Back in 2011, there was an outbreak of measles in Minnesota that affected 19 children and two adults. The outbreak was traced back to an unvaccinated Somali child. It sparked fears that Somali parents were refusing childhood vaccinations because of rumors they would lead to autism.
The anti-vax movement is typically associated with celebrity spokespeople like Jenny McCarthy and is most prominent locally in rural and island communities around Washington. But skepticism of vaccines is also strong in the local Somali immigrant community — thanks in part to the efforts of anti-vaccer guru Andrew Wakefield.
Startling research findings
Since 2011 outbreak, multiple studies have been conducted to find out if the vaccination rates in the Somali community are lower than the rest of the population.
Dr. Elizabeth Wolf, Dr. Ali Rowhani-Rahbar and others published a study in 2016, which concluded that under-immunization of certain immigrant populations could place them at high risk of experiencing disease outbreaks that could have been prevented by vaccines.
Wolf and Rowhani-Rahbar’s conclusions were based on a cohort study between Jan. 1, 2008 to May 1, 2013. They assessed 277,098 children, of which 65,466 were children of foreign-born parents from various countries. They found that the children of Somali-born parents were less likely to be immunized against measles than the children of U.S.-born parents and other immigrant groups.
Wolf and Rowhani-Rahbar concluded that patterns of immunization between immigrants from different countries reflected underlying cultural beliefs.
“We found that children of Somali-born parents were less likely to be immunized against measles compared with children of U.S.-born parents and this decrease became more pronounced over time,” Wolf, an assistant professor of pediatrics at Virginia Commonwealth University said in an email interview. “No such decline was observed with other included vaccines.
“Children of Ukrainian-born and Russian-born parents were less likely to be immunized, whereas children of Mexican-born and Indian-born parents were more likely to be immunized.”
Generally, the study found that immunization rates varied across different immigrant populations.
“Compared with children of U.S.-born parents, children of Ukrainian-born and Russian-born parents were less likely to be immunized, whereas children of Mexican-born and Indian-born parents were more likely to be immunized with any of the specified vaccines.”
But of all these immigrant populations studied, the Somali community was most vulnerable, and still are.
A vaccination generation gap
At the Voices of Seattle’s East African Communities event on earlier this month at the New Holly Gathering Hall, Somali Americans had the opportunity to voice community concerns, after listening to Mayor Ed Murray and other officials talk about work they’re doing to help resolve injustices in the community.
Hana Abdi Mohamed, a 24-year old mother of a two-year-old, and a graduate student studying Global Health at the University of Washington, was at the event and confirmed that there’s skepticism in her community around vaccines.
“The community is definitely concerned about the vaccinations, particularly the MMR [Measles, Mumps, Rubella] in relation to it causing autism,” she said. “Considering that the community itself has a significant prevalence of autism and they’re correlating it with the vaccination, since it’s around the same period when a child starts displaying whether or not they’re going to be autistic.”
“I got [my son] vaccinated late because of the hesitation my partner and I had, and my grandparents telling us do not vaccinate him because he could become autistic,” she said.
Mohamed attributes her hesitation to her grandparent’s misconception that vaccinations would cause autism. She suggests that there may be a generation gap regarding these opinions.
“I know that if you’re gonna be autistic, you’re gonna be autistic,” Mohamed said. “If your child is autistic, then he already has the preconditions for that, so the vaccine itself is not gonna change the reality of that child’s well-being.”
Mohamed is well-educated, but others at the Voices of Seattle event without medical training shared her positive view of vaccinations, indicating there may be a trend toward broader acceptance, in spite of Wolf and Rowhani-Rahbar’s research results.
“All my nephews have been vaccinated,” a teacher and an aunt, Farhiya Mohamed said at the Seattle Voices event. “Vaccinations are really good because if another kid is sick and comes to the classroom, [the vaccines] will protect the other kids.
Where did the rumors start?
“…So many mothers are hesitant and scared because they think they’re kids won’t be able to talk after they take the shot or they will become too sick,” Farhiya Mohamed went on. “But I know it’s not like that. When you vaccinate your kids, it’s not going to cause autism — that’s what Dr. Wakefield said, and he lost his license.”
She’s talking about British gastroenterologist and medical researcher, Dr. Andrew Wakefield, who released a now discredited study in 1998, which linked the administration of the MMR vaccine and the appearance of autism and bowel disease.
Despite being widely accused of deliberate fraud in his research, and barred from practicing medicine in his home country, Wakefield continues to hawk the anti-vac message, and seems to be specifically targeting the Minnesota Somali community. Wakefield is reported to have met with Minneapolis area Somalis both before and after the 2011 outbreak to build support for a new study about rising autism rates in that community.
“When you vaccinate your kids, it’s not going to cause autism — that’s what Dr. Wakefield said, and he lost his license.”
Wolf and Rowhani-Rahbar’s study implied a direct connection between Wakefield’s work and low vaccination rates among Somali Americans in Washington.
“The Minnesota Somali community receives frequent visits by Dr. Wakefield,” they wrote. “Somali families in Washington are in frequent contact with friends and family in Minnesota… It is possible that the trend [they] observed represents the adoption of Minnesota-based vaccine-hesitant beliefs.”
Another potential reason for lower vaccination rates is the community’s negative reaction to porcine gelatin ingredients in vaccinations, though that has not been studied in-depth yet. Most Somali Americans are Muslim and observe a religious prohibition against eating pork.
“Somalis are generally conservative about these Halal and pork issues. And, when it comes to Halal food and Halal issues, they are extremely sensitive.” That’s according to researchers Robin Pfohman and Mohamed Ali of Public Health in Seattle and King County,
Most versions MMR vaccine contains porcine gelatin, but there are brands such as Priorix, recommended by the National Health Service, in England, that with a full course of two doses will provide protection against MMR.
Turning the tide toward vaccination
“Somalis, get information from word of mouth,” Pfohman and Ali’s research concluded. “That’s the Somali culture; it spreads fast, and people trust those kinds of information that they heard from their relatives, trusted people, trusted elders, and television also, the internet, and radio.”
The misconceptions about an autism connection and avoidance of vaccines containing pork make tackling low immunization rates for the Somali community especially difficult. The biggest challenge is spreading appropriate information, arming people to make informed decisions.
“The next step is figuring out how to deliver targeted effective public health messages to the various immigrant groups,” Wolf said.
The Somali Health Board (SHB) is trying to do just that. It’s a voluntary organization comprised of Somali community leaders, professionals, and health and service providers, who collaborate to promote positive health outcomes to the Somali community within King County.
“In regards to the vaccination hesitancy among Somali parents, it’s one of the Somali Health Board’s goals to educate and reduce vaccination misconceptions among the community we serve,” SHB Executive Director Ahmed A. Ali, a Doctor of Pharmacy, said.
On November 19, the SHB is hosting its fourth annual Community Health Services Fair. The event is meant to provide public health education about issues like vaccines, as well as basic health services like blood pressure check, blood glucose check, cholesterol screening, and dental cleaning. The event will be from 10 a.m. to 5 p.m. at the New Holly Gathering Hall on 7054, 32nd Ave S, Seattle.
By educating the Somali community about public health, hopefully more people will consider taking measles-containing vaccines to prevent future outbreaks like the one in Minnesota.