Legal Obligations in Mandatory Vaccination in Schools: A Public Health Law and Ethics Perspective
Main Article Content
Abstract
This study analyzes the legal and ethical legitimacy of mandatory vaccination policies in schools from a public health law perspective. It focuses on the relationship between the state’s responsibility to protect public health, children’s right to health, and the boundaries of parental autonomy in making medical decisions for children. The study applies public health theory and legal certainty theory to examine the normative and ethical foundations underlying mandatory vaccination. A mixed-methods approach with a sequential explanatory design is employed, combining normative legal analysis with an empirical review of secondary data. The legal analysis examines national regulations concerning health, immunization, and child protection, while the empirical component reviews scholarly literature addressing public acceptance, implementation challenges, and ethical concerns surrounding school-based vaccination programs. The findings indicate that mandatory vaccination policies have strong legal justification as preventive measures aimed at controlling infectious diseases and protecting children’s health. From an ethical perspective, such policies may be justified when implemented proportionally, transparently, and on the basis of scientific evidence, while providing appropriate parental consent procedures and medically justified exemptions. The study further demonstrates that policy effectiveness depends not only on legal authority but also on regulatory clarity, effective risk communication, institutional accountability, and public trust. One important limitation is the restricted availability of primary empirical data concerning the experiences of parents, teachers, healthcare workers, and policymakers involved in school-level implementation. Therefore, future policy development should strengthen legal regulations, improve public health education, and establish transparent communication mechanisms. This study contributes to health law literature by integrating legal and ethical perspectives to develop a balanced framework for protecting collective health, children’s rights, parental autonomy, and legal certainty.
Article Details
The Authors submitting a manuscript do so on the understanding that if accepted for publication, copyright of the article shall be assigned to International Journal of Nusantara Islam, Sunan Gunung Djati State Islamic University.
The copyright encompasses exclusive rights to reproduce and disseminate articles in all forms and media, including reprints, photographs, microfilm, and similar reproductions, as well as translations. Some or all of the contents of this journal can be stored in databases and transmitted in any form and media without the need for written permission from the International Journal of Nusantara Islam, Sunan Gunung Djati State Islamic University.
The Editors and the Advisory International Editorial Board make every effort to ensure that no wrong or misleading data, opinions or statements be published in the journal. In any way, the contents of the articles and advertisements published in the International Journal of Nusantara Islam (IJNI) are sole and exclusive responsibility of their respective authors and advertisers.
References
Abbasi, M., Majdzadeh, R., Zali, A., Karimi, A., & Akrami, F. (2018). The evolution of public health ethics frameworks: systematic review of moral values and norms in public health policy. Medicine, Health Care and Philosophy, 21(3), 387–402. https://doi.org/10.1007/s11019-017-9813-y
Alanazi, F. T. H., Alharbi, B. N., Aljuaid, T. H., Alammar, F. A., Almarzouq, Y. F., Albalawi, I., Almutairi, M. N., Alshaghroud, S. M., Alhaosawi, M. E., Albalawi, M. A. S., & Alorf, A. A. (2024). The impact of vaccinations on disease prevention: A comprehensive analysis of their role in enhancing global public health and reducing morbidity and mortality rates. International Journal of Health Sciences, 8(S1), 1885–1907. https://doi.org/10.53730/ijhs.v8nS1.15436
Alfahmi, M. Z. (2022). Patients’ preference approach to overcome the moral implications of family-centred decisions in Saudi medical settings. BMC Medical Ethics, 23(1), 128. https://doi.org/10.1186/s12910-022-00868-8
Bardosh, K. et al. (2022). The unintended consequences of COVID-19 vaccine mandates. BMJ Global Health, 7, e008684.
Beccia, F., Rossi, M. F., Amantea, C., Villani, L., Daniele, A., Tumminello, A., Aristei, L., Santoro, P. E., Borrelli, I., Ricciardi, W., Gualano, M. R., & Moscato, U. (2022). COVID-19 Vaccination and Medical Liability: An International Perspective in 18 Countries. Vaccines, 10(8), 1275. https://doi.org/10.3390/vaccines10081275
Błaszczyk, M., Kovalisko, N., Pieńkowski, P., Pachkovskyy, Y., & Ryniejska-Kiełdanowicz, M. (2025). Coping with adversity: mechanisms of resilience in Ukrainian universities during the Russian-Ukrainian War—a perspective from Lviv University students. Higher Education. https://doi.org/10.1007/s10734-025-01506-z
Charrier, L., Garlasco, J., Thomas, R., Gardois, P., Bo, M., & Zotti, C. M. (2022). An Overview of Strategies to Improve Vaccination Compliance before and during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 19(17), 11044. https://doi.org/10.3390/ijerph191711044
Clemente-Suárez, V. J., Rodriguez-Besteiro, S., Cabello-Eras, J. J., Bustamante-Sanchez, A., Navarro-Jiménez, E., Donoso-Gonzalez, M., Beltrán-Velasco, A. I., & Tornero-Aguilera, J. F. (2022). Sustainable Development Goals in the COVID-19 Pandemic: A Narrative Review. Sustainability, 14(13), 7726. https://doi.org/10.3390/su14137726
Creswell, J. W., & Clark, V. L. P. (2018). Designing and Conducting Mixed Methods Research. SAGE Publications.
