Vaccinations are among the most successful preventive measures in medicine. Especially against many infectious diseases caused by viruses, which even today can only be treated symptomatically, vaccinations are the most important option to protect against potentially severe health risks. The example of measles shows, however, that despite the availability of a well-tolerated protective vaccination for which clear recommendations exist, local outbreaks of the disease can occur repeatedly. The German Ethics Council uses this example as an opportunity to look into national and international vaccination policies.
Peter Dabrock, Chair of the German Ethics Council, emphasised in his welcoming address that it was not a matter of doubting the general purpose or effectiveness of vaccinations. Rather, the question arises as to whether there should be an obligation to vaccinate. According to Dabrock, this question is particularly relevant “because it affects legally protected interests which are of paramount importance for liberal-constitutional democracies: personality rights, the right to life and bodily integrity, but also the expectation that the state should protect life and body against unnecessary and effectively controllable dangers.”
Ole Wichmann, head of the department on immunisation at the Robert Koch Institute, identified demographic groups with a particular need for action. In addition to adolescents, these include groups with a potential undersupply, such as people born abroad. Vaccinations are often given too late or incompletely. According to Wichmann, acceptance of vaccinations crucially depends on the advice provided by the attending physician. In order to increase vaccination rates, Wichmann suggested that health insurance companies should regularly remind their members to get vaccinated. Furthermore, not only paediatricians and general practitioners, but also consultants from other medical specialties should carry out vaccinations. Moreover, vaccinations in schools or in companies could contribute to increasing immunisation rates, so Wichmann.
Claude Muller from the Infectious Diseases Research Unit of the Luxembourg Institute of Health reported on international immunisation strategies. He elaborated on vaccine hesitancy which is widespread in various European countries. According to Muller, the current measles outbreaks made it clear that greater efforts in public relations are needed. In addition, barriers to accessing vaccinations should be reduced. According to Muller it is above all doctors and nursing staff who bear responsibility for educating patients. Mandatory vaccination should be considered predominantly for employees in the health services.
The political scientist Katharina Paul from the University of Vienna addressed questions of good governance in connection with vaccinations. According to Paul, mandatory vaccination policies do not help to build trust in the long run. Instead, she recommends establishing and strengthening (knowledge) infrastructures as well as more active and targeted involvement of the general public in matters of vaccination policy. Paul points out that vaccination registers are central instruments of governance. As interfaces between medicine, politics and society, they enable transparency and participation.
Wolfram Henn, chair of the working group “Vaccination as a duty?” of the German Ethics Council, summarised the speakers’ proposals: “Firstly, we need a vaccination register as a research resource and as an opportunity for targeted communication. Secondly, caution is required in adopting blanket coercive measures for the general public. And thirdly, there is a need for measures that focus on those with special responsibility, in particular the medical profession.” All three speakers agreed that mandatory vaccination should only be considered if all other strategies fail.
The presentations and documentation of the event can be accessed (in German) at: https://www.ethikrat.org/anhoerungen/nationale-und-internationale-impfstrategien.