CEDH · CASELAW;JUDGMENTS;GRANDCHAMBER;ENG — 8 avril 2021

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padding-left:0.66pt; font-family:Arial; font-weight:bold } .s807BA660 { margin-top:14pt; margin-left:24.16pt; margin-bottom:12pt; text-align:justify; page-break-inside:avoid; page-break-after:avoid; padding-left:1.34pt; font-family:Arial; font-weight:bold }   GRAND CHAMBER CASE OF VAVŘIČKA AND OTHERS v. THE CZECH REPUBLIC (Applications nos. 47621/13 and 5 others)   JUDGMENT   Art 8 • Private life • Fine on parent and exclusion of children from preschool for refusal to comply with statutory child vaccination duty • General European consensus to achieve highest possible degree of vaccine coverage • Social solidarity towards the most vulnerable requiring the rest of the population to assume a minimum risk in the form of vaccination • Mandatory approach answering a pressing social need to protect individual and public health against the diseases well-known to medical science and to guard against any downward trend in child vaccination rate • Compulsory policy consistent with the best interests of the children, to be considered both individually and as a group and requiring to protect every child from serious diseases through immunisation • Domestic system allowing exemptions and accompanied by procedural safeguards • Necessary precautions taken, including the monitoring of the safety of the vaccines in use and the checking for possible contraindications in each individual case • Fine not excessive and no repercussions for the education of school-age children • Effects on child applicants limited in time, admission to primary school not being affected by vaccine status • Impugned measures proportionate to the legitimate aims pursued • Wide margin of appreciation not overstepped STRASBOURG 8 April 2021 This judgment is final but it may be subject to editorial revision. In the case of Vavřička and Others v. the Czech Republic, The European Court of Human Rights, sitting as a Grand Chamber composed of:   Robert Spano, President ,   Jon Fridrik Kjølbro,   Ksenija Turković,   Paul Lemmens,   Síofra O’Leary,   Yonko Grozev,   Aleš Pejchal,   Krzysztof Wojtyczek,   Armen Harutyunyan,   Pere Pastor Vilanova,   Marko Bošnjak,   Tim Eicke,   Jovan Ilievski,   Lado Chanturia,   Erik Wennerström,   Raffaele Sabato,   Anja Seibert-Fohr, judges , and Johan Callewaert, Deputy Grand Chamber Registrar , Having deliberated in private on 1 July 2020 and 13 January 2021, Delivers the following judgment, which was adopted on the last-mentioned date: PROCEDURE 1.     The case originated in six applications (nos. 47621/13, 3867/14, 73094/14, 19298/15, 19306/15 and 43883/15) against the Czech Republic lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by six Czech nationals, Mr Pavel Vavřička, Ms Markéta Novotná, Mr   Pavel   Hornych, Mr Radomír Dubský, Mr Adam Brožík and Mr   Prokop   Roleček (“the applicants”), between 23 July 2013 and 31 August 2015. 2.     The applicants were initially represented by Mr D. Záhumenský, and subsequently by Ms Z. Candigliota and Mr J. Švejnoha, Mr J. Novák and Mr   T. Moravec, lawyers practising in the Czech Republic. Before the Grand Chamber, all of the applicants were represented by Ms Candigliota. The Czech Government (“the Government”) were represented by their Agent, Mr   V. A. Schorm, of the Ministry of Justice. 3.     The applicants alleged, in particular, that the various consequences for them of non-compliance with the statutory duty of vaccination had been incompatible with their right to respect for their private life under Article 8 of the Convention. 4.     The applications were allocated to the First Section of the Court (Rule   52 § 1 of the Rules of Court). On 7 and 9 September 2015 the Government were given notice of the above complaint, and also of related complaints made by Mr Vavřička, Ms Novotná and Mr Hornych under Article 9 of the Convention, and by all of the child applicants under Article   2 of Protocol No. 1. 5.     The President of the Section granted leave to submit written comments (Article 36 § 2 of the Convention and Rule 44 § 3) to the non ‑ governmental organisations Společnost pacientů s následky po očkování, z.s. (Association of Patients Injured by Vaccines), European Centre of Law and Justice and ROZALIO – Rodiče za lepší informovanost a   svobodnou volbu v očkování, z.s. (Group of Parents for Better Awareness and Free Choice with Regard to Vaccination – “ROZALIO”), each of which submitted comments. 6.     On 17 December 2019 a Chamber of the First Section, composed of Ksenija Turković, President, Aleš Pejchal, Armen Harutyunyan, Pere Pastor Vilanova, Tim Eicke, Jovan Ilievski, Raffaele Sabato, judges, and Abel   Campos, Section Registrar, relinquished jurisdiction in favour of the Grand Chamber, none of the parties having objected (Article 30 of the Convention and Rule 72). 