What has the manda­tory measles vacci­na­tion law in Germany achieved?

On 1 March 2020, a manda­tory measles vacci­na­tion law came into force in Germany to contain the spread of the highly conta­gious disease. But what has changed since then? Has the law increased the vacci­na­tion rate and prevented outbreaks?

Why was the manda­tory vacci­na­tion law introduced?

Before the intro­duc­tion of the law, the vacci­na­tion rate in Germany was below the 95% recom­mended by the WHO, which meant that the country was regu­larly hit by measles outbreaks. Measles is not a harm­less child­hood disease – in addi­tion to fever and skin rashes, it can cause serious compli­ca­tions such as pneu­monia or ence­pha­litis. Infants, immu­n­o­com­pro­mised indi­vi­duals and people who cannot be vacci­nated are parti­cu­larly at risk.

The effects of compul­sory vaccination

Compul­sory vacci­na­tion affects children in daycare centres and schools, as well as employees in medical faci­li­ties and shared accom­mo­da­tion. Parents must prove that their child has been vacci­nated before they can be admitted to a care faci­lity. Viola­tions are punis­hable by fines of up to €2,500, although these are enforced with varying degrees of consistency.

Since the law was intro­duced, the vacci­na­tion rate has increased slightly. The propor­tion of children starting school with full measles vacci­na­tion rose from 93% to around 95%, meeting the WHO recom­men­da­tion for the first time. In addi­tion, many adults who had previously not been vacci­nated or had only been parti­ally vacci­nated caught up on the vaccination.

Nevert­heless, chal­lenges remain: immu­nity gaps persist in some federal states, and certain groups – such as parents scep­tical of vacci­na­tion – are diffi­cult to reach. The fact that the measles vaccine is only available in Germany as a combi­na­tion vaccine (toge­ther with mumps and rubella, and some­times chickenpox) also deters some people.

The COVID-19 pandemic also led to delays in routine vacci­na­tions, which affected the vacci­na­tion rate. Mean­while, more than half of measles cases occur in people over the age of 15, who are at increased risk of complications.

Measles cases in Germany and worldwide

Despite manda­tory vacci­na­tion, outbreaks continue to occur. In 2024, around 550 cases of measles were reported in Germany – a signi­fi­cant increase compared to previous years. Most of those affected were unvac­ci­nated, which shows that immu­nity gaps have not yet been closed.

A look at the USA shows what can happen when people become less willing to be vacci­nated. Measles was declared elimi­nated there in 2000, but there have been more outbreaks in recent years, espe­ci­ally in commu­ni­ties that are scep­tical of vacci­na­tion. In early 2024, over 130 cases of measles were reported in Texas and New Mexico, inclu­ding the first child death in ten years.

World­wide, measles is on the rise: case numbers increased by 20% within one year. In 2023, there were around 10.3 million cases and almost 110,000 deaths, mainly among children under five years of age.

Conclu­sion

The manda­tory measles vacci­na­tion has improved the vacci­na­tion rate and is helping to contain the disease. Nevert­heless, further efforts are needed to close vacci­na­tion gaps and control measles in the long term.