Compulsory vaccination programmes

The Measles Protection Act has been in force in Germany since 1 March 2020. This amended the Infection Protection Act (IfSG) so that certain groups of people now have to prove they have had the measles vaccinations recommended by the Standing Committee on Vaccination (STIKO).

In particular, all children from the age of one must provide proof of a measles vaccination when they go to nursery school, childcare facilities or to school. There is sufficient protection against measles for children aged one or above if they have had at least one immunisation against measles, and for children from the age of two if they have had two immunisations against measles.

Anyone born after 1970 working in certain community insititutions or medical facilities must also be immunised against measles. This applies, for example, to childcare workers, teachers, childminders and medical staff. Asylum seekers and refugees must also be vaccinated within 4 weeks of being admitted to an accommodation centre.

Non-participation in compulsory vaccination programmes and consequences

Anyone who fails to provide the necessary evidence of measles vaccination will be not be permitted to attend or be employed in the relevant institutions, nor will they be permitted to work there. However, this provision does not apply to anyone for whom school attendance is compulsory.

Should the Paul-Ehrlich Institute indicate on its website that there are bottlenecks in the supply chain for vaccines with a measles component, then certain exemptions from the statutory admission and employment ban may be authorised by the highest state health authorities or the body designated by them.

In the event of intentional or negligent non-fulfilment of the vaccination obligations, fines of up to EUR 2 500 may be imposed by the competent authorities under the Act on Administrative Offences. For instance, a fine of up to EUR 2 500 can be issued in the following cases:

1. if the management of a facility or institution:

  • employs or allows the attendance of a person who is not permitted under the legislation
  • in the event of a notification obligation, fails to notify the health authorities of information required under the legislation
  1. if a person fails to provide the evidence required under the legislation within an appropriate time period, despite this information being requested by the health authorities.

A repeated imposition of the fine is also possible when a ruling or judgment becomes final or a new (injunctive) decision comes into force.

The competent authorities must always observe the principle of proportionality when determining the amount of the fine.

In addition to, or as an alternative to an administrative fine, a penalty payment (under administrative enforcement law) may apply in the event of non-compliance with the legally enforceable obligation to provide evidence.

Conditions for exemption from any compulsory vaccination programme

The legislation does not make any provision for an exemption on religious grounds. The legislator deliberately provided for only one exception for persons who cannot be vaccinated because of a medical contraindication, for instance if they are allergic to one of the vaccine components. In this case, a medical certificate confirming the existence of the medical contraindication must be submitted to the institution.

Health screening for children and young people

Children and young people are entitled to specific health screening as a statutory health insurance benefit. This is laid down in Section 26 of Book V of the Social Code (Sozialgesetzbuch, SBG). There are currently 10 health screening examinations for children (the U examinations U1 to U9) and 1 health screening examination for young people (J1 examination). At these examinations, the doctor assesses the general state of health and whether there are any risks to health or any specific serious illnesses. Finally, there is a check as to whether the child is developing in a way that corresponds to their age. The programme exactly matches the age of the child and includes, for example:

  • screening tests for congenital metabolic diseases
  • screening tests for serious bilateral hearing diseases in newborns
  • hip joint tests
  • a variety of examinations of individual organs
  • investigations into motor skills and social development.

The costs for these screening tests are borne by the statutory health insurance provider if they are carried out at the specified time. Participation is generally voluntary, although some individual states have made these examinations mandatory.

Medical care and midwife assistance during pregnancy

Insured persons are entitled to medical care and the assistance of a midwife, including examinations to establish pregnancy and maternity care, during pregnancy and during and after childbirth; an entitlement to the assistance of a midwife with regard to weekly care is available until 12 weeks after the birth; further services must be prescribed by a doctor. If, following the birth, the child cannot be looked after by the insured person, the insured child is entitled to the benefits of midwife assistance as applicable. Medical care also includes counselling pregnant women on the importance of oral health for mother and child, including the relationship between diet and the risk of disease, as well as the assessment or determination of the transmission risk of tooth decay. Medical advice to insured persons includes, where necessary, advice about regional support services for parents and children.

Since 2008, all women under the age of 25 have been offered a test for chlamydia once a year and when pregnant.

