Mandatory Vaccination Program Research Articles

Juridical Analysis of the Mandatory Vaccination Program in Combating the Covid-19 Virus

Vaccination implementation became mandatory after the issuance of Presidential Regulation no. 14 of 2021 concerning amendments to Presidential Regulation no. 99 of 2020 concerning Procurement of Vaccines and Implementation of Vaccinations in the Context of Combating the 2019 Coroiva Virus Dtsease (Covid-19) Pandemic. 14 of 2021 concerning amendments to Presidential Regulation no. 99 of 2020 concerning Procurement of Vaccines and Implementation of Vaccinations in the Context of Overcoming the Covid-19 Pandemic. this is contrary to Law No. 33 of 2014 concerning Halal Produce in Article 4. The results of the research show that the Implementation of Vaccinations is mandatory. Conflict of regulations regarding Vaccine obligations based on Presidential Regulation. In this case the Regulations President No. 14 of 2021 concerning amendments to Presidential Regulation no. 99 of 2020 concerning Procurement of Vaccines and Implementation of Vaccinations in the Context of Handling the 2019 Coroiva Virus Disease (Covid-19) Pandemic, it is the opposite, however, due to the massive spread of the Covid 19 virus plus the declaration of a health emergency, it is based on the principle of Salus populi suprema est where the safety of the people is more important. What is meant in this case is that under the threat of situations and emergencies, the safety of the people must be the most important goal, including if the rule of law must be set aside.

Healthcare workers’ perspectives on mandatory influenza vaccination: a scoping review

Background: Vaccination is efficacious at preventing influenza disease transmission, morbidity and mortality. Benefits of influenza vaccination for healthcare workers (HCW) are emphasized, yet vaccine uptake among HCW remains suboptimal. Mandatory vaccination programs may increase influenza vaccine uptake, however, attitudes and beliefs of HCW towards these mandates are not well known. Aims: This scoping review examined the attitudes and beliefs of HCW to ascertain the barriers and enablers to the implementation and acceptance of mandatory vaccination programs in healthcare settings. Design: Scoping review, guided by the PRISMA Extension for Scoping Reviews. Methods: Literature published between 2019 and 2023 was reviewed from five electronic databases, between June and October 2023. Data sources: Quantitative, qualitative and mixed-methods studies were obtained. Studies were limited to full-text English articles, published within peer-reviewed journals over the last five years. Data were extracted by both authors and documented using a modified version of the JBI’s scoping review data extraction instrument, and analyzed thematically. Results: The original search yielded 319 articles. Forty-two articles were screened, with 10 studies included. Most HCW had negative views towards mandatory influenza vaccination, influenced by geographical location, age and discipline. The protection of patients and affordability/accessibility of vaccination were described as enablers to the acceptance of mandatory measures. The belief that mandatory vaccination was a violation of autonomy and misconceptions concerning influenza transmission, vaccine mechanism of action, side effects and effectiveness, were described as common barriers. Conclusions: Health services must carefully consider the context in which mandatory vaccination programs are implemented and employ strategies that incorporate education and promote vaccine accessibility, affordability and HCW autonomy. The quality of evidence retrieved was moderate to poor, with high heterogeneity between studies. Minimal Australian research was evident, limiting the generalisability of findings. These results should be interpreted with caution and further high-quality research is recommended.

Considerations, challenges and gaps on mandatory childhood vaccination programs: A comprehensive analysis

Childhood vaccine coverage rates are not optimal for controlling vaccine-preventable diseases (VPDs), as outbreaks of VPDs occur from time to time globally. To address this gap, many countries have enacted and strengthened childhood vaccination programs, which are often mandatory. Mandatory vaccination programs are often controversial because they may reduce or eliminate individual choice. A standard approach for evaluating the mandatory vaccination program is not available. Vaccine types, target age groups, program rigidity, incentives or penalties, enforcement, and compensation mechanism for adverse events following immunization vary across the world. This article reviewed the mandatory childhood vaccination, and presented examples to illustrate the variations among different programs, outcomes, and key considerations when contemplating these programs. Before implementing mandatory childhood vaccination programs, it is critical to ensure financial sustainability, a steady supply of vaccines, equitable access for all target population, and tailored implementation to fit the local culture and context.

