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In 2006, at the request of the Conference of Cantonal Directors of Public Health (GDK), the Federal Council requested the Federal Department of Home Affairs (DHA) to revise the existing Federal Act on the Control of Communicable Diseases in Humans (Epidemics Act, EpG), originally introduced in 1970. The complete revision should ensure the application of up to date measures for the detection, monitoring, prevention and control of communicable diseases and should also help to improve the management of disease outbreaks which seriously endanger public health.
On 28 September 2012, the Federal Council’s draft Act was approved by a large majority in Parliament, with only minor amendments being made to the text of the legislation. Following the parliamentary decision, a referendum against the act was called for by members of the general public. On 21 February 2013 the Federal Chancellery confirmed the successful referendum with a total of 77 360 valid votes. The popular vote is expected to take place in autumn 2013.
Complete revision of the existing Epidemics Act has become essential because the conditions in which infectious diseases occur and endanger public health have changed over the last few decades. Growing mobility, ongoing urbanisation, migratory movements, climatic changes and other factors all have direct or indirect effects on living and environmental conditions. The extent and speed of transmission of communicable diseases have increased. As well as new diseases (e.g. SARS, pandemic H1N1 influenza), we are confronted with new characteristics of known pathogens (e.g. drug resistance) or new modes of transmission.
From a technical and legal viewpoint, the existing (1970) Epidemics Act can no longer meet contemporary needs. At the same time, the content of the new Epidemics Act is based on the existing legislation. Aspects of the existing Act which have stood the test of time have been retained, together with the division of tasks between the federal and cantonal authorities. Thus, responsibility for carrying out most measures (enforcement) remains with the cantons. In situations involving a major risk to public health, the federal authorities are to be responsible for coordination and management. Here, too, the cantons are responsible for carrying out measures. The option for cantons to order mandatory vaccination is already included in the 1970 Act and is to be retained. To date, this legal authority has been handled very responsibly by the cantons. In the new Act, the conditions for mandatory vaccination are more precisely specified and tightened. Also to be retained is the responsibility of the federal authorities to provide information.
The existing Act lacks provisions concerning preparation for new threats. In addition, the provisions for the management of a public health emergency are deficient and not sufficiently specific. Also inadequate from today's perspective are the legal foundations to permit early identification and assessment of the risks of infectious disease outbreaks and transmission. The revised Act creates a framework permitting effective prevention and control and appropriate international coordination of measures.
The complete revision of the Epidemics Act enjoys broad support. It was initiated by the Conference of Cantonal Directors of Public Health (GDK). In the consultation procedure, which ran from 21 December 2007 to 31 March 2008, the preliminary draft Act was widely welcomed and favourably received. It was considered to be comprehensive, mature, sound and balanced, and the measures were judged to be appropriate. The Federal Council took note of the consultation report on 5 December 2008 and requested the Federal Office of Public Health (FOPH) to prepare the revised Act and the Dispatch. On 3 December 2010, the Dispatch and the draft Act were adopted by the Federal Council for submission to Parliament (see documentation).
On 28 September 2012, the Federal Council's draft Act was approved by a large majority in Parliament (National Council: 149 in favour, 14 opposed, 25 abstentions; Council of States: 40 in favour, 2 opposed, 3 abstentions). Only minor amendments were made to the text of the legislation. Following the parliamentary decision, a referendum against the act was called for by members of the general public. On 21 February 2013 the Federal Chancellery confirmed the successful referendum with a total of 77 360 valid votes. The popular vote is expected to take place in autumn 2013.
The revision of the Epidemics Act is designed in particular:
Communicable diseases - particularly epidemics - endanger public health. The new Epidemics Act (nEpG) facilitates optimal preparation for risks, early detection and effective action in a crisis. Effective preparation and crisis management requires, for example, a coordinated approach to the development of emergency plans. National recommendations on vaccination and health education campaigns (e.g. STOP AIDS) have proved effective in the past and are transparently incorporated into the new Act.
