Measles outbreaks in recent years may have triggered a debate over parents’ responsibility for getting their children vaccinated, but in some places they also resulted in a legal dilemma. Most countries agree that the decision to vaccinate children is up to parents, but a growing number of lawmakers are questioning that position.

A law that took effect at the beginning of 2016 in the Australian state of Victoria made vaccinations a condition for the enrollment of children in preschool. Families unwilling to have their children vaccinated were also refused access to family assistance payments, except if kids were ineligible to receive vaccinations because of allergies.

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In Europe, Italian lawmakers followed suit in 2017, banning children from nurseries if they had not received a total of 10 mandatory vaccinations and imposing fines on parents of unvaccinated school-age kids. In a sign of how politically divisive the issue remains, the populist Five Star Movement later suspended the rule temporarily. When that suspension order expired this week, hundreds of children were denied access to kindergartens across the country.

Italy isn’t the first European Union country to expand measures on that front. In 2018, France significantly tightened its vaccination policies, barring children from schools and kindergartens unless they had received a total of 11 vaccinations. Several U.S. states have similar laws in place, as well.

Supporters of such measures have argued that children are especially vulnerable to being exposed to potentially lethal illnesses, and that contracting them in schools or kindergartens may also put their elderly relatives at serious risk.

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But critics point to studies that have raised doubts about the effectiveness of such policies. In 2016, an E.U.-funded study by the Action Plan on Science in Society Related Issues in Epidemics and Total Pandemics, known as ASSET, concluded that the researchers had found no evidence for any clear “relationship between mandatory vaccination and rates of childhood immunization in the EU/EEA countries.” Among other vaccinations, the researchers focused on measles vaccinations, blaming “misinformation” based on a “fraudulent source” for at least some of the hesitancy to get children vaccinated, even in countries where parents may face sanctions for it.

More important than threatening punishments, critics of such measures argue, would be serious efforts to debunk conspiracy theories and raise awareness for the need to have children vaccinated.

Finland, for instance, does not currently have mandatory vaccination policies, but it still dwarfs many other nations with immunization rates of 95 to 99 percent, depending on the respective vaccine. That rate has been achieved through a number of initiatives, including vaccinations in school buildings and public awareness campaigns.

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Supporters of Finland’s approach have also credited the popularity of publicly funded child welfare clinics for bringing down the number of unvaccinated children. Regularly sending children to public clinics for checkups and vaccinations is considered the norm by parents from all social backgrounds. The regular and free visits may have helped prevent the emergence of large anti-vaccination movements that are now common in the United States and elsewhere, where outbreaks are mounting.

“The picture for 2018 makes it clear that the current pace of progress in raising immunization rates will be insufficient to stop measles circulation,” Zsuzsanna Jakab, a Europe-focused senior official with the World Health Organization, said in February.

In some places, such as Italy, anti-vaccination movements have at times received a boost from top officials, rather than faced a crackdown. During its time as an opposition party, Italy’s Five Star Movement railed against vaccines and even suggested the introduction of a law against them. Faced with a surge in measles cases since becoming part of the government last year, it has had to soften its stance.

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Health officials hope that the mandatory regime will help raise vaccination rates from the 2017 average of 80 percent to the World Health Organization target of 95 percent.

But Italy’s Five Star Movement has already announced that it will seek to water down the law that once again took effect this week, raising doubts over how serious Italy’s ambitions should be taken.