Germany Considers Fines for Not Vaccinating Children Against Measles

BERLIN — Germany’s health minister has proposed a fine of up to 2,500 euros, or about $2,800, for parents who refuse to immunize their school-age children against measles, part of efforts to combat a disease that has surged after decades of decline.

The fine is part of a draft bill that the minister, Jens Spahn, submitted to Chancellor Angela Merkel’s government for debate this week, but the proposal has prompted a wider discussion about whether mandating vaccinations is an infringement on personal freedom. Germany has seen 300 cases of the disease already this year, after more than 500 cases in 2018.

Outbreaks of measles have increased around the world, in part because of the anti-vaccination movement.

Under the proposed draft, toddlers and young children in Germany who have not been immunized would not be allowed to enter preschool. But German law mandates school attendance starting at age 6, so parents whose children have not had their scheduled shots would face a fine.

Mr. Spahn has defended his proposal by drawing a parallel to traffic laws that force drivers who are caught speeding to pay a fine because their actions are a danger to others. “The goal is not to fine people, the goal is to ensure that people are immunized,” he said in an interview with the broadcaster ZDF on Monday.

“We have been having this debate every few months over the past 10, 20 years,” Mr. Spahn said. “Whenever there is an outbreak and children or students have to be kept away from lessons, everyone says we could, we should do something — but not enough happens.”

Under the proposed bill, which would be put to Parliament later this year and take effect in the first part of 2020 if approved, adults working in schools, hospitals and other public institutions would also be required to show proof of up-to-date immunizations.

Germany has seen measles outbreaks in several states recently, including Bavaria, Baden-Württemberg and North Rhine-Westphalia, concentrated largely around schools. In the United States, where the largest outbreaks have hit Orthodox Jewish communities in New York, more than 700 measles cases have been recorded so far this year, more than in any full year since 1994, according to the Centers for Disease Control and Prevention.

Worldwide, there were more than 112,000 reported cases in the first three months of this year, according to the World Health Organization, nearly four times as many as in the same period a year earlier, and the organization says there are far more unreported cases.

Germany has used information campaigns to encourage people, especially parents, to make sure they and their children are immunized, but Mr. Spahn said the outbreaks in recent years showed that those efforts were not effective enough.

Germany had pledged to eradicate measles by 2015, but studies by a national health agency, the Robert Koch Institute, showed that only 93 percent of first graders had sufficient immunity against the disease in 2017. Immunity is reached through an initial vaccination, usually given at around age 1, followed several months later by a booster shot.

According to the World Health Organization, 95 percent of a population must be immunized to inoculate society as a whole against the virus, and that includes infants too young to be vaccinated.

Measles is extremely contagious. It has a very low death rate in developed countries, but it can cause severe complications like blindness and seizures. In poorer parts of the world, where malnutrition and dehydration weaken the body’s response, it is much more likely to be lethal.

It kills about 100,000 people annually, according to the W.H.O., including 72 in Europe last year.