‘I don’t know anybody who said, “oh great, let’s get measles”’: a qualitative study of responses to childhood vaccinations (MMRV) among Orthodox Jews in Jerusalem following the 2018-19 measles outbreaks

Abstract

Measles outbreaks have emerged among religious minorities in the global north, which cross regional and national boundaries and raise implications for measles elimination targets. Yet, studies are ambiguous about the reasons that underlie non-vaccination in religious populations, and whether and how religious “beliefs” influence vaccine decision-making among populations with suboptimal vaccination coverage. In 2018-19, Israel experienced the largest measles outbreaks in a quarter century – the burden of which disproportionately affected Orthodox Jewish neighbourhoods in Jerusalem. The objective of this study was to explore how Orthodox Jewish households in Jerusalem responded to the measles outbreaks in their neighbourhoods and how they viewed childhood vaccination (MMRV) during a public health emergency.Research methods primarily consisted of 25 in-depth semi-structured interviews conducted with 23 household heads, and 2 public health professionals involved in planning and implementation of vaccination services. Thematic analysis generated five key themes, i) where the issue of sub-optimal vaccination uptake was perceived to be located; ii) how responsive people and services were to the measles outbreaks; iii) the sources of information used in vaccine decisions by religious parents; vi) whether vaccination was deemed a religious issue; and v) how vaccination influenced social relations within religious neighbourhoods.Results demonstrate parental investment in protecting child health, with decisions around vaccination reflecting vaccine efficacy and safety, and the risk of measles transmission. Household heads across all Orthodox Jewish backgrounds were not apathetic towards measles transmission. No religious “beliefs” were identified for non-vaccination among the household heads in this cohort. Rather than relegating suboptimal vaccination uptake among religious minorities and populations as an issue of religious “beliefs,” quality social science research should examine – and clearly convey – how religion influences vaccine decision-making. Such clarity can help to avoid stigmatizing religious minorities and populations, and to plan for appropriate vaccination programmes and promotion campaigns.