Enablers to high vaccination uptake among a disadvantaged minority population: a qualitative study of the Arab population of Israel

Background: Over 1.9 million Arabs live in Israel and constitute 21% of the total population. Despite being a disadvantaged minority population with wide gaps in health indicators, Arabs have higher Human Papillomavirus (HPV) and Measles, Mumps, and Rubella (MMR) vaccination rates compared with the general Jewish population.

Methods: In-depth interviews with 21 health care providers, 16 Arab mothers, and 16 teenagers were conducted to collect information about health system enablers to HPV and MMR vaccination. All interviews were conducted in Arabic by an Arab researcher, audio-recorded, transcribed, and analysed using thematic analysis of the transcripts. Themes were mapped according to the WHO Health Systems Building Block Framework.

Results: We identified several health system enablers. On the service delivery level, accessible and availability of vaccination services, delivery of vaccines through the school system and mother child clinics, and framing vaccinations as the norm were themes. 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 reported. Vaccination provided at no cost was also identified. On the leadership/governance level, the Arab community felt equal treatment and distribution of services, which was also an enabler reported. Despite high vaccine uptakes, parents and teenagers had limited knowledge regarding vaccination, particularly HPV.

Conclusions: This study highlights that a combination of good access and delivery to vaccination, delivered by a culturally competent, available, accessible respectful workforce can enable disadvantaged minorities to achieve high vaccine coverage, in particular in a cultural context where the population trusts and follows medical advice. Such evidence can serve as a basis for developing policies, interventions, and guidance to improve vaccine uptake among other underserved minority communities.