7.     The composition of the Grand Chamber was decided in accordance with the provisions of Article 26 §§ 4 and 5 of the Convention and Rule 24. 8.     The applicants and the Government each filed a memorial on the admissibility and merits of the applications. 9.     The President granted leave to submit written comments to the Governments of France, Germany, Poland and Slovakia, each of which filed observations. Leave to intervene was also granted to the European Forum for Vaccine Vigilance. Additional written comments were submitted by ROZALIO, and the comments submitted to the Chamber by the other third ‑ party interveners remained in the case-file. 10.     A hearing took place in the Human Rights Building, Strasbourg, on 1   July 2020, attended by the parties’ representatives and advisers. There appeared before the Court: (a)     for the Government Mr   V. A. Schorm ,   Agent , Mr   R. Prymula , President of the Czech Vaccinology Society and Government Agent for Health Science and Research, Ms   E. Petrová , Office of the Government Agent, Ministry of Justice, Ms   K. Radová , Office of the Government Agent, Ministry of Justice, Ms   D. Prudíková , Ministry of Education, Youth and Sports, Mr   T. Suchomel , Ministry of Health, Ms   H. Cabrnochová , Vice-president of the Czech Vaccinology Society and the Association of General Practitioners for Children and Youth, Advisers ; (b)     for the applicants Ms   Z. Candigliota ,   Counsel , Mr   D. Petrucha , Mr   K. Lach , Mr   D. Dušánek , Ms   P. Janíčková ,   Advisers , Ms   B. Rolečková ,   Applicant’s parent .   The Court heard addresses by Mr Schorm, Mr Prymula and Ms   Candigliota and their replies to questions put by the judges. THE FACTS BACKGROUND 11 .     In the Czech Republic, section 46(1) and (4) of the Public Health Protection Act ( Zákon o ochraně veřejného zdraví ) (Law no. 258/2000 Coll., as amended – “the PHP Act”) requires all permanent residents and all foreigners authorised to reside in the country on a long-term basis to   undergo a set of routine vaccinations in accordance with the detailed conditions set out in secondary legislation. For children under the age of fifteen, it is their statutory representatives ( zákonný zástupce ) who are responsible for compliance with this duty. 12.     In the Czech constitutional order duties may be imposed only on the basis and within the bounds of the law ( zákon ) and limitations on fundamental rights and freedoms may likewise only be imposed by the law, this term commonly being understood as an Act of Parliament. 13 .     The PHP Act is an Act of Parliament. Sections 46(6) and 80(1) provide for the adoption by the Ministry of Health (“the Ministry”) of implementing legislation in relation to vaccination. 14.     The Ministry issued the above-mentioned implementing measures in the form of the Decree on Vaccination against Infectious Diseases ( Vyhláška o očkování proti infekčním nemocem ) (Decree no. 439/2000 Coll., as amended – “the 2000 Ministerial Decree”, in force from l January 2001 to 31 December 2006, and Decree no. 537/2006 Coll., as amended, – “the 2006 Ministerial Decree”, in force as from 1 January 2007, jointly referred to hereafter as “the Ministerial Decree”). 15 .     Section 50 of the PHP Act provides that preschool facilities such as those concerned in the present case may only accept children who have received the required vaccinations, or who have been certified as having acquired immunity by other means or as being unable to undergo vaccination on health grounds. A similar provision appears in section 34(5) of the Education Act ( Zákon o předškolním, základním, středním, vyšším odborném a jiném vzdělávání (školský zákon) ) (Law no. 561/2004 Coll., as amended). 16.     The cost of vaccination is covered by public health insurance. The vaccines included in the list of specific vaccine variants for regular immunisation, which is published annually by the Ministry, are free of charge. Other vaccines can be used instead so long as they have been approved by the competent authority, but the cost is not covered by the State. 17 .     Under section 29(1)(f) and (2) of the Minor Offences Act ( Zákon o   přestupcích ) (Law no. 200/1990 Coll., as applicable at the relevant time – “the MO Act”), a person who violates a prohibition or fails to comply with a   duty provided for or imposed in order to prevent infectious diseases commits a minor offence punishable by a fine of up to 10,000 Czech korunas (CZK) (currently equivalent to nearly 400 euros (EUR)). 18 .     In the event of malpractice in administering a compulsory vaccination resulting in damage to the health of an individual who has been vaccinated, the person responsible may be held liable under the general law of tort to pay compensation in respect of the damage caused. 