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ROME (AP) — Italy’s health ministry says 4,991 cases of measles were reported last year, a nearly six-fold increase over 2016 that has been blamed in part on a highly politicized debate over vaccines.

Italy’s measles epidemic, which killed four people last year, has already caught the attention of the World Health Organization and other global health authorities.

But the toll, with 2017 data released Thursday, has only fueled debate after the Democratic Party pushed through legislation last year making 10 vaccines obligatory.

The right-wing League and the populist 5-Star Movement, which are seeking to wrest power from the Democrats in March 4 elections, have drawn scorn for comments opposing obligatory vaccinations or questioning their effectiveness.

Italy reported 2,211 measles cases in 2013, 1,674 in 2014, 251 in 2015 and 844 in 2016.