Vaccine Barriers, Vaccine Refusals: Situated Vaccine Decision-Making in the Wake of the 2017 Minnesota Measles Outbreak

Abstract

In April 2017, Minnesota experienced the state’s largest measles outbreak since 1990. The outbreak primarily affected Somali children and was attributed to declining vaccination rates in Minnesota’s Somali population, specifically. Examining empirical data from ethnographic interviews with Somali parents who experienced the outbreak, this article identifies four themes that shaped participants’ vaccination decision-making: 1) an experience-informed belief in vaccine effectiveness, 2) concerns about non-inclusive clinical research, 3) belief in personalized, flexible immunity, and 4) experiences of structural vulnerability. Findings show that race and ethnicity, migration history, and structural precarity in resettlement influence Somali parents’ vaccination decisions and should inform existing explanations for vaccine hesitancy and models for responsive public health outreach. Participants’ practices of vaccine hesitancy are often refusals: constrained and embodied acts of resistance and generative openings to collaboratively re-envision healthcare relationships and communication. Refusals can redirect public health efforts from vaccine compliance toward institutional change and resource redistribution as means of disease prevention. This possibility has yet to be fully explored, and this article uses rhetorical publics theory to study medical refusal as a public participation strategy.