Polish Legislation and Health Policy against the Background of Achievement of the Assumptions and Objectives of the Measles Eradication Programme in the European Region

Health is one of the most important aspects of every human life. Everyone’s health conditions are different. They depend on many congenital factors, including genetic and secondary (past diseases, injuries, and surgeries). The framing of health as a concept in the doctrine of medicine and health sciences focuses on two fundamentally convergent definitions. Galen’s definition from the 1st century AD indicates that health is a state of perfect harmony and balance of the body, and anything that deviates from this is called a disease.

Galen’s definition of health. See: Galen, ‘On Diseases and Symptoms’, translated by I. Johnston, Cambridge University Press, 2006, p. 21–22.

However, it should be acknowledged that the concept of health from the WHO Constitution is a kind of idea and attempt at identifying what qualities are required for health to be present. This sets a policy of constant struggle to improve the level of health on every level. This provides a starting point for considering the design of the measles programme in the European region and its objectives. One can see a kind of complementation of the WHO ‘health’ ideas in this programme. However, have the ideas reproduced in the WHO health policy been appropriately transposed into national legislation?

The science of public health and health policy focuses, among other things, on the problem of fighting infectious diseases. This is a very important issue, especially considering the constant mutation of biological pathogens that cause infectious diseases. Most importantly, the fact of continuing climate change is also raised.

Jan C. Semenza, Bettiana Menne, Climate change and infectious diseases in Europe, The Lancet. Infectious Diseases, Vol. 9, Issue 6, 2009, pp. 365–375.

The problem of the spread of infectious diseases continues to exist. Uncontrolled transmissions of biological pathogens can cause epidemic conditions in different regions of the world. Because of the widespread freedom of movement, they can be easily brought to new territories. Even infectious diseases that are known to medicine are a dangerous factor affecting human health and life. Examples of these include measles and tuberculosis, which in certain regions of Europe and the world are a significant threat to the public health of local communities. Questions arise as to the effectiveness of national and supranational mechanisms for preventing the spread of infectious diseases. An extremely important issue is the prevention of already known diseases, such as measles. With health policies being broken down nationally while being coordinated through WHO strategic programmes, it makes sense to try to assess national regulations in light of the recently completed measles elimination programme in the European region (2012–2020). This will contribute to further discussion on the need for uniform (or at least consistent) mechanisms to combat and prevent the spread of infectious diseases in the European region.

Measles is classified as a droplet-transmitted infectious disease. As indicated in the medical literature, respiratory droplets from infected individuals act as carriers of infection. They deliver the virus to the epithelial cells in the airways of susceptible hosts. During the 10–14-day incubation period between infection and the onset of clinical symptoms, the measles virus (MV) replicates and spreads in the infected host. Replication occurs initially in the epithelial cells at the site of entry into the upper respiratory tract.

William J. Moss, Diane E. Griffin, ‘Global measles elimination’, (2006) 4 Nature Reviews Microbiology, 900–901.

The spread of immunisations has significantly contributed to minimisation of the risk of recurrent measles epidemics. As indicated in the literature, exposed individuals who are not immunised have up to a 90% chance of contracting the disease and every person with measles can infect 9 to 18 other people in a susceptible population. It is worth pointing out that before the spread of vaccination, this virus caused an estimated 2–3 million deaths per year worldwide.

Catherine I. Paules, Hilary D. Marston, et al., ‘Measles in 2019 – Going Backward’, (2019) 380 The New England Journal of Medicine, 2185–2187 <doi.org/10.1056/NEJMp1905099>

When looking at the current data, the measles problem is still relevant. A study sample of 5 years was adopted (data from January 2015 to December 2019).

At the time of data compilation, the annual report for 2020 was not yet available.

The data presented clearly show an upward trend in the incidence of measles. The calculated annual incidence of measles for the selected 10 countries of the European region demonstrates the compounding problem of measles returning to the European region. Particularly worrying data can be seen for Bulgaria, France, and Romania. In the case of Poland in 2019, there was a serious increase in incidence compared to 2018. A dramatic increase in incidence compared to 2015 is also evident. For the countries surveyed, there is an overall upward trend in measles cases looking at 2015–2019. Only Germany sees a reduction in measles cases. However, these values are comparable to the other countries considering their populations. A slight decrease in cases can be seen in 2019, but more than a threefold increase in measles cases is recorded compared to 2015.

