Anthropology & Medicine

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/canm20

Vaccines and vitriol: an anthropological

commentary on vaccine hesitancy, decision-
making and interventionism among religious
minorities

Ben Kasstan

To cite this article: Ben Kasstan (2020): Vaccines and vitriol: an anthropological commentary on
vaccine hesitancy, decision-making and interventionism among religious minorities, Anthropology &
Medicine, DOI: 10.1080/13648470.2020.1825618

To link to this article: https://doi.org/10.1080/13648470.2020.1825618

Published online: 13 Nov 2020.

Submit your article to this journal

Article views: 93

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=canm20
Anthropology & Medicine
https://doi.org/10.1080/13648470.2020.1825618

Vaccines and vitriol: an anthropological commentary on

vaccine hesitancy, decision-making and interventionism
among religious minorities
Ben Kasstan
Department of Sociology & Anthropology, Hebrew University of Jerusalem, Jerusalem, Israel

ABSTRACT ARTICLE HISTORY

This commentary addresses the issue of vaccine hesitancy and deci- Received 2 May 2019
sion-making among religious minority groups in high-income country Accepted 15 September
settings. Recent measles outbreaks have been attributed to lower-level 2020
vaccination coverage among religious minorities, which has inspired KEYWORDS
targeted as well as wholesale public health interventions and legislation COVID-19; preparedness;
in a range of jurisdictions. The commentary takes the case of self-pro- public health relations;
tective ethnic and religious minority groups, especially Haredi or religious minorities;
‘ultra-Orthodox’ Jews in the United Kingdom, to address two key aims. vaccine hesitancy
First, this commentary flags how damaging representations of religious
minorities in recent measles outbreaks can be avoided by better under-
standing inner processes of vaccine decision-making and acceptance,
which can, in turn, help to address hesitancy sustainably and trustfully.
Second, the commentary advocates for addressing vaccine hesitancy
as part of a broader re-visioning of public health relations with minority
groups. This commentary calls on public health services to improve
confidence in childhood vaccinations rather than resorting to compul-
sory (and coercive) vaccination policies in order to address lower-level
vaccination coverage. The commentary signposts how essential it is to
carefully navigate relationships with minority groups amidst the new
forms of public health preparedness that will emerge from the 2020
Coronavirus pandemic (COVID-19).

Introduction
In 2019, the World Health Organization identified ‘vaccine hesitancy’ as being among the
top ten threats to global public health, with the potential to reverse the major gains in child
health that have been achieved since the mid-1950s (WHO 2019). Recent outbreaks of
vaccine-preventable diseases have posed unexpected challenges for public health services
in high-income country settings, prompting lawmakers to respond with a range of legal
and policy measures (e.g. Chantler, Karafillakis, and Wilson 2019). These interventions
include tightening existing vaccine mandates by ending religious exemptions (United
States), proposing the introduction of compulsory or coercive vaccination policies (United
Kingdom) and enforcing new mandates altogether (Germany). Moreover, vaccine mandates

