Minnesota has been facing a vaccination crisis among its child population.
Specifically, among children who turned two in 2018, rates show around 80 percent have received the measles, mumps, and rubella (MMR) vaccine. This figure is lower than in previous years, but the percentage of immunizations among Somali children is even lower.
Somali Minnesotan two-year-olds in 2018 had a vaccination rate of just 33.8%, according to the Minnesota Department of Health (MDH). That’s the lowest it has ever been.
That rate peaked in the early 2000s and has been dropping gradually since. It dropped even more at the beginning of the COVID-19 pandemic, according to Lynn Bahta, the immunization clinical consultant for MDH.
Hussein Santur, a nurse at People’s Center Clinics and Services, said that the clinic’s vaccination rates took a hit as telehealth appointments became more common. It could be for various reasons, but most likely, the fact that many vaccination clinics were closed at the height of the pandemic and in addition, the uptick in misinformation linking vaccinations to autism, he said.
The risk now is that if measles has a significant spread in Minnesota, unvaccinated children and others who may be vaccinated but are immunocompromised or only had one dose of the vaccine will experience the worst of it, Bahta said. Measles hasn’t been eliminated globally, so the risk is often from people traveling and bringing it to other areas.
“It’s a matter of when this outbreak will occur in Minnesota, not whether it will or not,” Bahta said.
Minnesota had a measles outbreak in 2017, with around 75 cases reported. The low rates of vaccination are alarming to Bahta, as the consequences of the 2017 outbreak put a big strain on families because of the required three-week quarantine.
What’s behind the low vaccination rates?
Several studies have been published linking the MMR vaccine with autism. One was in 1998 by Andrew Wakefield. That study was deemed fraudulent and was later retracted, but the misinformation was now out there. Many Somali parents were also receiving diagnoses of autism for their kids, and in their pursuit of looking into that, came across his explanation.
Santur says within the Somali community, there is a rich oral culture, with information most commonly passed through word of mouth. Although the Wakefield study was retracted, and it has since been proven that there is no link between the two, the stories and personal experiences have stayed present within the community, Santur said.
The myth has become an answer to something Santur feels there’s no answer to yet.
“Parents, when their child is diagnosed with autism, they’re looking for answers of why this is happening. And when they’re looking for answers, a lot of times the easiest is these campaigns that are out there that said (MMR vaccine) causes autism,” he said.
Deficiencies in the health care system
Generating trust between providers and patients is often a challenge, Bahta said. In addition to a lack of trust, other barriers, like short appointment time slots and using interpreters can restrict the amount of time and connection between the provider and patient.
“You have 15 or 20 minutes with a patient or with someone, and you’re attempting to complete the well-child exam and all of that. And then you have maybe five minutes left, and this (misinformation of vaccines) comes up. It can be very challenging to have this very important conversation in five minutes or less,” Santur said.
At People’s Center Clinic, providers will let parents know what the recommended vaccines are for a child. From there, the parent’s decision can be largely based on the conversation they have with the provider about those vaccines, Santur said. The clinic also encourages scheduling specific appointments for these conversations.
“When we do notice that hesitancy, it’s just a matter of having a conversation and focusing more on the disease that the lack of vaccine can cause,” he said. “Sometimes parents may bring up the myths that do exist, the misinformation that does exist and (as providers we are) not shying away from addressing those, but keeping it short and only really sharing facts with the parents of these children.”
People’s Center saw around 7,000 patients last year, with around 60% of them being East African or of East African descent, according to the clinic.
Another contributor to the low rates is the inequitable distribution and barriers to health care, as well as a lack of education targeted towards the community, Bahta said.
MDH is trying to promote the vaccine through different avenues, like radio shows and working with faith-based groups to host immunization sessions. MDH also received a federal grant, Bahta said, which puts funds towards hiring people from the Somali community to increase feelings of representation, connection and trust with patients.
A hard decision for many
Santur is a parent of three who, despite his medical knowledge, was hesitant about the vaccine.
“I read all the studies that debunked the original study that kind of made that link. However, I was still very hesitant, to be honest, extremely hesitant to give my child the MMR vaccine simply because of all the anecdotal stories that you hear from within our community, of children who have autism, or parents who feel that this vaccine is contributing.
He ultimately decided for his kids to get the MMR vaccine, but it wasn’t an easy process.
“I do understand why parents have hesitancy because of all the oral culture within the community, people sharing different stories,” he said. “These parents that we see, they’re not anti-vaxxers; they are trying to protect their children as best as they can. And sometimes they feel that not having them vaccinated is the way to protect their children.”
Santur says the Somali community generally looks up to physicians and medical providers as authority. Having Somali providers and people in the clinic could make a big difference in vaccination rates, he thinks.
“Having people that look like you care for you; that’s just a huge factor, in my opinion, in terms of acceptance and feeling comfortable. When I see a Somali patient or I’m providing education to a Somali patient, it’s a lot easier for them to trust me and to connect with me,” Santur said. “Whereby if it’s someone that doesn’t look like them, there might be some distrust there, and there is distrust in our healthcare system.”
On top of that, the stigma behind autism and the stereotypes and negative connotations people have is a significant reason some in the Somali community, and many other communities, have lower MMR vaccination rates. The Sahan Journal wrote a piece about efforts within the Somali community to change the way autism is perceived.
“Communities, including our own communities here in the U.S., people that have mental health challenges are viewed negatively. So that there’s always that battle to protect your child from that kind of negative thinking or reaction,” Bahta said.