The indicated annual summary of measles cases in the studied countries of the European region justifies the thesis of an overall increasing trend of measles cases in the European region. Compared to 2015, there were four times more measles cases in 2019. Considering that the WHO measles elimination programme was envisaged for the period 2012–2020, these data are not optimistic. It is worth noting that these are the last years of the current measles elimination programme in the European region. Despite the use of measles vaccination, it has not been possible to eliminate this disease from European society. Cases of measles have also been reported in other European countries. As indicated by the WHO, in early 2019, the WHO European Region reported a total of 83,540 measles cases, with 74 measles-related deaths in 2018.

<https://www.who.int/emergencies/disease-outbreak-news/item/2019-DON140 > accessed 2 January 2022

The 2019 annual report of the European Centre for Disease Prevention and Control (ECDC) indicated that the agency’s risk assessment concluded that the risk of further widespread measles outbreaks in the EU/EEA soon was high. Importantly, it highlighted that measles is currently a major cross-border public health threat. The European Regional Verification Commission for Measles and Rubella Elimination concluded in June 2019 that three EU/EEA Member States (Czech Republic, Greece, and the UK), which had previously eradicated measles, had re-established transmission during 2018, and five Member States (France, Germany, Italy, Poland, and Romania) are still struggling with measles outbreaks.

ECDC, ‘Annual Epidemiological Report for 2018 - Measles’ <www.ecdc.europa.eu/sites/default/files/documents/measles-annual-epidemiological-report-2018.pdf> accessed 2 February 2022

There are currently endemic outbreaks of measles in the European region.

P. Carrillo-Santisteve, P. L. Lopalco, ‘Measles still spreads in Europe: who is responsible for the failure to vaccinate?’, (2012) 18 Clinical Microbiology and Infections, 50–56; P. Plans-Rubió, (2017) 36 ‘Why does measles persist in Europe?’, European Journal of Clinical Microbiology & Infectious Diseases, 1899–1906; A. Robert, S. Funk, A. J. Kucharski, ‘The measles crisis in Europe – the need for a joined-up approach’, The Lancet (2019) 393(10185) <doi.org/10.1016/S0140-6736(19)31039-6>

The above-mentioned statistical data clearly indicate that the problem of continuing epidemic outbreaks of measles in the European region and the sudden increase in measles cases in European countries is still relevant, despite the final phase of the WHO’s strategic programme. The struggle with measles and the need for its elimination through the widespread availability of effective measles vaccination is still current, and the continuing upward trend in the incidence of measles does not inspire optimism about the realisation of the key objectives of the WHO programme.

The WHO’s first clear stance on measles appears to have been expressed at the 2001 meeting of the WHO’s European Regional Office in Copenhagen. At that time, a strategic plan was developed to interrupt the transmission of the measles virus and to confirm its eradication in the region composed of 51 European countries by 2010. During the implementation of this programme, the year 2010 was used as the target date; however, it was never considered to be very realistic due to the persistence of measles outbreaks in the European region.

‘Data collected at the time suggested an increasingly significant threat from measles in the European region and globally’ <https://cordis.europa.eu/article/id/30310-eliminating-measles-in-europe-by-2010-may-be-difficult-study-suggests/pl> accessed 2 March 2021. See also: Mark Muscat, Henrik Bang, Jan Wohlfahrt et al., ‘Measles in Europe: an epidemiological assessment’, (2009) 373(9661) The Lancet <doi.org/10.1016/S0140-6736(08)61849-8>

The Regional Verification Commission for Measles and Rubella Elimination (RVC) was established in 2011.

<www.euro.who.int/en/health-topics/communicable-diseases/measles-and-rubella/activities/regional-verification-commission-for-measles-and-rubella-elimination-rvc> accessed 4 October 2022

The latest strategic plan for the elimination of measles covers the period from 2012 to 2020.