de Figueiredo, A. et al. (2022). Mapping global trends in vaccine confidence. Nature Human Behaviour, 6, 1357–1367.
Ekardt, F., Günther, P., Hagemann, K., Garske, B., Heyl, K., & Weyland, R. (2023). Legally binding and ambitious biodiversity protection under the CBD, the global biodiversity framework, and human rights law. Environmental Sciences Europe, 35(1), 80. https://doi.org/10.1186/s12302-023-00786-5
Emanuel, E. J. et al. (2022). Ethical considerations in vaccine mandates. New England Journal of Medicine, 386.
Fahmi, F. (2023). Penolakan Vaksinasi Anak dan Implikasi Kebijakan Kesehatan. Jurnal Hukum Kesehatan Indonesia.
Feldstein, L. R., Fox, G., Shefer, A., Conklin, L. M., & Ward, K. (2020). School-based delivery of routinely recommended vaccines and opportunities to check vaccination status at school, a global summary, 2008–2017. Vaccine, 38(3), 680–689. https://doi.org/10.1016/j.vaccine.2019.10.054
Frasca, E., & Carlier, J.-Y. (2023). The best interests of the child in ECJ asylum and migration case law: Towards a safeguard principle for the genuine enjoyment of the substance of children’s rights? Common Market Law Review, 60(Issue 2), 345–390. https://doi.org/10.54648/COLA2023024
Fu, C., Qi, Q., & Wang, Y. (2026). Dialectical Interaction Between National Culture and Civic Culture: A Study on the Mechanism of Construction, Transformation and Influence. Culture, 2(1), 5. https://doi.org/10.3390/culture2010005
Ghedamu, T. B., & Meier, B. M. (2019). Assessing National Public Health Law to Prevent Infectious Disease Outbreaks: Immunization Law as a Basis for Global Health Security. Journal of Law, Medicine & Ethics, 47(3), 412–426. https://doi.org/10.1177/1073110519876174
Giubilini, A., & Savulescu, J. (2022a). Vaccination, Responsibility, and Children’s Rights. Journal of Medical Ethics.
Giubilini, A., & Savulescu, J. (2022b). Vaccination ethics and public health. Journal of Medical Ethics, 48(1), 1–3. https://doi.org/10.1136/medethics-2021-107498
Gostin, L. O., & Wiley, L. F. (2021). Global Health Law and Policy. Oxford University Press.
Grogan, J. (2022). COVID-19, The Rule of Law and Democracy. Analysis of Legal Responses to a Global Health Crisis. Hague Journal on the Rule of Law, 14(2–3), 349–369. https://doi.org/10.1007/s40803-022-00168-8
Guan, Y. (2025). The effectiveness of coercive measures in motivating vaccination: Evidence from China during the COVID-19 pandemic. Global Public Health, 20(1). https://doi.org/10.1080/17441692.2024.2445827
Gül, A., Alak, S. E., Gül, C., Karakavuk, T., Can, H., Karakavuk, M., Köseoğlu, A. E., Döşkaya, M., Hameş, E. E., Ün, C., Gürüz, A. Y., & Döşkaya, A. D. (2023). The Importance of Vaccines in a Sustainable Healthy Society. In A Sustainable Green Future (pp. 183–212). Springer International Publishing. https://doi.org/10.1007/978-3-031-24942-6_9
Harris, R. F., & Simanjuntak, N. C. (2022). Implementation of The Siracusa Principles as Foundations for Reformulation of Social Restriction Policies in Public Health Emergencies. Unnes Law Journal, 8(1), 39–64. https://doi.org/10.15294/ulj.v7i1.54504
Hester, K. A., Sakas, Z., Ellis, A. S., Bose, A. S., Darwar, R., Gautam, J., Jaishwal, C., James, H., Keskinocak, P., Nazzal, D., Awino Ogutu, E., Rodriguez, K., Castillo Zunino, F., Dixit, S., Bednarczyk, R. A., & Freeman, M. C. (2022). Critical success factors for high routine immunization performance: A case study of Nepal. Vaccine: X, 12, 100214. https://doi.org/10.1016/j.jvacx.2022.100214
Jalilian, H., Amraei, M., Javanshir, E., Jamebozorgi, K., & Faraji-Khiavi, F. (2023). Ethical considerations of the vaccine development process and vaccination: a scoping review. BMC Health Services Research, 23(1), 255. https://doi.org/10.1186/s12913-023-09237-6
Kalantari, N., Borisch, B., & Lomazzi, M. (2022). Vaccination—A Step Closer to Universal Health Coverage. Journal of Public Health, 30(3), 649–653. https://doi.org/10.1007/s10389-020-01322-y
Kementerian Kesehatan Republik Indonesia. (2023). Pedoman Pelaksanaan Imunisasi Anak Sekolah [Guidelines for School-Based Immunization Implementation]. Jakarta.
