[The contribution of social medicine to vaccination in Austria].

We mostly deal here with socio-medical aspects of vaccinations. Various initiatives are summed up that are intended to optimize the system of immunization by vaccines and to establish certain innovative, and also internationally remarkable approaches. In spite of the undoubted successes of vaccinations in Austria, there still are some major deficits that should be eliminated. The Austrian system of immunization by vaccines has been mainly concentrating on continuously adapting its vaccination schedules. Such modifications are based on current scientific knowledge and thus dynamic in nature whereas the public health system necessarily relies on commonly established and easily adoptable requirements. This discrepancy has brought about a certain degree of uncertainty in some instances.--(See K. Spork, I. Mutz: "Recommendations for Vaccination in Childhood and for Adults".) By further developing immunization programs into a general concept of immunization by vaccines we should be able to put the potential benefits of preventive medical care better into effect than before because such a concept based on clearly defined public health objectives provides strategic and tactical measures and, what is even more important, also includes evaluation.--(See Vutuc, Kunze: "Epidemiology as Background for Vaccinations".) In this connection it has also been necessary to develop various activities in the field of social marketing, examples of which will be mentioned in this issue. There is mainly one recurring source of dispute that must be discussed here, the question of what is immunization of the public at large and what is immunization to be recommended for certain groups (so called risk groups). It has to be principally noted that the idea of risk group immunization has not been too effective in many areas. A typical example for such a project that has to be reconsidered is the active immunization against Central European Encephalitis (CEE) or Tick Bone Encephalitis (TBE).--(See U. Kunze. G. Böhm: "Epidemiology of TBE and Consequences for Further Control Measures Including Vaccination"). Similar considerations also apply to active immunization against influenza or pneumococcal diseases.--(See Süss et al.: "Project 'Vaccinating Hospital Patients' in Upper Austria--Technical Report". Steger, Maczek, Berger. Grubeck-Loebenstein: "Immunizing Against Tetanus in the Elderly: How Long Does Protection Last?") So far, the basic question has been: "Who shall be vaccinated?". Very detailed recommendations have been worked out for that purpose, and some have led to highly complex definitions of which groups should be protected by a particular vaccine. For the future, we will have to reconsider if this question should not be asked the other way round, that is: "Who should not receive a certain vaccination?", based on the hypothesis that this approach may simplify many decision making processes. This would also guarantee optimal information for different target groups in the public health care system but mostly for the general public. Public health care officials and the general public alike have been much concerned with reactions and aversive reactions and side effects. We have to mention that this subject has been the topic of political debates on health, and that single interest groups, even though we must presume in the best of beliefs, have contributed to quite upsetting the public. Without doubt, the Australian health care system still has deficits in organization and substance which to some extent stem from these highly unobjective discussions. It must not be denied, however, that the system of medical care too has not always responded in an optimal way. As a consequence, public health research has been done on background-morbidity which is absolutely essential for scientific discussion. The name of the study, SERMO, is an abbreviation of the term "self-reported-morbidity"; another source for this name is the latin expression "sermo, sermonis".