‘Global Measles and Rubella Strategic Plan: 2012–2020’, (2012) World Health Organization, 8

As indicated in the strategic plan for the eradication of measles for 2012–2020, implementation of the Global Strategic Plan for measles can rapidly and sustainably protect and improve the lives of children and their mothers around the world. The WHO concludes that there is substantial evidence demonstrating the benefits of providing universal access to measles vaccines. The statement that ‘measles returns when we lose our vigilance’ is very important. This suggests that the WHO is aware of the importance of the problem and its timeliness.

Ibid., 6–10

The global plan’s measles eradication strategy focuses on the implementation of five core elements:

Achieving and maintaining a high level of population immunity by ensuring high vaccination coverage with two doses of measles vaccines.

The plan identifies the objectives and milestones to be achieved. The objectives were divided into two groups according to the time criterion. The first group (by the end of 2015) includes: reducing global measles mortality by at least 95% compared to 2000 estimates and achieving regional measles eradication targets. The second group of tasks, scheduled to be completed by the end of 2020, is to achieve measles and rubella eradication in at least five WHO regions. The milestones are also divided in terms of time. The milestones group by the end of 2015 includes strategic planning, coordination, and collaboration at every level. It also includes:

Reducing the annual incidence of measles to less than five cases per million and maintaining this level.

The milestones by the end of 2020 include maintaining the 2015 targets achieved and achieving at least 95% coverage of both the first and second routine dose of a measles-containing vaccine (or a measles- and rubella-containing vaccine, as appropriate) in each district and at the national level, and setting a target date for the global eradication of rubella and CRS.

These are the specific ideas that are to guide the states in achieving the programme’s objectives. The objectives achieved and any problems in achieving them are reported directly by the states. The following four guiding principles were identified:

Country ownership and sustainability – according to this principle, national public health officials are responsible for achieving public health objectives and, therefore, building a high level of immunity in the society.

It must be concluded that the objectives of the Programme have not been fully achieved. The increase in the incidence of measles since 2018 justifies questions about the effectiveness of the solutions provided by the programme, especially since these are the last years of the programme. The measles elimination programme probably should be extended, as the essential objectives and milestones have been aptly defined by the WHO.

To effectively combat measles, as well as other communicable diseases, it is necessary to evaluate the efforts made to date to eliminate measles from the European region. We need to look at public health policies at the national level, and at the legal regulations in place in countries where the incidence of the disease is on the rise. It is also important to examine whether the countries have qualified services to implement the measles elimination plan. It will be useful to define the key factors determining the criteria for assessing the implementation of the WHO plan at the national level. The following factors are worth considering:

Are the national public health policies against the spread of measles in line with the WHO measles elimination program?

Taking these factors into consideration, an analysis of the national regulations in Poland and an assessment of the national health policy aimed at preventing the spread of measles will be carried out.

The national policy against the spread of measles in Poland is mainly based on the implementation of preventive forms of control of the disease. Compulsory vaccination of children and adolescents up to the age of 19 is carried out continuously.

‘The obligation of preventive vaccinations in Poland is permanent and applies to children at 13–15 months of age and 6 years of age’ <https://szczepienia.pzh.gov.pl/szczepionki/odra> accessed 8 May 2022

It should be objectively concluded that the national public health policy for preventing the spread of measles in Poland is consistent with the WHO’s guidelines. In Poland, as part of the measles eradication programme, all suspected cases of measles are reported and confirmed in a laboratory. Within the framework of the measles eradication programme in the WHO’s European Region, in which Poland participates, laboratory tests must be carried out or confirmed in a laboratory accredited by the WHO. In Poland, this laboratory is the Department of Virology of the National Institute of Public Health of the National Institute of Hygiene (PZH). As indicated in the information posted on the government’s vaccination website, in 2019, a meeting was held at the PZH of representatives of the World Health Organization, the Chief Sanitary Inspectorate, and the PZH on the progress of the measles eradication programme in Poland. During the meeting, the current challenges for epidemiological-virologic measles surveillance in Poland were discussed, with particular attention paid to the degree of implementation of the National Action Plan for Rubella and Measles in Poland.

