1
|
Herzig van Wees S, Abunnaja K, Mounier-Jack S. Understanding and explaining the link between anthroposophy and vaccine hesitancy: a systematic review. BMC Public Health 2023; 23:2238. [PMID: 37957574 PMCID: PMC10644591 DOI: 10.1186/s12889-023-17081-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Due to low vaccination uptake and measles outbreaks across Europe, public health authorities have paid increasing attention to anthroposophic communities. Public media outlets have further described these communities as vaccine refusers or "anti-vaxxers". The aim of this review was to understand the scope of the problem and explore assumptions about vaccination beliefs in anthroposophic communities. For the purpose of this review, we define anthroposophic communities as people following some/certain views more or less loosely connected to the philosophies of anthroposophy. The systematic review addresses three research questions and (1) collates evidence documenting outbreaks linked to anthroposophic communities, (2) literature on vaccination coverage in anthroposophic communities, and (3) lastly describes literature that summarizes theories and factors influencing vaccine decision-making in anthroposophic communities. METHODS This is a systematic review using the following databases: Medline, Web of Science, Psycinfo, and CINAHL. Double-blinded article screening was conducted by two researchers. Data was summarized to address the research questions. For the qualitative research question the data was analysed using thematic analysis with the assistance of Nvivo12.0. RESULTS There were 12 articles documenting 18 measles outbreaks linked to anthroposophic communities between the years 2000 and 2012. Seven articles describe lower vaccination uptake in anthroposophic communities than in other communities, although one article describes that vaccination coverage in low-income communities with a migrant background was lower than in the anthroposophic community they studied. We found eight articles examining factors and theories influencing vaccine decision making in anthroposophic communities. The qualitative analysis revealed four common themes. Firstly, there was a very broad spectrum of vaccine beliefs among the anthroposophic communities. Secondly, there was a consistent narrative about problems or concerns with vaccines, including toxicity and lack of trust in the system. Thirdly, there was a strong notion of the importance of making individual and well-informed choices as opposed to simply following the masses. Lastly, making vaccine choices different from public health guidelines was highly stigmatized by those outside of the anthroposophic community but also those within the community. CONCLUSION Continuing to further knowledge of vaccine beliefs in anthroposophic communities is particularly important in view of increasing measles rates and potential sudden reliance on vaccines for emerging diseases. However, popular assumptions about vaccine beliefs in anthroposophic communities are challenged by the data presented in this systematic review.
Collapse
Affiliation(s)
| | - Khadija Abunnaja
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene and Tropical, London, UK
| |
Collapse
|
2
|
Social clustering of unvaccinated children in schools in the Netherlands. Epidemiol Infect 2022; 150:e200. [PMID: 36093608 PMCID: PMC9987017 DOI: 10.1017/s0950268822001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
For the measles-mumps-rubella (MMR) vaccine, the World Health Organization-recommended coverage for herd protection is 95% for measles and 80% for rubella and mumps. However, a national vaccine coverage does not reflect social clustering of unvaccinated children, e.g. in schools of Orthodox Protestant or Anthroposophic identity in The Netherlands. To fully characterise this clustering, we estimated one-dose MMR vaccination coverages at all schools in the Netherlands. By combining postcode catchment areas of schools and school feeder data, each child in the Netherlands was characterised by residential postcode, primary and secondary school (referred to as school career). Postcode-level vaccination data were used to estimate vaccination coverages per school career. These were translated to coverages per school, stratified by school identity. Most schools had vaccine coverages over 99%, but major exceptions were Orthodox Protestant schools (63% in primary and 58% in secondary schools) and Anthroposophic schools (67% and 78%). School-level vaccine coverage estimates reveal strong clustering of unvaccinated children. The school feeder data reveal strongly connected Orthodox Protestant and Anthroposophic communities, but separated from one another. This suggests that even at a national one-dose MMR coverage of 97.5%, thousands of children per cohort are not protected by herd immunity.