Legal Principles and Strategies to Encourage Citizens to Get Vaccinated against COVID-19 Virus

Background: Following the outbreak of COVID-19 pandemic, in some countries, mandatory vaccination programs were put to practice. However, there were widespread opposition against vaccination, which is investigated in this research.
 Methods: This was a descriptive-analytical research and data collection was conducted by referring to documents, books and articles in library.
 Results: With the emergence of corona virus in the world and the need to end this dangerous pandemic, various countries, including Iran's legal system, decided to implement "compulsory vaccination" mechanisms. The findings of this study indicated that the government from the perspective of various schools (even the school of individual originality) was not only allowed to legislate rules to make vaccination obligatory, but also it was expected to enact appropriate laws to create public safety.
 Conclusion: According to the principles of Islamic jurisprudence and law, including the priority of collective interests over the individual, the rule of no harm, and the authority of the Supreme Leader, the government is not only authorized but also obliged to enact laws for making vaccination obligatory.

Comparison of awareness, attitudes and knowledge on human papilloma virus vaccination in Singapore: 2019 versus 2013.

This study aimed to assess the changes in the awareness, attitudes and knowledge regarding human papillomavirus (HPV) vaccination among the local population. The secondary aims were to identify barriers and to evaluate the effectiveness of national HPV vaccination campaigns over a six-year period in Singapore. We conducted and compared two cross-sectional surveys in 2013 and 2019 among female participants attending a general gynaecology clinic. A total of 597 participants completed the survey in 2013 and 2019. The participants were comparable in their race, marital status, educational level, occupation and monthly household income. Knowledge scores for cervical cancer and HPV infection showed significant improvement from 2013 to 2019. There was no significant difference in knowledge scores for HPV vaccination, which resulted in similar uptake of the HPV vaccine. Age, educational level and knowledge of HPV vaccine were significant predictors of acceptance of the HPV vaccine. The top two reasons for declining the HPV vaccine were the lack of knowledge and cost, as noted in the 2019 survey. The Singapore government's efforts to improve cervical cancer awareness through national campaigns and policy changes have led to an improvement in knowledge of HPV infection. However, this has not translated into improvements in the vaccine acceptance rates. The decision for vaccine uptake is complex, and there are multiple factors to be addressed to ensure cost-effective implementation of the strategies. Our study highlights the need for effective dissemination of vaccine information, additional subsidies and consideration of a mandatory school-based vaccination programme.

Acceptability of mandatory vaccination: a survey experiment on the effects of thresholds and justifications

ABSTRACT Mandatory vaccination mightseem like a straightforward solution for reaching a sufficient vaccine coverage during a pandemic. However, the effectiveness of mandatory vaccination is undermined if the public does not perceive such a compulsory policy as acceptable. We report a population-based survey experiment (n = 1,131), conducted in Finland, that addresses the effects that different ways of framing a mandatory vaccination program have on three outcome variables: (1) the perceived acceptability of the program, (2) the willingness to take the vaccine voluntarily, and (3) the preparedness to refuse the mandatory vaccine. In the 2 × 3 factorial experiment, the respondents were presented with one of three justification alternatives that stressed the benefits of the program for either the economy, health, or basic rights. The justification was accompanied with one of two thresholds for herd immunity (70 or 90 percent). We found that the justification and the threshold for herd immunity interact when it comes to the acceptability of the program and the willingness to take the vaccine voluntarily. Importantly, justifications drawing on health were ineffective at the lower threshold level but very effective when the threshold was high. The preparedness to refuse a mandatory vaccine was low and reacted weakly with the experimental treatments.

Achievement of maximal SARS-CoV-2 collective immunity among the Tajik population by March 2022