CONTACT Ben Kasstan ben.kasstan@mail.huji.ac.il

© 2020 Informa UK Limited, trading as Taylor & Francis Group
2 B. KASSTAN

can be viewed with a renewed sense of possibility and leverage following the range of
requirements and restrictions that were quickly imposed by international governments as
part of public health responsiveness to the 2020 Coronavirus pandemic (COVID-19).
The United Kingdom lost its WHO ‘measles elimination status’ in 2019 due to an increase
in confirmed cases of measles, signalling that transmission had been re-established (Public
Health England 2019) – and which has been the impetus for debates on appropriate vaccine
governance. Whilst vaccinations are not compulsory in the United Kingdom, recent political
activity has indicated that enforced or coercive vaccine mandates could gain political cur-
rency. Matt Hancock MP, the current United Kingdom Secretary of State for Health and
Social Care was quoted in the British press as not wanting to ‘rule out’ a vaccine mandate
if coverage rates in England and Wales do not improve (The Guardian 2019). Similarly, the
All-Party Parliamentary Group on Vaccinations for All (2019), a cross-parliament lobby
group that aims to ‘raise the political profile of the importance of routine vaccinations, both
around the world and within the UK, launched an Inquiry in 2019 and called for written
evidence in ‘the uptake of vaccines and the increasing number of parents delaying or refusing
to accept vaccines where they are readily available’.1 The Inquiry specifically asked, ‘should
compulsory vaccinations be considered/continued in your region/country of expertise’.
Thus, it is reasonable to infer that British lawmakers would use the evidence base collected
as part of the Inquiry to inform any design of vaccine mandates. Yet, as this commentary
makes clear, public health must first grasp the underlying issues of vaccine hesitancy leading
to refusal, especially as much anthropological research signals a lack of confidence in vaccine
safety and a crisis of trust in public health relations.
Anthropologists have been at the forefront of the struggle to understand contemporary
vaccine hesitancy leading to refusal, particularly by focusing on the influences around
decision-making. Elisa Sobo (2015) has demonstrated how vaccine ‘refusers’ in Waldorf
Steiner (anthroposophic) school communities in the United States are not homogenous:
hesitancy can lead to selective refusal of vaccines or doses, and hesitancy can be traced
along nuanced roots of efficacy, adverse reactions, as well as the broader political and eco-
nomic culture of vaccine products, processing and procurement. Vaccine hesitant parents
in the United States, like the United Kingdom, are typically highly educated and heavily
invested in their children’s health, often researching vaccinations thoroughly and resorting
to refusal as a strategy to care for and to protect their children (Kaufman 2010; Leach and
Fairhead 2007; Poltorak et al. 2005; Reich 2014; Sobo 2015). The social processes through
which parents make vaccine decisions then conflict with public health representations of
non-vaccination as a social risk.
Ethnic and religious minority groups have been the particular focus of public health
interventionism in the United States and the United Kingdom, despite wide variation in
vaccine coverage at the national level. I suggest that such a focus reflects a bias around reli-
gious minorities in public (health) discourse, which is not conducive to building relationships
of trust with vaccination services. The purpose of this anthropological commentary is to
demonstrate how public (health) bias in messaging regarding self-protective or ‘hard to
reach’ minorities can be avoided by better understanding their processes of vaccine deci-
sion-making to address hesitancy. I use the case of Haredi or ‘ultra-Orthodox’ Jews to illus-
trate this point, as they have been implicated in global measles outbreaks, and which recently
led to a public health emergency being declared in areas of New York in 2019 (Silverberg
et al. 2019).2 Haredi Jews are largely represented in discourse around public (health) as an
 Anthropology & Medicine 3

‘ultra-Orthodox’ minority that makes rather ‘un-Orthodox’ decisions around vaccinations.

Yet, as I have noticed over many years of working closely with Haredi Jewish families in the
United Kingdom and in Israel-Palestine, they form a diverse collective with equally diverse
vaccine positions. Understanding the issue of public health relations with Haredi Jews offers
implications beyond the case at hand, as public health services are mandated to meet the
needs of increasingly diverse populations. Moreover, the commentary signposts how essential
it is to carefully navigate relationships with minority groups amidst the new forms of public
health preparedness that will emerge from the 2020 Coronavirus pandemic. This commen-
tary is organised into a series of ‘take home messages’ that call on public health services to
improve confidence in childhood vaccinations before resorting to compulsory (and coercive)
vaccination policies in order to address lower-level vaccination coverage.

Religious opposition to vaccinations?

Recent outbreaks of measles in high-income countries have been attributed to lower-level
vaccination coverage among ethnic and religious minorities, which include Amish, Gypsies,
Travellers, Roma and Haredi Jews (Jackson et al. 2017; Kettunen, Nemecek, and Wenger
2017; Public Health England 2016; Silverberg et al. 2019). Common to these minorities is
a preference to be self-protective from external influence or interference (including a cau-
tious use of the Internet), to travel between national and international networks and to
carefully negotiate their relations with public health and healthcare services. More broadly,
commentators have used the term ‘religious opposition’ to vaccination, especially when
referring to violent resistance to polio eradication programmes in Taliban-controlled regions
of the Afghanistan–Pakistan borderlands (Warraich 2009). Yet, there is a tendency in dis-
course around public health to amplify religion and ethnicity as categories of opposition,
when an emic approach to research demonstrates that issues of confidence in vaccines and
trust in public health are instead at play. These latter analytical categories are known to lead
to non-vaccination in the broader populations of the United States and United Kingdom,
and are thus, not unique to religious minorities.
Honing in on the Haredi Jewish context illustrates the complex processes of vaccine deci-
sion-making at play among ethnic and religious minorities, and raises implications beyond
the case at hand. International travel is associated with the transmission of measles between
the countries with the largest Haredi Jewish populations, which include England, Israel–
Palestine and the United States. Vaccination coverage among Haredi neighbourhoods is
reported to be an issue for public health services across these three regions. Higher fertility
rates among Haredi Jewish women (Staetsky and Boyd 2015), is reflected in more partially
vaccinated or unvaccinated children, particularly in Haredi neighbourhoods in north London
(Public Health England 2016). Haredi Jews form a global religious network sustained by
transnational ties and the circulation of authoritative knowledge pertaining to bodily practices,
care and taboos (Taragin-Zeller and Kasstan 2020). This means that vaccine-related challenges
and opportunities from one context can be applicable to another, though we should not forget
that public health relations involve context-specific and historically situated issues.
Societal responses to the 2018–2019 New York measles outbreaks (aforementioned) were
striking in that they reflected historical anti-Semitic representations of Jews as public
(health) risks. Media coverage, for example, reported that bus drivers tried to avoid picking
up Haredi Jewish passengers in New York City (Durkin 2019). Vitriolic representations of
4 B. KASSTAN

