Inclusion of persons with disabilities in the documents of the National Bioethics Committee of the Republic of San Marino

Vaccination has contributed to a healthier world population. While it is often considered compulsoryor recommended, people might refuse it for various reasons. According to the classification used inthe United States, refusals can be made on medical, religious (or conscientious), philosophical andother grounds. Although non-medical refusals have been tolerated in some states, some think thatrefusals undermine infection control and lead to outbreaks of vaccine-preventable diseases. Theobjective of this research is to shed some light on the status quo of vaccination refusal worldwideand consider rationales and implications of different reasons which some individuals cite to refusevaccination. This research examines literature on vaccination refusal published between January 1,2010 and September 1, 2019, using the PubMed database. Several sets of key words were chosen toidentify a sufficient number of relevant articles. Many studies in the search results sought to find outfactors related to refusal/hesitancy. The articles were classified according to the country or area ofprimary focus. Vaccination refusers are ubiquitous, regardless of whether vaccination is mandatoryor voluntary. Reports on the United States (US) accounted for the majority, and also the majority offirst authors belonged to institutions in the US. As well, the proportion of US-based refusal literatureis greater than that of publications in the medical field worldwide. Outside the US, there were onlysporadic reports for each country. Some reports on the same countries contradicted each other. Themajority of the reasons cited were non-conscientious (medical side-effects of vaccines, fatality frominfections, access, financial problems, etc.). Reports of religious refusal were rare and anecdotal.There is a possibility more people will refuse vaccinations worldwide in the future, as risks of infectionsappear smaller. Therefore, though the numbers of articles on vaccine refusal published each yeargradually increased and then began to decrease, from 2017 to the present, it is advisable to monitormore carefully the reason for refusals and to track the sources of information.