Mandatory Vaccination in In France

By: Kylie Cumback

In January 2017, the World Health Organization (WHO) issued a warning about the rise in measles cases in Europe. [1] The rise in measles cases is not limited to Europe, in fact over 134,000 children passed away from the disease in 2015 alone. [2]

France is getting ahead of the issue. In July, French prime minister Édouard Philippe announced that a series of vaccinations would be mandatory for French children by 2018. Vaccinations included under this mandate would include polio, pertussis, measles, mumps, rubella, hepatitis B, Haemophilus influenza bacteria, pneumococcus and meningococcus C.[3]  The new laws would be similar to a set of laws which mandate vaccination against tetanus, poliomyelitis, and diphtheria and would impose fines and other sanctions against parents who fail to vaccinate their children. [4]

France is not alone. In May, amid growing concerns over the rise in vaccine preventable disease outbreaks, Italy issued a similar mandate.[5] The Italian decree covers vaccines for chickenpox, diphtheria, haemophilus B (Hib), hepatitis B, meningitis B and C, measles, mumps, polio, rubella, tetanus, and whooping cough. The Italians will even impose stringent penalties against parents who fail to vaccinate their children, including, administrative fines ranging from nearly $600 to $8,380; a suspension of parental rights; and/or a prohibition from enrolling their children in public or private elementary schools or day-care centers.[6]

In many Western countries including France, the United States, Britain, and others, the percent of vaccinated individuals has fallen below the 95 percent “herd-immunity” threshold which protects the rest of the population against infectious diseases like measles. [7]  In France, this number is only at about 75%.[8]

Herd-immunity is the concept that a community must be comprised of enough immune people such that should someone contract a contagious disease the disease does not spread. [9] 

Herd immunity is achieved best in a random population.[10] In 2015, a measles outbreak occurred at Disneyland in California. According to IFL Science, the population at Disney is comprised of individuals who are less likely to vaccinate their children, thus, the disease spread quickly. [11] Like the population at Disneyland, the world population is not random, and there are clusters of people who believe that vaccines are dangerous (about 2-3 percent) and clusters of people who believe that all children should be vaccinated.[12] However, according to The Economist, the real danger is the group of individuals who are not wholly opposed to vaccines but pick and choose which vaccines their children get or delay their children’s vaccinations.

France is a notorious vaccine-skeptical nation.[13] A recent survey showed that nearly a third of the French population does not trust vaccines and only 52% of the population believed that the benefit to vaccines outweighed any dangers.[14]  The vaccine hesitancy has penetrated the population all the way to Doctors and Nurses. About “16-43% of French family doctors said they never or only sometimes recommended some specific vaccines.”[15] Other explanations for the lack of consistent vaccinations could include the fact that many children do not have access to a consistent family doctor, and thus are missing out on important vaccines, as is the case in the United States. [16]

The pro-vaccine movement in France has united two unlikely groups against the vaccinations: far right nationalists and far-left ecologists.[17] Marine Le Pen, a conservative French politician, stated that she was opposed to the new provision as it takes the free will away from parents who are opposed to vaccinations. Conspiracies have circulated for decades claiming causal connections between the vaccines and autism, multiple sclerosis, and others.[18] Notably, a 1998 study in the Lancet linked Autism with the Measles, Mumps and Rubella (MMR) vaccine. That study has since been retracted and disproven.[19]

In 2015, The French Conseil constitutionne, ruled that the French legal requirement that parents vaccinate their children against tetanus, poliomyelitis, and diphtheria was “constitutionally valid.” [20] The Conseil constitutionne, is a “French  Court with jurisdiction to verify the constitutionality of laws.”[21] This court can either opine as part of the legislative process or as from the recommendation of the two highest courts in the country. The question arose after two parents were charged with child endangerment and prosecuted for failure to vaccinate their children against diphtheria, tetanus, and poliomyelitis.[22] The parents argued that the three illnesses had been eradicated, that the vaccines  used against the three mandated illnesses were also used to prevent additional non-mandated illnesses.[23]

The Conseil constitutionnel did not touch specifically on the substance of the argument, but it decided that the statutes in question were constitutional. The conseil constitutionelle found that the vaccine mandates “are not clearly inappropriate for the intended goal’ of protecting individual and public health and that these laws did not violate any constitutional right or freedom.” [24]

In 2014, the French health minister Marisol Tourrain, boldly stated “freedom stops where public health begins.”[25] In order to protect the entire population from the dangerous vaccine preventable diseases, compulsory vaccinations may be the answer, but this comes at a cost. Ones may lose some individual freedoms, but the result may be

In the United States, for example, there are no federal law to mandate vaccinations; however, at times when public health is at risk, the courts have upheld the notion that some individual freedoms will be sacrificed for the benefit of the whole community. In the early 1900s the Supreme Court held in favor of mandatory vaccinations when a smallpox outbreak ravaged Cambridge, Massachusetts.[26]  In Jacobson v. Massachusetts, 197 U.S. 11 (1905), Justice Harlan held:  

The liberty secured by the Constitution of the United States does not import an absolute right to be wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good. Society based on the rule that each one is a law unto himself would soon be confronted with anarchy and disorder.

