Journal Article

Impact of vaccine mandates and removals on COVID-19 vaccine uptake in Australia and international comparators: a study protocol

Beard, Frank H, Macartney, Kristine, Liu, Bette, Moore, Hannah Catherine, Blyth, Christopher C, Genie, Mesfin, Paolucci, Francesco, Gebremariam, Aregawi Gebremedhin, Attwell, Katie, Regan, Annette K, Le, Huong

2025

Overview

BackgroundVaccination against SARS-CoV-2 was a crucial public health measure during the COVID-19 pandemic. Among the multiple strategies developed to increase vaccine uptake, governments often employed vaccine mandates. However, little evidence exists globally about the impact of these mandates and their subsequent removal on vaccine uptake, including in Australia, France, Italy and the USA. The aim of this study is to provide a protocol to evaluate and quantify the impact of COVID-19 vaccine mandates and removals on vaccine uptake in these countries, with a specific focus on comparing Australian policies with those from Europe and the USA. Actualising the work outlined in this protocol will help to provide policy and technical guidance for future pandemic preparedness and routine immunisation programmes.Methods and analysisThis protocol outlines a retrospective study using existing data sources including Australian Immunisation Register-Person Level Integrated Data Asset for Australia and publicly available data for France, Italy and California (USA). Causal inference methods such as interrupted time series, regression discontinuity design, difference-in-differences, matching and synthetic control will be employed to assess the estimated effects of vaccine mandates and removals on vaccine uptake.Ethics and disseminationThe University of Newcastle’s human research ethics committee has approved the study (reference number: H-2024-0160). Peer-reviewed papers will be submitted, and results will be presented at public health, immunisation and health economic conferences nationally and internationally. A lay summary will be published on the MandEval website.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Australia - epidemiology / Causality / Census of Population / COVID-19 / COVID-19 - epidemiology / COVID-19 - prevention & control / COVID-19 vaccines / COVID-19 Vaccines - administration & dosage / Employment / Europe / Government / Health Economics / Health Policy / Humans / Immunization / Immunization Programs / Investigations / Italy / Mandatory Programs / Mandatory Vaccination / Medicare / Pandemics / Protocol / Public health / Public spaces / Research Design / Retrospective Studies / SARS-CoV-2 / Time series / United States / Vaccination / Vaccination - legislation & jurisprudence / Vaccination - statistics & numerical data