19.     As regards damage to health resulting from a compulsory vaccine administered in compliance with the applicable rules and procedures ( lege artis ), until 31 December 2013 compensation could be claimed from the health professional who had performed the vaccination, on the basis of strict liability with no exonerating grounds under Article 421a of the then applicable Civil Code (Law no. 40/1964 Coll., as amended). In the context of a recodification of the civil law, this form of action was abolished with effect from 1 January 2014. However, under new special legislation that took effect on 8 April 2020, the State may be held liable for such damage. 20 .     Aside from the issue of compensation in such circumstances, a   person suffering from any side-effects of the vaccines in question will be eligible for medical treatment, covered by public health insurance. 21.     For further information on the relevant domestic law and practice, see paragraphs 65 to 93 below. APPLICATION OF Mr VAVŘIČKA, No. 47621/13 22.     The applicant was born in 1965 and lives in Kutná Hora. 23.     On 18 December 2003 the competent Disease Prevention and Control Centre ( hygienická stanice ) found him guilty of an offence under section 29(1)(f) of the MO Act for failure to comply with an order to bring his two children, then aged fourteen and thirteen, to a specified health-care establishment with a view to having them vaccinated against poliomyelitis, hepatitis B and tetanus. He was fined CZK 3,000 and ordered to pay CZK   500 in respect of costs (i.e. the equivalent of some EUR 110 in total at the relevant time). 24 .     The applicant challenged the decision at the administrative level, before the courts and ultimately before the Constitutional Court. He argued that the regulations in question were contrary to his fundamental rights and freedoms, in particular the right to refuse a medical intervention (referring to Articles 5 and 6 of the Convention on Human Rights and Biomedicine, which forms part of the legal order of the Czech Republic and takes precedence over statute in case of conflict (see paragraph 141 below) – the “Oviedo Convention”) and the right to hold and manifest his religious and philosophical beliefs. He opposed what he described as irresponsible experimentation with human health, emphasised the actual and potential side-effects of vaccines and argued that no risk to public health arose in his case, given that the last occurrence of poliomyelitis dated back to 1960, hepatitis B concerned only high-risk groups and tetanus was not transmissible among humans. 25.     The applicant’s cassation appeal was first dismissed by the Supreme Administrative Court (“the SAC”) in a judgment of 28 February 2006. That judgment was however quashed by the Constitutional Court in a   constitutional judgment ( nález ) of 3 February 2011. 26 .     The Constitutional Court found that the SAC had failed to provide an   adequate response to the applicant’s claim that the impugned decision was contrary to his right to manifest freely religion or belief under Article   16 of the Charter of Fundamental Rights and Freedoms ( Listina základních práv a svobod ) (Constitutional Law no. 2/1993 Coll.). It observed that the vaccination duty as such (imposed on the applicant by the decision of 3 June 2003 implementing the 2000 Ministerial Decree) was not at stake in the case, since his constitutional appeal concerned the penalty for non-compliance with this duty, imposed on him under the MO Act by the decision of 18 December 2003. Accordingly, the Constitutional Court could not exercise its jurisdiction to review the constitutionality of the vaccination duty. In any event, it had no power to substitute the assessment by the legislature or the executive as to the infectious diseases against which compulsory vaccination was needed. That assessment was for the legislature to make having regard to Article 26 of the Oviedo Convention. It was of a political and expert nature and subject to a   relatively wide margin of appreciation. 27 .     The Constitutional Court distinguished between making provision in law for compulsory vaccination and securing compliance with that duty. Compulsory vaccination amounted in principle to an admissible limitation on the fundamental right to manifest freely one’s religion or beliefs, since it was obviously a measure necessary in a democratic society for the protection of public safety, health and the rights and freedoms of others. However, for an interpretation of that limitation to be in conformity with the constitutional requirements, it could not entail unconditional enforcement of the vaccination duty in respect of any person, irrespective of the individual aspects of or motivations for that person’s resistance. 