Health screening for adults

Men and women are entitled to a single health screening check-up with a doctor between the ages of 18 and 34, and, from the age of 35, one such check-up every 3 years as a benefit under the statutory health insurance scheme. This is laid down in Section 25(2) of Book V of the Social Code. The purpose of health screening is to identify health risks and for early detection of common diseases, in particular cardiovascular diseases, kidney diseases and diabetes mellitus.

The screening covers:

  • medical history, in particular to measure the risk profile (e.g. being a smoker, being overweight, familial (cancer) risks) and check of vaccinations
  • physical examination, including measurement of blood pressure
  • laboratory analysis of urine, blood glucose and cholesterol (for 18-34 year-olds, only if there are risk factors)
  • advice on the results of the examination and, where appropriate, issuance of a preventive recommendation where appropriate (e.g. physical activity, nutrition, stress management or drug use).

Those aged 35 and over can also have a single test for the viruses Hepatitis B and Hepatitis C as part of the check-up.

Men aged 65 and over are also entitled, as part of the check-up, to a single ultrasonic screening for early detection of abdominal aortic aneurysms (pathological protusion of the abdominal arteries in the abdomen).

Cancer screening

Men and women are entitled to screening examinations for the early detection of cancer as part of statutory health insurance. This is laid down in Section 25(2) of Book V of the Social Code. The following cancer screening tests are currently available:

  • breast cancer in women: annual palpation from the age of 30 and mammography screening every 2 years between the ages of 50 and 69
  • cervical cancer in women: annual cytological smear test between the ages of 20 and 34, cytological smear test plus a test for the human papillomavirus every 3 years from the age of 35
  • prostate cancer in men: (annual palpation from the age of 45)
  • bowel (colorectal) cancer in men and women: from the age of 50, regular faecal immunochemical tests (FIT), or, from the age of 50 or 55, two screening colonoscopies at 10-year intervals
  • skin cancer in men and women: examination of the skin surface with the naked eye every 2 years from the age of 35.

Mammography screening for the early detection of breast cancer, and cervical cancer screening in women, and bowel cancer screening in men and women are offered as structured screening programmes based on EU guidelines. As a result, all women between the ages of 50 and 69 nationwide have been contacted in writing every 2 years since 2009 to invite them to a mammography screening session and provide information about the programme.

From July 2019, the statutory health insurance funds started sending invitations and information on bowel cancer screening to eligible insured persons at 5-yearly intervals from the age of 50.

From January 2020, the statutory health insurance funds started sending invitations and information on cervical cancer screening to eligible women from the age of 20.

Dental examinations

  • From the age of 6 months until the end of their 33rd month, small children are entitled to three dental check-ups (Section 26 Book V of the Social Code - SGB V). The check-ups include inspection of the oral cavity, information from the dental staff about the source of oral conditions, nutrition and mouth hygiene advice from the dental staff, and recommendations on fluoridation and on selecting suitable fluoridation agents. Children are also entitled to have fluoride varnish applied to harden the tooth enamel twice every calendar year.
  • Children from the age of 34 months until the end of their 6th year are entitled to three dental check-ups (Section 26 SGB V) The check-ups include inspection of the oral cavity, assessment of the risk of tooth decay, nutrition and oral hygiene advice for the parents, recommendation of suitable fluoridation agents for enamel hardening and, if need be, the provision or prescription of fluoride tablets. For children with a high risk of tooth decay, the supplementary application of fluoride varnish for cavity prevention is advisable twice per calendar year.
  • Children from the age of 6 until the end of their 17th year are entitled to semi-annual individual preventive treatment (Section 22 SGB V). This includes, for example, oral health information with guidance on oral hygiene measures and the fluoridation of teeth for tooth hardening. The content and scope of the preventive treatment services are decided upon by the dental practitioner according to the individual circumstances of the particular case.
  • Children under the age of 12 are cared for in nursery schools and schools as part of group preventive treatment. In schools and institutions for the disabled, where the risk of tooth decay is disproportionately high, the measures may be implemented until the age of 16 (Section 21 SGB V).

Regardless of their age, all insured persons are entitled to an in-depth dental examination every 6 months in order to identify dental, oral or maxillofacial conditions, and once a year for tartar removal.

Protection against measles

Health screening for children and young people

Antenatal care

Chlamydia screening

Health screening for adults

Cancer screening

Dental examinations

All screening tests carried out by the statutory health insurance at a glance

Federal Ministry of Health