Despite all efforts of the world community, the COVID-19 pandemic remains one of the main epidemiological challenges of our time. Even with its widespread distribution, the infection may have certain local features due to social, geographic, and climatic factors. Objective: to study collective immunity to SARS-CoV-2 in the population of the Republic of Tajikistan.A cross-sectional, randomized study of herd immunity was carried out according to a program developed by Rospotrebnadzor and the St. Petersburg Pasteur Institute, taking into account WHO recommendations. The ethics committees of the corresponding entities approved the study: Tajik Ministry of Health and Social Protection; and the St. Petersburg Pasteur Institute (Russia). Based on questionnaire results, 4,022 people were selected, representing 0.15% (95% CI: 0.14-0.15) of the total population randomized by age and region. In subsequent laboratory analysis, 3682 people took part. The distribution and quantitative content of antibodies (Abs) to viral nucleocapsid (N Ag) and receptor binding domain (RBD Ag) were determined by ELISA. When questioned, a history of SARS-CoV-2 vaccination was indicated by 69.7% (95% CI: 68.2-71.2) of the volunteer cohort. Vector vaccines were most frequently used (50.6%; 95% CI: 48.7-52.5), with whole-virion inactivated preparations in second place (23.0%: 95% CI: 21.4-26.6) and mRNA vaccines in third place (21.0%; 95% CI:19.4-22.6).The cohort (n = 3682) featured 27.5% men and 72.5% women. The overall seroprevalence was 98.5% (95% CI: 97.7-99.2) in men and 99.4% (95% CI: 99.0-99.6) in women (differences statistically insignificant). Overall seroprevalence in the cohort was 99.2% (95% CI: 98.8-99.4) and ranged from 97.2 to 100% in certain subgroups. Asymptomatic seropositivity in the whole cohort was 98.4% (95% CI: 97.6-99.1). As a result of a mandatory vaccination program introduced in Tajikistan under a COVID-19 Emergency Project, the level of herd immunity among vaccinated individuals reached 99.5% (95% CI: 99.1-99.7), which is similar to the level reached in the cohort as a whole.The epidemic situation that developed in Tajikistan by mid-March 2022 was characterized by an almost absolute level of herd immunity, as evidenced by an absence of detected overt COVID-19 cases since the end of February (2022).

Uptake of Influenza Vaccine and Factors Associated with Influenza Vaccination among Healthcare Workers in Tertiary Care Hospitals in Bangladesh: A Multicenter Cross-Sectional Study.

Influenza, highly contagious in hospital settings, imposes a substantial disease burden globally, and influenza vaccination is critical for healthcare workers (HCWs) to prevent this illness. This study assessed influenza vaccine uptake, including its associated factors among HCWs of tertiary care hospitals in Bangladesh. Between September and December 2020, this multicenter study included 2046 HCWs from 11 hospitals. Face-to-face interviews were conducted using a semi-structured questionnaire to collect data from physicians, nurses, and cleaning and administrative staff for the survey. Only 13.8% (283/2046) of HCWs received the influenza vaccine, of which the majority (76.7%, 217/283) received it for free from the hospital. Nurses had the highest (20.0%, 187/934) influenza vaccine coverage, followed by physicians at 13.5% (71/526), whereas cleaning staff had the lowest at 6.0% (19/318). Among unvaccinated HCWs, the desire to get vaccinated was high (86.2%), with half of the respondents even being willing to pay for it. The HCWs who were aware of the influenza vaccine were over five times more likely to get the vaccine (OR 5.63; 95% CI: 1.04, 1.88) compared to those who were not. HCWs in Bangladesh were vaccinated against influenza at a very low rate. Free and mandatory influenza vaccination programs should be initiated to optimize vaccine coverage among HCWs.

Bacille Calmette Guerin (BCG) and prevention of types 1 and 2 diabetes: Results of two observational studies.

Diabetes is a common disease marked by high blood sugars. An earlier clinical trial in type 1 diabetic subjects (T1Ds) found that repeat BCG vaccinations succeeded in lowering HbA1c values over a multi-year course. Here we seek to determine whether BCG therapy for bladder cancer may improve blood sugar levels in patients with comorbid T1D and type 2 diabetes (T2D). We also investigate whether BCG exposure may reduce onset of T1D and T2D by examining country-by-country impact of BCG childhood vaccination policies in relation to disease incidence. We first analyzed three large US patient datasets (Optum Labs data [N = 45 million], Massachusetts General Brigham [N = 6.5 million], and Quest Diagnostics [N = 263 million adults]), by sorting out subjects with documented T1D (N = 19) or T2D (N = 106) undergoing BCG therapy for bladder cancer, and then by retrospectively assessing BCG's subsequent year-by-year impact on blood sugar trends. Additionally, we performed an ecological analysis of global data to assess the country-by-country associations between mandatory neonatal BCG vaccination programs and T1D and T2D incidence. Multi-dose BCG therapy in adults with comorbid diabetes and bladder cancer was associated with multi-year and stable lowering of HbA1c in T1Ds, but not in T2Ds. The lack of a similar benefit in T2D may be due to concurrent administration of the diabetes drug metformin, which inhibits BCG's beneficial effect on glycolysis pathways. Countries with mandatory neonatal BCG vaccination policies had a lower incidence of T1D in two international databases and a lower incidence of T2D in one of the databases. The epidemiological evidence analyzed here suggests that BCG may play a role in the prevention of T1D. It does not support prevention of T2D, most likely because of interference by metformin. Our ecological analysis of global data suggests a role for neonatal BCG in the prevention of T1D and, to a lesser extent, T2D. Randomized clinical trials are needed to confirm these findings.