28 .     More specifically, the Constitutional Court held that: “A public authority deciding on the enforcement of the vaccination duty or on the penalty for non-compliance with it must take into account the exceptional reasons advanced by the claimant for refusing to undergo vaccination. If there are such circumstances which call, in a fundamental manner, for that person’s autonomy to be preserved, while nevertheless maintaining an opposite public interest ..., and therefore for an exceptional waiver of the penalty for [non-compliance with] the vaccination duty, the public authority must not penalise or otherwise enforce the [said] duty. ... The public authority, and then the administrative court in proceedings on an   administrative-law action, must take into account all the relevant circumstances of the case in its decision-making, in particular the urgency of the reasons claimed by the person concerned, their constitutional relevance, and the risk to society that may be caused by the conduct of the person concerned. The consistency and credibility of the claims of the person concerned will also be an important aspect. In a situation where a specific person does not communicate with the competent public authority from the outset, and only seeks to justify his or her attitude in respect of vaccination at later stages in the proceedings, as a general rule the conditions that the person’s attitude be consistent and that the constitutional interest in the protection of his or her autonomy be urgent would usually not be satisfied.” 29 .     The Constitutional Court further held that if these criteria were to be applied to the specific facts of the applicant’s case, the fulfilment of the criterion of consistency in his attitude appeared problematic. In that regard, it noted that he had given the reasons for his refusal to allow vaccination only at a   late stage of the proceedings and that even at a hearing before the Constitutional Court, he had submitted that his reasons were primarily health-related as, in his view, vaccination was harmful to children, with any philosophical or religious aspects being secondary. However, the criteria were primarily for the SAC to apply, and the applicant’s case was remitted to it for re ‑ examination. 30.     In a judgment of 30 September 2011, the SAC dismissed the applicant’s case. In response to the Constitutional Court’s directions, the SAC established that it had not been until a late stage in the proceedings that the applicant had relied, without further explanation, on the protection of his religious and philosophical convictions. He had subsequently explained his belief that he had the right to refuse compulsory vaccination for himself and his children on account of such convictions. However, he had not advanced any concrete argument concerning his religion and the degree of the potential interference caused by vaccination. The interest in protecting public health thus outweighed the applicant’s right to manifest his religion or beliefs. 31.     The final decision was given by the Constitutional Court on 24   January 2013, dismissing the applicant’s complaint against the judgment of 30 September 2011 as manifestly ill-founded. APPLICATION OF Ms NOVOTNÁ, No. 3867/14 32.     The applicant was born on 12 October 2002. She was granted admission to a Montessori nursery school by a decision of 4 April 2006, when she was some three and a half years old. 33.     On 10 April 2008 the principal of the establishment decided to   reopen the admission procedure, having been informed by the applicant’s paediatrician that – contrary to a previously submitted medical certificate of 15 March 2006 to the effect that she “had received the basic vaccination” – the applicant had not actually received the MMR (measles, mumps and rubella) vaccine. The reopened proceedings resulted in a decision of 14 July 2008 reversing, for lack of a required vaccination, the previous decision to admit the applicant to the establishment. 34.     In her subsequent unsuccessful appeals at the administrative level and before the courts, as well as to the Constitutional Court, the applicant argued that an exception to the right protected under Article 5 of the Oviedo Convention (that any intervention in the health field be subject to free and informed consent) could not be provided for by secondary legislation, i.e. the 2006 Ministerial Decree. That Decree did not set an age limit for the MMR vaccination. With reference to “statistical information” and the “opinion of experts”, she contended that vaccination presented a risk to health and was not necessary in a democratic society. The decision of 14   July 2008 was contrary to her interests and her right to education. She was prevented from continuing in the Montessori educational system unless she submitted to a medical procedure to which she did not consent. 