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COVID-19 VACCINES

EXPLAINED: Why vaccinations are not mandatory in Switzerland

Swiss law prevents mandatory vaccinations, even for dangerous conditions common among children. Here's why.

Unlike in many countries, vaccines are not mandatory in Switzerland. Here's why. Photo by Towfiqu barbhuiya on Unsplash
Unlike in many countries, vaccines are not mandatory in Switzerland. Here's why. Photo by Towfiqu barbhuiya on Unsplash

Vaccinations are a relatively established form of healthcare, but the topic has become enshrined in the collective consciousness again since the Covid pandemic. 

As it became clear during the Covid pandemic, vaccinations — whether against coronavirus or other diseases — are not obligatory in Switzerland.

However, a number of them are highly ‘recommended’, according to the government. 

Switzerland doesn’t mandate common childhood vaccines, including those against measles, whooping cough, tetanus, and others required in many other countries around the world, including neighbours Germany, France and Italy.

Vaccinations are not required to attend public schools in Switzerland, unlike many other countries. 

The map below shows countries where childhood vaccines are required versus those, like Switzerland, where they are merely recommended.

Image: Our World in Data

Why are vaccinations not mandatory in Switzerland?

Switzerland is so lax about immunisations because, pursuant to the constitutional right of each person to “self-determination”, including in matters of health, “no vaccination is compulsory in Switzerland; everyone can decide for themselves”, according to the Federal Office of Public Health (FOPH).

The topic of compulsory vaccinations reached a head during the Covid pandemic, with the government repeatedly saying there would be no mandatory jab order. 

READ MORE: Will Switzerland make the Covid vaccine compulsory?

As usual childhood vaccines are not compulsory, a number of children begin school without having received routine immunisations recommended by health authorities (see below).

The good news is that the number of children in Switzerland who had not been vaccinated against measles has diminished in the last two decades: from 18 percent in 2000 to 4 percent in 2018 — the last year for which official statistics are available.

Image: Statista

Image: Statista

“Despite having an advanced healthcare system, Switzerland has only partially reached its objectives in terms of vaccination, both for individual protection and collective immunity”, according to FOPH.

Among the main reasons why many people avoid vaccines, or refuse to have their children vaccinated, is “because they harbour doubts about their effectiveness, or fear harmful side-effects”, FOPH said.

Can unvaccinated children attend school?

Since immunisations are not mandatory in Switzerland, no public school can turn away a child because he or she had not had the recommended shots.

However, the key word here is “public”.

In 2019, for the first time in Switzerland, a network of private nursery schools called Kita ruled that all children attending their facilities must be vaccinated against at least measles and whooping cough. If parents refuse to comply, the children will be denied attendance.

Generally speaking, any private institution can deny admission to unvaccinated children as they are not held to the same standards as public schools; however, no official data shows any other private establishments following Kita’s example to date.

What if mother and father disagree about vaccinating their child?

Such situations do occur from time to time.

In 2020, Switzerland’s Federal Court ruled that if parents hold opposing views about this issue,  the final decision must be based on the recommendations of the public health authorities which, of course, favour vaccinations.

More recently, the Local reported about one such case. “In late February, a Swiss court handed down an order requiring a mother to vaccinate her child against several childhood diseases”.

“The mother, a vaccination sceptic who believed all forms of vaccination constitute bodily harm, was engaged in a dispute with the child’s father, who wanted the child vaccinated”. 

READ MORE: Can children be vaccinated without parental consent in Switzerland?

Can children be vaccinated without parental consent?

Swiss Health Minister Alain Berset confirmed to parliament that parental consent is not required in order for children to be vaccinated, whether for Covid or otherwise. 

While some parents, particularly those who are sceptical about vaccines, may be dismayed by the decision, the position is valid in Swiss law.

Berset said minors from the age of 12 were “largely capable of judgement” and therefore can make their own decisions with regard to vaccinations, provided they are mentally healthy.

“Only if a child or a young person is incapable of judgment do the owners of parental authority have to give consent to the vaccination,” FOPH said.

Which vaccines do Swiss health authorities recommend for children?

For babies, FOPH recommends the following shots:

  • Measles
  • Diphteria
  • Tetanus
  • Whooping cough
  • Polio
  • Invasive infections by Haemophilus influenzae type b (severe meningitis and laryngitis)
  • Hepatitis B
  • Pneumococci
  • Mumps
  • Rubella

For adolescents aged from 11 to 15, FOPH recommends a Hepatitis B vaccine, chicken pox (for those who have not had it earlier), as well as human papillomavirus (HPV) for girls.

It is also important to keep up with booster shots, health authorities, say: “Some vaccines, especially those against diphtheria or tetanus, do not protect against the disease for life. To benefit from long-lasting protection, the vaccine must be renewed at regular intervals. A catch-up vaccination is also necessary if the basic vaccination is deficient or incomplete, in particular to protect against tetanus, measles, mumps, rubella or whooping cough”.

READ MORE: Measles is spreading in Switzerland: Here’s what you should know about prevention

More information about which vaccines are recommended for infants and older children, as well as other vaccine-related information, can be found here in German, French and Italian

What about adults?

FOPH recommends seasonal flu vaccines, as well as Covid shots.

Also, those who have not had the full set of childhood vaccines, as outlined above, should have them as well.

“Booster vaccines at regular intervals are sometimes necessary to maintain protection against the disease in question. The FOPH thus recommends regular booster shots for the following diseases: diphtheria, whooping cough and tetanus. A catch-up vaccination is also necessary if the basic vaccination is deficient or incomplete, in particular for protection against measles, mumps and rubella”.

