Table 2.

Vaccination Selectivity (Enforcement and Exemption)

Mode	Elaboration	Example	Policy Logic
Broad and clear exemption regimes	You can get out of vaccinating if you follow set procedures	Michigan (US): Exemption after attending education session	Govern the complacent, don't squeeze refusers
Engineered selectivity (individuals approve cases)	Limited decisions to allow exemptions are enacted by senior functionaries	Australia: Federal Departmental secretary grants limited exemptions	Some (minimal) flexibility to be responsive case by case
Informal nonenforcement	Noncompliance with stated laws or policies not investigated or punished	Italian children not excluded from school, 1999–2017	Avoid publicity of removing mandate (may damage uptake)
Mirage mandates	Policy design facilitates noncompliance	Queensland (Australia): Childcare providers decide whether to exclude unvaccinated children	Appear to be taking tough action while facilitating noncompliance