35.     The applicant’s arguments were dismissed at all levels, the final decision being given by the Constitutional Court on 9 July 2013. Its conclusion can be summarised as follows. 36 .     To the extent that the applicant was challenging the legal basis for the vaccination duty, limitations to the guarantees under Articles 5 and 6 of the Oviedo Convention were provided for by an Act of Parliament (the PHP Act) setting out the duty to submit to routine vaccination, in respect of which only particular aspects such as the vaccine types and the conditions for administering them were set out in the 2006 Ministerial Decree adopted in application of that law. This arrangement satisfied the constitutional requirements that duties be imposed on the basis and within the bounds of the law (Article 4 § 1 of the Charter) and that limitations on fundamental rights and freedoms be imposed only by the law (Article 4 § 2 of the Charter). Any case-law inconsistencies in that regard had been resolved (see, in particular, paragraphs 85 et seq. below). 37 .     In so far as the applicant contested the need to protect public health by means of the vaccination at stake in her case, the objection was dismissed as unfounded. It was noted that she had raised no arguments whatsoever as regards any “circumstances which require in a   fundamental manner that the individual’s autonomy be preserved” within the meaning of the Constitutional Court’s judgment in the Vavřička case (see paragraph   28 above). 38.     In that regard, the Constitutional Court specifically pointed out that effective protection of those fundamental rights that were in conflict with the public interest in the protection of health could be ensured through a   rigorous assessment of the individual circumstances of each case, rather than by calling into question the vaccination duty as such. In the applicant’s case, the courts had duly examined and responded to her objections. She had failed to   show that on the facts of her case the duty to undergo the MMR vaccination amounted to a disproportionate interference with her fundamental rights. Nor had she established any circumstance that would have enabled her, in accordance with section 50 of the PHP Act, to be admitted to a nursery school without being vaccinated. 39.     Leaving open the question whether attendance at a nursery school fell within the ambit of the right to education, the Constitutional Court nevertheless held that in a situation where the applicant’s continued attendance was likely to put at risk the health of others, the public’s subjective right to the protection of health took priority. Her non-admission to the nursery school was accordingly free from any error. 40.     In addition, the applicant had prevented herself from being able to   attend preschool by refusing to meet conditions which were identical for everyone, and had probably not acted in good faith when submitting an   inaccurate medical certificate with her initial application for admission. APPLICATION OF Mr HORNYCH, No. 73094/14 41.     The applicant was born on 26 September 2008. At a young age, he suffered from various ailments and did not receive any vaccinations. He claimed that his parents had never actually refused to have him vaccinated and that the failure to vaccinate him was due to the lack of an individualised vaccination recommendation from his paediatrician. 42.     When applying for admission to nursery school, his paediatrician certified in the relevant form that the applicant had not been vaccinated. The form also contained the following handwritten text: “[the applicant] is not lacking any routine vaccination required under the law”. It was later established by the authorities, and not disputed by the applicant, that the handwritten text had been added by someone other than the paediatrician. 43.     By a decision of 27 June 2011, the applicant was refused admission to the nursery school pursuant to section 50 of the PHP Act because he had failed to prove that he had been vaccinated. His administrative appeal was dismissed, the authority having established through telephone contact with the paediatrician that there had been no relevant change in the situation since the above-mentioned certificate had been issued. 44.     