The Covid-19 Vaccination’s Obligation in Pandemic Era Relates to Autonomous Rights and Informed Consent

The government requires the Covid-19 vaccination in a pandemic emergency to reduce and stop the spread of this virus. Based on the study of several previous studies, this mandatory vaccination program received a great reaction in the community, not only in Indonesia, there were those who supported it and there were those who opposed it This paper aims to examine the obligation of Covid-19 vaccination with autonomous rights and informed consent. This research was conducted using a normative legal research method, with a statute and a conceptual approach. The research results are vaccination is part of health care efforts. Informed consent is obligation in every health care efforts. The Covid-19 Vaccination is also obligation in pandemic era. The mandatory Covid-19 vaccination program can be justified because the country is in a pandemic emergency. My advice in terms of respecting the right to autonomy, every act of Covid-19 vaccination should be accompanied by informed consent, either in an implied or written form, even though this program is a mandatory program.

A Libertarian Legitimacy for Mandatory Covid-19 Vaccination

Since its inception, the 2019 coronavirus disease (Covid-19) outbreak has become a major health problem. At the same time, countries worldwide have been waiting for a Covid-19 vaccine to be sufficiently available. When the Covid-19 vaccine became available, several countries began to adopt mandatory Covid-19 vaccination policies. However, mandatory Covid-19 vaccination has received strong opposition from the start. Rejections have emerged from various parties, including from libertarians. The researcher observes that the current research attempting to analyze the mandatory Covid-19 vaccination still revolves around the perspective of human rights and utilitarianism. Then, this study aims to explore and find out how the libertarian perspective toward mandatory vaccination. Normative research methods with conceptual and comparative approaches were used in this study. After analyzing secondary data sources with prescriptive analysis methods, this study finally succeeded in finding that mandatory Covid-19 vaccination has its place, legitimacy, and justification on the ideological side of libertarianism. It is because libertarians accept that the government may require a mandatory vaccination program against Covid-19. In addition, due to the libertarian framework, the government is still justified in enforcing coercive policies that violate the rights of certain individuals if the policy is necessary to avoid greater harm to others.

Monetary penalties for refusal of mandatory Covid-19 vaccination: state’s right to regulate vs people’s rights and freedom in health care

PurposeThe Covid-19 pandemic has persisted for almost three years. States have since then enforced laws, policies and measures believed to be the most effective to handle the global pandemic. Along this line, the Indonesian Government opted to implement mandatory vaccination and refusal of which entails monetary penalties. Hence, this study aims to analyze two legal issues that touch upon the realm of International Human Rights Law: first, whether state has the authority to implement the said mandatory vaccine program to those who refuse to be vaccinated, and second, how is the more appropriate legal policy to obligate vaccination but without coercive sanction.Design/methodology/approachThis is a normative legal research that uses a qualitative method with case studies, conceptual, historical and comparative approaches. A descriptive-analytical deduction process was used in analyzing the issue.FindingsThe results present, as part of state’s right to regulate, it has the authority to enact mandatory vaccination with monetary penalties to fulfil its obligation to protect public health in times of emergency; this is legal and constitutional but only if it satisfies the requirements under the International Human Rights Law: public health necessity, reasonableness, proportionality and harm avoidance. Alternatively, herd immunity is achievable without deploying unnecessary coercive sanctions, such as improving public channels of communication and information, adopting legal policies that incentivize people’s compliance like exclusion from public services, subsidies revocation, employment restrictions, higher health insurance premiums, etc.Research limitations/implicationsThis study analyzes in depth the following issues: of whether the government has the authority to apply mandatory vaccination laws enforced through monetary penalties for those who refused to be vaccinated and how does the government implement the appropriate legal policy to enforce mandatory vaccination without imposing penalties for non-compliance while maintaining a balance between the interests of protecting public health and the human rights of individuals to choose medical treatment for themselves, including whether they are willing to be vaccinated. Hence, the political affairs, economic matters and other non-legal related issues are excluded from this study.Originality/valueThis paper hence offers a suggestive insight for state in formulating a policy relating to the mandatory vaccination program. Although the monetary penalties do not directly violate the rule of law, a more non-coercive approach to the society would be more favorable.