Collapse
|
3
|
de Munter AC, Klooster TMSVT, van Lier A, Akkermans R, de Melker HE, Ruijs WLM. Determinants of HPV-vaccination uptake and subgroups with a lower uptake in the Netherlands. BMC Public Health 2021; 21:1848. [PMID: 34641851 PMCID: PMC8513172 DOI: 10.1186/s12889-021-11897-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/29/2021] [Indexed: 01/18/2023] Open
Abstract
Background In the Netherlands, the HPV-vaccine uptake was 52% during the 2009 catch-up campaign (birth cohorts 1993–1996). This increased to 61% in the regular immunization program (birth cohorts 2000–2001). However for birth cohorts 2003–2004 the uptake declined to 45.5%. With this study we aimed to gain insight into social, economic and cultural determinants that are associated with HPV-vaccination uptake and which subgroups with a lower HPV-vaccination uptake can be identified. In addition, we investigated whether the influence of these factors changed over time. Methods To study the determinants of HPV-vaccine uptake we performed a database study using different aggregation levels, i.e. individual level, postal code level and municipality level. All Dutch girls who were invited for HPV-vaccination through the National Immunization Program in the years 2012, 2014 and 2017 (i.e. birth cohorts 1999, 2001 and 2004, respectively) were included in the study population. We conducted multilevel logistic regression analyses to analyze the influence of the determinants on HPV-vaccination uptake, taking into account that the delivery of HPV-vaccine was nested within municipalities. Results Results showed that in particular having not received a MMR-vaccination, having one or two parents born in Morocco or Turkey, living in an area with lower socioeconomic status and higher municipal voting proportions for Christian political parties or populist parties with liberal-conservative views were associated with a lower HPV-vaccination uptake. Besides some changes in political preferences of the population and changes in the association between HPV uptake and urbanization level we found no clear determinants which could possibly explain the decrease in the HPV-vaccination uptake. Conclusions In this study we identified current social, economic and cultural determinants that are associated with HPV-vaccination uptake and which low-vaccination subgroups can be identified. However, no clear determinants were found which could explain the decrease in the HPV-vaccination uptake. Tailored information and/or consultation for groups that are associated with a lower HPV-vaccination uptake might help to increase the HPV-vaccination uptake in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11897-0.
Collapse
Affiliation(s)
- A C de Munter
- Department of Infectious Disease Control, Public Health Service Gelderland-Zuid, Nijmegen, The Netherlands.,Radboud University Nijmegen Medical Centre, Department of Primary and Community Care & IQ Health care, Nijmegen, The Netherlands.,GGD GHOR Nederland, Utrecht, The Netherlands
| | - T M Schurink-van T Klooster
- Department National Immunization Program, Center of Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, PO box 1, 3720, BA, Bilthoven, The Netherlands.
| | - A van Lier
- Department National Immunization Program, Center of Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, PO box 1, 3720, BA, Bilthoven, The Netherlands
| | - R Akkermans
- Radboud University Nijmegen Medical Centre, Department of Primary and Community Care & IQ Health care, Nijmegen, The Netherlands.,Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - H E de Melker
- Department National Immunization Program, Center of Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, PO box 1, 3720, BA, Bilthoven, The Netherlands
| | - W L M Ruijs
- Department of Infectious Disease Control, Public Health Service Gelderland-Zuid, Nijmegen, The Netherlands.,Department National Immunization Program, Center of Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, PO box 1, 3720, BA, Bilthoven, The Netherlands
| |
Collapse
|
4
|
Wilder-Smith AB, Qureshi K. Resurgence of Measles in Europe: A Systematic Review on Parental Attitudes and Beliefs of Measles Vaccine. J Epidemiol Glob Health 2021; 10:46-58. [PMID: 32175710 PMCID: PMC7310814 DOI: 10.2991/jegh.k.191117.