A new German law requiring measles vaccinations for all children in schools and pre-schools took effect Monday.

The law is designed to combat a resurgence of the disease. Last year, there were more than 500 measles cases in Germany, despite recommendations that everyone should be immunized.

Typically, German children receive their first measles vaccination aged around 11 months and a second before their second birthday. Berlin pediatrician Jakob Maske regularly administers vaccinations for measles and other diseases.

"With measles it's really important people know that one in 1,000 cases is fatal," Maske said. "And when the children are under one or two years old, it's as high as one in 300 deaths."

But despite those odds, not everyone here is vaccinated for measles. A government institute estimated in 2017 that 7 percent of children starting school weren't properly immunized against the disease. Several outbreaks over the years and concern over so-called anti-vaxxers – parents who think vaccinations are harmful – led to the new law being passed last November.

"Freedom also means that I will not be unnecessarily put at risk," said Germany's health minister, Jens Spahn. "And that is precisely why, from the point of view of preserving freedom, this law is a good law because it protects freedom and health,"

Parents will now have to present measles immunization documents for their children – or face fines of more than $2,500 and lose their right to attend day care centers.

The German law is part of a global trend of harsher measures for parents who don't vaccinate their children. Italy and France recently passed similar laws and there has been a movement in the U.S. to close vaccination loopholes that sometimes allow parents to opt out because of religious or personal beliefs.

But some educators are concerned they haven't received enough information yet about how they're supposed to enforce the new rules. While German teachers' unions say they are pro-vaccination, some are concerned that they're being left to enforce this often contentious issue.

"The problem for the schools and day-cares is that it's still not really clear how this protection should be implemented," said Tom Erdmann, co-chairperson of the Berlin branch of the GEW teachers' union. "Should the educators now examine the vaccination cards themselves? Should the school management report who is not vaccinated?"

The plan is to put the country on a path to the 95 percent vaccination rate the World Health Organization says will prevent future outbreaks. Still, the new rules remain controversial. 

A group of parents has already filed a complaint stating the law violates their constitutional rights.

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