© Borgis - Postępy Nauk Medycznych 5/2016, s. 356-360
*Iwona Wrześniewska-Wal, Anna Augustynowicz
Obligatory vaccinations as a tool for public health
Obowiązkowe szczepienia ochronne jako narzędzie zdrowia publicznego
Department of Economics, Law and Management, School of Public Health, Centre of Postgraduate Medical Education, Warsaw
Head of Department: Iwona Wrześniewska-Wal, MD, PhD
W artykule przedstawiono problematykę szczepień ochronnych jako narzędzia realizacji jednego z podstawowych zadań zdrowia publicznego, jakim jest profilaktyka chorób. Obowiązek poddawania się określonym szczepieniom ochronnym określa ustawa o zapobieganiu oraz zwalczaniu zakażeń i chorób zakaźnych u ludzi. Wykaz chorób zakaźnych objętych obowiązkiem szczepień ochronnych, a także osoby lub grupy osób obowiązane do poddania się obowiązkowym szczepieniom ochronnym, określa rozporządzenie Ministra Zdrowia w sprawie obowiązkowych szczepień ochronnych. Szczegółowy wykaz szczepionek na dany rok ogłasza Główny Inspektor Sanitarny w formie komunikatu. Wykonanie szczepienia ochronnego poprzedzone jest lekarskim badaniem kwalifikacyjnym. Niezbędne jest także uzyskanie zgody uprawnionego podmiotu: pacjenta lub jego przedstawiciela ustawowego.
The article presents the problem as of vaccination a tool for implementing one of the basic tasks of public health, which is the prevention of diseases. The obligation to undergo certain vaccines have been specified in the Act on the prevention and fighting infections and infectious diseases in humans. The list of diseases of compulsory vaccinations, as well as persons or groups of persons required to undergo mandatory protective vaccinations, defined in the Regulation of the Minister of Health on compulsory vaccinations. A detailed list of vaccines for that year announces Chief Sanitary Inspector in the form of a message. Vaccination protection is preceded by a medical examination of qualifying. It is also necessary to obtain the consent of the authorized entity: the patient or his legal representative.
Intensive development of medicine offers great opportunities not only for diagnosis and treatment of many diseases, but also to prevent getting sick. The basic condition that determines the legality of medical action of a prophylactic or therapeutic agent is the patient’s consent. However, in certain statutorily defined cases, introduced legal solutions which might affect the autonomy of the patient. In these cases, the dilemma between the values of the protection of community health patient autonomy is resolved in favor of the first one (1). Examples of such solutions are the provisions of the law on the prevention and combating of infections and infectious diseases in humans (2), including those that relate to mandatory vaccinations. In art. 1 of this Act states that it specifies “the rules and procedures of preventing and combating infections and infectious diseases in humans” and “the rights and obligations of service providers and persons residing in the territory of the Polish Republic in the prevention and combating of infections and infectious diseases in humans”. The obligations referred to in that provision include undergo sanitary treatment, preventive vaccination, after-exposure prophylactic medicines, sanitary-epidemiological studies, disease surveillance, quarantine, treatment, hospitalization, isolation (art. 5, paragraph. 1, item 1 of the Act).
Vaccinations, both compulsory and recommended pursue one of the basic tasks of public health, which is the prevention of diseases (3). The current decline in the incidence of severe, often fatal infectious disease is the result of 200 years of work of researchers (4). It is worth to add some historical statistics of the epidemiology of some infectious diseases. In 1963, Wrocław there was an epidemic of smallpox (5). There have been 99 cases, including 7 deaths. In the twentieth century. Smallpox was responsible for 300-500 million deaths. The World Health Organization (WHO) estimated that in the 1967. 15 million people infected with the disease, of which 2 million died. Thanks to vaccinations, the disease was until 1980. Completely eliminated (4). WHO announced the eradication of smallpox. The germ is stored only in the laboratory WHO w Moscow and Atlanta (6). Another example is the diphtheria. In 1952, Poland had as many as 40 562 cases, including 782 deaths. After the introduction of vaccination in 1955 and the public vaccination program in 1960 there has been a rapid decline in incidence. Currently, since 2001 Poland was not a single disease (7). In 1973 it was recorded in Poland, 184 308 cases of measles and 109 deaths from the disease. Since the 90s. the number of cases is usually below 100 and they occur most frequently among unvaccinated. In Poland after 2000 deaths from measles are not present (4). Data from recent years show that measles fell ill in 2012 – 70 people, 2013 – 84 people and in 2014 – 110 people. In the case of rubella in 2009-2011 were recorded respectively 7856 cases, 4197 and 4292 cases of infection. In the last year of rubella fell ill 5891 people (7). These data indicate that the resignation of the immunization carries the risk of serious consequences not only for the individual non-vaccinated people, but above all for the whole population (8).
