Germany may adopt the strictest stance on measles vaccines in Western Europe—and certainly one that goes beyond current requirements in most of the United States.
On Sunday, German Health Minister Jens Spahn proposed a new law that would see parents fined up to €2,500 ($2,800) for failing to vaccinate their children against measles. Unvaccinated kids would also be banned from attending kindergartens because they might come in contact with babies who are still too young to receive their first measles shot.
In the U.S., where measles was supposedly eradicated in 2000 but has now returned, measles vaccines are technically required but many places allow opt-outs on religious or philosophical grounds. The first quarter of this year saw 387 cases in the U.S., the highest since a rash of outbreaks in 2014.
New York City recently started fining parents $1,000 for not giving their kids measles vaccines due to an outbreak that largely centers on the city’s ultra-Orthodox Jewish community, where anti-vaccination misinformation has been spreading. A previous decline in vaccinations in California—which attracted attention after an outbreak in Disneyland in 2014—has since been reversed after legislators in that state barred parents from opting out due to their personal beliefs.
Germany’s move follows the same debate that’s still raging across the world: whether vaccines should be a choice or a rule.
In parts of Western Europe—where the “anti-vaxxer” movement has been growing recently despite being based on bogus science—falling immunization rates have prompted politicians to take action. (Under a concept called “herd immunity,” vaccination rates of at least 95% are seen as essential to stopping the spread of the disease through populations.)
In France, where only 90% of kids get even their first measles vaccine—uptake rates for the second shot are typically lower—a recent law forbids unvaccinated children from attending nurseries or schools, though it does not involve any fines. In Italy, where measles vaccination rates are below 80%, a new law also bans unvaccinated kids from attending school, and hits parents with a fine if they send their children to school regardless.
Fears over measles outbreaks are not theoretical. In France, there were 54 cases in December, 125 in January and 188 in February—a 248% increase in two months. In Italy, the numbers jumped from 76 cases in December to 172 cases in January, though they fell slightly to 160 new cases in February.
The figures in Germany, where there is a first-shot vaccination rate of 93%, suggest a worrying resurgence of the disease, with 164 cases already in just the first two months of this year. That trend has been enough to spur the German government’s new proposals, which is broadly supported and likely to be in place within a year.
Unlike in France and Italy, Germany’s approach does not involve banning any kids from attending elementary school. Spahn, the Germany health minister, said this is because school education is compulsory by law; the same does not apply to kindergarten attendance, hence the ban there.
“I want to eradicate measles,” Spahn told the Bild am Sonntag newspaper. “All parents should be secure in the knowledge that their children will not be infected and endangered by measles.”
To force or not to force
In the German states of Schleswig-Holstein and Lower Saxony, measles outbreaks prompted schools to tell unvaccinated kids to stay at home. And Spahn’s move at the federal level came a few weeks after the state of Brandenburg became the first in the country to demand vaccinations for all children attending kindergarten. The state’s mandate covers measles vaccines, and legislators there are considering adding other vaccinations to the list.
There are differing opinions on the subject across health officials from various states—for example, the health minister in Hessen has come out in favor of better education as a way of encouraging vaccination, rather than forcing them on people, but the health minister in Saxony favors mandatory shots.
In early April, amid rumors of Spahn’s proposal to introduce fines, an organization called Doctors for Individual Vaccine Choice launched a petition against it. The petition has gathered steam in recent days, and currently stands at around 94,000 signatures.
“We have a problem with the trust in this technology, and the more mandatory you make it, the more people will be skeptical about it,” said Stefan Schmidt-Troschke, an alternative-medicine pediatrician who acts as the group’s spokesman.
Schmidt-Troschke said he is certainly no anti-vaxxer, but said given the high vaccination rates for small children, the government should focus more on getting kids to take that second booster shot, and leave it to local regional authorities to decide on how to address vaccinations.
‘The right time’
Other medical professionals agree more kids need to be brought back for their second shot, but object to leaving vaccine enforcement to regional authorities. For example, Frank Ulrich Montgomery, the president of the Federal Medical Association, said in a statement that Spahn’s proposal was “an important step at the right time.”
“We find it [to be] a good proposal,” said Dr. Hermann Josef Kahl, the spokesman for the German Association of Pediatricians. He said his organization also wanted to see the introduction of a national vaccination registry, to make it easier to remind people about that second shot.
Regarding the suggestion that forcing the issue with fines and kindergarten bans would increase distrust, Kahl said time will tell.
“We had a lot of proposals in the last 10 to 15 years and they didn’t have the effect we wanted,” he said. “We should try this law. If it doesn’t help, we can cancel it again.”