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/11/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Europe has experienced a major resurgence of measles in recent years, despite the availability and free access to a safe, effective, and affordable vaccination measles, mumps and rubella vaccine (MMR). The main driver for this is suboptimal vaccine coverage. The three objectives of this study are to synthesize and critically assess parental attitudes and beliefs toward MMR uptake, to develop strategies and policy recommendations to effectively improve MMR vaccine uptake accordingly, and ultimately to identify areas for further research. METHODS A systematic review was conducted using primary studies from PubMed, Medline, Embase, and Scopus published between 2011 and April 2019. Inclusion criteria comprised primary studies in English conducted in Europe and studying parental attitudes and behavior regarding MMR uptake. Data were extracted using an inductive grounded theory approach. RESULTS In all, 20 high-quality studies were identified. Vaccine hesitancy or refusal were mainly due to concerns about vaccine safety, effectiveness, perception of measles risk and burden, mistrust in experts, and accessibility. Factors for MMR uptake included a sense of responsibility toward child and community health, peer judgement, trust in experts and vaccine, and measles severity. Anthroposophical and Gypsy, Roma, and Traveler populations presented unique barriers such as accessibility. CONCLUSION A multi-interventional, evidence-based approach is vital to improve confidence, competence, and convenience of measles vaccination uptake. Healthcare professionals need an understanding of individual contextual attitudes and barriers to MMR uptake to tailor effective communication. Effective surveillance is needed to identify under-vaccinated populations for vaccination outreach programs to improve accessibility and uptake.
Collapse
Affiliation(s)
- Annika B Wilder-Smith
- School of Social and Political Science, Usher Institute of Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - Kaveri Qureshi
- School of Social and Political Science, Global Health Policy Unit, University of Edinburgh, Crystal Macmillan Building, Edinburgh EH8 9LD, UK
| |
Collapse
|
5
|
Mittring-Junghans N, Holmberg C, Witt CM, Teut M. Thoughts, beliefs and concepts concerning infectious childhood diseases of physicians practicing homeopathic, anthroposophic and conventional medicine - a qualitative study. BMC Complement Med Ther 2021; 21:46. [PMID: 33499846 PMCID: PMC7835107 DOI: 10.1186/s12906-021-03216-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background Physicians who include complementary medicine in their practice are thought to have an understanding of health and disease different from that of colleagues practicing conventional medicine. The aim of this study was to identify and compare the thoughts and concepts concerning infectious childhood diseases (measles, mumps, rubella, chickenpox, pertussis and scarlet fever) of physicians practicing homeopathic, anthroposophic and conventional medicine. Methods This qualitative study used semistructured interviews. Participating physicians were either general practitioners or pediatricians. Data collection and analysis were guided by a grounded theory approach. Results Eighteen physicians were interviewed (6 homeopathic, 6 anthroposophic and 6 conventional). All physicians agreed that while many classic infectious childhood diseases such as measles, mumps and rubella are rarely observed today, other diseases, such as chickenpox and scarlet fever, are still commonly diagnosed. All interviewed physicians vaccinated against childhood diseases. A core concern for physicians practicing conventional medicine was the risk of complications of the diseases. Therefore, it was considered essential for them to advise their patients to strictly follow the vaccination schedule. Homeopathic-oriented physicians viewed acute disease as a biological process necessary to strengthen health, fortify the immune system and increase resistance to chronic disease. They tended to treat infectious childhood diseases with homeopathic remedies and administered available vaccines as part of individual decision-making approaches with parents. For anthroposophic-oriented physicians, infectious childhood diseases were considered a crucial factor in the psychosocial growth of children. They tended to treat these diseases with anthroposophic medicine and underlined the importance of the family’s resources. Informing parents about the potential benefits and risks of vaccination was considered important. All physicians agreed that parent-delivered loving care of a sick child could benefit the parent-child relationship. Additionally, all recognized that existing working conditions hindered parents from providing such care for longer durations of time. Conclusions The interviewed physicians agreed that vaccines are an important aspect of modern pediatrics. They differed in their approach regarding when and what to vaccinate against. The different conceptual understandings of infectious childhood diseases influenced this decision-making. A survey with a larger sample would be needed to verify these observations.
