with, because it's a particular vaccine. And it's in response to an outbreak, which probably has more in common with COVID-19.

Eva Schaper  15:18
Right. And we also asked her, What might be the best strategy over time?

Vanderslott  15:25
I think the main takeaway is that it, it takes time, and it takes quite a lot of resources. And it's relationship golden and improving your, your services. So something that doesn't have an effect very quickly, a lot of the time. And then we see it's really quite historical examples of vaccine communication and publicity campaigns that did work quite well in the, in the 40s. And in Britain and the US. Maybe more recently, I think Australia have been doing quite a few of these sort of pro pro vaccine campaigns, which they may think have been successful. And using role models. They had this eye immunise campaign where they wanted to use kind of pro vaccine role models to say that, yeah, they're also vegetarian and they immunise and Genesis tried to tap into groups that might be associated with not wanting to have vaccines, because they see it as not as natural and adopt a certain lifestyle. So there maybe hasn't been a big national campaign promoting vaccines or Vaccine Education, they tend to, I think they've tended to have trialled in smaller regions and smaller areas. So yeah, looking for that big example of it working. I don't think we've got, but it will be interesting to see, with COVID-19 I think, keeping an eye on Israel. what they've been doing has, has been quite interested in.

Eva Schaper  17:19
The key to vaccine uptake doesn't lie with persuading people who hold strict anti vaccine beliefs. Jason reifler, a professor at the University of Exeter told us reifler studies ways in which people respond to vaccine related misinformation.

Reifler  17:37
If this now becomes an issue that people start thinking about, they might start having more formed or more crystallised attitudes about vaccines, about this specific policy. I think it's hard to predict which way they might be. Some will probably become, you know, mobilised by, by messages against this. Yeah. Part of it's also gonna see the extent to which it overlaps with is this just more generalised, populist anti elites, as I go governments sentiment, and so it taps into that and the specific vehicle for that may not be super important. But there also will be some people who, because they started thinking about this issue, some more will become more pro vaccine the sale of course, this makes sense. I don't want my kids to get sick because other people were unwilling to get vaccinated. This is a this is why that vaccine hesitancy population i think is is really, really important that most of the time they comply. The true is strong vaxxers they're just not going to be very unlikely they're going to comply, but it's very, very small.

Daiva Repeckaite  19:01
Coming back to the former EU Health Commission that andriukaitis the mastermind of this crap mandatory vaccination policy in Lithuania. He says that both voluntary and mandatory vaccination I needed

Andriukaitis  19:13
I need to quit bit strange opposition between voluntary vaccination and mandatory you need to have both voluntary and mitogenic is not in contradiction to each other. Be safe to say that you guys constantly now, you need to see if you have a decline in your pagination it is and you say yes and until you have no chance to achieve and to guarantee safety of society and to guarantee possibilities to monitor to monitor situation and to prevent people from from outbreaks. Then you can propose one method of submission You can see now pictures in the Netherlands they have more than 30 vaccination system, but the vaccination evidence is very very high, because societal perception is very, you know, positive vaccination. As you bet if you look at it as richer in France for example, now in France we see the biggest figures of vaccine hesitancy and the same was situation in Italia. When they started my job as European Commission, I the analyse situation in Italy, they get assessed and they had a very complicated picture, because their system do not allow to have fun national vaccination codesin and to introduce a more or less more harmonised and more synergetic approach on vaccination issues, and Mr Vyas said bottom line says police weren't seen she asked me what how can we join our forces and and always more clear science based vaccination strategy. Silence base okay the join our forces we propose that if you have no chance to learn to do or you know to stop measles outbreak, you can introduce measures which should be obliterated, for example, you can't allow them to go to kindergartens, if they are not vaccinated. It means that you have to go to protect children who are in in kindergartens and also to protect those children who are not but sedated and you can, you know, monitor situation encourage parents to vaccinate their children. It means that mandatory and voluntary instruments can be used together depending on a real epidemiological situation. How many students do you have and how you are capable to prevent yourself from outbreaks. Okay, so

Eva Schaper  22:12
that was our show for today. Please join us again in two weeks.

Daiva Repeckaite  22:18
If you want to hear more stories about vaccine hesitancy, you can look up the inoculation. wherever you'd like to listen to podcasts.

Eva Schaper  22:25
Don't forget to subscribe to our newsletter inoculated with the link is in the show notes.

Daiva Repeckaite  22:32
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Transcribed by https://otter.ai