Vaccination mandates and their alternatives and complements

Vaccination mandates are often suggested as a solution to low vaccine uptake. However, mandates are criticized because they aim to bypass rather than overcome the cognitive, emotional and social components of vaccine hesitancy and because they are highly restrictive interventions that can cause unintended psychological effects. In this Review, we contextualize the costs and benefits of implementing vaccination mandates on the basis of the evidence of their effectiveness, ethical considerations and unintended psychological effects. We present a toolbox of alternative interventions that specifically aim to overcome the cognitive, emotional and social barriers identified by psychological science. These interventions vary in degree of restrictiveness but are ultimately designed to preserve freedom of choice. They can be implemented in addition or as an alternative to mandates to tackle the psychological roots of vaccine hesitancy. We recommend that policies are tailored according to each country’s specific situation by selecting the set of interventions from the toolbox that cover the specific needs of the population.