Peer-reviewed article
The introduction of ‘No jab, No school’ policy and the refinement of measles immunisation strategies in high-income countries
Filippo Trentini, Piero Poletti, Alessia Melegaro, Stefano Merler ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study modelled how measles immunity levels would change in seven high-income countries from 2018 to 2050 under different vaccination policies. The researchers found that current vaccination strategies alone are not sufficient to eliminate measles in most countries, but mandatory vaccination at school entry combined with higher coverage of routine programmes could help maintain immunity levels below the threshold for disease elimination. The study highlights that 'no jab, no school' policies introduced in Italy and France could be an effective tool, though some countries may also need strategies targeting adults.
Key points
- Under current policies, only Singapore and South Korea would maintain susceptible population below measles elimination threshold by 2050
- In UK, Ireland, USA and Australia, either routine programme coverage above 95% or mandatory school-entry vaccination with 40%+ coverage is needed to maintain elimination thresholds
- Italy would require mandatory school vaccination plus adult-targeted strategies to prevent future outbreaks
- Strategies targeting unvaccinated children before primary school entry can significantly improve achievement of WHO measles elimination targets
- Anti-vaccination movements and parental vaccine hesitancy in high-income countries are major challenges to maintaining high vaccination coverage
Limitations
This is a modelling study based on projections to 2050, so it cannot account for unforeseen policy changes, shifts in vaccine hesitancy, or actual implementation challenges of mandatory vaccination policies. The model relies on assumptions about demographic patterns and vaccination uptake that may not reflect real-world complexity.
Abstract
BACKGROUND: In recent years, we witnessed a resurgence of measles even in countries where, according to WHO guidelines, elimination should have already been achieved. In high-income countries, the raise of anti-vaccination movements and parental vaccine hesitancy are posing major challenges for the achievement and maintenance of high coverage during routine programmes. Italy and France approved new regulations, respectively in 2017 and 2018, aimed at raising immunisation rates among children by introducing mandatory vaccination at school entry. METHODS: We simulated the evolution of measles immunity profiles in seven distinct countries for the period 2018-2050 and evaluated the effect of possible adjustments of immunisation strategies adopted in the past on the overall fraction and age distribution of susceptible individuals in different high-income demographic settings. The proposed model accounts for country-specific demographic components, current immunity gaps and immunisation activities in 2018. Vaccination strategies considered include the enhancement of coverage for routine programmes already in place and the introduction of a compulsory vaccination at primary school entry in countries where universal school enrolment is likely achieved. RESULTS: Our model shows that, under current vaccination policies, the susceptible fraction of the population would remain below measles elimination threshold only in Singapore and South Korea. In the UK, Ireland, the USA and Australia either the increase of coverage of routine programmes above 95% or the introduction of a compulsory vaccination at school entry with coverage above 40% are needed to maintain susceptible individuals below 7.5% up to 2050. Although the implementation of mandatory vaccination at school entry would be surely beneficial in Italy, strategies targeting adults would also be required to avoid future outbreaks in this country. CONCLUSIONS: Current vaccination policies are not sufficient to achieve and maintain measles elimination in most countries. Strategies targeting unvaccinated children before they enter primary school can remarkably enhance the fulfilment of WHO targets.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.