{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:20:41Z","timestamp":1789683641583,"version":"4.0.1"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T00:00:00Z","timestamp":1719273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Measles is a highly contagious disease with the potential for severe complications. Despite the availability of effective vaccines, there have been recurrent measles outbreaks in Germany over the past decades. In response, a new measles vaccine mandate was introduced on March 1, 2020, aimed at closing vaccination gaps in high-risk populations. This study evaluates the mandate\u2019s implementation, identifies operational challenges, assesses the impact of the Coronavirus disease 2019 pandemic, and investigates expert attitudes towards the new policy.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Semi-structured expert interviews were conducted with staff members of 16 different local health departments in Germany. The interviews, carried out in April and May 2021, were electronically recorded, transcribed verbatim, and analyzed using the Framework method.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The implementation of the measles vaccine mandate in local health departments varied substantially. Challenges in implementing the mandate primarily arose from uncertainties regarding procedural specifics, such as handling fraudulent medical certificates and imposing sanctions, leading to a call from many interviewees for uniform guidelines to ensure coherent implementation. At the time the measles vaccine mandate came into force, managing the Coronavirus disease 2019 pandemic was a priority in most local health departments, often delaying the implementation of the mandate. Despite the difficulties encountered, most experts considered the mandate to be an effective step towards measles elimination.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The measles vaccine mandate has imposed a new responsibility on staff in German local health departments, which is associated with implementation challenges such as procedural uncertainties and vaccine hesitancy, but also the Coronavirus disease 2019 pandemic as a contextual impediment. Significant differences in the implementation approach underscore the need for harmonization to enhance implementation efficiency and public acceptance of the mandate. Despite the mandate\u2019s potential to increase vaccination rates, our findings advocate for a comprehensive approach, incorporating public education, accessible vaccination, and measures to address social disparities.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0306003","type":"journal-article","created":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T18:53:15Z","timestamp":1719341595000},"page":"e0306003","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["The implementation of a new measles vaccine mandate in Germany: A qualitative study in local health departments"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0269-5403","authenticated-orcid":true,"given":"Sophia","family":"Werdin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Neufeind","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,6,25]]},"reference":[{"key":"pone.0306003.ref001","unstructured":"German Federal Office of Public Health, Paul Ehrlich Institute, Robert Koch Institute, German Federal Centre for Health Education. Rechtliche Aspekte n.d. [Available from: https:\/\/www.masernschutz.de\/themen\/rechtliche-aspekte\/."},{"issue":"10","key":"pone.0306003.ref002","first-page":"3","article-title":"Gesetz f\u00fcr den Schutz vor Masern und zur St\u00e4rkung der Impfpr\u00e4vention (Masernschutzgesetz)","author":"N K\u00fcpke","year":"2020","journal-title":"Epid Bull"},{"key":"pone.0306003.ref003","unstructured":"German Federal Office of Public Health, Paul Ehrlich Institute, Robert Koch Institute, German Federal Centre for Health Education. Masern-Erkrankungen n.d. [23 May 2023]. Available from: https:\/\/www.masernschutz.de\/themen\/masern-erkrankungen\/."},{"key":"pone.0306003.ref004","unstructured":"Robert Koch Institute. Masern RKI-Ratgeber: Robert Koch Institute; 2021 [updated 23 July 2021. Available from: https:\/\/www.rki.de\/DE\/Content\/Infekt\/EpidBull\/Merkblaetter\/Ratgeber_Masern.html."},{"key":"pone.0306003.ref005","volume-title":"Measles in the WHO European Region: situation report #3","year":"2019"},{"key":"pone.0306003.ref006","unstructured":"Web-basierte Abfrage der Meldedaten gem\u00e4\u00df Infektionsschutzgesetz. [Internet]. SurvStat@RKI 2.0. 2021 [cited 16 Oct 2022]. Available from: https:\/\/survstat.rki.de\/Content\/Query\/Create.aspx."},{"key":"pone.0306003.ref007","unstructured":"Robert Koch Institute. Elimination der Masern und R\u00f6teln in Europa: Robert Koch Institute; [updated 23 Aug 2021. Available from: https:\/\/www.rki.de\/DE\/Content\/Infekt\/Impfen\/Praevention\/elimination_03.html."},{"key":"pone.0306003.ref008","unstructured":"German Federal Office of Public Health. Masern [updated 13.10.2022. Available from: https:\/\/www.bundesgesundheitsministerium.de\/service\/begriffe-von-a-z\/m\/masern.html."},{"issue":"32\u201333","key":"pone.0306003.ref009","first-page":"9","article-title":"Impfquoten von Kinderschutzimpfungen in Deutschland\u2014aktuelle Ergebnisse aus der RKI-Impfsurveillance","author":"T Rieck","year":"2020","journal-title":"Epid Bull"},{"key":"pone.0306003.ref010","unstructured":"German Infection Protection Act of July 20, 2000 (BGBl. I p. 1045), as last revised by Article 1b of the Ordinance of September 16, 2022 (BGBl. I p. 1454)."},{"issue":"1","key":"pone.0306003.ref011","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1186\/s12889-022-14075-y","article-title":"How a generally well-accepted measles vaccine mandate may lead to inequities and decreased vaccine uptake: a preregistered survey study in Germany","volume":"22","author":"J Neufeind","year":"2022","journal-title":"BMC Public Health"},{"key":"pone.0306003.ref012","unstructured":"The Academy of Public Health Services in D\u00fcsseldorf. Gesundheits\u00e4mter leisten Herausragendes. Blickpunkt \u00f6ffentliche Gesundheit. 2020;Special issue 2020."