The evolution of vaccine mandates: from historical perspectives to contemporary applications

Abstract Luigi Sacco pioneered efforts in 19th-century Italian vaccination campaigns when mandatory vaccination practices began as a public health strategy. We bridge past and present through a systematic review of both historical and contemporary vaccine mandate policies. While Sacco’s early initiatives, characterised by compulsory vaccination and effective communication strategies, set foundational principles for vaccine mandates, the modern era, especially during the COVID-19 pandemic, has seen a significant shift in the nature and application of vaccine mandates. Recent legislative changes across various countries have introduced stricter mandates aimed at managing public health crises. For instance, Italy and France, deeply impacted by reduced vaccine uptake and subsequent measles outbreaks, responded by reinforcing vaccine mandates. These countries aimed to mitigate the dual challenges of achieving high vaccination coverage and combating growing vaccine hesitancy. Comparative analysis of recent legislative changes reveals a trend towards increasing coerciveness in vaccine mandates, reflecting a blend of functional and political pressures driving government decisions. This trend is evident in the legislative adjustments made in California, Australia, France, and Italy, where heightened penalties and reduced exemptions were introduced to counteract declining public compliance. The synthesis of these experiences highlights the critical role of robust, credible communication and the nuanced application of mandates that consider societal and cultural contexts. Contemporary strategies are characterised by targeted interventions aimed at specific populations, reflecting the complex interplay of social, political, and health dynamics in vaccine policy. The enduring relevance of vaccine mandates underscores the necessity of flexible, responsive public health strategies that effectively address both long-standing and emergent vaccine hesitancy and coverage challenges. Speakers/Panelists Carlo Signorelli HSR, Milan, Italy Maria Gańczak Department of Infectious Diseases, University of Zielona Góra, Zielona Góra, Poland