After months of being excluded as a possibility by politicians and with no requirement even for people working in health care, the COVID-19 vaccine mandate was announced on Nov 19, 2021. On Feb 3, 2022, the Federal Council, the upper house of the Austrian Parliament, approved a national COVID-19 vaccine mandate for residents older than 18 years by an overwhelming majority. 1–3 The law was the first of its kind in Europe4 and went into effect 2 days later. Why did the Austrian Government have this sudden U-turn? Historically, Austria has been reluctant to introduce mandatory vaccinations. Austria’s first and only vaccine mandate was introduced against smallpox5 in 1938/39, after the German 1874 Reich Vaccination Act was extended to recently annexed Austria. Mandatory smallpox vaccination was then renewed in 1948 and remained until 1980, in keeping with the WHO campaign to eradicate smallpox. Since then, high immunisation rates have been achieved without vaccine mandates for infectious diseases such as polio. In 2014, rates of vaccination against measles in children and young adults dramatically declined and cases concomitantly increased. The Minister of Health asked the Austrian Bioethics Commission to assess