This guidance states that children up to the age of 10 must have their diphtheria and tetanus vaccinations up to date to be able to enrol in school.

However, the legislation behind the requirement has effectively not been enforced for years.

As reported by CNN Portugal, the rule dates back to Decree-Law 44198, introduced in 1962, when diphtheria and tetanus were considered significant public health threats.

Health landscape

Bernardo Gomes, President of the National Association of Public Health Doctors, said the law was introduced in response to high numbers of deaths from the two diseases at the time, but argued that Portugal’s health landscape has changed dramatically since then.

In 2017, the Government under António Costa attempted to remove the compulsory vaccination requirement, but the proposal did not progress through Parliament.

Paediatrician Hugo Rodrigues believes the legislation should be reviewed, pointing out that both diseases are now extremely rare in Portugal largely because of the country’s strong vaccination coverage, warning that changing the legal framework should not undermine efforts to explain the benefits of vaccination.

He added that “obligation” alone does not necessarily translate into higher vaccination rates, as Portugal’s high uptake has largely been achieved through voluntary participation and public confidence in vaccines.

Enrolment system

This apparent contradiction between the law and current practice was accentuated when CNN Portugal questioned the authorities about whether children were actually being prevented from enrolling in school because of missing vaccinations.

The Ministry of Education initially said vaccination information was not collected through the school enrolment system and did not prevent registration, while the Ministry of Health referred the questions to the Directorate-General of Health (DGS), which added that being unvaccinated does not constitute an obstacle to enrolment or school attendance, continuing to recommend compliance with the National Vaccination Programme.

Meanwhile, the DGS position appears to conflict with the wording of the 1962 legislation.

In 2017, a government order instructed schools to notify health authorities about pupils whose vaccinations are not up to date so that families can be advised and encouraged to complete the recommended schedule. Currently, schools are also no longer routinely enforcing the requirement.

Several local health units contacted by CNN Portugal said they had no record of receiving such notifications from schools in recent years.

Instead, school health teams generally identify children with missing or incomplete vaccinations and work with families to bring their records up to date.

Overall coverage

Although there are regional differences, vaccination coverage remains high overall.

The latest National Vaccination Programme report reveals that the fifth dose of the combined diphtheria, tetanus, whooping cough and polio vaccine has a 92 percent uptake in 2025.

Among the municipalities with the lowest coverage were Vilar do Bispo, Penamacor and Aljezur.

Paediatrician Alberto Caldas Afonso stated that Portugal’s strong vaccination record has helped keep reported diphtheria cases at zero in recent decades, while tetanus cases have generally been extremely rare.

He believes greater emphasis should be placed on education and awareness rather than punishment.

Nevertheless, public health experts warn that the confusion surrounding the current rules could become more serious if Portugal faced a resurgence of a highly contagious disease.

Bernardo Gomes also pointed to measles as an example, with nine cases confirmed in Portugal since the beginning of 2026, amid rising concern over declining vaccination coverage in parts of Europe.

He stressed that the Government should clarify whether the 1962 legislation remains applicable, arguing that ambiguity could create avoidable problems, particularly when vaccination decisions affect vulnerable people who share schools or other public spaces.

Therefore, the debate is not simply about whether vaccines should be compulsory, but it is also about whether Portugal should continue to rely on an outdated law that is apparently not being enforced or replace it with a modern and clearly defined approach to protecting public health.