Dr. Jumanah Essa-Hadad
Health Promotion, Lead Researcher River-EU, Bar Ilan University (BIU), Israel
Populations that come from lower socio-economic backgrounds or migrant communities, or belong to cultural or religious minorities usually achieve substantially lower vaccine uptake compared to the general population (Smith et al., 2017). There are some underserved populations, however, that manage to achieve vaccine coverage similar or higher than the general population (Byrne et al, 2018). The Arab minority in Israel is one such example.
Arabs make up 21% of the Israeli population (1.9 million citizens) and are split between a Muslim majority and a Christian minority. Most Arabs live in Israel’s social and geographic periphery, which impacts their socio-economic status: about 36% live below the poverty line compared to 18% of the Jewish population (CBS, 2021). Only 53% of Arab adults, compared to 83% of Jewish adults, participate in the labour market, mainly due to low participation of women. Similarly, only 36% of Arab adult women work, compared to 82% of Jewish women. Household income is little over half of that of the Jewish population (CBS, 2021).
Despite poorer health outcomes on many levels, including lower life expectancy rates and higher infant mortality among the Arab population, Arab children achieve higher coverage for routine vaccines than the general Jewish population. For example, in 2018, by the 13th month of their life, 82% of Arab children compared to 61% of Jewish children had received the first dose of the MMR vaccine (Zimmerman et al, 2019). In addition, consent rate to the HPV vaccine was 98.8% among Arab mothers compared to 54.3% among Jewish mothers (Myers et al., 2021).
Understanding the health system barriers and enablers
As part of the RIVER-EU project, we implemented a comprehensive qualitative study to understand the health system enablers to MMR and HPV child vaccination among the Arab minority in Israel. To do this we interviewed 21 health professionals, 16 mothers, and 16 teenagers. All interviews were held in the Arabic language and conducted by an Arab researcher, each one audio-recorded, transcribed, and analysed using thematic analysis. Themes were mapped according to the WHO Health Systems Building Block Framework and were related to service delivery, health workforce, health information systems, medical products, financing, and leadership and governance.
Several health system enablers were identified:
- Accessibility and availability of vaccination services.
- Delivery of vaccines through the school system and mother child clinics.
- Framing vaccinations as the ‘norm.’
In addition, personable characteristics of the health workforce, the health care providers belonging to the same cultural group, and high levels of trust towards healthcare professionals were also reported. Vaccinations provided free of charge was also an important factor that facilitates access to vaccines.
Overall, the Arab community felt they were receiving equal treatment and fair distribution of services. However, interviews also showed that despite high vaccine uptake, parents and teenagers within the Arab community had limited knowledge regarding vaccination, particularly HPV.
This research provides important insights in health system enablers regarding HPV and MMR vaccination among the Arab minority in Israel. We aim to use the research findings to make health system recommendations that can benefit other underserved populations in Europe who experience low vaccination rates.
Byrne L, Ward C, White JM, Amirthalingam G, Edelstein M. Predictors of coverage of the national maternal pertussis and infant rotavirus vaccination programmes in England. Epidemiol Infect. 2018;146(2).
Israel Central Bureau of Statistics. Population of Israel on the Eve of 2021. 2021
Myers V, Saban M, Valinsky L, Luxenburg O, Wilf-Miron R. Timely childhood vaccination in Israel: a national retrospective study of ethnic and socioeconomic disparities. Health Promot Int. 2021;
Smith LE, Amlôt R, Weinman J, Yiend J, Rubin GJ. A systematic review of factors affecting vaccine uptake in young children. Vol. 35, Vaccine. 2017.
Zimmerman DR, Verbov G, Edelstein N, Stein-Zamir C. Preventive health services for young children in Israel: Historical development and current challenges. Isr J Health Policy Res. 2019;8(1).
Scientific poster presented at the national conference in Israel
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