The debate for and against the vaccine in the country has become intense. Thirty children have been taken into hospital and the authorities fear there could be deaths if the infection rate continues to rise.

On one side are the alternative healthcare enthusiasts who dominate Coburg, an affluent Bavarian town that is a centre for parents who opt out of conventional schooling and question the medical orthodoxy.

Two of the town’s seven paediatricians are enthusiasts for homoeopathic medicine and fiercely oppose the MMR.

On the other side are Germany’s public health experts, who accuse the “nest” of militant anti-MMR activists in Coburg of putting children’s lives in danger. They say that the advice of the homoeopathic doctors is irresponsible and may lead to levels of measles so high that Germans will be forced to get vaccination certificates before travelling.

Virus specialists say that Germany is fast becoming famous as a world leader in “exporting measles”.

Helmut Weiss, head of the state Health Office in Coburg, blamed the epidemic on “a widespread belief in anthropology” among Coburg residents. “There are some strong-willed homoeopathic doctors in the town who argue against vaccination,” Dr Weiss said.

“Their stronghold is the Waldorf School, which actively encourages people not to have their children vaccinated. Now we have an epidemic.”

The Waldorf School is a holistic teaching centre based on the methods of the late Dr Rudolf Steiner and is one of several in Germany that promotes alternative medicine.

The health department in the town refused to name the doctors who were advising against inoculation, saying that it was not permissible for it to do so. The Waldorf School would not comment.

One local doctor, however, said that Thomas Scheller, whose “natural healing” practice is in Heimatring, was among those who opposed the MMR vaccine. Dr Scheller was unavailable for comment last night.

One pamphlet that has been circulated in Coburg reads: “Classical child diseases permanently strengthen the child’s immunity and aid progress in the development of the child.”

Anti-MMR letters have also been sent to parents by activists advising them not to vaccinate their children.

The Children and Youth Doctor Association in Bavaria blames two homoeopathic paediatricians, claiming that they have neglected their duty of care to children by advising against the recommended MMR vaccine. “The willingness to vaccinate has gone, especially in Bavaria, where the number of militant vaccination opponents is on the rise,” Waltraud Knipping, head of the association, said.

Klaus Schnell, from Coburg, is one of those baffled by the attitudes prevailing in the town. “This is part of the world where many believe that measles are good for your personal development. Therefore they don’t vaccinate their children.”

The 30 children to be treated in hospital so far have ear, lung and larynx infections brought on by measles.

Dr Heinrich Müller, a health statistician in Berlin, said: “Coburg is regarded as the nest of vaccination opponents in Germany. According to the latest study, half of the school children have not received a sufficient protection against measles. Not just numerous parents, but also two of the seven paediatricians there reject vaccinations.”

Homoeopathic doctors defended their decision to veto government campaigns to inoculate with the MMR vaccine.

Joachim Grätz, a homoeopath and vaccination critic, said: “A vaccination is the forced introduction of a bigger number of viruses and alien proteins into the healthy body. It disturbs the biological balance and causes biochemical damage in the body. I am against it for these reasons, not purely the autism claims, although they deserve more research.”

The Coburg epidemic has served to ignite the vaccination debate in Germany again. The German uptake of the MMR is about 70 per cent, more than 10 per cent below that in Britain and far below the World Health Organisation’s target of 95 per cent to prevent outbreaks.

Heinz-Joseph Schmitt, head of the National Vaccination Committee, said: “Germany is one of the only countries where there are still measles epidemics. WHO demands that we erase domestic measles cases by 2007, but we can’t achieve that with our current rate.”

Hans Wilhelm Dörr, for the German Association for Fighting Virus Diseases, regards Germany as a Third World country when it comes to offering protection against measles. The virus expert said: “We are regarded as one of the biggest measles exporters in the world.”

Dr Dörr is among several doctors who believe that Germans will soon have to present vaccination passports if they want to travel to the United States. Germany has between 7,000 and 10,000 measles cases every year. There is no obligation to report cases so the estimates fluctuate.

There is a great regional difference over vaccinations. In general, 90.3 per cent of all new school pupils were given injections against measles, 89.9 against mumps and 83.4 against rubella. Parents usually choose the triple injections, but they can opt out.

The minimum waiting time between the first and second injection is four weeks, depending on the product.

It is recommended that children are given the first injection between the ages of 12 and 15 months and the second one between five and six years, but not later than the age of 18. There is no compulsory vaccination in Germany.

There are triple and single injections in the country. Double measles and mumps injections have been used since 1975, and the triple injections since 1980. Nowadays, the permanent commission that acts on behalf of the Government recommends triple injections.

Patchy progress towards eradication

WHEN experts met in Copenhagen in 1996 to evaluate efforts to eradicate measles, Britain was ranked in first place, along with Scandinavian countries, for a high uptake of MMR and low numbers of infections (Helen Rumbelow writes). “Elimination is near at hand,” the report said.

France, Italy and Germany were put in third ranking, for insufficient MMR coverage leading to “endemic” measles.

• Finland has been the most successful at eradicating measles, with nearly universal MMR uptake levels and very few cases of the virus.
• France and Germany have been much less successful.

  France has such high levels of the virus that an extra single dose of the measles vaccine is given to babies if there is a risk of an outbreak. This is in addition to a recommended double dose of MMR at the same times as in Britain.

   

• In Germany fewer than 80 per cent of children who reach their fifth birthday have had MMR, and only 10 per cent receive the second dose.
• In America, where some states insist on the vaccine before a child can attend school, rates are up to 90 per cent.