The poorer the neighborhood, the fewer the number of vaccinations

Shakib Sanaa has been working as a general practitioner for fourteen years. In all those years, he had not had a single measles patient – ​​until recently, several children with measles symptoms suddenly came to his consulting room in Leerdam. “To be sure it was measles, I had to look at the medical evidence and consult a colleague and a pediatrician,” says Sanaa.

Measles has returned to the Netherlands, including an outbreak in Eindhoven in March. Whooping cough is also on the rise and will now kill four children in 2024. “Last year we had one case of whooping cough in Amsterdam in the first quarter,” says councilor Alexander Schulz (Public Health, D66). “This year we have already had 250 cases in the same period.”

This is because too few children have been vaccinated with the MMR (mumps, measles, and rubella) injection and the DKTP (diphtheria, pertussis, tetanus, and polio) injection. Adequate collective protection for children will only be available if nine out of ten children are vaccinated – and also for children who cannot be vaccinated until nine months later. In Amsterdam, Rotterdam, The Hague and Utrecht, the vaccination rate among two-year-old children is below the critical threshold of 90 percent.

The differences are large within major cities. An overview shows that the vaccination rate in 40 out of 136 regions is below the critical limit Norwegian Refugee Council to make. Even an area in West Amsterdam got 69.5 percent (DKTP) and 64.6 percent (BMR). Only in ten major city neighbourhoods, including one in central Amsterdam, does the measles vaccination rate exceed the ideal of 95 percent.

AmsterdamThe lowest vaccination rate is in the west of the city

Because measles is contagious, 95 out of every 100 children should be vaccinated against it. “We are almost waiting for a measles outbreak to happen here as well,” says Amsterdam councilor Schultes. “Measles and whooping cough were the first diseases to emerge with a low vaccination rate, which is the tip of the iceberg among all infectious diseases.”

That's why Hague Council Councilor Hilbert Bredemeijer (Youth, CDA) was recently the first to receive one a report Preparing information about the vaccination rate at the region level. In some districts of The Hague, the percentage dropped to less than 80 percent. Later, the other three major cities surrendered upon request Norwegian Refugee Council Also vaccination numbers for each region. “The vaccination rate is now at a very alarming level,” Bredemeijer says. “We as a community need to have a good discussion about this topic. This starts with knowing which neighborhoods the vaccination rate is too low.

poor neighborhoods

Why do so few parents vaccinate their children? The National Institute of Public Health and the Environment (RIVM) offers some different explanations in its latest report on the topic National vaccination programme. Since the outbreak of the Corona pandemic, citizens’ trust in the government has declined. Myths about the harmful effects of vaccines are circulating on social media. Quite a number of parents mistook the message about MMR and DKTP shots as an invitation to get a Corona shot and threw it away without opening it.

Shakib Sanaa, general practitioner

It sounds familiar to Shakib Sana. As a general practitioner in the Delfshavn district of Rotterdam (DKTP: 76 percent, BMR: 79 percent), where he worked until recently, he often talks with patients and colleagues about whether or not to get vaccinated. Sanaa went in light of the Corona pandemic In the market Even talking to strangers about their doubts about vaccination against Corona. He was one of the founders of Doubt Phone, where people could ask medical students questions about all kinds of health issues.

RotterdamThe lowest vaccination rate is in the south of the city

“In my experience, there are roughly three types of vaccine refusers,” says Sanaa, who is writing her doctoral dissertation on health disparities in underserved neighborhoods. “The first: people with religious arguments, often Orthodox Protestants. Second: People who consciously decide that it is better not to vaccinate their children, but to let them suffer from childhood diseases. Third: People with an immigrant background. He notes about the latter: “This is not because of their culture or religion, but because of their weak social and economic situation.”

Anyone who compares vaccination numbers in one neighborhood with income numbers there will see that a low vaccination rate often goes hand in hand with poverty. The Amsterdam region with a low vaccination score is also one of the poorest in the Netherlands. The neighborhoods with unsatisfactory results in Rotterdam, The Hague and Utrecht are mostly neighborhoods with many poor residents. The fact that Utrecht is the only city not to score below 80 percent in one area is probably due to the relatively high prosperity of its population.

