LNSLNS

We thank Dr. Lampl for his comments. We agree with him as shown in our article, which says that compulsory vaccination for a single disease only—apart from legal considerations—may well have the opposite effect of what is intended and that persons wary of vaccinations may then refuse all other vaccinations, even some of those that are not compulsory (1, 2). For this reason it does not seem sensible to introduce partial compulsory vaccination. As a first step the legal implications of implementing compulsory vaccination would have to be clarified. Dr. Lampl raises the principle of therapy freedom. Since vaccination is not therapy but a primary prevention measure, however, it needs to be legally clarified whether this principle would actually apply in this setting. Our research prompted us to see vaccine-hesitant doctors in a more critical light than the constant proportion of antivaccinationists in the population (3). The Federal Social Court (B 6KA 54/00 R) explained on the subject of obligations of statutory health insurance physicians—even when they are vaccine-hesitant—that vaccinations that are included in the statutory services for members of statutory health insurance schemes (especially vaccinations that are listed in the Federal Joint Committee’s vaccination guideline) have to be provided on a mandatory basis and therefore administered at the request of a member of a statutory health insurance scheme (4).

Regarding the question of whether vaccine-hesitant primary care physicians should be under threat of professional (conceivable), liability related (conceivable), or even penal/criminal (unlikely) consequences if they do not provide their patients with information about vaccinations, I refer readers to a publication of the charitable foundation “Eine Chance für Kinder” [give children a chance] (5), which discusses these options. The authors explain that in Germany, vaccination is still regarded as an individual medical service. At least a focus on general prevention would be desirable for the future—whether in the setting of a trusting/confidential consultation, in concerted easy-access services from the public health authorities, or—as a last resort—by means of compulsory vaccination.

DOI: 10.3238/arztebl.2019.0096b

On behalf of the authors

Dr. med. Constanze Storr

Institut für Allgemeinmedizin der Technischen Universität München, constanze.storr@tum.de

Conflict of interest statement

All correspondents declare that no conflict of interest exists.

1.
Storr C, Sanftenberg L, Schelling J, Heininger U, Schneider A: Measles status—barriers to vaccination and strategies for overcoming them. Dtsch Arztebl Int 2018; 115: 723–30. VOLLTEXT
2.
Betsch C, Bohm R: Detrimental effects of introducing partial compulsory vaccination: experimental evidence. Eur J Public Health 2016; 26: 378–81 CrossRef MEDLINE
3.
Betsch C, Korn L, Holtmann C: Don’t try to convert the antivaccinators, instead target the fence-sitters. Proc Natl Acad Sci USA 2015; 33: 4180–90 CrossRef
4.
Bundessozialgericht Verpflichtung des Vertragsarztes https://sozialgerichtsbarkeit.de/sgb/esgb/show.php?modul=esgb&id=1496, (last accessed on December 4th 2018).
5.
Deutsch E, Spickhoff A, Ullrich K: Die Pflicht des Arztes, den Patienten auf eine Impfung hinzuweisen. www.eine-chance-fuer-kinder.de/wp-content/uploads/2017/12/als-PDF-herunterladen.pdf (last accessed on 2 January 2019).
1. Storr C, Sanftenberg L, Schelling J, Heininger U, Schneider A: Measles status—barriers to vaccination and strategies for overcoming them. Dtsch Arztebl Int 2018; 115: 723–30. VOLLTEXT
2.Betsch C, Bohm R: Detrimental effects of introducing partial compulsory vaccination: experimental evidence. Eur J Public Health 2016; 26: 378–81 CrossRef MEDLINE
3.Betsch C, Korn L, Holtmann C: Don’t try to convert the antivaccinators, instead target the fence-sitters. Proc Natl Acad Sci USA 2015; 33: 4180–90 CrossRef
4.Bundessozialgericht Verpflichtung des Vertragsarztes https://sozialgerichtsbarkeit.de/sgb/esgb/show.php?modul=esgb&id=1496, (last accessed on December 4th 2018).
5.Deutsch E, Spickhoff A, Ullrich K: Die Pflicht des Arztes, den Patienten auf eine Impfung hinzuweisen. www.eine-chance-fuer-kinder.de/wp-content/uploads/2017/12/als-PDF-herunterladen.pdf (last accessed on 2 January 2019).

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