Information on the meeting on the implementation of the Programme for the elimination of measles and rubella in Poland <https://szczepienia.pzh.gov.pl/spotkanie-w-sprawie-realizacji-programu-eliminacji-odry-i-rozyczki-w-polsce> accessed 22 February 2022

The Polish institutional approach to measles elimination is not without flaws. The coordination of the Government Security Center, the State Sanitary Inspectorate, and the reporting of the PZH seem to be a coherent mechanism for assessing the possible risk of measles epidemic outbreaks in Poland. However, the increase in measles cases after 2018 with the simultaneous obligation to vaccinate against measles in Poland raises some doubts about the effectiveness of the methods and measures used to protect against the spread of measles. When assessing the national public health policy in terms of the implementation of the WHO plan, the fundamental goal of the programme, which is to reduce the annual number of measles cases to less than five cases per million, and to maintain this level, has not been achieved. In the case of Poland, this will be at most 189 cases per year. Considering the statistics compiled, Poland as of 2018 does not meet this condition. This is a worrying phenomenon. With the universal availability of measles vaccination and the obligation to perform it, the number of unvaccinated is increasing.

UNICEF, ‘Immunization Coverage: Are We Losing Ground?’ <https://data.unicef.org/resources/immunization-coverage-are-we-losing-ground> accessed 10 May 2022

The increase in the activity of anti-vaccine movements and the evasion of children from receiving mandatory immunisations raises concerns about a permanent loss of collective immunity, not only to measles. The reduction in the number of vaccinated people is causing a negative trend,

‘The number of measles cases in Poland is growing exponentially’ <www.healthcaremarketexperts.com/en/news/the-number-of-measles-cases-in-poland-is-growing-exponentially> accessed 10 August 2022

Reference should also be made to the implementation of the 4 guiding principles of the WHO programme. Polish public health policy on measles vaccination appears to be underdeveloped. Services do not respond properly to evasions of measles vaccination in children. A 2015 report by the Supreme Chamber of Control revealed several systemic flaws that have not been rectified to date.

Supreme Chamber of Control, ‘The system of immunization of children’, reference number 209/2015/P15/080/LKR

Referring to the WHO principles introduced in this measles elimination programme, it is important to point out that national public health representatives are responsible for achieving the public health objectives and therefore building a high level of immunity of the population against measles. According to the first objective, it is the responsibility of public administrations to work towards achieving high vaccination rates. In Poland, despite the introduction of compulsory measles vaccination, this objective has not been achieved. Thus, this determines the failure to achieve the second objective, that is, to have an effective health care system and proper functioning of preventive vaccinations. General protective vaccinations are available in Poland, which realises the third goal of the Programme. As indicated, these are obligatory vaccinations, but despite this, the percentage of unvaccinated persons is increasing. This results in the inefficiency of the system for controlling the performance of obligatory preventive vaccinations and enforcing them on citizens. Unfortunately, this synergy is far from being achieved in Poland, and the increasing tendency to evade protective vaccinations and the worrying trend in measles cases are clear examples of this. Health policy shaped by state authorities is obviously based on legal regulations. The lack of clear progress in implementing the programme in the intended direction will be caused not only by the lack of an effective health policy, but above all by inconsistent legal regulations.

The first strategic plan, which covered the period from 2001 to 2010, the following legal mechanisms were developed in Poland. First, the registration and reporting of suspected measles cases was to be performed in accordance with the requirements of the Act of 6 September 2001 on infectious diseases and infections (this Act is no longer in force). In addition, laboratory confirmation of all suspected measles cases, as well as identification of strains circulating in each area and classification of measles cases as caused by indigenous or imported strains were introduced. This requires methods of measles virus isolation and genotyping.

