Abstract
BackgroundAlthough childhood vaccination programs have been very successful, vaccination coverage in minority groups may be considerably lower than in the general population. In order to increase vaccination coverage in such minority groups involvement of faith-based organizations and religious leaders has been advocated. We assessed the role of religious leaders in promoting acceptance or refusal of vaccination within an orthodox Protestant minority group with low vaccination coverage in The Netherlands.MethodsSemi-structured interviews were conducted with orthodox Protestant religious leaders from various denominations, who were selected via purposeful sampling. Transcripts of the interviews were thematically analyzed, and emerging concepts were assessed for consistency using the constant comparative method from grounded theory.ResultsData saturation was reached after 12 interviews. Three subgroups of religious leaders stood out: those who fully accepted vaccination and did not address the subject, those who had religious objections to vaccination but focused on a deliberate choice, and those who had religious objections to vaccination and preached against vaccination. The various approaches of the religious leaders seemed to be determined by the acceptance of vaccination in their congregation as well as by their personal point of view. All religious leaders emphasized the importance of voluntary vaccination programs and religious exemptions from vaccination requirements. In case of an epidemic of a vaccine preventable disease, they would appreciate a dialogue with the authorities. However, they were not willing to promote vaccination on behalf of authorities.ConclusionReligious leaders’ attitudes towards vaccination vary from full acceptance to clear refusal. According to orthodox Protestant church order, local congregation members appoint their religious leaders themselves. Obviously they choose leaders whose views are compatible with the views of the congregation members. Moreover, the positions of orthodox Protestant religious leaders on vaccination will not change easily, as their objections to vaccination are rooted in religious doctrine and they owe their authority to their interpretation and application of this doctrine. Although the dialogue with religious leaders that is pursued by the Dutch government may be helpful in controlling epidemics by other means than vaccination, it is unlikely to increase vaccination coverage.
Highlights
Childhood vaccination programs have been very successful, vaccination coverage in minority groups may be considerably lower than in the general population
That is not in accordance with scripture. With regard to their addressing of the topic of vaccination in contacts with congregation members, three subgroups of orthodox Protestant religious leaders could be distinguished in our study: those who do not address the topic; those who focus on members of the congregation making their own deliberate choice; and those who preach against vaccination
Orthodox Protestant religious leaders are appointed by their congregations and generally hold views that are compatible with those of the majority
Summary
Childhood vaccination programs have been very successful, vaccination coverage in minority groups may be considerably lower than in the general population. We assessed the role of religious leaders in promoting acceptance or refusal of vaccination within an orthodox Protestant minority group with low vaccination coverage in The Netherlands. A number of epidemics started in the orthodox Protestant population of the Netherlands: a polio epidemic in 1978 (110 cases, one death) and 1992/1993 (71 cases, 3 deaths), a measles epidemic in 1999/2000 (over 3000 notified cases, 3 deaths), a rubella epidemic in 2004/2005 (almost 400 notified cases, 11 cases of congenital rubella syndrome, 2 fetal deaths) and a mumps epidemic in 2007/2008 [5,6,7,8,9] All these epidemics spread to their religious counterparts in Canada [6,7,8,9]. Vaccination coverage may be higher or lower than the national average for that denomination [16]
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