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There’s a *lot* riding on vaccines right now.

While the fate of the world as we know it rests with scientists battling to find an inoculation that will tackle Covid-19, ministers are relying on the flu jab to save the NHS this winter in the face of a second surge in coronavirus cases. 

But despite this – and ministers having previously indicated they were keen to make some childhood vaccinations mandatory – the government has been quick to distance itself from talk it could make a coronavirus vaccine compulsory.

So why is it so controversial? Here are the facts.

Vaccine trials are looking good 

With the world unlikely to get back to normal until a vaccine is found for Covid-19 – which has killed almost 650,000 people globally – all eyes are on trials for a jab that could offer immunity to the virus.

Last week, findings from the first phase of the Oxford University trial suggested “promising” results, with early indications suggesting the vaccine was “safe, causes few side effects, and induces strong immune responses”. 

Meanwhile, on Friday, the government announced it was expanding England’s flu vaccination programme to another 30m people to help stop the NHS becoming overwhelmed this winter in the face of another wave of coronavirus. 

Under the new plans, free flu jabs will also be offered to over 50s, people who are shielding because of coronavirus – and their households – and schoolchildren aged 11. 

That is in addition to the groups who are already eligible for the flu vaccine.  

The PM thinks anti-vaxxers are ‘nuts’

On Friday, while promoting the new flu vaccination programme Boris Johnson called people who are actively-opposed to vaccinations “nuts”. 

Speaking to staff at a GP surgery in London, the prime minister said: “There’s all these anti-vaxxers now. They are nuts. They are nuts.” 

Johnson is not the only one in the cabinet who has shared similar sentiments. In September, health secretary Matt Hancock told HuffPost UK he had received legal advice about how vaccinations for children could be made compulsory. 

“There is a very strong argument for having compulsory vaccinations for children for when they go to school – because otherwise they are putting other children at risk,” he said.

“Actually, I’ve received advice inside government this week on how we might go about it. And I’m looking very seriously at it.”

The government hopes people will get the jab by choice

But when health minister Helen Whately was quizzed about potentially making the flu vaccine compulsory for NHS and care staff, it’s fair to say she was rather less forthcoming.

“This year, I’m confident that people will realise the importance of getting a flu vaccination, and they’ll realise that this year it really, really is imperative to come forward if you’re eligible and get it, so we expect to see higher take-up rates,” she told BBC Radio 4′s Today programme. 

Asked again whether ministers would make it compulsory, Whately said only: “We will look at what we need to do.” 

Meanwhile, a Department of Health and Social Care spokesperson told HuffPost UK: “In the UK, we do not currently have mandatory vaccination but operate a system of informed consent – it is everyone’s responsibility to seek NHS advice to get the right information to make an informed choice. 

“Our priority is to ensure any potential new Covid-19 vaccine is safe and effective, and that the balance of benefits outweighs the harm from Covid-19.”

Are there are *any* compulsory vaccines in the UK? 

At the start of the coronavirus pandemic, a number of rumours circulated on social media suggesting that a Covid-19 vaccine would be mandatory under the Coronavirus Act. These were untrue. 

In the UK, vaccines are not currently mandatory under law, with the Public Health (Control of Diseases) Act 1984 ruling out compulsory medical treatment – including vaccines. 

Why do people object to mandatory vaccines?

Most arguments against mandatory vaccines centre on the idea of individual freedoms and the so-called right to choose.

A lot of rhetoric from anti-vaccine campaigners, particularly in the US, uses phrases such as “my body, my choice”, more commonly associated with the abortion rights movement.

But Michael Shermer, publisher of Skeptic magazine, points out that by refusing a vaccine people are taking away choice from others – and the rest of society as a whole.

“If anti-vaxxers have their way, herd immunity will be breached and those vulnerable people who cannot get vaccinated [but want to] risk catching the germs of those who simply refuse to,” he told HuffPost UK.

“That’s a violation of their freedom.”

What’s more, he added: “There’s nothing unique at the idea of governments mandating vaccines, in the same manner that governments already mandate a great many things in our lives in the interest of public safety and security.”

Would compulsory vaccination be helpful in the UK? 

Professor Julian Savulescu, whose title is Uehiro chair in practical ethics at the University of Oxford, has argued that if a coronavirus vaccine is found it must be made compulsory. 

“Large numbers of people are dying from the virus, but also from the strategy,” he said on ITV’s Good Morning Britain, referring to the UK’s lockdown. 

“What people don’t realise is that we’re going to have large number of cancer deaths over many years because of delayed treatment. Already the estimates are that 200,000 people will die.

“So the cost of going slow are also significant and that has to be balanced in this case.”

But Dr Doug Brown, who is the chief executive at the British Society for Immunology, disagrees. 

He told HuffPost UK that, in most of the countries where mandatory vaccination has been introduced, it’s because of high anti-vaccination sentiment. 

For example, a 2018 Wellcome study revealed that in France – where compulsory vaccinations have been introduced – one-in-three people disagree with the idea that vaccines are safe. That is the highest percentage for any country in the world. 

In comparison, the survey found that 75% of Brits agree that vaccines are safe, with 9% disagreeing.

“What we have seen is that in countries that have introduced mandatory programmes, that’s often off the back of there being quite a high anti-vaccine sentiment in those countries and lots of misinformation floating around,” Brown said. 

“What we need to be doing in the UK is to be tackling the issues we face, which are not around vaccine confidence, which is very high.” 

Instead, the UK must launch public health awareness campaigns about the importance of vaccines and how they work, he said. 

“We must ensure we have very high public awareness of vaccines, vaccine development, the value of vaccines – in particular with the coronavirus vaccine,” Brown said.

“We need to take the general public on a journey with us so they can understand and trust that an eventual vaccine is safe and effective.”

Meanwhile, the UK must make sure it has the services on the ground to deliver vaccines. 

“One of the problems we have had in recent years is in the disinvestment in local vaccine services to make these vaccines accessible and openly available to everybody in the community who should be benefiting,” said Brown.

“With those two issues solved, we’re confident that there will be a high enough uptake of flu vaccine and a potential vaccine for coronavirus.” 

Brown – along with other scientists – are also worried that making vaccines mandatory could increase health inequalities. 

“If you penalise people who aren’t having the vaccine […] you’re penalising parts of the population who will really struggle,” he said. 

It could even mean people are barred from other health services, or that children are unable to attend nursery or school without certain jabs.

Does it work in other countries? 

While there are no mandatory vaccines in the UK, in other countries there are compulsory vaccination programmes. 

In the US, children must be vaccinated before they can attend school or nursery, with each state deciding which vaccinations are required. 

There are some exceptions to the rule based on factors such as health issues and religious beliefs. However, New York banned religious exemptions for school vaccines in 2019 after an outbreak of measles. 

Last year, Italy introduced a new law which allowed parents to be fined up to €500 if they sent their unvaccinated children to school. 

Among the mandatory vaccinations are jabs for chickenpox, polio, measles, mumps and rubella, the BBC reported. Children under the age of six can be turned away from school if their parents can’t provide proof they have had their vaccines. 

In recent years, France has also added extra vaccinations to the list of jabs children must have.