National Institute of Hygiene - Scientific and Research Institute, ‘Measles/rubella elimination - WHO Programme - Implementation in Poland - Principles – Instructions’ (2007)

Regarding the second plan for the period from 2012 to 2020, there has been a change in the law. The law currently in force is the Act of 5 December 2008 on the prevention and control of infections and infectious diseases in humans.

Unified text: Journal of Laws of 2022., item 1657.

The previously mentioned law directly relates to protection against the spread of infectious diseases. Article 1 indicates the objectives of the law, which include establishing rules and procedures for preventing and combating human infections and infectious diseases. In addition, it contains rules and procedures for recognising and monitoring the epidemiological situation and taking anti-epidemic and preventive measures to neutralise sources of infection. The law also contains provisions on cutting the routes of the spread of infections and infectious diseases, and the immunisation of susceptible persons, as well as defining the tasks of public administration bodies in preventing and combating infections and infectious diseases in humans. The act defines the concept of an infectious disease, by which is meant a disease that has been caused by a biological pathogen. The act also distinguishes so-called ‘particularly dangerous and highly contagious’ diseases, which are defined as infectious diseases that spread easily; have a high mortality rate; pose a special threat to public health; and require special methods of control, including cholera, plague, smallpox, viral haemorrhagic fevers, among others. Given that the statutory enumeration of these diseases is not taxative, measles can also be included in this category. Such a qualification allows certain legal solutions to be applied to people suffering from this disease, and even to healthy but exposed people, limiting the spread of such a disease. In fact, it is possible to apply so-called home isolation, which consists of secluding a sick person in a course of an infectious disease that does not require absolute hospitalisation for medical reasons in his or her place of residence or stay, in order to prevent the spread of particularly dangerous and highly contagious diseases.

On the other hand, in the case of a person who is healthy, but is suspected of being infected, the law allows the use of what is called quarantine. This consists of isolating a healthy person who has been exposed to infection to prevent the spread of particularly dangerous and highly contagious diseases. In addition, in the case of such a disease, the law provides for several additional intervening procedures and related duties by medical personnel. For example, a doctor or feldsher who suspects or diagnoses a particularly dangerous and highly contagious disease is obliged to refer a person suspected of being infected or ill with a contagious disease to a specialised hospital providing isolation and treatment for that person, and to immediately inform the hospital of this fact. It shall also arrange sanitary transport for such a person. Given the population risks that may arise from the spread of such a disease, the law provides for the possibility of enforcing the anti-epidemic orders imposed on the sick person or the person suspected of having such a disease even by means of direct coercion. This is an exceptional solution, strongly interfering with the personal rights of such a person but justified by the need to protect the society. It is worth adding that under Article 36 of the law, this normalisation can also be applied to a person who does not submit to mandatory vaccination, including, it can be assumed, vaccination against measles.

The Act on the Prevention and Control of Infections and Infectious Diseases in Humans also mentions three important concepts. The first is an epidemic threat, which is the existence of conditions or circumstances in each area that indicate the risk of an epidemic. The second is a state of epidemic, which is defined as a legal situation introduced in each area in connection with the occurrence of an epidemic to undertake anti-epidemic and preventive measures specified by law to minimise the effects of the epidemic. The third is a state of epidemic hazard – a legal situation introduced in each area in connection with the risk of an epidemic to undertake preventive measures specified by law. It should be noted that the following will be authorised to introduce the states: the voivode, the minister responsible for health, and the field units of the state sanitary inspection reporting to the voivode.

It is worth emphasising that in the case of a threat from infectious diseases, every hour counts, and every moment of delay in waiting for a decision from another authority only paralyses the system of anti-epidemic regulations. Moreover, the introduction of any of the above states requires central decisions. Within a province, such a decision may only be made by the voivode. This raises many problems of an organisational nature in the practice of application of the law. The legal situation is not improved by the broad conglomeration of concepts. Additional concept include an epidemic risk zone, defined by the Act as the area in which the risk of an epidemic state is present. As you can see, the concepts are very numerous, but in practice, it is hard to find mechanisms for their quick implementation. Most significantly, some concepts did not appear until 2020 during the numerous amendments to this Act in connection with the COVID-19 pandemic. Indeed, this has contributed to organisational and terminological confusion. It can be said that this law deals holistically with the protection of public health against the spread of infectious diseases and the rules of conduct in the event of an epidemic threat.

