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Italy made vaccinations compulsory  this week. Children under the age of 6 will be turned away from nurseries and kindergartens unless their parents have provided proof of their vaccination status.

Children aged 6 and over won’t be stopped from attending school, but their parents will have to pay fines of €500 (£430). The required vaccines include measles, mumps and rubella, known as MMR, as well as chickenpox and polio.

Children’s immunisation rates have been falling in many Western countries for the past couple of decades, stemming from mistaken fears that vaccines carry health risks. Only a minority of places have made vaccinations mandatory for attending school. These include France, Germany, the US and parts of Australia.

In Italy, the law was introduced in 2017 but there have been tussles over whether and when it would come into force. Parents had until this week to provide immunisation certificates to schools, so parents in some regions are now being sent letters saying their child has been suspended.

Health officials seek to get vaccination rates up to 95 per cent, the level that gives herd immunity. This means there are so few unvaccinated people that if one person brings in the disease from elsewhere they are unlikely to come into contact with anyone they can pass it on to.

This stops outbreaks from spreading, and so shields infants who are too young to be vaccinated or people who cannot be vaccinated because of an impaired immune system. “These children need to be protected,” says Siddhartha Datta of the World Health Organization.

Measles is a particular concern as it is highly contagious and can cause pneumonia and brain damage. Before vaccination was introduced in the 1960s, it used to cause epidemics every two or three years, with 95 per cent of children having had it by their 15th birthday.

Countries have to balance the protection of those who cannot be vaccinated against parents’ wishes to determine their children’s medical care. Different countries need to set their own policies, says Datta. “What works in in one country won’t necessarily work in another.”

In the US this year there have been six outbreaks of measles, including in New York state and California, linked to travellers returning from areas where there are currently large outbreaks, such as Israel and Ukraine. Lawmakers in New York are proposing a bill that would allow children 14 years old and over to get vaccinated against their parents’ wishes.

In the UK, vaccine fears were mainly driven by a single researcher, Andrew Wakefield, who pushed the now-discredited claim that the MMR vaccine was causing a rise in autism. But countless studies – including a massive one from Denmark published earlier this month – show children who received the injection are no more likely to be diagnosed with autism than those who didn’t get it. Other studies have shown autism isn’t really on the rise, doctors are just becoming better at identifying it.

Wakefield has since been struck off the UK’s medical register for dishonesty by the UK’s regulatory body for doctors, the General Medical Council, and his original paper making the link was retracted by The Lancet, the medical journal that published it.

In the US, anti-vax sentiment centres more on the mistaken belief that the ingredients in vaccines are harmful or that too many could overload a child’s immune system, which isn’t possible.

Recently the World Health Organization said that “vaccine hesitancy” was one of the, along with other risks such as antibiotic resistance and the possibility of a new flu pandemic.