Communication and capacity in outbreak response: vaccination outreach to ultra-Orthodox communities during Israel's 2025 to 2026 measles outbreak: a mixed-methods study

When a contagious disease like measles enters a community, the speed at which it spreads depends less on the virus itself and more on the people it encounters. If a large number of people in a neighborhood have been vaccinated, the virus hits a wall and dies out. But if many people remain unvaccinated, the virus finds a path through, infecting the vulnerable and causing an outbreak. Public health officials usually face two main questions when this happens: are people refusing the vaccine because they do not believe in it, or are they simply unable to get to a clinic because of logistics, such as long lines, bad hours, or a lack of nearby doctors? In Israel, a specific religious community known as the ultra-Orthodox has historically faced higher rates of measles infection. For years, the assumption was that their tight-knit culture and religious leadership might be creating a barrier of belief against vaccination. However, a new study suggests the problem might be much more practical than that.

Researchers from Tel Aviv University set out to investigate the massive measles outbreak that swept through Israel between 2025 and 2026. The outbreak began with a single imported case in April 2025 and quickly grew, eventually infecting over 3,600 people and causing 17 deaths, most of them young children in ultra-Orthodox neighborhoods. The team wanted to understand why the disease spread so far in this specific population. They looked at two competing explanations. One theory was that the community was refusing the vaccine due to religious or cultural reasons. The other theory was that the health system simply failed to provide enough convenient places and times for families to get vaccinated. To find the answer, the researchers did not just look at numbers; they read thousands of news articles, government press releases, and official records to see what was actually happening on the ground.

The study began by examining the conversation inside the ultra-Orthodox community. The researchers collected 169 news items from seven major ultra-Orthodox media outlets, ranging from websites to news wires, covering the period before, during, and after the outbreak. They were looking for signs of anti-vaccine sentiment. What they found was surprising. In the months leading up to the outbreak, these media outlets were almost completely silent on the topic of measles. But once the outbreak started, the tone changed. The outlets did not amplify messages refusing the vaccine. Instead, they reported on the disease as a serious threat to the community. When religious leaders spoke out, they were overwhelmingly in favor of vaccination. The researchers found that when a rabbi or a community leader did speak, they were clear: getting vaccinated was a duty to protect life. The media did not act as a barrier; in fact, they were ready to carry a message of protection if one was given to them.

While the media was willing to help, the physical ability to get vaccinated was a different story. The researchers tracked every change in the health system's capacity to deliver vaccines. They looked for new clinics, extended opening hours, and mobile units that could go directly to neighborhoods. They found that when the government did make these changes—such as opening clinics late at night, allowing people to walk in without an appointment, or sending mobile units to specific areas—vaccination rates went up quickly. In Jerusalem and Beit Shemesh, two major centers of the outbreak, the percentage of young children who received their first dose of the vaccine jumped significantly within weeks of these changes. This proved that when access was made easy, families were eager to take advantage of it.

However, the study also uncovered a critical disconnect between what the government said and what it actually provided. There were moments when the government issued many press releases urging people to get vaccinated, but the actual number of available clinics or open hours did not increase. In fact, for five months during the height of the outbreak, the official online list of where to get vaccinated was not updated at all. Families were being told to go to clinics that might not have been open or might not have had the vaccine in stock. The researchers also discovered that the Ministry of Health had let a standing contract for community outreach expire two years before the outbreak began. This contract had previously funded a dedicated team to work with the ultra-Orthodox community. When the outbreak started, the government had to scramble to hire small, temporary groups to do the same work, rather than relying on a permanent, experienced team.

The evidence points to a clear conclusion: the main obstacle was not a refusal to believe in the vaccine, but a failure to provide the means to get it. The study explicitly rules out the idea that the community was hostile to vaccination. The media was receptive, the religious leaders were supportive, and the families responded positively when the logistics were fixed. The problem was one of capacity and planning. The health system had the tools to stop the spread—mobile units, extended hours, and community partnerships—but it did not maintain them consistently. The researchers noted that the government's communication often moved faster than its ability to deliver the vaccine, creating a gap where people were told to get vaccinated but had nowhere to go.

This research offers a specific lesson for future outbreaks. It suggests that fighting vaccine hesitancy in tight-knit communities requires more than just good messaging. It requires a reliable infrastructure that is ready before a crisis hits. The study found that when the government invested in physical access—making sure clinics were open when people could go, and that the information about where to go was accurate—vaccination rates soared. The most effective steps were not new laws or new speeches, but practical solutions like evening hours and walk-in appointments. The researchers argue that the health system should treat these community connections as permanent infrastructure, not as emergency measures to be assembled only when a disease appears. By keeping the lines of communication open and the clinics accessible year-round, the system can protect the most vulnerable people before a virus ever has a chance to spread.