The presented law defines the obligation to undergo immunisation. According to Article 5(1), this obligation is imposed on persons residing in the territory of the Republic of Poland. However, according to Article 17 paragraph 1a, persons residing in the territory of the Republic of Poland for less than three months (except for post-exposure vaccinations) were excluded from this obligation.

E.g. see: Judgment of the Supreme Administrative Court of 1.08.2013, II OSK 745/12, LEX No. 1360426; Judgment of the Regional Administrative Court in Warsaw of 28.09.2018 r., VII SA/Wa 2983/17, LEX No. 2584268; Judgment of the Regional Administrative Court in Warsaw of 31.05.2019, VII SA/Wa 2815/18, LEX No. 2686869.

The law does not explicitly indicate the types of diseases against which mandatory immunisations are administered. Their list is included in an executive act, currently the Decree of the Minister of Health of August 18, 2011 on mandatory vaccination.

Journal of Laws of 2018, item 753 as amended.

In addition to the general provisions discussed above, an additional act has been dedicated to the issue of measles prevention, namely the Regulation of the Minister of Health of September 6, 2016 on how to prevent measles.

Journal of Laws of 2016, item 1418.

In addition to the discussed regulations, Poland has the Public Health Act of September 11, 2015.

Journal of Laws of 2021, Item 183.

The Act contains phrases that are not specific and ‘key words’ that reflect some objectives rather than being a means to achieve them. As indicated in Article 4, all the indicated activities are coordinated by the minister responsible for health. This is an important provision, as it indicates the fact of performance of public health tasks by other public administration bodies whose activities are coordinated by the minister responsible for health. Hence, in the event of a state of epidemic, close cooperation between these authorities is extremely important. Any delays or errors in communication could lead to the spread of an infectious disease, resulting in an epidemic. Article 4 also indicates that the minister responsible for health must signal to the competent authorities and entities the need to undertake specific public health tasks. The law knows no such term as ‘signalling’. It is hard to identify this action as, for example, an activity within the public administration. Will this ‘signalling’ take the form of guidelines, a circular letter, or perhaps an order? The Act is vague in this regard. The situation is similar in the case of the performance of public health tasks related to infectious diseases.

In Article 5, the Act provides that the minister responsible for health ‘shall cooperate’ with, among others, the National Institute of Public Health – the National Institute of Hygiene and the Chief Sanitary Inspector. The word ‘cooperate’ indicates equivalence between these bodies. So, the minister does not have an overriding position in this regard. This is in conflict with the Act on preventing and combating infections and infectious diseases in humans, as well as with the Act on the State Sanitary Inspectorate, where the subordination of the Inspectorate to the Minister is clearly noticeable. Problems may arise on this basis because the forms used by the different acts are different. This can lead to problems. Another problem is the omission of the institution of the voivode, which has strong competences under the Act on Prevention and Control of Infections and Infectious Diseases in Humans.

Answering the question posed as to whether the national regulations for preventing the spread of infectious diseases and the specific legal acts for the elimination of measles are adequate for the timely implementation of the objectives of the WHO measles elimination program, the answer should in principle be in the affirmative. Poland has a qualified sanitary service (State Sanitary Inspection). National regulations contain framework provisions shaping the powers and competencies of public administration bodies, assigning them tasks in this regard. Measles has been included among the diseases against which mandatory immunisation is applied. The categories of persons subject to this duty were also designated. At the same time, mechanisms have been developed for both systemic vaccination (to which all persons of a certain age are subject) and ad hoc vaccination, applied to persons who are unvaccinated and reside in environments where there is a danger of infection. However, this regulation is not perfect and has several shortcomings. First, at the conceptual level, the legislator leaves quite a lot of freedom to public administration bodies in implementing anti-epidemic orders and bans. Such terms as ‘epidemic threat’, ‘epidemic state’ and ‘epidemic emergency’ are vague. Indeed, it is not clear, for example, how many cases of measles must exist in each area for there to be legal grounds for the introduction of any of these states. However, it can be assumed that a more precise delineation of such parameters would be difficult. Administrative authorities must have a certain amount of discretion and be able to freely (albeit not arbitrarily) assess the health situation, guided concretely by the risk conditions in their area (e.g. population density, the sizes of the clusters of people in which the disease may spread, etc.). It is essential that they perform their tasks reliably and make the appropriate decisions promptly. It seems, therefore, that the problem in this case lies not in regulation, but in its correct application.

