Abstract
BACKGROUND: In Germany, two vaccination mandates were introduced in response to measles outbreaks and stagnating COVID-19 vaccination rates. In March 2020, the Measles Protection Act came into effect, and in December 2021, a COVID-19 vaccination mandate for medical institutions was enacted. The aim of this study was to examine the implementation of both vaccination mandates and the associated challenges in public health authorities (PHAs) and other affected institutions. METHODS: Thirty semi-structured expert interviews were conducted with PHAs and other institutions from federal states with both high and low vaccination rates. The online interviews took place in October and November 2022, were electronically recorded, transcribed verbatim, and analyzed using framework analysis. RESULTS: The implementation of the measles vaccination mandate was delayed due to the COVID-19 pandemic and postponed several times until after the end of the transition period. For the temporary COVID-19 vaccination mandate, lengthy administrative processes were a major aspect that hindered the implementation of measures and limited its effectiveness. Sanctions were rarely imposed in either case. Implementation was characterized by significant heterogeneity; PHAs reported legal uncertainties regarding practical implementation and a lack of clarity on who should report. The mandates also created conflicting aims between the mandate and concerns over potential personnel shortages or denied educational opportunities. DISCUSSION: This study identified key factors for the successful implementation of a vaccination mandate. Mandatory reporting, even in cases where no problems exist, standardized procedures, and legal support could facilitate implementation. However, it remains uncertain how to resolve conflicts of aims arising from vaccination mandates.