Collapse
Affiliation(s)
- N Mittring-Junghans
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Luisenstr. 57, 10117, Berlin, Germany
| | - C Holmberg
- Institute of Social Medicine and Epidemiology, Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - C M Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Luisenstr. 57, 10117, Berlin, Germany
| | - M Teut
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Luisenstr. 57, 10117, Berlin, Germany.
| |
Collapse
|
6
|
Kmeid M, Azouri H, Aaraj R, Bechara E, Antonios D. Vaccine coverage for Lebanese citizens and Syrian refugees in Lebanon. Int Health 2019; 11:568-579. [DOI: 10.1093/inthealth/ihz023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/06/2019] [Accepted: 03/26/2019] [Indexed: 01/03/2023] Open
Abstract
Abstract
Article History
Following the refugee crisis in Lebanon, the on-going inflow of Syrian refugees presented new challenges to optimal immunization coverage for all the children living in the country. Healthcare facilities have been overburdened during this period and the country witnessed outbreaks of many infectious diseases. Thus, the evaluation of vaccine compliance for mandatory and non-mandatory vaccines as well as the factors affecting the vaccination rate among Lebanese residents and Syrian refugees is fundamental.
Background
Since 2012, Lebanon has hosted around 1.2 million Syrian refugees, a high number in a country whose population does not exceed 4.4 million. Healthcare facilities have been overburdened during this period, which has led to the spread of many infectious diseases, including outbreaks of measles, mumps and hepatitis. At the appearance of such outbreaks, it becomes essential to evaluate vaccine compliance and the factors influencing the vaccination rate among Lebanese residents and Syrian refugees in infants and children up to 15 y of age.
Methods
A total of 571 infants and children were recruited in Beirut and Mount Lebanon, two governorates that together host half of the Lebanese population.
Results
A very high rate of vaccine compliance was seen for mandatory vaccines, whereas an intermediate to very low rate of compliance was found for non-mandatory vaccines. Both bivariate and multiple regression analyses indicated that age group and regular consultation of a pediatrician were independently associated with immunization coverage. Bivariate analysis indicated that parental age, occupational and educational status of parents, family size and vaccine price were also independently associated with immunization coverage. Incomplete vaccination coverage was associated with socioeconomic factors.
Conclusions
From these results, it becomes apparent that it may be necessary to reassess vaccination priorities considering the current socioeconomic situation.
Collapse
Affiliation(s)
- Maria Kmeid
- Toxicology Laboratory and Poison Control Center, Faculty of Pharmacy, Campus of Medical Sciences, Saint Joseph University, Damascus Road, Beirut, Lebanon. P.O. Box: 11-5076—Riad El Solh, Beirut 1107 2180, Lebanon
| | - Hayat Azouri
- Toxicology Laboratory and Poison Control Center, Faculty of Pharmacy, Campus of Medical Sciences, Saint Joseph University, Damascus Road, Beirut, Lebanon. P.O. Box: 11-5076—Riad El Solh, Beirut 1107 2180, Lebanon
| | - Racha Aaraj
- Toxicology Laboratory and Poison Control Center, Faculty of Pharmacy, Campus of Medical Sciences, Saint Joseph University, Damascus Road, Beirut, Lebanon. P.O. Box: 11-5076—Riad El Solh, Beirut 1107 2180, Lebanon
| | - Elissa Bechara
- Toxicology Laboratory and Poison Control Center, Faculty of Pharmacy, Campus of Medical Sciences, Saint Joseph University, Damascus Road, Beirut, Lebanon. P.O. Box: 11-5076—Riad El Solh, Beirut 1107 2180, Lebanon
| | - Diane Antonios
- Toxicology Laboratory and Poison Control Center, Faculty of Pharmacy, Campus of Medical Sciences, Saint Joseph University, Damascus Road, Beirut, Lebanon. P.O. Box: 11-5076—Riad El Solh, Beirut 1107 2180, Lebanon
| |
Collapse
|