Jews as risks to the nation’s health can be situated in a history of public health prejudice in
the United States and United Kingdom. Public health was used as a political technique to
contain and control reviled groups migrating to the United States in the late nineteenth and
early twentieth centuries – such as European Jews and Italians (Markel 1999). Public (health)
bias is not specific to Haredi Jews, especially if we consider current United Kingdom
Government strategies around anti-terror prevention, where British healthcare workers are
expected to identify and report suspects believed to be vulnerable to radicalisation, which
is premised on a ‘hegemonic association of terrorism to Muslims’ (Younis and Jadhav 2020,
616). Thus, ‘healthcare settings embody the race frames found in society’ (Younis and Jadhav
2020, 612), and the ways that these frames are projected by healthcare services colour
relationships with minority groups.
Haredi Jews are viewed as ‘hard to reach’ by public health services, and as ‘ultra-Orthodox’
or ‘non-compliant communities’ because of ‘culture’ or ‘beliefs’. Studies that explore issues
of ‘religious opposition’ to vaccinations (e.g. Henderson, Millett, and Thorogood 2008) tend
to homogenise ‘Orthodox Jews’ as a community, and thus, overlook the internal diversity
of religious groups and the plurality of religious worldviews that inform health decisions.
More often than not, practical issues of convenience and broader issues of safety concerns
are at play (Kasstan 2019; Letley et al. 2018) – similar to Amish groups in the United States
(Kettunen, Nemecek, and Wenger 2017). The emphasis on ‘culture’ and ‘religious beliefs’,
which essentialise religious minorities, are therefore not grounded in how Haredi Jews and
religious minorities formulate vaccine decisions based on trust in the state and healthcare
services more broadly.

Healthcare relationships and confidence

Haredi Jews are similar to Amish, Gypsy, Traveller and Roma groups as they can be char-
acterised by a self-protective stance, maintained by separate educational institutions,
employment patterns, welfare services and social relations. Haredi Jews cautiously and
selectively engage with the Internet and with forms of external (non-Haredi) information,
which can reduce access to accurate public health information on vaccinations. Positive
and personal relationships with healthcare providers – especially nurses and General
Practitioners – are then highly valued, and can be essential for self-protective minorities to
accept vaccinations (Jackson et al. 2017; Kasstan 2019). Public health relationships with
Haredi families often need to be nurtured in tailored ways. In response to the 2018–2019
measles outbreaks in Haredi neighbourhoods of New York, a group of Orthodox Jewish
nurses set up a task force to address vaccine hesitancy and misinformation. This kind of
initiative demonstrates the internal ways of working around public health issues in Haredi
minorities and attempts to improve and mediate public health relations, which challenges
the representation of a uniformly ultra-Orthodox and ‘non- compliant’ community. Public
health mandates that attempts to enforce childhood vaccinations, but not focus on the
underlying issue of trust and safety concerns, will likely disrupt relationships with providers.