Secondly, it may be questionable not to regulate the obligation to vaccinate against measles in the law, but in lower-ranking acts – regulations. However, such a move can be justified by the dynamics of epidemic changes. Determination at the level of the law of the list of diseases against which mandatory immunisation is carried out could give rise to practical problems in the situation of importation of a disease not yet included in this catalogue. There would be a need to amend the law, which is a rather lengthy process. It is faster and more efficient to amend the regulation, which allows for a sufficiently robust, interventionist response from the legislator. Thus, the currently adopted solutions, although imperfect, are a compromise between the rank of normalisation and practical needs. Thus, in the context of the WHO program in question, it can be assumed that at the legislative level in the sphere of imposing measles vaccination, Polish regulations do not raise significant doubts. Despite their existence, however, Poland has not achieved the goals set by the WHO. The reasons for this situation can be seen in the mechanisms of enforcement of the imposed obligations. Difficulties in this regard are compounded by the pan-European trend of increasing activity of anti-vaccine movements, which undermine the essence and importance of immunisation. The issue has a global dimension and requires supranational action. However, returning to the foundation of Polish law and its application, it can be noted that in the case of measles vaccination, administrative bodies do not seem to be exercising their powers. Supervision of the implementation of mandatory immunisation is carried out by the State Sanitary Inspectorate. However, this institution does not have the authority to punish entities obliged to vaccinate that fail to perform this duty.

Judgment of the Regional Administrative Court in Poznan of 21.03.2013, II SA/Po 96/13, LEX No. 1301191. Simirarly: Judgment of the Regional Administrative Court in Warsaw of 21.02.2018, VII SA/Wa 1853/17, LEX No. 2471647; Judgment of the Regional Administrative Court in Poznan of 21.06.2017, IV SA/Po 413/17, LEX No. 2311973. See more: Sebastian Czechowicz, Ustalenie właściwości organu administracji publicznej w zakresie prowadzenia egzekucji obowiązkowych szczepień ochronnych i występowania z wnioskiem o ukaranie za uchylanie się od tego obowiązku, ‘Zeszyty Prawnicze Biura Analiz Sejmowych’ 2021, Vol.70, no. 2, pp. 33–49.

Another affliction of the Polish legal system is its dynamic changeability. Regulations are frequently amended, which is not conducive to their internalisation. In addition, these novelties are of a bumpy nature and are not based on the systemic outlook of their drafters. This can lead to contradictory provisions, and thus to their ineffectiveness. These shortcomings also naturally impinge on the difficulties of implementing the WHO measles control program in Poland.

The remedy seems to be a thorough examination of all anti-epidemic regulation in the face of the spread of measles and the development of a new, coherent public health system, thus implementing the WHO program. First and foremost, the competence to counter infectious diseases should be clearly defined and transferred to a single body. In this case, it should be given to the State Sanitary Inspectorate. This body should be given broad powers to implement and enforce mandatory measles vaccination. This would significantly shorten the procedure and ensure that children are vaccinated against measles. Giving this body broad inspection powers would allow better detection of unvaccinated persons, including foreigners. Involving governors in the process only delays the decision-making process.

The Public Health Law should be repealed and, after wide consultation, a new one should be enacted that combines (and perhaps welds together) public health norms in other laws. Vague wording based on ideas should be avoided, and the focus should be on setting specific tasks, giving clear powers to public administration bodies, and identifying appropriate goals to be achieved.

