Germany received global attention after increasing rates of measles. Measles is one of the most contagious diseases and is effectively preventable by two doses of vaccine. As part of the current debate around mandatory vaccination in the country, the German Ethics Council invited three experts – Ole Wichmann (Robert Koch Institute), Claude Muller (Luxembourg Institute of Health) and Katharina Paul (University of Vienna). The speakers answered questions from the Ethics Council members on alternatives to the introduction of mandatory vaccination in Germany. The debate reflects the role of vaccine hesitancy as a challenge for immunisation programmes (WHO).
Vaccine sceptics have diverse reasons, ranging from religious and philosophical beliefs to personal autonomy. Most vaccines are given by physicians in offices and health professionals are the most trusted source of public health information. However, many sceptics still prevail amongst them. Above biased information in the media, a mistrust concerning independent study quality exists between information providers at policy level and information recipients.
One suggested solution is to narrow the vaccination gap in young adults. Most measles cases occur in four German federal states and more than half of those affected are over 15 years old. The medical community is another target set. A first step is to overcome the reimbursement deficit for medical specialists who want to vaccinate outside their own speciality. Reaching parents by paediatricians or spouses by gynaecologists, for example. Further measures for higher vaccination acceptance include the introduction of a vaccine registry and nudges. Due to the complexity of behavioural change, it is important to include a more social science-based approach.
Questions raised concerned the current role of the Federal Joint Committee (G-BA) on the vaccination recommendations by the Standing Committee on Vaccination (STIKO). A potential cost-benefit assessment by the Institute for Quality and Efficiency in Health Care (IQWiG) was under discussion. This latter debate reminds of the recent controversy on the impact of G-BA resolutions on the daily life of physicians. Consequently, the Federal Ministry of Health introduced key features of the physician information system.
German Ethics Council: National and international vaccination strategies