Attitude et croyances du personnel soignant en Médecine Interne vis-à-vis de la vaccination antigrippale saisonnière : étude transversale descriptive

IntroductionThe rate of vaccination in HCWs in France remains low. We aimed to analyze the attitude and beliefs of HCWs toward influenza vaccination in Internal Medicine wards. MethodsWe conducted a cross-sectional survey of HCWs in the departments of Internal Medicine of two tertiary hospitals in France. An anonymous questionnaire designed for this study was used to collect demographic, health beliefs and attitudes, and medical knowledge related to the influenza and influenza vaccine. The survey started shortly prior the 2019 influenza season. ResultsThe surveys were completed by 158 (29[18–62] years-old ; 75.9% female ; 69.6% non-medical workers) of 187 (84.5%) HCWs. Overall, influenza vaccination coverage rate was 50.6% (n=80/158). Higher vaccination coverage was found in physician and in HCWs who had a better knowledge about the virus transmission. The reason to fulfill vaccination recommendations was to protect the patients, their relatives and themselves for more than 80% of HCWs compliant to vaccination recommendation. More than a third of HCWs (n=59/158; 37.3%) refused to be vaccinated or hesitated. Among them, 12 (12/59, 20.3%) believed that influenza vaccine could cause flu. The main reasons for reluctant HCWs to eventually accept to be vaccinated were a mandatory vaccination program and the demonstration of a better vaccine efficacy to prevent the disease. ConclusionInfluenza vaccination coverage among HCWs in Internal Medicine remains low. Education campaigns targeting in priority nurses and nurse assistants is mandatory to improve the compliance of HCWs to vaccination recommendation.

Level of Acceptance of Mandatory Vaccination and Legal Sanctions for Refusing Mandatory Vaccination of Children.

A preventive vaccination program is in operation in Poland. There are mandatory vaccinations for Polish residents under the age of 19 years. The law provides for financial penalties for parents who refuse to vaccinate their children. The aim of this study was to describe the attitudes of Polish residents aged 15–39 years to mandatory preventive vaccination and the level of acceptance for legal and financial sanctions for refusing mandatory vaccination of children. Materials and Methods: A face-to-face questionnaire-based study of a representative sample of 1560 residents of Poland aged 15–39 years. Data was collected in the fourth quarter of 2021. Results: In the study group, 51.5% of the respondents believed that preventive vaccination should be mandatory, and parents should have the right to decide only about additional vaccinations. Multivariate analyses (logistic regression) revealed a significant association between acceptance of mandatory vaccination and the following factors: positive COVID-19 vaccination status, self-declared religiosity, and having children. Of the 1560 respondents, 25.3% declared support for legal or financial sanctions for those refusing to vaccinate their children. In this group (n = 394), the highest percentage of respondents (59.4%) supported sanctions in the form of refusal to admit an unvaccinated child to a nursery or kindergarten. Conclusions: Despite preventive (mandatory) vaccination programs having been in operation in Poland since the 1960′s, only a little over 50% of adolescent Poles and young adults accept the vaccine mandate. Only 25% of this group declare their support for sanctions for refusing mandatory vaccination of children.