Diverse communities, diverse decisions

What is true of any ethnic or religious ‘community’ is diversity. While Jewish parents broadly
accept vaccinations to protect their children’s health, there is an emic perception that ‘the
 Anthropology & Medicine 5

NHS [National Health Service] thinks that the Jewish community fears immunizations’
(Wineberg and Mann 2016) [my emphasis]. Haredi Jews have a diverse range of responses
to vaccinations that include acceptance, selective acceptance, delayed acceptance and out-
right refusal (Kasstan 2019). Similarly, Amish groups in the United States are known to
selectively accept vaccinations (Kettunen, Nemecek, and Wenger 2017, 633), therefore sug-
gesting there is not a widespread culture of opposition.
I found that the most common cause of vaccine hesitancy or non-vaccination among
Haredi Jewish parents in England was safety and a lingering concern that the MMR vaccine
could cause autism. Parents directly attributed this hesitancy to the state, and remarked
that they received conflicting advice from the United Kingdom Government and public
health services following (refuted) claims that the triple-antigen MMR vaccine was causally
associated with autism. The perceived hesitancy of the State and United Kingdom politicians
to reassure parents has left a long-lasting legacy, with parents saying they feel compelled to
scrutinise NHS information pertaining to childhood vaccinations. Whilst non-vaccination
is seen as a moral issue (‘good’ parents vaccinate, ‘bad’ parents do not vaccinate), the broader
anthropological record demonstrates how parents from religious and non-religious back-
grounds declined vaccinations to protect their children amidst uncertainty. Thus, vaccine
hesitancy among Haredi Jews is poorly understood if viewed in terms of ‘religious opposi-
tion’, ‘beliefs’ or ‘culture’.

Religious teachings and authorities

The Jewish body of religious law (Halachah) does not oppose vaccinations, but neither does
it explicitly promote uptake. Vaccinations are widely considered pikuach nefesh from a
religious standpoint, which is the commandment to protect health and preserve life – and
takes precedent in virtually every situation. Religious frameworks such pikuach nefesh may
then offer leverage to engage with parents over vaccine hesitancy and non-vaccination, and
thus, reconcile public health and religious positions on protection. Yet, in my work in Israel-
Palestine and the United Kingdom, I have also met parents who reference pikuach nefesh
in their opposition to vaccinations. From the Hippocratic Oath to contemporary ethical
codes of medical practice, physicians also interpret and calculate risk when making decisions
surrounding pharmaceutical intervention. While pikuach nefesh and contemporary codes
of medical conduct are not equivalent, they signify how ethical frameworks give rise to
consensus, as well as interpretative conflicts, surrounding health decisions.
Haredi Jews commonly approach religious authorities for a psak halachah regarding
health decisions, which is a binding judgement of law formulated in relation to an indi-
vidual’s situation or dilemma (Coleman-Brueckheimer, Spitzer, and Koffman 2009). Yet
the role of religious authority in vaccine decisions is contingent. I found that Orthodox
Jewish parents opposed to vaccinations would not approach religious authorities for guid-
ance, and claimed they would subvert rabbinic rulings to vaccinate (Kasstan 2019, 231–
232). Public health services can benefit from discussing the benefits of vaccinations with
rabbis. However, the diversity of Haredi Jewish families means that public health services
cannot rely on rabbinical endorsement alone to promote vaccine confidence amongst this
minority group. Addressing parental reservations is the most sustainable way to promote
vaccine confidence.
6 B. KASSTAN

‘Anti-vax’ material and religious minority groups

An emerging issue to consider is whether and how self-protective minorities are being
exposed to non-vaccination advocacy from outside their communities, via the Internet or
other forms of social exchange. This issue indicates that non-vaccination advocacy has
filtered into religious minority groups who otherwise maintain a cautious and selective use
of external (non-Haredi) information as well as Internet resources. Parents Educating and
Advocating for Children’s Health (PEACH 2017) are a high-profile and contentious group
circulating non-vaccination material among Haredi Jewish neighbourhoods in the United
States. In the United Kingdom, I found that opposition among Haredi parents is informed
by their discursive reflections around vaccine materials (described as ‘toxic’, ‘a cocktail’ or
made from ‘aborted flesh’) or procurement from pharmaceuticals (viewed as ‘corrupt’),
signalling an assimilation of non-vaccination advocacy.
It is especially important to address the dissemination of non-vaccination advocacy material
within self-protective religious minority groups. Accurate information on childhood vaccina-
tions can be made more accessible for Haredi Jews by producing health messages, with refer-
ences to pikuach nefesh, in neighbourhood circulars. Messages can also be tailored by producing
information in English, Yiddish and Hebrew (in print and electronically). Engaging religious
authorities, as well as welfare services that are tailored to Haredi families, with accurate child
health information may support GP services to improve vaccination coverage. Public health
services should explore similar strategies of tailoring messages to ethnic and religious minorities,
with continued funding for such projects to ensure long-term engagement.

