Fear among Minnesota’s Somali community compounds a public health woe: Low measles vaccination rates

MINNEAPOLIS– Public health officials and community leaders say that even before federal immigration authorities launched a crackdown in Minneapolis, a crisis was brewing.

Measles vaccination rates among the state’s large Somali community have fallen as the myth that the vaccine causes the spread of autism has spread. Not even four measles outbreaks since 2011 have dented the trend. But recently, vaccination advocates have noted small victories, including mobile clinics and a vaccine confidence task force.

Now, as the United States stands on the verge of losing its measles elimination status, those on the front lines of fighting vaccine misinformation say much progress has been lost. Many residents are afraid to leave their homes, let alone see a doctor or go to a doctor’s office.

“People are worried about survival,” said nurse practitioner Munira Maalimisaq, CEO of the Inspire Change clinic, located near a Minneapolis neighborhood where many Somalis live. “Vaccines are the last thing people think about. But it’s a major problem.”

A discussion group for Somali mothers from Inspire Change is now online indefinitely. In community WhatsApp groups and other channels, parents have more pressing priorities: Who will look after the children when they can’t go to school? How can we get groceries and medicine safely?

In 2006, 92 percent of Somali 2-year-old children were up to date on their measles vaccinations, according to the Minnesota Department of Health. The current rate is closer to 24%, according to state data. A rate of 95% is needed to prevent outbreaks of measles, an extremely contagious disease.

Community vaccination efforts go through cycles, Maalimisaq said, with initiatives starting and stopping.

Imam Yusuf Abdulle said the immigration measures had put everything on hold.

“People are stuck at home, can’t go to work,” he said. “It’s crazy. And the last thing we should think about is talking about autism, talking about vaccinating children. Adults can’t leave the house, forget about the children.”

Estimated autism rates among Somali 4-year-olds are 3.5 times higher than those among white 4-year-olds in Minnesota, according to University of Minnesota data. Researchers say they don’t know why. And in this vacuum of scientific certainty, inaccurate beliefs thrive.

Many blame the measles, mumps and rubella vaccine – a single shot proven to safely protect against all three viruses, with the first dose recommended when children are between 12 and 15 months old.

In November, during one of the last gatherings of the Maalimisaq Maternity Circle, Somali mothers and grandmothers asked the facilitators questions. Won’t an injection against three viruses overwhelm a baby? Why does autism seem more common here than back home?

Vaccines are being tested for safety, Maalimisaq and his panel explained. Delaying an injection is risky, they warned, because of the consequences of measles – which is seeing its greatest spread in the country in more than three decades.

Local health officials have long followed best practices: enlisting community members to advocate for vaccines, organizing mobile clinics and promoting the work of Somali health providers like Maalimisaq.

But the initiatives have been intermittent. Cuts in federal funding have affected efforts, and public health officials admit their action could be more consistent and comprehensive.

Here, most parents end up vaccinating their children. Many Somali families prefer to wait until their child is 5 years old, despite a lack of evidence that this would reduce autism rates. Measles is endemic in Somalia, where war and cuts in international aid have crippled the medical system, and elsewhere in East Africa where residents often travel.

“Measles is just a plane ride away, and measles is going to affect the unvaccinated,” said Carly Edson, vaccination campaign coordinator for the state Department of Health. “We are still in danger.”

About 84,000 Somalis live in the Twin Cities area, out of 260,000 nationally. The community is the largest in the country and most are American citizens. Before the immigration crackdown, mosques and shopping malls were buzzing, with people gathering in the evenings to sip chai or have henna drawn on their hands.

Today, many members of the community want to keep a low profile. People are afraid to seek routine medical care. Without these touchpoints, trust erodes quickly, Maalimisaq said.

Among the last cohort of Somali mothers at the clinic, 83% had vaccinated their children by the end of the 12-month program, she said. Some made 10-second videos explaining why they were getting vaccinated. But the efforts paused.

Parents here have long faced racism and isolation, even as they have built a strong community. They want answers about autism rates, but science doesn’t have simple answers about what causes this lifelong neurological condition, said Mahdi Warsama, CEO of the Somali Parents Autism Network.

Warsama said Trump’s unproven claims last fall that taking Tylenol during pregnancy could cause autism had sparked fears and questions here. The idea that the MMR vaccine should be split into three vaccines — including one supported, without scientific basis, by the acting director of the Centers for Disease Control and Prevention, Jim O’Neill, although no standalone vaccine is available in the United States — has also become widespread.

Warsama traces the issue back more than a decade, when discredited researcher Andrew Wakefield published his study – since retracted – claiming a link between autism and the MMR vaccine. Wakefield visited the Twin Cities Somalis in 2011.

“Disinformers will always fill the void,” Warsama said.

Parents want to be heard, not debated — that’s why short medical appointments don’t work, said Fatuma Sharif-Mohamed, a Somali community health educator.

“Those 15 minutes won’t change a parent’s mind,” she said.

Some doctors go beyond the exam room – a job they describe as slow and grueling. Changing a family’s mind can take several visits, even years.

Dr. Bryan Fate, head of a Minnesota Children’s Vaccine Confidence Committee, said new strategies are underway, including videos from doctors on social media and possibly prenatal classes for expectant parents.

“I will call you in five days,” Fate said to the hesitant parents, “and there will be no change to this speech.”

Overall, the MMR vaccination rate in Minnesota kindergarteners has fallen more than 6 percentage points over the past five years, compared to a 2-point decline nationally.

State data suggests that efforts to catch up with children could be effective: While fewer than one in four Somali children in Minnesota are vaccinated against measles before age 2, 86% receive at least one dose by age 6 — just below the national rate, 89%.

Doctors are particularly concerned about unprotected young children, for whom serious complications – pneumonia, brain swelling and blindness – are more common.

Imam Abdulle said that when parents ask him about the vaccine, he tells his own story. He wasn’t opposed to it but decided to err on the side of waiting. Her son was diagnosed with autism at age 3, Abdulle said, and was later vaccinated.

Correlation, he reminds parents, is not causation.

The community does not want to be portrayed as a source of disease, Abdulle said. But after the epidemics of 2011, 2017, 2022 and 2024, it is also accepted that measles is not going to disappear.

“It’s our children who are getting sick,” Abdulle said. “Our community is suffering.”

Last year, Minnesota recorded 26 cases of measles. The state Health Department said the cases span several different communities with pockets of unvaccinated people.

In Maalimisaq maternity circles, the most effective words often come not from doctors but from other parents, like Mirad Farah. Farah’s daughter was born prematurely. She was concerned that the MMR vaccine would be too much and would delay vaccination. Her daughter still developed autism.

“So what did that tell me?” she asked the room. “This confirmed that autism did not arise from MMR.”

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