Zimbabwe’s health ministry says the death toll from a measles outbreak has risen to almost 700 children.

The ministry said 37 of the deaths occurred on the first of September, hence 6291 cases were recorded on September 4.

The latest figures are more than four times the number of deaths announced about two weeks ago when the ministry said 157 children, most of whom were unvaccinated due to their family’s religious beliefs, had succumbed to the disease.

The president of the Medical and Dental Private Practitioners of Zimbabwe Association Dr. Johannes Marisa said that the government should escalate an ongoing mass vaccination campaign and embark on awareness programs targeted especially at anti-vaccine religious groups.

“Because of the resistance, education may not be enough so the government should also consider using coercive measures to ensure that no one is allowed to refuse vaccination for their children,” said Marisa.

French medical non-profit MSF (Doctors without Borders) tweeted that “no child should die of measles”.

The measles outbreak was first reported in the eastern Manicaland province in early April and has since spread to all parts of the country. Many of the deaths have been of children who were not vaccinated.

Measles is among the most infectious diseases in the world and mostly spreads in the air by coughing, sneezing or close contact. Symptoms include coughing, fever, and a skin rash, while the risk of severe measles or dying from complications is high among unvaccinated children.

Outbreaks in unvaccinated and malnourished populations have been known to kill thousands. Scientists estimate that more than 90% of the population needs to be immunized to prevent measles outbreaks.

The World Health Organization in this year, April warned of an increase in measles in vulnerable countries because of a disruption of services due to COVID-19.