},{"key":"pone.0306003.ref013","first-page":"669","volume-title":"Handbuch Methoden der empirischen Sozialforschung","author":"C. Helfferich","year":"2014"},{"key":"pone.0306003.ref014","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-662-64762-2","volume-title":"Forschungsmethoden und Evaluation in den Sozial- und Humanwissenschaften","author":"N. D\u00f6ring","year":"2023"},{"key":"pone.0306003.ref015","volume-title":"Die Qualit\u00e4t qualitativer Daten: Manual f\u00fcr die Durchf\u00fchrung qualitativer Interviews","author":"Wiesbaden","year":"2011"},{"key":"pone.0306003.ref016","volume-title":"Praxisbuch Interview, Transkription & Analyse","author":"T Dresing","year":"2015"},{"key":"pone.0306003.ref017","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research","volume":"13","author":"NK Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"issue":"6","key":"pone.0306003.ref018","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"A Tong","year":"2007","journal-title":"International Journal for Quality in Health Care"},{"issue":"10292","key":"pone.0306003.ref019","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.1016\/S0140-6736(21)01106-5","article-title":"Divergent vaccination policies could fuel mistrust and hesitancy","volume":"397","author":"R Forman","year":"2021","journal-title":"The Lancet"},{"key":"pone.0306003.ref020","volume-title":"The organization and delivery of vaccination services in the European Union: prepared for the European Commission","author":"European Observatory on Health Systems and Policies","year":"2018"},{"key":"pone.0306003.ref021","unstructured":"Deutsches \u00c4rzteblatt. Befreiung von der Maskenpflicht: Welche Anforderungen ein \u00e4rztliches Attest erf\u00fcllen muss. [updated 10.11.2020. Available from: https:\/\/www.aerzteblatt.de\/nachrichten\/118227\/Befreiung-von-der-Maskenpflicht-Welche-Anforderungen-ein-aerztliches-Attest-erfuellen-muss."},{"key":"pone.0306003.ref022","unstructured":"German Criminal Code in the version promulgated on November 13, 1998 (BGBl. I p. 3322), as last revised by Article 1 of the Act of July 11, 2022 (BGBl. I p. 1082)."},{"key":"pone.0306003.ref023","volume-title":"Einstellungen, Wissen und Verhalten von Erwachsenen und Eltern gegen\u00fcber Impfungen\u2014Ergebnisse der Repr\u00e4sentativbefragung 2020 zum Infektionsschutz","author":"N Horstk\u00f6tter","year":"2021"},{"issue":"39","key":"pone.0306003.ref024","doi-asserted-by":"crossref","first-page":"5811","DOI":"10.1016\/j.vaccine.2018.08.042","article-title":"Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps","volume":"36","author":"NE MacDonald","year":"2018","journal-title":"Vaccine"},{"issue":"2","key":"pone.0306003.ref025","article-title":"Mandatory vaccination in europe","volume":"145","author":"OM Vaz","year":"2020","journal-title":"Pediatrics"},{"issue":"22","key":"pone.0306003.ref026","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2018.23.22.1800238","article-title":"Introduction of new and reinforcement of existing compulsory vaccinations in Italy: first evaluation of the impact on vaccination coverage in 2017","volume":"23","author":"F D\u2019Ancona","year":"2018","journal-title":"Euro Surveill"},{"issue":"26","key":"pone.0306003.ref027","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2019.24.26.1900301","article-title":"Assessment of the impact of the extension of vaccination mandates on vaccine coverage after 1 year, France, 2019","volume":"24","author":"D L\u00e9vy-Bruhl","year":"2019","journal-title":"Euro Surveill"},{"issue":"9508","key":"pone.0306003.ref028","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/S0140-6736(06)68144-0","article-title":"Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future","volume":"367","author":"DA Salmon","year":"2006","journal-title":"Lancet"},{"issue":"7766","key":"pone.0306003.ref029","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1038\/d41586-019-02232-0","article-title":"Mandate vaccination with care","volume":"571","author":"SB Omer","year":"2019","journal-title":"Nature"},{"issue":"6","key":"pone.0306003.ref030","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2018-3301","article-title":"Elimination of nonmedical immunization exemptions in california and school-entry vaccine status","volume":"143","author":"PL Delamater","year":"2019","journal-title":"Pediatrics"},{"issue":"4","key":"pone.0306003.ref031","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1007\/s00103-019-02901-5","article-title":"Durchimpfung von Kindern und Jugendlichen in Deutschland: Aktuelle Daten aus KiGGS Welle 2 und Trends aus der KiGGS-Studie.","volume":"62","author":"C Poethko-M\u00fcller","year":"2019","journal-title":"Bundesgesundheitsblatt\u2014Gesundheitsforschung\u2014Gesundheitsschutz"},{"issue":"1","key":"pone.0306003.ref032","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1111\/j.1467-842X.2002.tb00272.x","article-title":"Increases in vaccination coverage for children in child care, 1997 to 2000: an evaluation of the impact of government incentives and initiatives.","volume":"26","author":"L Bond","year":"2002","journal-title":"Aust N Z J Public Health"},{"issue":"3","key":"pone.0306003.ref033","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1177\/1529100618760521","article-title":"Increasing vaccination: putting psychological science into action","volume":"18","author":"NT Brewer","year":"2017","journal-title":"Psychol Sci Public Interest"},{"key":"pone.0306003.ref034","volume-title":"Behavioural and social drivers of vaccination: tools and practical guidance for achieving high uptake","author":"World Health Organization","year":"2022"},{"key":"pone.0306003.ref035","volume-title":"Methoden der empirischen Sozialforschung.","author":"R Schnell","year":"2011","edition":"9"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0306003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T18:53:45Z","timestamp":1719341625000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0306003"}},"subtitle":[],"editor":[{"given":"Mohammad Hossein","family":"Ebrahimi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,6,25]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0306003","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,25]]}}}