This post is written by Dr. Ben Kasstan, a medical anthropologist at the University of Sussex.
It is unreasonable to expect hesitant parents to accept vaccinations automatically. Vaccinations are among the most successful public health interventions to reduce childhood morbidity and mortality, but they also remain one of the most controversial.
Uptake of the Measles, Mumps and Rubella (MMR) vaccination in England has suffered since 1998, when Andrew Wakefield and colleagues falsely claimed in The Lancet that the triple-vaccine may be a cause of childhood autism. Whilst their article has since been retracted and Wakefield’s claims refuted, the legacy for vaccination coverage has been catastrophic. Parents continue to fear that the all-in-one vaccine could put their children at risk of developing autism, which has been linked to outbreaks of measles in UK media.
From a public health perspective, maintaining high levels of vaccination coverage across the population is vital to prevent and resist the spread of infectious outbreaks. High coverage rates help to protect people with vulnerable immune systems, such as newborn babies, pregnant women, or people who can’t be vaccinated. 95% of the population need to be vaccinated for protection against measles, though coverage rates at the national level do not reflect rates at local levels.
Recent outbreaks of measles in areas of New York have been largely blamed on Haredi Jews, who are otherwise described as being ‘ultra-Orthodox’ or ‘non-compliant communities’ because of ‘culture’ or ‘beliefs.’ Yet there is little understanding around the vaccine decision-making and hesitancies among Haredi Jewish parents. Reactions to the outbreak have been so damaging that age-old anti-semitic representations of Jews as public health risks have resurfaced. Public health in the United States was used as a political technique to contain and control reviled migrant groups in the late nineteenth and early twentieth centuries, such as European Jews and Italians.
Similarly Haredi Jews are viewed as a ‘hard to reach’ group by Public Health England due to lower vaccination coverage in London and Manchester neighbourhoods. Haredi families tend to be much larger than the national average, which presents a concern of more unvaccinated or partially-vaccinated children.
My research has explored vaccine decision-making among Haredi Jewish families in England. What is true of any community is diversity, and I found a range of responses that included complete acceptance, selective acceptance, delayed acceptance and refusal of childhood vaccines. Parents were not opposed to vaccinations because of ‘religious beliefs,’ to the contrary, I was frequently told that they were important to preserve health and save lives (a core Jewish principle known as pikuach nefesh). The most common problem for parents with vaccine hesitancies, or who opposed vaccinations altogether, was safety and a lingering concern that the MMR vaccine could cause autism. More importantly, parents felt healthcare professionals did not treat their concerns seriously, and parents perceived healthcare professionals as not being able to address their concerns transparently. Whilst non-vaccination is seen as a moral issue (‘good’ parents vaccinate, ‘bad’ parents don’t vaccinate) – and even ‘child endangerment’ as one friend put it – the Haredi parents in my study declined vaccinations to protect their children.
There is a danger here in scapegoating minority groups for what is, in reality, a national anxiety. The Childhood Vaccination Coverage Statistics for 2017-18 in England indicates a worrying trend towards lower vaccine uptake, which raises critical questions of the trust between England’s diverse population and public health services. The statistics report that rates of MMR coverage at two years of age have lowered for the fourth year in a row, with coverage stalling at around 91.2%. This falls short of the 95% threshold of MMR coverage needed to protect population health. Whilst the 95% threshold was secured in County Durham, regions such as the Isle of Wight and Camden (London) were below 90%.Recent media reports claim that up to half a million children in the UK remain unvaccinated against measles, which could spread like ‘wildfire’ without action.
It is not enough to tell parents that ‘vaccines work’ (as the 2019 World Immunisation Week hashtag puts it), and it is unreasonable to expect hesitant parents to accept vaccinations automatically — without a process of informed consent. Healthcare professionals need to be responsive and sensitive to the vaccine hesitancies of parents in order to promote public confidence, and they need to be prepared to address questions of safety by offering clear information about vaccine products, processing and procurement.
If parents are to accept that vaccinations are the safest way to protect their children, then healthcare professionals and public health services should accept that some parents need assurance and reassurance of why and how vaccines are so safe.
Protecting child health is the aspiration of parents, healthcare professionals, and anthropologists like me. Working together to understand how concerns can be addressed is the most sustainable and effective way to show that vaccines can work for everybody.
This post is written by Dr. Ben Kasstan. Ben’s research focuses on reproductive and family health among ethnic and religious minority groups. His forthcoming book ‘Making Bodies Kosher’ (Berghahn Books) explores vaccine and child health decision-making among Haredi Jews in England.