Currently, measures to increase the vaccination rate for measles are being discussed intensively, and, according to the German Ethics Council, rightly so. However, the debate is dominated by calls for the introduction of mandatory vaccination for children. The Ethics Council considers this limitation of the debate to be misguided for the following reasons:
Unacceptable narrowing of the target group to children:
Almost half of all people suffering from measles in Germany are adults, with a rising tendency in recent years. Measures aimed at increasing the measles vaccination rate must address both children and adults. Effective community protection requires a population-wide rate of 95 percent for both of the two doses of measles vaccination. This can only be achieved if adult vaccination rates are also improved. Persons who pose an increased risk of infection for others due to their work or work-related contacts (health professionals, educational staff) have a special responsibility here.
Insufficient consideration of available data:
Nationwide, the rate for the first dose of vaccination for children at the time of school enrolment is 97.1 percent. This shows that measles vaccination is widely accepted. However, problems arise above all from the still insufficient 92.9 percent rate for the second dose of vaccination and the considerable regional differences.
Ambiguities in the concept of mandatory vaccination:
It is unclear how such a policy can be shaped and enforced. Depending on the person concerned, sanctions could include fines, exclusion from day-care centres or schools, restrictions on the professional freedom of physicians or even coercive physical interventions. An appropriate balancing of the relevant ethically and legally protected goods presupposes precise answers on what mandatory vaccination implies and how it should be enforced.
Rather than focussing narrowly on the question of a legal obligation to vaccinate, a successful vaccination policy requires a comprehensive approach. This approach must take into account the entire spectrum of actors, addressees, instruments and regulatory levels, including their interactions. On this basis alone is it possible to examine how the goal of sufficient vaccination coverage can be achieved with measures of the lowest possible invasiveness. This examination has to take place before the current law is changed.
The German Ethics Council is currently preparing an Opinion on the subject, which will be available before the parliamentary summer recess.
Further information can be accessed at www.ethikrat.org.