Among the minority of Amish parents who do not immunize their children, the most common reasons for skipping the shots were more related to concerns over the potential side effects of vaccines, than to religious beliefs, a new study finds.
"The reasons that Amish parents resist immunizations mirror reasons that non-Amish parents resist immunizations," Dr. Olivia K. Wenger of Akron Children's Hospital and her colleagues wrote in the journal Pediatrics.
Previous research had suggested that lack of access could be a factor keeping vaccination rates low in Amish communities.
The Amish are conservative Christians known for living in closed communities and without much modern technology. Their tenets don't prohibit vaccination, but outbreaks of measles, whooping cough and other vaccine-preventable diseases in underimmunized Amish communities have raised concern.
The researchers mailed surveys to hundreds of families in Holmes County, Ohio, where a large number of Amish live.
Ohio records showed about 45 percent of the Holmes county population was fully immunized, compared with a statewide rate of 80 percent.
Of 359 households that responded to the survey, 85 percent said that at least some of their children had received at least one vaccine.
Forty-nine families refused all vaccines for their children, mostly because they worried the vaccines could cause harm and were not worth the risk.
Other common reasons included concerns that the shots have dangerous chemicals in them and that the diseases the vaccines protect against are not a problem in the community.
Just one out of the 49 totally unvaccinated families cited difficulty in getting to the doctor's office, three said the shots are too expensive, and three of the parents agreed that "giving shots means I'm not putting faith in God to take care of my children."
None of the families said that their ministers disagreed with giving shots.
Saad Omer, an assistant professor at Emory University who was not involved in the study, said he was not surprised by the results.
Most parents' decisions about immunizations are based upon perceptions of how common and dangerous a disease is, Omer said, and perceptions of how safe and effective a vaccine is.
"It's a multifaceted issue," he added. "It's not an issue of access."
If parents observe that a particular disease is rare, for example, they might choose to exempt their children from immunizations. But that decision, Omer told Reuters Health, could put their child at a greater health risk.
"There is a reason why the rates of vaccine-preventable diseases are low," he said, "and that's because of the vaccines."
The other factor that plays into vaccine refusal is the relative convenience of getting a shot, compared to the convenience of getting an exemption for that vaccine.
Ohio, like 19 other states, allows children to be exempt from immunizations based on personal as well as religious beliefs.
The Centers for Disease Control and Prevention recommend immunizations against 14 diseases, which include about two dozen doses of vaccines during the first six years of life.
Parental resistance to immunizations has been blamed for recent outbreaks of childhood diseases.
One study found that one in 20 children who were not immunized for whooping cough caught the illness, compared to one in 500 who had been vaccinated.
"Understanding separatist groups such as the Amish is crucial for prevention of disease epidemics, because underimmunized populations are proven reservoirs of serious infections," wrote Wenger and her colleagues.