Additionally, in view of the increasing number of tick-borne diseases such as Lyme and meningoencephalitis, authorities recommend a vaccine to prevent complications from those conditions as well, especially if you often venture outdoors into grassy areas in the summer.

For more information about which vaccines are recommended for adults in Switzerland, ask your doctor or call the nationwide vaccine hotline at 0844 448 448 (in German, French or Italian).

Where in Switzerland can you vaccinate your child?

For babies born in Switzerland, shots will be administered by a paediatrician of your choice, who will also set appointments for follow-up boosters.

If you are newly arrived with a small child but don’t have a local paediatrician yet, get in touch with the Swiss Pediatric Society which might be able to direct you to paediatrician in your area.

All vaccinations recommended by FOPH are paid by the compulsory health insurance.

READ MORE: Swiss MPs call for fines for parents who fail to vaccinate kids against measles

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HEALTH

How is Swiss healthcare system different from the rest of Europe?

Switzerland’s health infrastructure is consistently rated among the best in the world, but how does it compare with other countries?

How is Swiss healthcare system different from the rest of Europe?

Whether in terms of politics, social system or economy, the Swiss often chart their own course, which fundamentally diverges from that of its European neighbours.

Healthcare is no exception.

The differences lie primarily in who finances the scheme — public versus private — and how the overall system functions.

Like much of the European Union, Switzerland has a universal health system, which means everyone in the country is covered by insurance and has access to medical care.

In most countries, the government typically has control, to a lesser or greater extent, over funding, health insurance, and health providers.

In France, for instance, most healthcare costs are covered by the state healthcare system, known as assurance maladie, and this is funded by taxes – healthcare costs account for about 13 percent of the average person’s gross salary.

In Germany, health costs are shared by employers and workers, with employees paying 7.5 percent of their salaries into a public health insurance fund, and companies matching that amount.

Italy’s national, system, called the Servizio Sanitario Nazionale, or simply SSN, which is financed mainly though federal and regional taxes, automatically covers all residents. Medical care is largely free of charge at the point of service.

Public healthcare also exists in Austria, with certain portions of salaries being automatically deducted to fund the scheme. However, healthcare is free of charge for low-income people or those who who are disabled, studying, or retired.

Although no longer part of the EU, the UK health system is also based on state healthcare via the NHS. It is funded by taxes which account for about 4.5 percent of the average citizens’ gross income.

What about Switzerland?

The system here is fundamentally different in that it is not tax-based or financed by employers, but rather by individuals themselves.

Everyone must have a basic health insurance coverage and purchase it from one of dozens of private carriers.

Basic insurance — KVG in German and LaMal in French and Italian — is compulsory in Switzerland. It doesn’t come cheap — premiums are based on the canton of residence and age, costing 300 to 400 francs a month on average — but it is quite comprehensive; it includes coverage for illness, medications, tests, maternity, physical therapy, preventive care, and many other treatments.

READ MORE: Everything you need to know about health insurance in Switzerland

There are no employer-sponsored or state-run insurance programmes, and the government’s only role is to ensure that all insurance companies offer the same basic coverage to everyone and that they have the same pricing.

While companies can’t compete on prices or benefits offered by the basic compulsory insurance — which are defined by the Health Ministry — they can, and do, compete on supplemental polices which offer perks not included in the basic coverage.

READ MORE: What isn’t covered by Switzerland’s compulsory health insurance?

All policies have deductibles (also called co-pays) that can range from 300 to 2,500 francs a year.

After the deductible is reached, 90 percent of all medical costs will be covered by insurance, with 10 percent being paid by the patient; however, this co-pay is capped at 700 francs a year for adults and 350 francs for children under 18.

The government does subsidise healthcare for the low-income individuals and households – defined as those for whom insurance premiums exceed 10 percent of their income.

What percentage of a person’s income goes to health insurance premiums?

This depends on wages and premiums, for instance, whether a person chose the cheapest option with a high deductible or the expensive one with a 300-franc deductible.

Generally speaking, however, based on the average monthly income of just over 7,000 francs, about 6.5 percent is spent on premiums.

What happens if you don’t take out an health insurance policy?

Anyone who arrives in  Switzerland must get insured within three months. If you don’t, the government will choose one for you and send you the bill. If this happens you may end up with more expensive premiums than you might have gotten if you shopped around yourself.

If you are still delinquent on your payments, your healthcare will be restricted to emergencies only; any other non-urgent medical treatment will be denied, unless you pay for it out of pocket.

The pros and cons of the Swiss system

Let’s look at the ‘cons’ first. Basically, there is one: the cost.

Not only are insurance premiums high and steadily increasing, but, at 7,179 francs per capita, Switzerland has the third most expensive healthcare scheme in the world — behind only the United States ($12,318) and Germany ($7,383).

Unlike taxpayer-funded models, there is no price grading according to income, so people on a low income pay a high proportion of their income for healthcare than higher earners. 

However, the system is generally efficient, has an extensive network of doctors, as well as well-equipped hospitals and clinics.

Patients are free to choose their own doctor and usually have unlimited access to specialists.

READ MORE: EXPLAINED: How to see a specialist doctor in Switzerland without a referral

Waiting lists for medical treatments are relatively short.

According to a survey by the Organisation  for Economic Cooperation and Development  (OECD) on how long patients in various countries typically wait for an appointment with a specialist, the share of people in Switzerland waiting a month or more is 23 percent, compared to 36 percent in France, 52 percent in Sweden, and 61 percent in Norway.

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