Access rights or obligations to participate in available public preventive healthcare measures
Mandatory vaccination programmes
The Masernschutzgesetz (Measles Protection Act) was introduced in Germany on 1 March 2020. The law requires that all children over the age of one must have received the measles vaccine recommended by the Standing Committee on Vaccination at the Robert Koch Institute (STIKO) before being admitted to pre-school, child daycare facilities or school.
Anyone born after 1970 must also prove they are protected against measles before being allowed to work in certain community institutions or medical facilities (e.g. childcare workers, teachers, childminders and medical workers). Asylum seekers and refugees must also be vaccinated within four weeks of being admitted to an accommodation centre.
Children aged over one must prove they have been vaccinated at least once against measles (or have immunity against measles). Anyone aged over two must provide proof they have complete protection against measles (i.e. two vaccinations).
- What are the implications if people refuse to comply with mandatory vaccination programmes (e.g. are vaccinations a prerequisite for admission to schools or childcare facilities)?
Anyone who fails to provide the necessary evidence, will be not be permitted to attend facilities or institutions covered by the Measles Protection Act, nor will they be permitted to work there. However, this provision does not apply to anyone for whom school attendance is compulsory.
Special provisions are also in place for people who were already attending or working at one of the facilities or institutions covered by the Measles Protection Act at the time it entered into force on 1 March 2020. They have until 31 July 2021 to provide the management of these organisations with the necessary evidence. Otherwise the health authorities will decide, on a case-by-case basis, whether individuals will no longer be permitted to attend or work at these organisations (with the exception of anyone for whom school attendance is compulsory).
Failure to comply with the legislation will result in a fine from the competent authorities
If the management of a facility or institution:
- employs or allows the attendance of someone who is not permitted under the legislation;
- fails to notify the health authorities of information required under the legislation.
- If an individual fails to provide the evidence required under the legislation within an appropriate time period, despite this information being requested by the health authorities.
The competent authorities must ensure that the amount of the fine is proportionate to the offence.
A fine may be reissued when a ruling or judgment becomes final (see Dresden Higher Regional Court NStZ-RR 97, 314) or if a new decision (by omission) comes into force.
In addition or as an alternative to an administrative fine (under the Administrative Offences Act), a penalty payment (under the Administrative Enforcement Act) may apply in the event of non-compliance with the legally enforceable obligation to provide evidence.
- What are the permitted exemptions from participating in mandatory vaccination programmes, e.g. immunodeficiency or religious grounds?
The legislation does not make any provision for an exemption on religious grounds. Based on experiences from other countries with mandatory vaccination programmes, the only permitted exemption is people who cannot be immunised due medical contraindications, for instance if they are allergic to one of the vaccine components. In this case, individuals must provide the facility or institution in question with a medical certificate confirming the existence of medical contraindications.
Children and young people health examinations
Children and young people are entitled to specific health examinations as a statutory health insurance benefit. This is set out in Section 26 Fünftes Buch Sozialgesetzbuch (Book V of the Social Code). There are currently ten health examinations available for children (the U examinations U1 to U9) and one examination for young people (J1 examination). In these, the doctor examines the general health condition and checks if certain serious conditions are present and if the child is developing according to their age. The programme is tailored precisely to the childs age group and includes, for example, check-ups for congenital metabolic disorders, for serious hearing disorders on both sides in newborns, examinations of the hip joints, as well as various examinations of individual organs and examinations of motor skills and social development. The costs for these check-ups are borne by the statutory health insurance provider, if they are taken up at the specified time. Participation is generally voluntary; however, some individual states have made these examinations mandatory.
Women and men are entitled to screening examinations for the early detection of cancer as part of statutory health insurance. This is laid down in § 25(2) of Book Five of the German Social Code. The following screening tests to help prevent cancer are currently available for the early detection of:
- 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 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),
- colorectal cancer in men and women (regular immunological stool blood tests from the age of 50 or two screening colonoscopies at 10-yearly intervals from age 50 or age 55), and
- 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, as well as colorectal cancer screening in women and men are offered as structured screening programmes based on European guidelines. As a result, all women between the ages of 50 and 69 nationwide have been written to every 2 years since 2009 to remind them to go for a mammography screening and provide information about the programme. From July 2019, the statutory health insurance funds began a programme of contacting at 5-yearly intervals eligible insured individuals from the age of 50 with invitations and information on colorectal cancer screening. And in January 2020, they started doing the same for cervical cancer screening to eligible women from the age of 20.
- From the 6th until the end of their 33rd month of life, minors are entitled to three dental check-ups (Section 26 Fünftes Buch Sozialgesetzbuch [Book Five of the German Social Code, SGB V]). The check-ups include inspection of the oral cavity, information from the dental staff about the origin 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.
- From the 34th month of life until their sixth birthday, children are entitled to three dental check-ups (Section 26 of the SGB V). The check-ups include the inspection of the oral cavity, assessment of cavity risk, nutrition and oral hygiene advice for the parents, the 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 cavities, the supplementary application of fluoride varnish for cavity prevention is indicated twice per calendar year.
- Children and young people from six until their 18th birthday are entitled to individual prophylaxis every six months (Section 22 of the SGB V); this includes, for example, information on oral health with instructions on oral hygiene measures and fluoridation of teeth for enamel hardening. The content and scope of the prophylaxis services are decided upon by the dental practitioner according to the individual circumstances of the particular case.
- Children under the age of the twelve are provided with group prophylaxis in kindergartens and schools; in schools and institutions for disabled people in which the cavity risk of schoolchildren is disproportionately high, the measures can be provided until the children turn 16 (Section 21 of the SGB V).
Regardless of their age, all insured parties are entitled to an in-depth dental examination every six months to identify dental, oral and maxillofacial issues, and once a year for scaling.
Mandatory vaccination programmes
Other useful information can be found
The relevant legislation (Section 20(814) of the German Protection against Infection Act) is available
Gesundheitsuntersuchung Kinder und Jugendliche
Information on cancer screening
Federal Joint Committee (Gemeinsamer Bundesausschuss):
Cancer information service at the DKFZ:
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) (Institute for Quality and Efficiency in Health Care):
Responsible for the content
Federal Ministry of Health
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