After contending with outbreaks, several European countries tightened their legal requirements for childhood vaccinations — and immunization rates increased as a result.

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Immunization rates rose in both Italy and France after a wide array of vaccinations were made mandatory. Getty Images

Childhood immunization rates rose in Europe after a broader range of vaccinations were made mandatory in both France and Italy.

Public health experts see that as good news in the battle against spreading potentially deadly diseases, while vaccination skeptics worry about safety issues and civil rights.

As in the United States, both France and Italy have long mandated childhood vaccinations for polio, diphtheria, and tetanus. Italy also required school-age children to be vaccinated against hepatitis B.

In 2017, after a major measles outbreak, Italy mandated another six vaccinations, including shots for haemophilus influenzae B, measles, mumps, rubella, pertussis (whooping cough), and varicella (chickenpox).

The following year, France began requiring that infants be given another eight vaccines — for whooping cough, haemophilus influenzae type B, hepatitis B, measles, mumps and rubella, chickenpox, pneumococcal disease, and meningococcus C disease — before being allowed to enroll in school.

In a new study published in Eurosurveillance, a journal of the European Centre for Disease Prevention and Control, French researchers found that vaccination rates “notably increased” among children born in 2018 when compared to older children who weren’t subject to the newer requirements.

The vaccination rate in France for hepatitis B rose from around 92 percent in 2017 to 98 percent in 2018, while the rate of pneumococcal vaccination increased from 98 percent to 99.4 percent.

Vaccine coverage for the first dose of meningococcal C vaccine increased from 39.3 percent to 75.7 percent.

“Moreover, vaccine coverage for children and for vaccines not concerned by the law have also shown an increasing trend, supporting a positive impact of the ongoing communication strategy on vaccination, beyond the extension of vaccination mandates,” the report concluded.

In Italy, measles vaccination rates rose from 87.3 percent in 2016 to 91.8 percent in 2017 and 94.1 percent in 2018 among children 30 months old, Italian researchers reported in a separate study published in the same journal.

“Despite the implementation of this law, vaccine hesitancy is still a problem in Italy and the political and social debate on mandatory vaccination is ongoing,” the researchers noted.

The same is true in the United States, where advocates for vaccination and people opposed to vaccines have clashed over compulsory vaccination and whether vaccines are safe and effective.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices issues a list of recommended childhood vaccinations that states generally follow.

All 50 states mandate vaccination as a condition of entry into school, although exceptions vary from state to state.

In addition to mandating vaccination against childhood diseases like polio, diphtheria, and measles, three states — Rhode Island, Virginia, and the District of Columbia — also have passed laws requiring school-aged children to get vaccinated against the HPV virus, which can cause cervical cancer as well as certain head and neck cancers.

“A national enforcement of mandatory vaccination will reduce local outbreaks, morbidity, and mortality associated with vaccine-preventable diseases,” Suman Radhakrishna, MD, FACP, infectious disease physician at CHA Hollywood Presbyterian Medical Center in Los Angeles, California, told Healthline.

Few states, on the other hand, require adult vaccinations, according to the National Conference of State Legislatures (NCSL).

Also, “all states allow vaccination exemptions for medical reasons, and almost all states (except California, Mississippi, and West Virginia) grant religious or philosophical exemptions for people who have sincerely held beliefs that prohibit immunizations,” according to a report from the NCSL.

“Currently, 29 states and D.C. have a religious exemption law, and 16 states have a religious and philosophical exemption law. These laws allow parents to claim an exemption based on their personal, moral, or other beliefs.”

Faced with rising exemption rates and measles outbreaks in communities with large percentages of children who aren’t immunized, California lawmakers voted in 2015 to eliminate the state’s personal beliefs exemption.

Advocates said that the change resulted in an increase in immunization rates — but also increases in the number of medical exemption claims.

“Waning immunity due to lack of exposure to vaccine-preventable illnesses and the increasing number of unvaccinated individuals makes for a large susceptible population,” said Radhakrishna. “Outbreaks have been noted in several developed countries including the United States.”

Hundreds of people in Orthodox Jewish communities in Brooklyn contracted measles in a recent outbreak attributed to low vaccination rates among children.

Vaccination experts aim for a 95 percent vaccination rate to produce so-called “herd immunity,” which protects the entire population from disease outbreaks, even those who are partially or completely unvaccinated.

For that reason, “The only people who should be allowed to bypass the mandate are those with bonafide medical illnesses,” Aaron Glatt, MD, chairman of the department of medicine & hospital epidemiologist at South Nassau Communities Hospital in Oceanside, New York, told Healthline.

Currently, only 83.4 percent of U.S. children ages 18–34 months are vaccinated against diphtheria, tetanus, and pertussis, 91.9 percent get the recommended vaccinations against polio, and 91.1 percent are vaccinated against measles, mumps, and rubella.

Glatt said that while 95 percent vaccination is a laudable goal, even that high rate isn’t a guarantee against disease transmission — particularly in settings where large numbers of children come in close proximity to one another, such as schools and daycare centers.

“The goal should be to vaccinate 100 percent of children,” he said.

Shira Miller, MD, founder and medical director of the Integrative Center for Health & Wellness in Sherman Oaks, California, and president of Physicians for Informed Consent, called mandatory vaccinations “unscientific and unethical.”

“Mandated vaccines have not yet been proven less risky than the diseases they are designed to prevent,” she said. “For example, the chance of dying from measles is 1 in 10,000, based on U.S. data from the pre-vaccine era. However, the risk of dying or being permanently disabled by the measles, mumps, and rubella (MMR) vaccine has not been proven to be less than 1 in 10,000.”

Miller said that vaccine makers are effectively protected by law from being sued directly for vaccine injuries, with such cases referred instead to the Vaccine Injury Compensation Program for redress.

Mandatory vaccination “promotes medical bullying and obstructs parents from being able to protect their children from the potential risk of vaccine injuries,” she said.

Advocates contend that vaccination was one of the greatest public health success stories of the 20th century. For example, polio — an illness that paralyzed 15,000 Americans annually before mandatory vaccination began — has been virtually wiped out in the United States. And decades of mandatory smallpox vaccinations helped eliminate a disease that once killed millions.

Glatt, who said he’s old enough to know children who ended up in wheelchairs for life due to polio, added, “I’m certainly not in favor of ripping kids away from their parents and forcibly vaccinating them. But there should be consequences for not doing it.”