“The question I get a lot,” says GP Harm van Blijderveen, is: “My child is coughing, is this whooping cough?” Van Blijderveen has a practice in Opheusden, in the Bible Belt. About 50 percent of his patients are Christian, Van Blijderveen himself is Reformed. This means that many patients do not have their children vaccinated for religious reasons. And that means a greater chance of teething problems.
The questions started in November last year, says Van Blijderveen, when the number of infections increased. At times the doctor suddenly received more concerned parents in his practice. A few weeks ago, a baby from Ede reportedly died of whooping cough. “At such a moment it is very alive,” says Van Blijderveen.
Helma Ruijs, infectious disease control doctor at the RIVM, calls the situation at the moment “worrisome”. “Because whooping cough vaccinations wear off after a number of years, whooping cough is common among teenagers and adults,” says Ruijs. “That is annoying for them, but not serious.” Whooping cough, a contagious bacterial disease, causes a person to have coughing fits that can sometimes last for months. This is especially dangerous for babies. Infants can become very ill and, in exceptional cases, die. The RIVM now sees that the number of newborn babies seriously ill with whooping cough is increasing rapidly. This especially happens in the Bible Belt. Every week, 110 children become ill, of which 20 are babies. About half of these babies have been hospitalized.
Of the babies who got whooping cough this year, about 90 percent were not vaccinated. Precisely because there are more unvaccinated people huddled together in the Bible Belt, epidemics can arise there. The municipality of Neder-Betuwe, the municipality in which Harm van Blijderveen’s practice is located, has for years had the lowest vaccination rate in the whole of the Netherlands when it comes to vaccinating children. In 2023, about 52 percent of babies will receive a DKTP injection. About 45 percent of the babies received all the shots in the national vaccination program.
Also read
Vaccination rates among children continue to decline
Resignation
The majority of people who come to his practice with whooping cough questions are “resigned and calm,” says GP Van Blijderveen. “I have the feeling that the secular world is more concerned about outbreaks in the Bible Belt than people in the Bible Belt itself.” This resignation can be explained because people do not vaccinate because of their trust in God’s providence, the GP explains. “God decides whether my child will get sick.”
Van Blijderveen hardly received any questions about vaccination. “I think the community is used to outbreaks of childhood illnesses,” he said. “The danger to children is not seen as a danger. Medically speaking, of course, I think so, but if you have seen all your children with measles and a fever of 40 degrees for a few days, then you find it less scary.” Van Blijderveen did have his three children vaccinated and also promotes his pro position. “Differences of opinion about vaccination also exist within the same church,” he says. Some Christians see vaccination as a personal choice about which the Bible does not clearly prescribe. Others think vaccination is just playing God.
General practitioner Lennard Wijnmaalen occasionally discusses vaccination in his practice in Opheusden, on the Bible Belt, he says. “But if someone’s motivation for not doing it is a conscientious objection, there is little point in coming up with all kinds of medical arguments.” Sometimes Wijnmaalen, himself a Christian, has more of a theological conversation than a substantive medical conversation with his patients. “I think God gives us tools not only to treat diseases, but also to prevent them,” he says. “And I think it is lawful to use those resources. When I say this, there are sometimes people who come to different insights.”
Corona vaccine
Both Wijnmaalen and Van Blijderveen saw that there was a lot of discussion among Reformed people about vaccination during the corona pandemic. The vaccination rate for the corona vaccine was higher than the vaccination rate in children in many municipalities with many Reformed residents. “While it is more or less the same thing,” says Van Blijderveen. “But corona was new and exciting, and then there was a kind of compulsion: the QR code.”
“We have had exactly one question about whooping cough vaccination in recent weeks,” says Martijn Schot. He is interim director at the Dutch Patients Association (NPV), a Christian association that advises on medical ethical themes such as abortion or vaccination. “During corona this was much more,” he says. And when the government included a whooping cough vaccine for pregnant women in the National Vaccination Program in 2019, a number of questions were raised about it. “These questions mainly came from couples who had their children vaccinated, but had hesitation about vaccination during pregnancy.”
Helma Ruijs of the RIVM obtained her PhD on willingness to vaccinate among Reformed people. “Before corona, we saw willingness increasing with every generation,” she says. No research has been done into this since the corona pandemic. The willingness to be vaccinated has decreased in recent years throughout the Netherlands. The RIVM message about whooping cough is therefore mainly intended to raise awareness of the outbreak, also for people outside the Bible Belt. “If you do not vaccinate your baby, it is now extra important to avoid contact with people who are coughing and sniffling,” says Ruijs.
According to Ruijs, whooping cough is now occurring because there has been no ‘normal’ spread of infectious diseases for a number of years due to the corona measures. “Whooping cough normally has a peak every few years, but it is very large,” says Ruijs. “If the vaccination rate in the Netherlands continues to decline, we will have to take into account more peaks in the future.” Ruijs sees that mumps is currently being diagnosed more often. That could easily become the next outbreak.
GP Blijderveen was already aware of this. “There are people with mumps in Waardenburg and Rheden,” he says. “That is the advantage of our community. People are close. And many people have relatives living all over the Bible Belt. There is a lot of talk about whooping cough at birthdays and in the supermarket. Being resigned does not mean that one is not alert.”