The applicant further pursued his case through an administrative-law action and a cassation appeal, arguing principally that he had fulfilled all the statutory admission requirements, since – given that he had not received any individualised vaccination recommendations – he could not be regarded as missing any vaccination required by law. The authorities had failed to   establish the opposite. It had been arbitrary and contrary to his right to protection of personal information for them to have obtained further information from his paediatrician by telephone. He had been deprived of the opportunity to comment. It was apparent that no minor offence had been committed in connection with his vaccination status, as no proceedings had been brought in that respect. 45 .     His appeals were dismissed, inter alia on the grounds that although the administrative appeal authority had obtained information from the paediatrician by an extraordinary channel, the applicant had had access to the case-file and the contested decision was based solely on facts of which he had been aware. Moreover, under section 50 of the PHP Act the relevant criterion for being admitted to nursery school was whether or not the vaccination duty had been complied with, and not the reasons for possible non-compliance. Finally, the applicant had not even argued that there were any “circumstances which require in a fundamental manner that the individual’s autonomy be preserved”, within the meaning of the definition established in the Constitutional Court’s judgment in the Vavřička case (“the Vavřička jurisprudence” – see paragraph 28 above), nor had he relied on any of his fundamental rights. 46 .     In his ensuing constitutional appeal, the applicant alleged a violation of his rights under Articles 6 § 1 (fairness) and 8 (private and family life, in particular the right to personal development) of the Convention, essentially on the same grounds as before the lower courts. He argued that these courts had failed to assess the medical necessity of the vaccinations he had been required to undergo. In addition, “for the sake of completeness” he submitted specifically that since his parents had not refused to have him vaccinated, they could not be blamed for failing to justify their refusal on the grounds of their beliefs or convictions. 47.     On 7 May 2014 the Constitutional Court rejected the appeal as manifestly ill-founded, noting that the courts had duly examined all the relevant elements and endorsing their conclusions. APPLICATIONS OF Mr BROŽÍK AND Mr DUBSKÝ, Nos.   19298/15 AND 19306/15 48.     The applicants were born on 11 and 16 May 2011 respectively. Their parents refused to have them vaccinated. It was later noted by the authorities that in their application for admission to nursery school they had submitted a certificate issued by their paediatrician to the effect that they had not been vaccinated on account of their parents’ beliefs and convictions. 49.     On 2 May 2014 they were refused admission to nursery school with reference to the Vavřička jurisprudence and on the grounds that compulsory vaccination amounted to an acceptable restriction on the right to manifest one’s religion or beliefs freely, since it was necessary for the protection of public health and of the rights and freedoms of others. 50.     The applicants challenged that decision through an administrative appeal and through an administrative-law action against the subsequent dismissal of that appeal. 51 .     Together with their administrative-law action, on 18 July 2014 the applicants requested the Hradec Králové Regional Court to adopt an   interim measure authorising them to attend a given nursery school from 1   September 2014 pending the outcome of the proceedings on the merits of that action. They argued that they would otherwise be liable to serious harm, consisting in discrimination against them and a limitation of their personal development and access to preschool education. They asserted furthermore that their admission could not pose any risk to the other children who had been vaccinated, and that many adults were not, or were no longer, immunised against the illnesses in question. 52.     On 13 August 2014 the Regional Court dismissed the request for an   interim measure. It noted that there was no right, as such, of admission to preschool and that such admission was subject to conditions, including that set out in section 50 of the PHP Act. Non-admission was thus envisaged by law and was not a rare occurrence, especially on account of the lack of available places. Accordingly, the impugned decision could not have entailed a serious type of harm justifying the adoption of an interim measure. 53.     Relying on Article 6 of the Convention, the applicants challenged this judgment by way of a constitutional appeal. At the same time, they requested the Constitutional Court itself to adopt an interim measure similar to that previously requested from the Regional Court. 54 .     