Scepticism and critical attitudes towards immunisation have prevailed since the introduction of the smallpox vaccine. In Germany the anti-vaccine movement is rather small (3-5% of the population). Nevertheless its influence on the acceptance of immunisation by the population may be substantial, as shown by the examples of smallpox vaccination and the recent discussion of the combined MMR vaccine in the UK. Modern societies facilitate networking and the dissemination of anti-vaccination ideas. The decline in the incidence of vaccine-preventable diseases has led to a reduced awareness of possible complications from infectious diseases and to an overestimation of the incidence of rarely occurring adverse events following immunisation. Proposals for managing the anti-vaccine movement must take into account changes in immunisation policies and draw on elements of risk communication.