Ethics Council: Increasing measles vaccination rate by a package of measures rather than by mandatory vaccination

The German Ethics Council states that it is not a purely private matter whether one is vaccinated against a highly contagious infectious disease such as measles. In every society there are particularly vulnerable people who, for example for medical reasons, cannot themselves be vaccinated against measles, but for whom the disease can take a particularly severe course. These people can only be protected from infection if a sufficiently high proportion of the population is vaccinated against measles. In addition, there is the aspect of intergenerational responsibility, as measles is one of the diseases that could be completely eradicated by coordinated efforts worldwide. Since measles vaccination is highly effective and very well tolerated, the German Ethics Council is of the opinion that every person is morally obliged to have him- or herself vaccinated against measles and, if applicable, to provide appropriate immunisation for his or her own children.

The existence of this moral duty to vaccinate against measles does not, however, directly justify the introduction of a legal duty which ultimately would have to be enforced by coercive measures. It rather has to be assessed whether and for whom such an obligation is suitable, necessary and commensurate in order to achieve the goal of increasing the vaccination rate. In the case of the much-discussed mandatory vaccination of infants in day care and of schoolchildren, this assessment leads to the conclusion that in view of the generally high vaccination rates in these age groups a mandatory vaccination policy is not justified. However, it would be advisable to amend the German Infection Protection Act (“Infektionsschutzgesetz”) in order to more easily identify unvaccinated children, intensify the counselling of parents and enable vaccination campaigns in the facilities themselves. Exclusions from educational and child care institutions should be restricted to exceptional cases requiring individual justification. In addition, the relatively large group of unvaccinated adults should be given increased attention. It is urgent to address this group with specific information and vaccination campaigns.

With the exception of one member of the Council who, in a dissenting vote, speaks out against any form of mandatory vaccination policy, the German Ethics Council also considers it justified and even imperative to introduce mandatory vaccination for certain occupational groups. Violations of this duty could be sanctioned with a ban on certain professional activities. This applies primarily to personnel in health, social and educational services, who are more likely to pass on infections in their work.
Accompanying, the German Ethics Council recommends a number of other measures to facilitate access to vaccinations, such as the use of vaccination reminder systems in doctors’ surgeries, as well as to inform the public about the great opportunities and low risks associated with vaccination. Only if these measures do not show the desired success or if the risk assessment changes considerably due to spreading measles epidemics, mandatory policies with appropriate sanctions should be considered for further population groups.

Background:
This year, the World Health Organization has declared vaccination hesitancy to be one of the ten greatest threats to health worldwide. Furthermore, in May, it issued a warning on the continuing measles outbreaks in the European region, where more than 100,000 people fell ill within 14 months. In Germany, the goal of permanently eliminating measles could only be achieved if vaccination rates would be further increased and, in particular, regional gaps in vaccination coverage closed. For some months now, the introduction of a mandatory measles vaccination policy has been debated. The Federal Ministry of Health has already put forward a corresponding draft bill. At the end of April, the German Ethics Council issued a press release on the ongoing debate, criticising in particular the dominance of demands for the compulsory vaccination of children. In its Opinion published today, the Ethics Council now explains in detail which measures it considers advisable to increase the vaccination rates for measles.

Further information can be accessed at www.ethikrat.org.