Vaccine hesitancy, mandatory covid-19 vaccination and the right to personal autonomy in Nigeria: A constitutional analysis

Since countries began vaccine rollout against the COVID-19 virus, all hands have been on deck to vaccinate as many people as possible, in order to achieve a high vaccine uptake towards herd immunity. Though slow, Nigeria just like other countries, has been vaccinating its citizens. However, the vaccination effort, like similar programmes has continued to encounter the familiar foe of vaccine hesitancy. Where vaccine hesitancy becomes an issue, a likely response is for the government to explore the option of mandatory vaccination, either directly or indirectly, with the goal of compelling citizens to be vaccinated, or suffer some jeopardy. Such a move is bound to touch on core human rights, especially the right to personal autonomy. This article examines the extent to which a mandatory COVID-19 vaccination programme in Nigeria, conflicts with the citizen’s right to determine what should be done to his/her body. It concludes that rather than forcing vaccines on people, a better option is for government to gain the trust of the people, through multi-layered social engagements.

Estimated Cost Effectiveness of Influenza Vaccination for Emergency Medical Services Professionals.

IntroductionBecause of their frequent contact with compromised patients, vaccination against influenza is recommended for all healthcare workers. Recent studies suggest that vaccination decreases influenza transmission to patients and reduces worker illness and absenteeism. However, few emergency medical services (EMS) agencies provide annual vaccination, and the vaccination rate among EMS personnel remains low. Reticence among EMS agencies to provide influenza vaccination to their employees may be due in part to the unknown fiscal consequences of implementing a vaccination program. In this study, we sought to estimate the cost effectiveness of an employer-provided influenza vaccination program for EMS personnel.MethodsUsing data from published reports on influenza vaccination, we developed a cost-effectiveness model of vaccination for a hypothesized EMS system of 100 employees. Model inputs included vaccination costs, vaccination rate, infection rate, costs associated with absenteeism, lost productivity due to working while ill (presenteeism), and medical care for treating illness. To assess the robustness of the model we performed a series of sensitivity analyses on the input variables.ResultsThe proportion of employees contracting influenza or influenza-like illness (ILI) was estimated at 19% among vaccinated employees compared to 26% among non-vaccinated employees. The costs of the vaccine, consumables, and employee time for vaccination totaled $44.19 per vaccinated employee, with a total system cost of $4,419. Compared to no vaccination, a mandatory vaccination program would save $20,745 in lost productivity and medical costs, or $16,325 in net savings after accounting for vaccination costs. The savings were 3.7 times the cost of the vaccination program and were derived from avoided absenteeism ($7,988), avoided presenteeism productivity losses ($10,303), and avoided medical costs of treating employees with influenza/ILI ($2,454). Through sensitivity analyses the model was verified to be robust across a wide range of input variable assumptions. The net monetary benefits were positive across all ranges of input assumptions, but cost savings were most sensitive to the vaccination uptake rate, ILI rate, and presenteeism productivity losses.ConclusionThis cost-effectiveness analysis suggests that an employer-provided influenza vaccination program is a financially favorable strategy for reducing costs associated with influenza/ILI employee absenteeism, presenteeism, and medical care.

The Feasibility of Mandatory Vaccination Program Under the Malaysian Legal Framework for Education Sector

The spread of the COVID-19 virus has been halted partially due to the vaccination program around the globe. However, such initiation has been actively under attack by a portion of society that believes vaccination is not the way out of the pandemic. A similar notion of anti-vaccine has slipped through Malaysia, particularly in the education sector, as they refuse to be vaccinated. This has been contributed by the lack of legal provision that regulates vaccination in Malaysia. Based on the literature and scientific data on the effectiveness of vaccination programs in curbing the spread of COVID-19, this paper aimed to weigh the legal argument on the possibility of imposing mandatory COVID-19 vaccination in Malaysia’s education sector to eradicate this deadly disease virus permanently. This paper embarked on a comparative, doctrinal analysis methodology where secondary data were collected and analysed. Literature from primary and secondary sources such as the laws, guidelines, textbooks, journal articles, government reports, newspaper articles, and online sources from multiple jurisdictions was analysed. The outcome of such analysis is laid down in a narrative design in highlighting the importance of mandatory vaccination within the education sector. This paper proposed hard and soft approaches on imposing mandatory vaccination programs within the education sectors in Malaysia is highly recommended, considering that the benefits of vaccination outweigh the risk of eradicating COVID-19 in Malaysia.