Looking ahead: pandemics and preparedness

The issue of vaccinations offers a signpost to explore critical representations of religious
minorities and relations with public health services in high-income country settings amidst
the 2020 Coronavirus pandemic. The language of ‘non-compliant communities’ is not only
at play in discussions around lower-levels of vaccination coverage, but also around the
public health restrictions of social distancing and home isolation for preventing transmis-
sion of COVID-19 (see Kasstan 2020). The Coronavirus situation has exposed long running
issues and mutual lack of understanding between public health services and minority
groups, such as the Haredim, that this commentary on vaccines has sought to contextualise.
Future plans to introduce vaccinations against COVID-19, of which much public health
hope is pinned on, should be introduced through existing relationships of trust and tailored
information, and it should be presented in ways that speak to the worldviews of minority
groups. The long-term management of COVID-19 rests on maintaining sustainable public
health relations with minority groups, with many insights at hand from issues surrounding
childhood vaccinations. Addressing the legacy of the MMR safety controversy among
minorities and the underlining issue of confidence in the state to appropriately protect
population health will prove crucial in the roll-out of a COVID-19 vaccine.

What does this commentary mean for public health?

The lack of in-depth research into vaccine decision-making among religious minorities in
high-income countries has inspired this commentary to support lawmakers with the public
 Anthropology & Medicine 7

heath dilemma of promoting vaccine confidence and coverage in areas where vaccinations
are readily available. The causes of vaccine hesitancy among religious minorities, such as
Haredi Jews, accord strongly with past research around public confidence in the MMR
vaccine conducted amongst the United Kingdom and United States populations (e.g.
Casiday 2007; Leach and Fairhead 2007; Sobo 2015). Thus, there is a danger in scapegoating
religious minority groups for what are in reality, national anxieties pertaining to public
health confidence.
The Childhood Vaccination Coverage Statistics for 2017–2018 in England indicates a wor-
rying trend towards lower vaccine uptake at the national level, which raises critical questions
of the trust between England’s increasingly diverse population and public health services (NHS
Digital 2018). MMR coverage in England at two years of age has lowered for the fourth year
in a row, with coverage stalling at around 91.2%. This falls short of the 95% threshold of MMR
coverage required to protect population health against measles. Whilst the 95% threshold was
secured in County Durham, regions such as the Isle of Wight and Camden (London) were
below 90%. Similarly, national MMR coverage by two years of age sits at 90.4% in the United
States, with the scale of national variation signalling lower rates of vaccination uptake beyond
the case of religious minorities (Hill et al. 2019). Against this backdrop, we can read a bias
against religious minorities in discourse surrounding public health. The vitriolic public (health)
representations and singling out of religious minorities only run the risk of damaging their
relations with public health, and can be avoided by better understanding the processes of vaccine
decision-making.
Moves to address lower-level vaccination coverage in the United Kingdom by initiating
compulsory or coercive childhood vaccination policies (e.g. that are tied to the receipt of
welfare benefits) would undermine the trust that hesitant patients put in their local pro-
viders, in what can evidently be a fraught area of child health. Patient-provider relation-
ships built on trust and transparency are the most effective way to promote childhood
vaccinations across the continuum of maternity and infant care. Being responsive to the
forms of vaccine hesitancy (including adverse reactions) presented by parents is important
in order to promote confidence in vaccinations. Vaccination policies that are compulsory
or coercive are counter-productive to promoting confidence among vaccine hesitant fam-
ilies. There is genuine potential for compulsory vaccination policies to undermine rela-
tionships between parents and local-level GP providers, which should otherwise be built
on trust and transparency. The onus is on proponents of compulsory or coercive vacci-
nation policies to explain how this strategy would promote public confidence in
vaccinations.