Here, the Court put the safety of the entire population above that of the few. 

At which point to the individual freedoms of the few outweigh public safety? In order to remain a healthy society and prevent the spread of vILRaccine preventable diseases laws like those recommended by France are just what the doctor ordered.

[1] Doha Madani, France Makes Vacciinations Mandatory For all Children as of 2020, Huffington Post (July 5, 2017), http://www.huffingtonpost.com/entry/france-makes-vaccinations-mandatory_us_595d114de4b02734df3579c6.

[2] Id.

[3] Josh Lowe, Child Health: Vaccinations For 11 Diseases Mandatory In France Starting in 2018,  Newsweek (July 5, 2017), http://www.newsweek.com/france-vaccinations-compulsory-632060.

[4] Nicolas Boring, France: Constitutional Court Confirms Legal Obligation to Vaccinate Children, Library of Congress: Global Legal Monitor (June 23, 2015), http://www.loc.gov/law/foreign-news/article/france-constitutional-court-confirms-legal-obligation-to-vaccinate-children/.

[5] Lowe, supra note 3.

[6] Italy: Vaccinations for Children Made Mandatory, Library of Congress: Global Legal Monitor (June 13, 2017), http://www.loc.gov/law/foreign-news/article/italy-vaccinations-for-children-made-mandatory/.

[7] S.C., Why Vaccination Rates In The West Are Too Low, The Economist (Mar. 30, 2016), https://www.economist.com/blogs/economist-explains/2016/03/economist-explains-24

[8] France Is Making Vaccinations for 11 Diseases Compulsory From Next Year, IFL Science, http://www.iflscience.com/health-and-medicine/france-is-making-vaccinations-for-11-diseases-compulsory-from-next-year/ (last visited Sept. 3, 2017).

[9] Herd Immunity and Measles: Why We Should Aim for 100% Vaccination Coverage, IFL Science, http://www.iflscience.com/health-and-medicine/herd-immunity-and-measles-why-we-should-aim-100-vaccination-coverage/ (last visited Sept. 3, 2017).

[10] Id.

[11] Id.

[12] S.C., supra note 7.

[13] Jon Cohen, France Most Skeptical Country About Vaccine Safety, ScienceMag (Sept. 8, 2016), http://www.sciencemag.org/news/2016/09/france-most-skeptical-country-about-vaccine-safety

[14] Katie Forster, France To Make Vaccination Mandatory From 2018 As It Is ‘Unacceptable

Children Are Still Dying Of Measles,’ The Independent (July 5, 2017), http://www.independent.co.uk/news/world/europe/france-vaccination-mandatory-2018-next-year-children-health-measles-dying-anti-vaxxers-edouard-a7824246.html

[15] S.C., supra note 7.

[16] S.C., supra note 7.

[17] Amar Toor, France Looks To Curb Its Growing Anti-Vaccination Movement With A New Law, The Verge (July 13, 2017), https://www.theverge.com/science/2017/7/13/15964628/france-vaccination-skeptic-law-vaccine-mandate

[18] Id.

[19] Steven Novella, The Lancet Retracts Andrew Wakefield’s Article, Science Based Medicine (Feb. 3, 2010), https://sciencebasedmedicine.org/lancet-retracts-wakefield-article/

[20] Boring, supra note 4.

[21] Boring, supra note 4.

[22] Boring, supra note 4.

[23] Boring, supra note 4.

[24] Boring, supra note 4 (quoting Conseil Constitutionnel, Decision No. 2015-458 QPC).

[25] Kim Willsher, French Couple Who Refused Vaccinations For Their Children Go To Highest Court, The Guardian (Oct. 9, 2014), https://www.theguardian.com/society/2014/oct/09/french-couple-refused-vaccinations-for-children-face-judge.

[26] Paul A. Offit, When Parents Force The Government’s Hand On Vaccines, The Daily Beast (June 18, 2017), http://www.thedailybeast.com/when-parents-force-the-governments-hand-on-vaccines