Medical freedom / M5
Refusing a vaccine
An adult declines a vaccine the state recommends or mandates for adults (score the strictest adult mandate in force in the last 5 years).
What we score
What does refusal cost them?
Default assumptions: Unless a vignette says otherwise, the person is a 30-year-old citizen of sound mind with no criminal record, acting alone, on their own behalf and not for profit, in an ordinary residential area. Where subnational units (states, provinces, cantons, Länder) make their own law, each unit is scored and the result is weighted by population. 'The state' includes police, prosecutors, courts, regulators, tax authorities and anyone acting on their orders, including platforms obeying takedown orders.
Score anchors
Both the law score and the practice score use these anchors. Half points are used when a country sits between two of them.
| Score | What it means for this vignette |
|---|---|
| 10 | No consequence. |
| 8 | A form or counselling session only. |
| 6 | Exclusion from a few specific settings (e.g. healthcare jobs). |
| 4 | Broad exclusion from work, travel or public venues. |
| 3 | Fines. |
| 2 | Criminal penalty. |
| 0 | Forced vaccination. |
Evidence used: Vaccination laws and mandates for adults, including emergency measures in the last 5 years; penalties applied.
How each country scores
| Country | Law | Practice | Process | Score | Why |
|---|---|---|---|---|---|
| Mexico | 8 | 9.5 | 0 | 8.9 | LGS art. 144 makes vaccinations obligatory 'en los términos que fije' the Health Ministry, and art. 408 lets authorities order vaccination as a security measure, but no adult mandate was imposed nationally during COVID-19. The strictest measure in the last 5 years was in Jalisco (about 6% of the population): from 14 January 2022, bars, stadiums and mass events required a vaccination certificate or a 48-hour PCR test. |
| Netherlands | 7 | 7 | 0 | 7.0 | NL has had no adult vaccine mandate. The strictest measure of the last 5 years was the coronatoegangsbewijs (25 Sept 2021 to 25 Feb 2022), required for restaurants, culture, events and indoor sport. It accepted vaccination, recovery or a negative test (3G), with free testing, and the planned 2G version was never introduced. So refusing the vaccine meant getting tested, not exclusion. |
| Denmark | 7 | 7 | 0 | 7.0 | The Epidemic Act 2021 lets the authorities order examination, hospitalisation, isolation and treatment of infected people (§§ 12-15), but has no power to compel vaccination. A proposal for compulsory vaccination was dropped in 2020. The strictest adult measure in the last 5 years was the 2021-22 corona pass, which required vaccination, recent infection or a free negative test for venues and some workplaces, so refusers could still take part by testing. I sourced the Act; the corona-pass details are from my knowledge and I did not open a source for them. |
| United Kingdom | 6 | 6 | 0 | 6.0 | The strictest adult mandate in the last 5 years was COVID-19 vaccination as a condition of deployment for care-home workers in England (in force 11 November 2021 to 15 March 2022). Unvaccinated staff were dismissed, and tribunals held the dismissals fair. A wider NHS mandate was revoked before taking effect, venue COVID passes allowed a test instead, and there were no fines or forced vaccination. No adult mandate is in force today. |
| Ireland | 4.5 | 4.5 | 0 | 4.5 | The strictest adult measure in the last 5 years was the Health (Amendment) (No. 2) Act 2021 pass, under which only vaccinated or recovered people (no test option) could enter indoor restaurants and pubs from 26 July 2021, later extended to cinemas, theatres and gyms, until it was lifted in January 2022. There were no job mandates, fines on individuals or forced vaccination, and no adult mandate is in force today. |
| Czechia | 3 | 5 | 0 | 4.2 | Adults must take periodic tetanus boosters (Decree 537/2006 § 4(5)), and refusal is an administrative offence with a fine of up to 10,000 CZK (Public Health Act § 92k(6)(a), (7)(d)); this is rarely enforced. From November 2021, a '2G' rule barred unvaccinated people from restaurants, hotels, events and services. The Supreme Administrative Court annulled it on 2 February 2022. A planned COVID mandate for over-60s and some professions was withdrawn before taking effect. |
| United States | 4 | 4 | 0 | 4.0 | In the past 5 years the strictest adult mandates were COVID-19 vaccine rules. The OSHA vaccinate-or-test rule for 84 million workers was stayed by SCOTUS in Jan 2022, but the healthcare-worker, federal and military mandates operated, and unvaccinated service members and workers were discharged or fired. Until 7 Mar 2022, New York City's Key to NYC barred unvaccinated adults from indoor dining, gyms and entertainment, and its private-employer mandate continued after that. This was broad exclusion from work and venues, with no fines or forced vaccination. All such mandates have now ended. |
| Switzerland | 4 | 4 | 0 | 4.0 | The Epidemics Act lets cantons (Art. 22) and the Federal Council (Art. 6(2)(d)) mandate vaccination for at-risk groups, exposed persons and certain occupations, but not by force. From 20 Dec 2021 to Feb 2022, the federal 2G rule barred unvaccinated people who had not recovered from Covid from restaurants, cultural, sporting and leisure venues and indoor events. That measure, within the last 5 years, sets the score. |
| New Zealand | 4 | 4 | 0 | 4.0 | The strictest adult measures in the last 5 years were COVID-19 vaccination orders under the COVID-19 Public Health Response Act 2020 covering health, education, Police, Defence, corrections and border workers, with dismissal for refusal, plus My Vaccine Pass entry rules for many venues until 4 April 2022. In Yardley v Minister [2022] NZHC 291 the High Court struck down the Police/Defence mandate as an unjustified limit on rights. From April 2022 mandates were narrowed to health, aged care, corrections and border workers, and all have since lapsed. There was no forced vaccination. |
| Germany | 3 | 4 | 0 | 3.6 | The strictest adult mandate in the last 5 years was the COVID-19 vaccine requirement for health and care staff (§ 20a IfSG, Mar-Dec 2022): fines of up to €2,500 and bans from entering the workplace. Enforcement was sparse. 2G rules in winter 2021/22 also excluded the unvaccinated from many venues. The measles mandate for staff born after 1970 in schools, daycare and health settings remains in force: work bans and fines of up to €2,500, never forced vaccination. |
| Singapore | 2 | 4 | 0 | 3.2 | Infectious Diseases Act s47 lets the Director-General of Health order any person to be vaccinated during an outbreak. Refusal is an offence under s51 and s65: a fine of up to S$10,000 or 6 months for a first offence. The order was not used for COVID-19. From 15 Jan 2022, however, only vaccinated, medically ineligible or recently recovered employees could return to the workplace, so unvaccinated workers faced work-from-home, unpaid leave or dismissal. Vaccination-differentiated rules also barred them from dining in and other venues. |