• Georg Marckmann.
• Institut für Ethik und Geschichte der Medizin, Universität Tübingen, Schleichstrasse 8, Tübingen, BRD. georg.marckmann@uni-tuebingen.de
• Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008 Feb 1; 51 (2): 175-83.

AbstractVaccinations are among the most effective and cost-effective means to prevent serious infectious diseases. Actual vaccination rates, however, still fall short of their full potential to reduce morbidity and mortality both in industrialized and low-income countries. Therefore, strategies to increase immunization rates are ethically and economically mandated, raising the following ethical issue: To what extent is it ethically appropriate to restrict individual autonomy by compulsory immunization requirements in order to achieve a sufficient collective protection of the community? Restrictions of individual autonomy are ethically justified if the following five conditions are met: (1) proven benefit, (2) favourable benefit-risk-ratio, (3) acceptable cost-benefit ratio, (4) as little restrictions as possible and (5) fair and transparent decision procedures. Depending on how far these five criteria are met, different strengths of recommendation result for each specific immunization program. However, there are good ethical and pragmatic arguments against compulsory vaccination enforced by law. Rather, one should try to strengthen public support and trust in vaccination programs by a proactive and persuasive information policy.

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