What a compulsory vaccination would mean in concrete terms

Requirements and consequences

What a compulsory vaccination would mean in concrete terms

dpa / Jörg Carstensen

Audio: radioeins | 11/23/2021 | Interview with medical ethicist Helmut Frister | Image: dpa / Jörg Carstensen

The vaccination rate is too low to contain the fourth corona wave. That is why a discussion about compulsory vaccination has flared up. What that would mean and how it could be implemented – questions and answers.

What does mandatory vaccination mean?

Compulsory vaccination does not mean that someone is physically forced to get vaccinated. Compulsory vaccination would mean that people would face fines, activity and entry bans for certain facilities if they are not vaccinated.

Austria will be the first country in the world to introduce such a compulsory corona vaccination in February 2022 – initially only for employees in the health sector. The Austrian draft provides for fines of up to 3,600 euros or four weeks of substitute imprisonment. In Germany, a refusal of the Covid vaccination obligation – as with the measles vaccination obligation – would be punished as an administrative offense with 2,500 euros. If the refusal was repeated, higher penalties followed.

Is such a compulsory vaccination even legally enforceable in Germany?

The Infection Protection Act (IfSG) basically opens up the possibility of a general vaccination requirement. This has already been enforced twice in the Federal Republic of Germany: from 1959 to 1983 for compulsory vaccination against smallpox and since 2020 for measles vaccination for school-age children and employees of day-care centers and schools. The IfSG also regulates which compensation applies in the event of vaccination damage through mandatory vaccinations.

In order to make a vaccination compulsory against Covid-19 legally binding, the constitutional positions must be weighed. The right to physical integrity is anchored in the Basic Law. An interference with the physical integrity is only justified if the interference is proportionate. This “proportionality” is currently being debated.

In which case would the prerequisite for proportionality be met?

An interference with the physical integrity is justified if it can be assumed that the interference serves a legitimate aim; that the intervention is suitable to achieve this goal and that there is no more lenient means of achieving this goal. In the case of smallpox, for example, this intervention was considered proportionate because the death rate from smallpox infection was 30 percent. Incidentally, the compulsory smallpox vaccination was lifted again in 1983 – when smallpox was considered to be eradicated worldwide thanks to vaccination.

The current debate for or against compulsory corona vaccination is based on just that appropriate weighing of interests, says the medical ethicist Helmut Frister, who is also a member of the German Ethics Council, the rbb. “I see the prerequisite for proportionality as fulfilled. Basically, as this winter showed us, our health system is overburdened.”

This can only be prevented by increasing the vaccination rate or expanding the lockdown measures, said Frister. The German Ethics Council has not yet spoken out in favor of a general compulsory vaccination – but in favor of a job-related compulsory vaccination, for example for employees in the health and education sectors. According to the deliberations of the Prime Minister’s Conference on November 18, this is also likely.

What would compulsory vaccination mean for health professionals?

This specific vaccination requirement is about protecting particularly vulnerable groups from the coronavirus. Therefore, employees in the healing and nursing professions as well as hospitals should in future only be allowed to work in their facilities if they have been vaccinated. The condition would then be that they present their employer with a certificate of vaccination or recovery.

However, there are also doubts about the benefit of a job-specific vaccination requirement. For this it would have to be proven that vaccination of the employees minimizes or eliminates the risk of infection. If this cannot be proven, compulsory vaccination for health professions alone could be overturned before the Federal Constitutional Court.

How could compulsory vaccination be controlled?

Proof of vaccination would then have to be provided to the employer in order to work. However, apart from that, it is difficult to control. Because, unlike in other countries, there is no central vaccination register in Germany.

That is why experts see this point as a central problem. Without controls, the compulsory vaccination could even have negative effects. “If the compulsory vaccination is introduced, but cannot be enforced by the state, people then lose confidence in the government,” says behavioral economist Katrin Schmelz from ARD. In addition, a Covid-19 vaccination does not last a lifetime, unlike the smallpox or measles vaccination, but has to be refreshed regularly. That should make regular checks even more difficult.

Would compulsory vaccination help break the fourth wave of corona?

Unfortunately, no. Experts largely agree that compulsory vaccination would come too late at this point in time to break through the fourth wave. The medical ethicist Frister assumes, however, that it could protect against a fifth wave. Because the vaccination rate would tend to decrease again if the corona situation relaxed again in spring or summer, as expected. “I am personally skeptical whether we can then persuade people to vaccinate voluntarily,” says Frister.

From the point of view of epidemiologists, however, there will be more waves ahead of us in the coming year. For the virologist Christian Drosten, it is therefore essential to further increase the vaccination rate in order to break the impending waves.

What makes it so difficult to weigh up for or against compulsory vaccination?

Proportionality, which is a prerequisite for a constitutionally legitimized vaccination requirement, is constantly changing in the corona pandemic. At first, compulsory vaccination could not be implemented because there was no vaccine. Then there was vaccine, but it was not recommended for many social groups. First there was the “wild” Corona variant, in the meantime the much more contagious Delta virus has prevailed. Last but not least, compulsory vaccinations can suddenly be disproportionate again in a relaxed corona situation in spring or summer 2022. The discretion for ethicists, lawyers and politicians is therefore enormous.

Against this background, politicians are faced with a dilemma: If they do not require a vaccination, there is a risk of further waves of pandemics and the associated economic and social consequences. If she decides to be vaccinated, this could lead to a further loss of confidence.

Broadcast: radioeins, 11/23/2021, 7:10 a.m.

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