Notes
1. I submitted research evidence conducted as part of a three-year (2013–2016) anthropological
study into maternity care and child health among Haredi Jews in England, funded by The
Wellcome Trust (grant code: 101955/Z/13/Z). I specifically cautioned against introducing any
compulsory or coercive vaccination policy. The recommendations I submitted to the All-
Party Parliamentary Group on Vaccinations for All have been included in this Commentary
to raise further debate in the anthropological and medical community on policy engagement
vis-à-vis childhood vaccinations in religious groups.
2. The term Haredi means ‘God fearing’, or to tremble in awe of God.
8 B. KASSTAN

Acknowledgements
This commentary has been much improved by the helpful comments of two anonymous reviewers,
Aaron Parkhurst (University College London) and Nurit Stadler (Hebrew University of Jerusalem).

Disclosure statement
No potential conflict of interest was reported by the authors.

Ethical Approval
This commentary draws on research that was approved by the Research Ethics and Data Protection
Committee at the Department of Anthropology, Durham University (6 March 2014).

References
All-Party Parliamentary Group on Vaccinations for All. 2019. “Call for written evidence.” Accessed
29 July 2019. https://appg-vfa.org.uk/2019/06/17/appg-inquiry-call-for-written-evidence/
Casiday, R. 2007. “Children’s Health and the Social Theory of Risk: Insights from the British
Measles, Mumps and Rubella (MMR) Controversy.” Social Science & Medicine 65: 1059–1070.
Chantler, T., E. Karafillakis, and J. Wilson. 2019. “Vaccination: Is There a Place for Penalties for
Non-Compliance?” Applied Health Economics and Health Policy 17 (3): 265–271. doi:10.1007/
s40258-019-00460-z.
Coleman-Brueckheimer, K., J. Spitzer, and J. Koffman. 2009. “Involvement of Rabbinic and
Communal Authorities in Decision-Making by Haredi Jews in the UK with Breast Cancer: An
Interpretative Phenomenological Analysis.” Social Science & Medicine (1982) 68 (2): 323–333.
doi:10.1016/j.socscimed.2008.10.003.
Durkin, E. 2019. “Orthodox Jewish communities face antisemitism over measles outbreak.” The
Guardian, May 17. Accessed 11 March 2020. https://www.theguardian.com/us-news/2019/
may/17/new-york-brooklyn-measles-outbreak-orthodox-jewish-antisemitism
Henderson, L., C. Millett, and N. Thorogood. 2008. “Perceptions of Childhood Immunization in a
Minority Community: Qualitative Study.” Journal of the Royal Society of Medicine 101 (5): 244–
251. doi:10.1258/jrsm.2008.070363.
Hill, H. A., J. A. Singleton, D. Yankey, L. D. Elam-Evans, S. C. Pingali, and Y. Kang. 2019. “Vaccination
Coverage by Age 24 Months among Children Born in 2015 and 2016 – National Immunization
Survey-Child, United States, 2016-2018.” MMWR Morbidity and Mortality Weekly Report 68 (41):
913–918. doi:10.15585/mmwr.mm6841e2.
Jackson, C., H. Bedford, F. M. Cheater, L. Condon, C. Emslie, L. Ireland, P. Kemsley, et al. 2017.
“Needles, Jabs and Jags: A Qualitative Exploration of Barriers and Facilitators to Child and Adult
Immunisation Uptake among Gypsies, Travellers and Roma.” BMC Public Health 17 (1): 254.
doi:10.1186/s12889-017-4178-y.
Kasstan, B. 2019. Making Bodies Kosher: The Politics of Reproduction among Haredi Jews in England.
Oxford: Berghahn Books.
Kasstan, B. 2020. “Angry at ultra-orthodox Jews for ‘defying’ coronavirus rules? It’s more complicat-
ed than that.” Haaretz, April 16. Accessed 6 September 2020. https://www.haaretz.com/
world-news/.premium-angry-at-ultra-orthodox-jews-for-defying-covid-19-rules-it-s-more-
complicated-1.8764711
Kaufman, S. 2010. “Regarding the Rise in Autism: Vaccine Safety Doubt, Conditions of Inquiry, and
the Shape of Freedom.” Ethos 38 (1): 8–32. doi:10.1111/j.1548-1352.2009.01079.x.
Kettunen, C., J. Nemecek, and O. Wenger. 2017. “Evaluation of Low Immunization Coverage among
the Amish Population in Rural Ohio.” American Journal of Infection Control 45 (6): 630–634.
doi:10.1016/j.ajic.2017.01.032.
 Anthropology & Medicine 9