On 23 October 2014 the Constitutional Court dismissed both the applicants’ constitutional appeal and their request for an interim measure as manifestly ill-founded. Emphasising that the proceedings on the merits were still ongoing at the relevant time, it considered that the dismissal of the requests for interim measures had not entailed constitutionally unacceptable consequences. Moreover, the applicants had not demonstrated that it was necessary to adopt interim measures, and the Regional Court’s reasoning in that respect was logical, understandable and relevant. 55 .     Once the Constitutional Court had resolved the matter of the interim measure, it remained to determine the merits of the applicants’ administrative-law action. This was dismissed in a judgment of the Regional Court of 10 May 2016. Although further appeals were available, the applicants did not pursue the matter any further. APPLICATION OF Mr ROLEČEK, No. 43883/15 56.     The applicant was born on 9 April 2008. His parents, who are biologists, decided to draw up an individual vaccination plan for him. As a   result, he was vaccinated later than provided for by the applicable rules and was not vaccinated against tuberculosis, poliomyelitis or hepatitis B, and did not receive the MMR vaccine. 57.     On 22 and 30 April 2010 the principals of two nursery schools refused him admission under section 50 of the PHP Act. 58.     In his subsequent unsuccessful appeals at the administrative level and before the courts, including the Constitutional Court, the applicant argued, inter alia , that there had been a violation of his right to respect for private and family life, his right to education and his right not to be subjected to discrimination. No account had been taken of his parents’ convictions in pursuing his best interests, or of the principle of proportionality. Section 50 of the PHP Act should be set aside. The interference with his rights had been disproportionate, and less radical measures had been available to allow for the protection of public health. His non-admission had had repercussions for the entire family, in that his mother had been obliged to stay at home to look after him. 59 .     The applicant’s arguments were dismissed on grounds that can be summarised as follows, the key decisions being given by the Constitutional Court on 27 January 2015 (validity of section 50 of the PHP Act) and 25   March 2015 (merits of the applicant’s individual case). 60 .     Section 50 of the PHP Act did not breach in any way the rule that some matters were to be regulated solely by an Act of Parliament. It laid down a   condition for being admitted to day-care or preschool facilities, with reference to section 46 of the PHP Act. The latter provision defined the scope and content of the underlying duty. To the extent that the applicant might be understood as wishing to challenge the vaccination duty as such, this was beyond the scope of his challenge to section 50 of the PHP Act and should have been raised separately. As this had not been done, the Constitutional Court was prevented from reviewing the vaccination duty in the present proceedings. Nevertheless, its constitutionality had already been examined and upheld in another judgment in an unrelated case, namely no.   Pl. ÚS 19/14, concerning a different consequence (a fine) of a breach of the vaccination duty (see paragraphs 90 et seq. below). 61 .     Having an individual vaccination plan did not fall within any of the discrimination grounds provided for by law. Contrary to the applicant’s suggestion, non-admission to nursery school was not a penalty. As regards proportionality, the applicant had not referred to any exceptional circumstances to outweigh the interest of the protection of public health, within the meaning of the Vavřička case-law (see paragraph 28 above). 62 .     The detailed content of the right to education under Article 33 of the Charter was set out in the Education Act (see paragraphs 80 seq . below) and pertained to all types and levels of education. In the Constitutional Court’s view, this included preschool education, as this involved a process of acquiring skills, attitudes and knowledge, rather than just childcare or child ‑ minding. A limitation on that right, consisting in a requirement of compliance with the vaccination duty, did not suppress the very essence of the right and clearly pursued the legitimate aim of protecting public health. Moreover, the means provided for achieving this aim were rational and free from any arbitrariness. Vaccination represented an act of social solidarity on the part of those accepting a minimum risk in order to protect the health of society as a whole. This was all the more valid as the number of vaccinated children attending preschool establishments grew. 63.     