In light of rising outbreaks of measles and other vaccine-preventable diseases in Europe, the Sabin Vaccine Institute in 2018 conducted a review of immunization legislation in the region. “Legislative Approaches to Immunization Across the European Region” examines how countries have approached immunization legislation, ranging from voluntary or recommended (the state asks that individuals seek out immunization) to mandatory (the state requires that individuals are immunized). This study is the first and only systematic review of immunization legislation that includes all 53 countries in the region and provides a comprehensive overview that can be used by countries as a point of reference when evaluating legislative frameworks for immunization law.

View the report (PDF)
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Supporting Materials

European Immunization Policy Database
This comprehensive examination included legislation, supporting documents, national constitutions, public regulations, decrees and other relevant information on country immunization programs, which are now publicly available in Sabin’s European Immunization Policy Database.  

European Region Matrix: Immunization Legislation (PDF)
Because approaches to immunization legislation across the European Region are diverse, a Matrix: Immunization Legislation was developed to categorize country laws and policies and provide an overview of the degree of immunization oversight.
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Likert Scale: Assessing Levels of Immunization Legislation (PDF)
The Likert Scale: Assessing Levels of Immunization Legislation was developed to further classify country immunization legislation with a scale from recommended to mandatory immunization with robust monitoring and follow-up, divided into five levels. Additionally, five national and regional case studies provide further comparison and analysis of legislative approaches to immunization.
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Public Presentation (PDF)
This presentation provides an overview of the report in a digestible format, including information from the supporting case studies.
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Case Studies

The Baltic States
A comparison of legislative approaches across three countries with similar historical, geographic and health contexts
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France
Moving toward a more coercive approach to immunization
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Moldova
Reviewing a recommended approach with mandatory requirements for school attendance
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The Nordic Countries of Denmark, Finland, Norway and Sweden
The recommended approach in practice
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The Ukraine
Exploring factors that undermine a strong legislative framework for immunization
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