Leach, M., and J. Fairhead. 2007. Vaccine Anxieties: Global Science, Child Health, and Society.
London: Earthscan.
Letley, L., V. Rew, R. Ahmed, K. B. Habersaat, P. Paterson, T. Chantler, M. Saavedra-Campos, et al.
2018. “Tailoring Immunization Programmes: Using Behavioural Insights to Identify Barriers and
Enablers to Childhood Immunisations in a Jewish Community in London, UK.” Vaccine 36 (31):
4687–4692. doi:10.1016/j.vaccine.2018.06.028.
Markel, H. 1999. Quarantine! East European Jewish Immigrants and the New York City Epidemics of
1892. Baltimore, MD: John Hopkins University Press.
NHS Digital. 2018. “The childhood vaccination coverage statistics for 2017-18 in England.”
September 18. Accessed 1 May 2019. https://digital.nhs.uk/data-and-information/publications/
statistical/nhs-immunisation-statistics/england-2017-18
Parents Educating and Advocating for Children’s Health. 2017. “The vaccine safety handbook.”
Accessed 28 April 2019. https://issuu.com/peachmoms/docs/the_vaccine_safety_handbook_a4
Poltorak, M., M. Leach, J. Fairhead, and J. Cassell. 2005. “‘MMR Talk’ and Vaccination Choices: An
Ethnographic Study in Brighton.” Social Science & Medicine (1982) 61 (3): 709–719. doi:10.1016/j.
socscimed.2004.12.014.
Public Health England. 2016. “Tailoring Immunisation Programmes: Charedi Community, North
London.” Accessed 5 September 2020. https://assets.publishing.service.gov.uk/government/
uploads/system/uploads/attachment_data/file/705096/Tailoring_Immunisatio_report_includ-
ing_Protocols_and_research_appendix.pdf
Public Health England. 2019. “Measles in England.” Accessed 5 September 2020. https://publi-
chealthmatters.blog.gov.uk/2019/08/19/measles-in-england/
Reich, J. 2014. “Neoliberal Mothering and Vaccine Refusal: Imagined Gated Communities and the
Privilege of Choice.” Gender & Society 28 (5): 679–704. doi:10.1177/0891243214532711.
Silverberg, R., J. Caceres, S. Greene, M. Hart, and C. H. Hennekens. 2019. “Lack of Measles
Vaccination of a Few Portends Future Epidemics and Vaccination of Many.” The American Journal
of Medicine 132 (9): 1005–1006. doi:10.1016/j.amjmed.2019.04.041.
Sobo, E. 2015. “Social Cultivation of Vaccine Refusal and Delay among Waldorf (Steiner) School
Parents.” Medical Anthropology Quarterly 29 (3): 381–399. doi:10.1111/maq.12214.
Staetsky, L. D., and J. Boyd. 2015. “Strictly orthodox rising: What the demography tells us about
the future of the community.” Institute for Jewish Policy Research. Accessed 28 April 2019.
http://archive.jpr.org.uk/object-uk285
Taragin-Zeller, L., and B. Kasstan. 2020. ““I Didn’t Know How to Be with My Husband”: State-Religion
Struggles over Sex Education in Israel and England.” Anthropology & Education Quarterly. https://
doi.org/10.1111/aeq.12358
The Guardian. 2019. “Matt Hancock ‘won’t rule out’ compulsory vaccinations.” May 4. Accessed 6
September 2020. https://www.theguardian.com/politics/2019/may/04/matt-hancock-wont-rule-
out-compulsory-vaccinations
Warraich, H. J. 2009. “Religious Opposition to Vaccination.” Emerging Infectious Diseases 15 (6):
978a–9978. doi:10.3201/eid1506.090087.
Wineberg, J., and S. Mann. 2016. “Salford Jewish Community Health Research Report 2015”.
Accessed 30 May 2016. http://archive.jpr.org.uk/download?id=2721
World Health Organization. 2019. “Ten Threats to Global Health in 2019.” Accessed 5 September
2020. https://www.who.int/emergencies/ten-threats-to-global-health-in-2019
Younis, T., and S. Jadhav. 2020. “Islamophobia in the National Health Service: An Ethnography of
Institutional Racism in PREVENT’s Counter-Radicalisation Policy.” Sociology of Health & Illness
42 (3): 610–626. doi:10.1111/1467-9566.13047.