The effective implementation of vaccination, especially those with compulsory important role played by the legal provisions governing this issue. It is a clear indication of the list of infectious diseases, of persons obliged to fulfill the obligation of vaccination, as well as the means to enforce this obligation.
THE LEGAL BASIS OF PROTECTIVE VACCINATION
The Law on prevention and fighting infections and infectious diseases in humans in art. 5 paragraph. 1 point. 1 point b in the compound of the art. 17 paragraph. 1 imposes on the persons on the territory of the Polish obligation to subject to specific protective vaccinations. Regulation of the Minister of Health on compulsory immunization (9) defines: the list of communicable diseases covered by the obligation of vaccination, as well as persons or groups of persons obliged to undergo mandatory preventive vaccination, specifying their age and other circumstances which are prerequisite to the possible exercise vaccination defined in the Regulation of the Minister health on compulsory vaccinations. Additionally, pursuant to art. 17 paragraph. 11 above Act detailed list of vaccines for that year announces the Chief Sanitary Inspector, in the form of an announcement in the official gazette of the Ministry of Health. This is the Immunization Program for the year, with specific indications regarding the use of individual vaccines. The program for 2016 was published in the Communication Chief Sanitary Inspector of 16 October 2015 on Immunization Program for 2016 (10). In the previous year there were changes concerning, among others guidelines for vaccination against acute poliomyelitis (Polio) and pertussis, as well as changes in the group of persons to whom it is recommended that some vaccinations. Allowed to use 5-component vaccine (DTaP-IPV-Hib). Still does not include vaccination of all infants against pneumococcal or public vaccination formulations of acellular pertussis component (11). However, the vaccination kit intended for use in Poland does not differ significantly from those in force in other European Union countries. It is worth mentioning two different approaches to vaccination in EU countries. They may be exercised within the framework of the mandatory vaccination schedule and recommended. The differences arise, among others, used approaches the conditions of cultural, historical, the organization of health care, the level of economic development, and public awareness (12).
At this point it is worth noting that the nature issued by the Chief Sanitary Inspector statement, although it has its statutory authorization may raise doubts as to the compatibility with Article. 87 paragraph. 1 of the Constitution (13). Neither the law on the prevention and combating of infections and infectious diseases in humans or above. Regulation – i.e. the provisions of current law – do not define the requirements for vaccination in sufficient detail (14). This obligation concrete mentioned above message that is not a source of universally binding law. We are therefore faced with a reference to the legal regulation which is outside the constitutional catalog of sources of law (15). From a legal point of view, such a rule may be grounds to invoke subjecting the compulsory vaccination protective concretized in the document is not located in the directory of sources of law. And that may raise doubts as to the compatibility with the Constitution of the Republic of Poland. However, from a medical point of view, the legislative procedure is understandable and convenient because it allows relatively easy, from a regulatory point of view, the way to take into account the dynamically changing epidemiological situation (1).
It is worth noting that since 2017 change the rules of financing vaccines. The purchase of vaccines for the insured to finance the payer, currently the National Health Fund, and the vaccine for people not covered by insurance will pay the Ministry of Health (16).
PROCEDURES RELATED TO THE PERFORMANCE OF PROTECTIVE VACCINATION
Procedures associated with the implementation of mandatory vaccination defines art. 17 of the Law on preventing and fighting infections and infectious diseases in humans and the regulation on compulsory vaccinations. Vaccination protection is preceded by a medical examination qualifying. Research qualifying performs a doctor who has the necessary knowledge in the field of immunization, knowledge of indications and contraindications to vaccination, as well as the side effects of vaccination and the rules of conduct and documentation of vaccination. After the survey qualifying physician shall issue a certificate indicating the date and time of the audit. Preventive vaccination cannot be performed if 24 hours have passed from the date and time indicated in the certificate. Pursuant to § 7 of the mandatory vaccinations, medical examination qualification and mandatory vaccinations a person who has not attained the age of 6 are carried out in the presence of a person who in the legal custody of that person or the actual guardian within the meaning of the Act on the Rights of patient and patient Ombudsman (17). The presence of a person having permanent custody of the minor or the actual guardian is not required if the minor completed six years of age and obtained the written consent of these persons and information on the determinants of health which may constitute a contraindication to vaccination. If your doctor determines that there is a basis for long-term postponement of the protective vaccination directs the child to consult a specialist. Pediatrician should medical records, i.e., immunization record card of the consultation specialist, with emphasis on the period contraindications to perform the vaccination, kind of vaccine contraindicated for use or individual vaccination program indicating the type of vaccine used and the date of the next consultation. Important is the fact that undergo mandatory preventive vaccination may be exempt only those who have the specialist sees steady contraindications to the vaccination or specific vaccinations. Individual calendar vaccination program (mandatory and recommended) laid by a doctor for the child, taking into account the delays in the implementation of vaccination in relation to the Programme of Immunization.
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