Penalties for failure to undergo mandatory vaccinations could prima facie also be a convenient tool to motivate people to perform this duty. Following this line of reasoning, one could postulate that such an act should be penalised and described in the Law on Prevention and Control of Infections and Infectious Diseases in Humans. It would also be tempting to propose tightening the sanctions and classifying such an act as a crime. However, it seems that such a move would be a simplification based on a false assumption about the effectiveness of harsh penalties. This is because the typification of a given act and the determination of its punishability require deep criminological and political-criminal thinking and analysis. In the case of behaviour motivated by entrenched ideological beliefs, the use of criminal sanctions may be ineffective and even counterproductive. This is because the people against whom such penalties would be imposed would not understand their justification. In turn, this leads to a failure to achieve the goals of punishment, such as upbringing, rehabilitation, and individual prevention. In turn, it can intensify negative phenomena, resulting from the lack of internalisation of the criminal law norm. The purpose of the sanction will then not be achieved. In the case of vaccination evasion, as indicated, such behaviour is often dictated by deeply held beliefs. In turn, as statistics show, punishment for such behaviour is not effective, and even increases the resistance to vaccination. Perhaps, therefore, other instruments should be used, e.g. spreading knowledge, educating, dispelling medical myths. The criminal sanction, on the other hand, on the principle of ultima ratio, should be the last resort.

To conclude this part of the discussion, in view of the growing trend of measles cases, the legislator should take a holistic view of the shape of the system of public health and epidemic prevention regulations. Only such an approach will make it possible to eliminate the legislative errors accumulated over the years. Obviously, many laws and executive acts should be avoided. A broader formulation of the problem in a specific law (e.g. on the prevention and control of infections and infectious diseases in humans) should be considered, so as not to duplicate certain issues in the public health law.

Infectious diseases remain an important risk factor. Their unexpected transmission can cause epidemics and even pandemics. We are finding this out even today in the time of the global COVID-19 pandemic. This should give us some lessons for the future. It is essential to call for uniform procedures, even within the European Union, but preferably in association with the WHO. Only clear, transparent and, most importantly, uniform procedures will make it possible to reduce the risk of an epidemic of a given infectious disease.

Measles remains a significant threat to the health security of Europe and the world. This known disease cannot be ignored, despite widespread vaccination campaigns. Vaccination is not progressing evenly in all regions of the world. The statistics presented clearly show that the problem of measles, as well as that of other infectious diseases, needs to be reconsidered. So do vaccination programmes and the rationalisation of the entry into countries of people who have not been vaccinated against those diseases. These are challenges faced by numerous countries of the world, as well as by international organisations, and a clear and firm WHO policy on this issue is particularly important.

It is worth quoting, following the authors of the strategic measles eradication plan, that ‘public health is all about people’.

Global Measles and Rubella Strategic Plan: 2012–2020, World Health Organization 2012, p. 6.

National laws should be aligned with supranational guidelines and regulations. Health and epidemiological authorities should have clear powers. The distribution of powers related to anti-epidemic efforts among several national authorities should be opposed, as it leads to organisational chaos and unnecessarily prolonged decision-making processes, which are not conducive to finding a solution to the problem.

The development of national anti-epidemic regulations in Poland is not without its shortcomings. It seems that some procedures could be shortened, and authoritative competencies could be merged into one body. Assigning certain competencies to a voivode, powiat state sanitary inspectors, state voivodeship sanitary inspectors, the Chief Sanitary Inspector and the Minister of Health may cause problems in case of an epidemic threat. The repeated amendment of the Act on prevention and control of infections and infectious diseases in humans from 2020 in connection with the COVID-19 pandemic is evidence of negligence in the framework of anti-epidemic procedures.

The implementation of the measles elimination programme should be assessed moderately well, but with some reservations. Cases of measles continue to occur and are even becoming epidemic in some regions. This is a worrying phenomenon, and more so given the existence of an effective measles vaccine. The universal measles vaccination programme should be kept under review across the whole of Europe. Poland stands out among countries with a high level of measles vaccination. Despite the epidemic threats of measles since 2018, the actions taken are consistent with the framework objectives of the WHO strategic programme.