Lastly, with reference to the considerations mentioned in the preceding paragraph as well as in the other constitutional judgment mentioned above (case no. Pl. ÚS 19/14), the Constitutional Court found that the lower courts’ conclusions in the proceedings brought by the applicant had an   adequate basis in findings of fact and were supported by cogent reasoning. There had accordingly been no breach of the applicant’s fundamental rights. 64.     The judgment of 27 January 2015 concerning the validity of section   50 of the PHP Act was adopted by a majority. A dissenting judge attached a separate opinion, in which she considered, inter alia , that the scope of the vaccination duty extending to nine diseases as a requirement for admission to the preschool system was excessive and that the existing regulations infringed the applicant’s basic rights. In her view, linked as it was to the public debate on the possible harmful effects of vaccination, the judgment of the plenary formation had limited itself to general statements about solidarity. RELEVANT LEGAL FRAMEWORK AND PRACTICE DOMESTIC LAW AND PRACTICE Domestic law Charter of Fundamental Rights and Freedoms (Constitutional Law no.   2/1993 Coll.) 65 .     In so far as relevant, Article 4 provides: “1.     Duties may be imposed only on the basis and within the bounds of the law and only if the fundamental rights and freedoms of the individual are respected. 2.     Limitations may be placed upon fundamental rights and freedoms only by the law and under the conditions prescribed in [this Charter].” 66.     Pursuant to Article 7 § 1: “The inviolability of the person and of his or her private life shall be guaranteed. It may only be restricted in the cases provided for by law.” 67.     The relevant part of Article 15 § 1 reads as follows: “Freedom of thought, conscience and religious conviction shall be guaranteed. ...” 68.     Under Article 16 § 1: “Everybody has the right to manifest freely his or her religion or faith, alone or jointly with others, privately or in public, through religious service, instruction, religious practice, or religious rites.” 69 .     Article 31 provides that: “Everyone shall have the right to the protection of his or her health. Citizens shall have the right, on the basis of public insurance, to free health care and to health aids under the conditions provided for by law.” 70.     As to the scope of the second sentence of Article 31, the Constitutional Court held (constitutional judgment of 10 July 1996, published in the Collection of Laws under no. 206/1996) that its content is limited to what is covered by public insurance, which in turn depends on the amount of the insurance premiums collected. All of the relevant Chapter of the Charter depends on the economic and social level achieved by the State and the attendant standard of living. 71.     Under Article 33 § 1: “Everybody shall have the right to education. School attendance shall be mandatory for the period specified by law.” 72.     Pursuant to the relevant part of Article 41 § 1; “[The right to education under Article 33] can be relied on only within the scope of the laws adopted for the implementation of that provision.” Public-Health Protection Act (Law no. 258/2000 Coll., as amended) 73 .     This legislation sets out the general framework for vaccination, defining its purpose, personal scope, vaccine types, the conditions for administering vaccination as well as for assessing immunity, and other matters. Section 46(1) and (6) provides for the adoption by the Ministry of Health of implementing measures, regulating in greater detail matters such as the classification of vaccines, the timing of injections and other conditions for the administration of vaccinations, and methods for checking immunity (see below). Moreover, it provides that day-care facilities for children up to the age of three and other types of preschool facilities (i.e.   those that receive children until the school year following the date on which they reach the age of six) may only accept children who have received the required vaccinations, or who have been certified as having acquired immunity by other means or as being unable to undergo vaccination due to a permanent contraindication (section 50). Decree on Vaccination against Infectious Diseases 74 .     As provided for in the PHP Act, the Ministry adopted the Decree on Vaccination against Infectious Diseases. In the period under consideration in the present case, there were two successive Decrees in force: Decree no.   439/2000 Coll., as amended, until 31 December 2006, replaced by Decree no. 537/2006 Coll., as amended, from 1 January 2007 onwards. Since the provisions that are relevant to the present case are essentially identical in both instruments, further references to the Decree in this judgment mean the 2006 Decree, unless otherwise indicated. 75.     The Decree determines the classification of vaccinations, the conditions for the administrat