EFFECTIVENESS OF BCG VACCINATION AGAINST SARS-COV-2

Background: Bacillus Calmette-Guerin (BCG) vaccine is weakened Mycobacterium bovis based preparation that provides protective effects and immunotherapy against many ailments and may be tested against SARS-COV-2. Herein, we compare the prevalence of COVID-19 in countries with and without mandatory BCG vaccination program along with a study to examine its incidence in doctors working at quarantine facility with and without history of prior BCG vaccination. Methods: For cross-sectional examination, the data was collated from worldometer.info, BCG World Atlas and COVID-19 stats at National Command and Operation Centre (NCOC), Government of Pakistan accessed on Apr 30, 2021. For a real-time analysis, total of one hundred random male and female doctors working at a COVID-19 healthcare facility in Pakistan were voluntarily selected. Chi-square test was used to perform the statistical analysis with the help of SPSS-22. Results: The prevalence of COVID-19 in countries with and without a mandatory BCG vaccination policy was found to be 5,512 and 75,592 cases per million, respectively, and mortality rates were 98 and 1,435 per million, respectively. Amongst our randomly selected doctors, only 28% of the BCG vaccinated doctors were affected by COVID-19 contrary to 94% of those who were unvaccinated. Conclusions: The incidence of COVID-19 was considerably lower in the doctors with a history of BCG vaccination supported by the evidence that the countries with a universal BCG vaccine policy had a significantly low incidence and lower mortality rate due to COVID-19.

Mandatory HPV Vaccination; Opportunity to Save Lives, Improve Readiness and Cut Costs.

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the U.S. military and accounts for more healthcare visits than the next two most common STIs combined. Human papillomavirus is preventable with a safe, effective, prophylactic vaccine that has been available since 2006, yet vaccination rates remain low. The vaccine is approved for females and males aged 9-45 years for prevention of HPV-related dysplasia and cancers. Although it is recommended by the Centers for Disease Control and Prevention (CDC)'s Advisory Committee on Immunization Practices (ACIP), it is not part of the U.S. military's mandatory vaccine list. Human papillomavirus does not just affect female service members-male service members have a higher reported seropositive rate than their civilian counterparts and can develop oropharyngeal, anal, or penile cancers as sequelae of HPV. Oropharyngeal cancer, more common in males, is the fastest growing and most prevalent HPV-related cancer in the USA. Several countries, such as Australia and Sweden, have successfully implemented mandatory vaccine programs and have seen rates of HPV-related diseases, including cancer, decline significantly. Some models project that cervical cancer, which is the fifth-most common cancer in active duty women, will be eliminated in the next 20 years as a result of mandatory vaccination programs. Between higher seropositive rates and lack of widespread vaccination, HPV dysplasia and cancer result in lost work time, decreased force readiness, negative monetary implications, and even separation from service. With more than half of the 1.3 million service members in the catch-up vaccination age range of less than 26 years of age, we are poised to have a profound impact through mandatory active duty service member vaccination. Although multiple strategies for improving vaccination rates have been proposed, mandatory vaccination would be in line with current joint service policy that requires all ACIP-recommended vaccines. It is time to update the joint service guidelines and add HPV vaccine to the list of mandatory vaccines.

Fulton and Government-Mandated Vaccinations

COVID-19 vaccine distribution is now in full swing. Some states have signaled that, in the coming months, they may require certain people to be vaccinated—health care workers, public university and college students, and public school students among them. But what about those who refuse a government-mandated vaccination on the basis of their sincerely held religious beliefs? Not all states exempt religious believers from vaccination requirements. In such situations, the First Amendment’s Free Exercise Clause may—or may not—relieve a religious objector from receiving an otherwise required vaccine. This Term, the Supreme Court will decide Fulton v. City of Philadelphia, in which the Court has been asked to overturn Employment Division v. Smith (1990). Smith prohibits the judiciary from carving religious exemptions to neutral and generally applicable laws, even if such laws burden a person’s free exercise rights. Overturning Smith could, then, affect the constitutionality of mandatory COVID-19 vaccination programs. Nonetheless, I argue in this essay that no matter how Fulton is ultimately resolved, it likely won’t have much to say about whether the judiciary can craft religious exemptions to government-mandated COVID-19 vaccinations. I argue that this is the case for at least two reasons. First, Smith isn’t likely to be overturned this Term given some of the complexities in Fulton’s factual and procedural history. And second, even if it is, state governments likely have a compelling state interest in mandating vaccinations to combat COVID-19, at least in many instances.