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“enhanced”

Why are low-income people hesitant to get vaccinated? “It's not about not wanting, it's mainly about not knowing,” Aziz Kalla says. He is a community nurse at Kleurrijk Zorg in Utrecht and works in the Overvecht district (DKTP: 86.4 percent, BMR: 85.9 percent). “You could also say that people are not being properly immersed in vaccines.”

Aziz Kalla, community nurse

Many people with immigrant backgrounds and little money live in Overvicht. “The coronavirus pandemic has had a huge impact,” says Kalla. Then the population remained isolated and alone. Then inflation made groceries more expensive. Many people are concerned about survival. Often there is not much room in the head for thoughts about vaccinations.

And then, according to Kalla, all that needs to happen is for people to think: just leave the vaccination alone. “Repeated injections were mentioned in the invitation letter Supporter The name of the thing. This was not well received by a number of people, because they think of the Corona vaccine when they hear this word.” Kala had heard the story many times that the vaccine could cause autism. “People often say: 'It's going well, aren't there? Are there hardly any diseases left anymore?' And then I say: 'That's because a lot of parents are vaccinating their children.'”

Key people

Kala is conducting this kind of conversation under the wing of the Key People of Utrecht (SSU), which is active in several neighborhoods with the support of the municipality. “Key people like Aziz Kalla know the neighbourhood, and the workplace in the community,” says Elko Ehrenberg, Utrecht Council Councilor (Public Health, D66). “They understand residents’ dilemmas and can help clear parents’ doubts.”

Kala, who grew up in Aurvecht, has campaigned for vaccination during the coronavirus pandemic. “The residents mainly ask me: ‘Aziz, did you take it yourself?’ They trust me because they know me.” Kala now makes educational films in which he interviews GGD doctors, for example: “Of course you can also make a video with just the expert, but it's useful for people to see that I'm asking these questions.”

UtrechtThe vaccination rate is not less than eighty percent

Utrecht also wants to remove practical barriers, says councilor Ehrenberg: “For someone living in Overvecht, vaccination in Jarbors is out of reach. Ideally, we would soon have a small-scale site near the shopping centre, just as we did during the coronavirus,” he said. Where you can, so to speak, combine shopping with opportunity and Utrecht has so far saved money for only three such sites.

Amsterdam has already made progress with this small-scale approach, with weekly and monthly consultations for children and young people in twenty sites. “I know of an example of a mother from Zuidoost who did not come to the Ziggo Dome with her three children in the metro, but went to live counseling hours in the area,” says Councilor Schulz. In addition, GGD sent out new calls for compensatory injections.

This approach works in combination with additional information and the publication of key persons. Participation has increased significantly in DKTP and MMR vaccines – although it is not yet sufficient. The extra effort cost Amsterdam an additional eight thousand euros last year. “Not many municipalities can afford to pay that kind of amount,” says Schulz. Municipalities receive money to cover the basics – advocacy and vaccination – and according to him, they should receive additional money from the government for additional efforts: “It is the government's vaccination programme.” In a letter to the Council of Ministers, the councilors responsible for the four largest municipalities recently requested additional funds for their ward campaigns.

The HagueMany poor neighborhoods have low vaccination rates

These campaigns sometimes pose a difficult puzzle, because not all neighborhoods fit the pattern of poor people with fewer injections. The Geusenpoort district in Amsterdam is poor but has a high vaccination rate (DKTP: 96.8 percent, basic vaccination rate 90.3 percent). The traditionally poor district of Zeheldenquartier has more and more residents with good incomes, but has only seen a decline in the vaccination rate since the Corona pandemic (DKTP: 80.5 percent, BMR: 79.3 percent). “This is a neighborhood with an average population of highly educated young professionals,” says Bredemeijer, a member of The Hague city council. “This population is really a new target group that we need to delve into.” Misinformation may play a role here.

Municipalities have to solve this puzzle themselves, because there is no additional money coming from the government at the moment. “Very sad,” Bredemeijer says. “It's about the health of our children.” Four children dying from whooping cough may not seem like a big deal, says JP Sana: “They had a whole life ahead of them, about eighty years. That means, as doctors often say, 320 years of life lost.”

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