Interviews with Orthodox Jewish moms reveal barriers to measles vaccination
Findings from a small case series of interviews with Orthodox Jewish mothers revealed several factors that are impacting childhood vaccination rates in New York communities with large Jewish populations. These results may help officials tailor interventions to improve vaccine uptake because Jewish mothers hold important influence among social networks within Orthodox communities
“Our data suggest that establishing trust, influencing social networks as well as media and cultural or religious factors among ultra-Orthodox Jewish mothers may have a favorable impact on the measles vaccination,” Charles H. Hennekens, MD, DrPH, senior author and senior academic advisor at Florida Atlantic University’s Schmidt College of Medicine, said in a press release.
The New York City Department of Health and Mental Hygiene has confirmed 550 cases in the city since September. The city has mandated vaccines in certain zip codes, imposing a potential $1,000 fine on those who have not received the MMR vaccine. Rockland County, New York, has also been struggling to contain the disease, having declared a state of emergency and banning unvaccinated children from public places.
“The situation has raised the specter of ethical concerns about the freedom of parents to choose not to vaccinate, as well as the need to protect the health of the general public,” Hennekens and colleagues wrote in the commentary. “In that regard, the residents of Rockland County have raised a legal challenge temporarily blocking the state of emergency order.”
The authors noted that the outbreaks in New York City and in Rockland County seem confined to ultra-Orthodox Jewish residents who have not had their children vaccinated, and some cases have been linked to travel to Israel, where the prevalence of measles has been increasing.
“Thus, at present, increasing the understanding of barriers to childhood vaccination among the ultra-Orthodox will have important and timely implications for the health of the general public,” they wrote.
Rachael Silverberg, MPH, from FAU, conducted semi-structured interviews with five mothers who self-identified as members of the ultra-Orthodox Jewish communities in Brooklyn and Rockland counties. All five, according to the study, were unwilling to have their children vaccinated. The reasons they gave included suspicion for and animosity toward the vaccine, as well as cultural factors within the community. In some ultra-Orthodox neighborhoods, for example, “religious fatalism,” or the belief that God is in control of the illness rather than a vaccine, contributed to low vaccination rates, Hennekens and colleagues wrote. They also named large family size as a contributing factor, given that ultra-Orthodox families have an average of 8.33 children, which increases the risk for disease transmission between children. Other factors include poverty, limited secular education and domestic overcrowding, according to the study.
Rabbis, health care practitioners, mothers of high social standing and other community members of influence should be identified and recruited as advocates for childhood immunization, they wrote.
“The success of these partnerships would be dependent upon the strength and durability of relationships forged between health officials and the community,” Hennekens and colleagues wrote. “Lack of trust in perceived agents of outside establishment presents a considerable barrier to the success of externally motivated health intervention and highlights the importance of outreach activities that seek to dispel suspicion and fear.”
This week, the CDC reported 971 confirmed cases of measles in the United States thus far in 2019. This is the largest number of cases reported in the U.S. since 1992 — 8 years before measles was declared eliminated in the country. The outbreaks in New York City and Rockland County have dragged on for nearly 8 months, and if they continue through the summer and fall, the U.S. may lose its elimination status, the agency warned. – by Joe Gramigna
NYC Health. Measles. https://www1.nyc.gov/site/doh/health/health-topics/measles.page. Accessed May 30, 2019.
Disclosures: Silverberg is currently a medical student at the Charles E. Schmidt College of Medicine at FAU. Please see the full commentary for a list of all other authors’ relevant financial disclosures.