More Israeli Parents Refusing to Vaccinate Their Babies According to State Regulations

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Parents, especially highly-educated ones, are showing a tendency to refuse to have their babies vaccinated according to the state's vaccination program, and deciding for themselves which vaccines they want administered, according to a new study. In response to the trend, the Health Ministry has established a committee to study the possibility of public input on inoculation policy.

Selective refusal of immunizations is becoming more common in Western countries, with estimates ranging from between 1 to 20 percent of parents deciding against some vaccines for their babies.

The findings of the study, carried out by the University of Haifa and funded by the National Institute for the Health Policy Research, were presented Monday in an international meeting sponsored by the institute in Jerusalem.

The study, which sought to ascertain the reasons for refusal to inoculate, examined a sampling of 14,232 babies out of 18,740 files of babies treated in well-baby clinics in Tel Aviv that are operated by the municipality, and well-baby clinics operated by the Health Ministry in Haifa and Hadera. The sampling, which took in babies of parents of varying socioeconomic background, revealed that 7.4 percent - 1,052 babies - had not completed the vaccinations for their age group, and were lacking at least one of the three main immunizations in the national program.

Of this group, 36.7 percent had not completed the recommended five-vaccination series against diphtheria, tetanus, whooping cough, Haemophilus influenza type B, and polio, while 27.1 percent had not had their babies given the triple vaccination against measles, mumps and rubella. A dose against chicken pox has been added to the program in recent years.

The findings show that 31.7 percent of the parents skipped all three of the latter vaccinations (41.4 skipped one, and 26.8 skipped two ). According to the lead researcher, Anat Amit Aharon, head nurse in the Tel Aviv municipality's Public Health Department, the group that skipped all three is "from our perspective the hard core of those who refuse, refraining on an ideological basis."

Refusing on principle

As recorded by nurses in the well-baby clinic files, 41.3 percent of parents refused the vaccinations on principle. Some parents (18 percent ) asked that the immunizations be administered separately to reduce the risk of side effects, sometimes on the advice of an alternative practitioner, such as a homeopath.

Amit Aharon says the study showed that in 10.6 percent of cases where immunizations were not completed, there was no well-baby clinic to go to in the community, or there was no documentation that the well-baby nurse informed the parents to bring the baby in for immunization.

In the group of parents who refused immunization, 3.4 percent did so for medical reasons, the same rate as has been recorded globally. This includes babies who are sensitive to one or more of the vaccines or suffer from immune-system deficiencies.

The study found that university-educated parents were 2.13 times more likely to refuse vaccinations compared to parents with a high school education. Jewish parents were 4.22 times more likely to refuse to have their children vaccinated compared to Muslims, and Christian parents were 3.29 percent more likely to refuse than Muslim parents.

The older the mother, the more likely the refusal to vaccinate, the study found. Socioeconomic elements also factor into the refusal to vaccinate. "While socioeconomically better-off mothers refused vaccinations as a matter of choice, poorer mothers miss vaccinations because of behavioral or cultural blocks, lack of knowledge or organization," Amit Aharon said. Prof. Orna Brown-Apple of the University of Haifa's School of Public Health, which also took part in the study, said it also revealed that some doctors and practitioners are giving parents advice that differs from Health Ministry recommendations. "These are wealthier parents who can afford to pay such practitioners and also have access to information through the Internet," where criticism of vaccinations abounds, Brown-Apple said.

Although vaccination rates in Israel, at 90 percent, are relatively high for the Western world, the Health Ministry is concerned about the phenomenon of selective refusal and has begun considering ways to involve the public in setting vaccination policy. Last week the Health Ministry established a committee headed by Dr. Sonia Haviv, deputy to the chief physician of the Health Ministry's Haifa district, to make recommendations on vaccination policy, to be based on principles formulated by the unit for improving public service in the Prime Minister's Office.

According to Prof. Shmuel Rishpon, head of the Health Ministry's Haifa district, who was one of the study's researchers, "The phenomenon is not 'refusal' but includes parents who want autonomy over their lives and the lives of their children. ... This is a typical process in developed nations, not only in the realm of vaccinations, and requires increased investment of resources and providing transparent information and involving the public in decision-making."

Campaign on to reverse trend

Action is already being taken to reduce vaccination refusal. According to Amit Aharon, "The ideological parents who don't have the triple vaccination administered are very hard to persuade. But for parents who miss one or two vaccinations, there is room for intervention. In Tel Aviv we open the well-baby clinics in the afternoon for working parents and phone parents who haven't come in."

Sanctions against parents who do not vaccinate have also been considered, which, according to Rishpon, "is the complete opposite of the trend of public involvement under discussion now." Nevertheless, the Economic Arrangements Law of 2009 included a clause - whose implementation has been stopped by a High Court injunction - to reduce National Insurance Institute allowances to parents who do not vaccinate their children.

A baby receiving a hepatitis vaccination at Meir Hospital, Meir HospitalCredit: Alon Ron / Haaretz Archive

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