Larson, A., Skolnik, A., Bhatti, A., & Mitrovich, R. (2022). Addressing an urgent global public health need: Strategies to recover routine vaccination during the COVID-19 pandemic. Human Vaccines & Immunotherapeutics, 18(1). https://doi.org/10.1080/21645515.2021.1975453
Larson, C. B. (2022). Inspirational Preaching. Hendrickson Publishers.
Luyten, J., & Beutels, P. (2021). The Social Value of Vaccination Programs. Health Economics, Policy and Law, 16(1), 1–15. https://doi.org/10.1017/S1744133120000125
Ma, C., Qirui, C., & Lv, Y. (2023). “One community at a time”: promoting community resilience in the face of natural hazards and public health challenges. BMC Public Health, 23(1), 2510. https://doi.org/10.1186/s12889-023-17458-x
März, J. W. (2022). What does the best interests principle of the convention on the rights of the child mean for paediatric healthcare? European Journal of Pediatrics, 181(11), 3805–3816. https://doi.org/10.1007/s00431-022-04609-2
Mathews, B. (2022). Adolescent Capacity to Consent to Participate in Research: A Review and Analysis Informed by Law, Human Rights, Ethics, and Developmental Science. Laws, 12(1), 2. https://doi.org/10.3390/laws12010002
McDougall, L. (2016). Discourse, ideas and power in global health policy networks: political attention for maternal and child health in the millennium development goal era. Globalization and Health, 12(1), 21. https://doi.org/10.1186/s12992-016-0157-9
Mulla, M. S. Al, & Barafi, J. (2024). The legality of vaccination in accordance with international and national standards. International Journal of Public Law and Policy, 10(4), 430–448. https://doi.org/10.1504/IJPLAP.2024.141721
Odone, A., Dallagiacoma, G., Frascella, B., Signorelli, C., & Leask, J. (2021). Current understandings of the impact of mandatory vaccination laws in Europe. Expert Review of Vaccines, 20(5), 559–575. https://doi.org/10.1080/14760584.2021.1912603
Okesanya, O., Olatunji, G., Olaleke, N., Mercy, M., Ilesanmi, A., Kayode, H., Manirambona, E., Ahmed, M., Ukoaka, B., & Lucero-Prisno III, D. (2024). Advancing Immunization in Africa: Overcoming Challenges to Achieve the 2030 Global Immunization Targets. Adolescent Health, Medicine and Therapeutics, Volume 15, 83–91. https://doi.org/10.2147/AHMT.S494099
Omer, S. B., Betsch, C., & Leask, J. (2023). Mandate Vaccination with Care. Nature Human Behaviour, 7, 239–241. https://doi.org/10.1038/s41562-023-01544-0
Omer, S. B. et al. (2023). School vaccination requirements and immunization policy. The Lancet Public Health, 8, e187–e195.
