With the resurgence of measles—a disease we thought had been all but conquered—gaps in vaccination coverage are gaining increasing public attention. If vaccination rates continue their downward trajectory measles may once again become endemic. What should we do in the face of growing “vaccine hesitancy,” now listed as one of the World Health Organization’s 10 threats to global health (www. who. int/emergencies/ten-threats-to-global-health-in-2019)? Should we blame the parents, censor social media, enforce vaccination through school exclusion, or penalise non-vaccination through fines or loss of benefits?

These are just some of the approaches found around the world and championed by Eleanor Draeger in this week’s Head to Head debate (doi: 10.1136/bmj. l2359). To get vaccination coverage back to levels that will restore herd immunity, the UK should legislate to ban unvaccinated children from school, she says. Helen Bedford and David Elliman aren’t convinced. It’s not vaccine hesitancy that’s driving the decline in the UK, they say, but the many small barriers that can make it hard for parents to get their children vaccinated. And even with better services and easier access, making vaccination mandatory could be counterproductive, they say, as it would damage the public’s trust in health professionals and disproportionately affect children of poorer parents.