The revised Epidemics Act provides for the development and implementation of national programmes in the area of antibiotic resistance and hospital-acquired infections. Antibiotics should be used with care and restraint in human and veterinary medicine, and also in agriculture, in order to ensure that severe infections such as pneumonia or meningitis can still be effectively controlled with antibiotics in the future.
The division of tasks between the federal and cantonal authorities specified in the existing (1970) Epidemics Act is to be retained. However, the federal and cantonal authorities' respective responsibilities are defined in more detail in the new Act. The management role and the supervisory and coordinating functions of the federal authorities are strengthened. The federal authorities, in consultation with the cantons, set national goals in the area of communicable diseases and are responsible for preparing for emergencies. The cantons remain responsible for implementing measures (enforcement). A permanent coordination body is to improve federal/cantonal cooperation and promote consistent enforcement. It was expressly requested by the cantons that the federal authorities should assume a strategic management role, and this role is to be strengthened with their agreement.
Neither the existing nor the revised Act provides for forced vaccination - i.e. nobody can be vaccinated by coercive means or against their wishes. In future, citizens will retain the right to decide freely for themselves whether they wish to be vaccinated or not.
Under the existing Epidemics Act, cantons have the option of introducing mandatory vaccination. In the new Act, the conditions which have to be met before a canton can declare vaccination to be mandatory are tightened: a new requirement (compared to the existing legislation) is that the group of persons concerned has to be designated and mandatory vaccination restricted to this group. In addition, there must be a substantial risk. The new provisions thus clarify and restrict the situations in which cantons can introduce mandatory vaccination.
For example, mandatory vaccination of staff may be indicated in sensitive areas of hospitals (e.g. neonatal or cancer units) in order to protect patients from dangerous infectious diseases. Even so, individuals are still free to decide in each case for or against vaccination. If individuals decide not to be vaccinated, this may mean that they cannot then be deployed in sensitive hospital areas.
In each case, measures ordered by the authorities are to undergo several assessments of proportionality and appropriateness. For this reason, mandatory vaccination was not contemplated by either the federal or cantonal authorities during the 2009 H1N1 influenza pandemic.
Data collection has always been crucial for the detection, prevention and control of communicable diseases. In the existing Act, the authorities' responsibilities and powers are only described in general terms, and no data protection requirements are specified. This gap is filled in the revised Act. The new Act heralds, not the "naked citizen", but the "transparent state". In order to prevent the spread of diseases, physicians and laboratories have to report certain data rapidly. This allows authorities to order disease control measures immediately. With the revision of the Epidemics Act, the data protection provisions have been brought into line with contemporary requirements for legal safeguards.
Communicable diseases cross national borders. Effective cooperation with neighbouring countries and the World Health Organization (WHO) - of which Switzerland is a member state - is therefore indispensable. With the new Act, coordination of international cooperation is improved. In addition, as regards the communication of information and data to other countries, the new Act includes stricter regulations than the existing legislation.
Switzerland is a member of the WHO, the essential coordinating authority for the early detection and control of cross-border epidemics and pandemics. Its powers do not in any way affect Switzerland's autonomy. States' decision-making freedom is maintained. However, in order to protect the international community, the WHO requires member states to monitor and control dangerous communicable diseases.
The Epidemics Act strengthens the position of individuals who claim financial compensation for serious adverse effects of vaccinations. To date, the area of financial compensation for serious adverse effects of vaccinations has been regulated at the cantonal level. Here, the revised Act offers a substantial improvement: at the federal level, a uniform procedure for the management of claims is established for Switzerland as a whole. The new Act makes it easier for an injured party unfortunate enough to have suffered harm as a result of vaccination to receive appropriate compensation and satisfaction. This improvement was included in the revised Act even though such cases are extremely rare.
In addition, the Act makes it possible to inform the population about infectious diseases in a targeted and comprehensive manner. The federal authorities are permitted to provide information about infectious diseases - including sexually transmissible diseases - not only in public spaces, but also in schools. This measure is designed in particular to promote equal opportunities - i.e. equal access to information for all students - so as to support individual decisions about health behaviour.
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