Ota, M. O. C., de Moraes, J. C., Vojtek, I., Constenla, D., Doherty, T. M., Cintra, O., & Kirigia, J. M. (2022). Unveiling the contributions of immunization for progressing towards Universal Health Coverage. Human Vaccines & Immunotherapeutics, 18(1). https://doi.org/10.1080/21645515.2022.2036048
Owolabi, M. O., Leonardi, M., Bassetti, C., Jaarsma, J., Hawrot, T., Makanjuola, A. I., Dhamija, R. K., Feng, W., Straub, V., Camaradou, J., Dodick, D. W., Sunna, R., Menon, B., Wright, C., Lynch, C., Chadha, A. S., Ferretti, M. T., Dé, A., Catsman-Berrevoets, C. E., … Servadei, F. (2023). Global synergistic actions to improve brain health for human development. Nature Reviews Neurology, 19(6), 371–383. https://doi.org/10.1038/s41582-023-00808-z
Pahruroji, P., & Virgianita, A. (2024). The Global and Indonesian Landscape on Child Vaccination, Immunization, and Gender. Hasanuddin Journal of Strategic and International Studies (HJSIS), 3(1), 1–15. https://doi.org/10.20956/hjsis.v3i1.36123
Rahman, N. H. A., Mohd Zahir, M. Z., & Althabhawi, N. M. (2023). Repercussions of COVID-19 Lockdown on Implementation of Children’s Rights to Education. Children, 10(3), 474. https://doi.org/10.3390/children10030474
Reiss, D. R., & Karako-Eyal, N. (2019). Informed Consent to Vaccination: Theoretical, Legal, and Empirical Insights. American Journal of Law & Medicine, 45(4), 357–419. https://doi.org/10.1177/0098858819892745
Rus, M., & Groselj, U. (2021). Ethics of Vaccination in Childhood—A Framework Based on the Four Principles of Biomedical Ethics. Vaccines, 9(2), 113. https://doi.org/10.3390/vaccines9020113
Savulescu, J. (2021). Good reasons to vaccinate: Mandatory or payment for risk? Journal of Medical Ethics, 47(2), 78–85. https://doi.org/10.1136/medethics-2020-106821
Sela, Y., Grinberg, K., & Nissanholtz-Gannot, R. (2023). The Dilemma of Compulsory Vaccinations—Ethical and Legal Considerations. Healthcare, 11(8), 1140. https://doi.org/10.3390/healthcare11081140
Stålberg, A., Söderbäck, M., Kerstis, B., Harder, M., Widarsson, M., Almqvist, L., Velandia, M., & Andersson, A. K. (2024). Children’s Right to Health through the Principles of Protection, Promotion, and Participation, from the Perspectives for Children, Parents, and Professionals: A Systematic Review. Child Care in Practice, 30(4), 537–572. https://doi.org/10.1080/13575279.2023.2298312
Steffens, M. S., Dunn, A. G., Wiley, K. E., & Leask, J. (2019). How organisations promoting vaccination respond to misinformation on social media: a qualitative investigation. BMC Public Health, 19(1), 1348. https://doi.org/10.1186/s12889-019-7659-3
Steiner, A., McMillan, C., & Hill O’Connor, C. (2023). Investigating the contribution of community empowerment policies to successful co-production- evidence from Scotland. Public Management Review, 25(8), 1587–1609. https://doi.org/10.1080/14719037.2022.2033053
Thahir, P. S., & Tongat, T. (2024). Legal Review of Medical Crime: Patient Protection and Professional Responsibility in Medical Practice. Audito Comparative Law Journal (ACLJ), 5(2), 130–142. https://doi.org/10.22219/aclj.v5i2.33832
Vigezzi, G. Pietro, Maggioni, E., Bert, F., de Vito, C., Siliquini, R., & Odone, A. (2024). Who is (not) vaccinated? A proposal for a comprehensive immunization information system. Human Vaccines & Immunotherapeutics, 20(1). https://doi.org/10.1080/21645515.2024.2386739
Wahyudi, Y. (2022). Evaluasi Program Pembiasaan Keagamaan dalam Perspektif Manajemen Pendidikan. Jurnal Evaluasi Pendidikan, 4(2), 121–137.
Wardhani, L. T. A. L., Noho, M. D. H., & Natalis, A. (2022). The adoption of various legal systems in Indonesia: an effort to initiate the prismatic Mixed Legal Systems. Cogent Social Sciences, 8(1). https://doi.org/10.1080/23311886.2022.2104710
Watson, D., Mhlaba, M., Molelekeng, G., Chauke, T. A., Simao, S. C., Jenner, S., Ware, L. J., & Barker, M. (2023). How do we best engage young people in decision-making about their health? A scoping review of deliberative priority setting methods. International Journal for Equity in Health, 22(1), 17. https://doi.org/10.1186/s12939-022-01794-2
Yan, R., Yin, X., Hu, Y., Wang, H., Sun, C., Gong, E., Xin, X., & Zhang, J. (2023). Identifying implementation strategies to address barriers of implementing a school-located influenza vaccination program in Beijing. Implementation Science Communications, 4(1), 123. https://doi.org/10.1186/s43058-023-00501-8
Zhang, X., & Wang, L. (2022). Factors Contributing to Citizens’ Participation in COVID-19 Prevention and Control in China: An Integrated Model Based on Theory of Planned Behavior, Norm Activation Model, and Political Opportunity Structure Theory. International Journal of Environmental Research and Public Health, 19(23), 15794. https://doi.org/10.3390/ijerph192315794