“Till Corona Sets Us Apart”: Emerging Vaccination Risks among Serbian Parents in the Netherlands

Study Participants

From July to September 2020, I conducted 42 in-depth semi-structured and open-ended interviews with one (29 mothers and 5 fathers) or both parents (8) of Serbian origin, who were aged between 28 and 65 at the time. When I stopped getting any new information from new interviews, I closed my data sample. While mothers usually see themselves as decision-makers when it comes to child immunisation (see Petts and Niemeyer 2004), most of my interviewees explained that they discussed this issue with their spouse because the vaccination decision had to be a joint agreement. However, in most cases the mothers were more willing to describe their experiences in more detail than the fathers. The mothers were usually the ones responsible for health check-ups, reading additional information and making the final decision about vaccination. The majority of respondents are highly educated: 25 have a university degree and nine have a PhD, while 16 have secondary school education. Some interviewees re-skilled themselves or significantly improved their education level in the Netherlands. The majority of respondents are married to a Serb; one person is divorced. There are 13 respondents married to non-Serb spouses (one American-Iranian, one Slovak, one British, one Greek, one Greek-Dutch, and eight Dutch spouses). We talked about vaccination practices regarding a total of 66 children. Most of the interviewees have children aged eight months to 14 years, who still fall under the Dutch NIP (49 children). I also conducted a small number of interviews with parents who have a child or children aged up to 25 years. In most cases, parents who have more than one child have children in different age groups, so it is difficult to make a numerical classification. In some cases, respondents did not vaccinate their children at the same rate because of an individual child’s health sensitivities, such as certain allergies, or because their views on the safety of certain vaccines had changed over time. Some parents started vaccinating their children in Serbia and continued when they moved to the Netherlands.

Procedure

I used various methods to find potential interviewees and collect the necessary data. First, I posted a short research description in three Facebook groups: Srbi u Holandiji [the Serbs in the Netherlands], Žene u Holandiji [Women in the Netherlands] and Obožavamo petak u Amsterdamu [We love Friday in Amsterdam]. Second, I announced my research among the parishioners of several Serbian Orthodox parishes: the Parish of the Saint Nicholas in Amsterdam-Zaandam, the Parish of Simeon the Outpourer of Myrrh in Utrecht-Zeist and the Parish of the Holy Trinity in Rotterdam, since the majority of Serbs in the Netherlands live in these three cities (Lopušina 1998). Consequently, many of the parents interviewed are devout Serbian Orthodox Christians. Finally, I used the snowball method. Some of the people I knew in the Netherlands, as well as my first interviewees, established further contacts with their Serbian friends. In addition to the interviews, I collected ethnographic data as I spent most of my free time with Serbs. Although I did not have the opportunity to observe any health activities, including child vaccination, we went shopping and sightseeing. I visited their homes, helped with the general cleaning of the church and sang in the services of the Serbian Orthodox Church. This position allowed me to broaden my perspective. As a Serbian citizen and mother of young children, I was an insider among people “like me”. At the same time, as an anthropologist in the Netherlands, I felt like a distanced outsider.^[5]

Before the interviews, all participants were familiarised with the nature of the research. They all gave their verbal or written consent that the interviews could be audio or audio-visually (in the case of online interviews) recorded and that the data could be used for my further analysis. The interviews lasted between 60 and 220 min, with an average duration of 80 min. Most of the interviews were conducted in person: in cafés (14), in respondents’ homes (11) or in public places such as parks or parish halls (3). I also conducted online interviews (Skype or Facebook video calls) (14), which was a financially, temporally and, in the light of the pandemic, more practical solution. All interviews were transcribed verbatim, anonymised and manually coded by me. I relied on thematic analysis to “describe and explain social phenomena” (Pope, Ziebland, and Mays 2020, 116–20), using risk as a main theoretical concept.

Risk

The concept of risk has changed its meaning over time. According to Lupton (1999, 5–8), it has gone from referring to a natural event—such as a storm, a flood, or an epidemic—to a consequence caused by human activities, and this is the notion which has prevailed since the 19th century. Lupton furthermore usefully classifies contemporary sociocultural theoretical approaches into the “cultural/symbolic”, “risk society” and “governmentality” perspectives. In short, the cultural/symbolic perspective, introduced by Mary Douglas, problematises risk as a western strategy of creating conceptual boundaries between “self” and “other” to achieve social order. The risk society perspective, coined separately by Beck and Giddens, is interested in contemporary processes and the outcomes of reflexive modernisation, individualisation and globalisation. Finally, Foucauldian scholars of risk study discourses, strategies, practices and institutions within the context of governing subjects (Lupton 1999).

I decided to design my research on childhood vaccination among Serbian migrants by combining the risk society and governmentality theoretical frameworks. The ideas of Giddens (1991, 1994 and Beck ([1995] 2002) about personal responsibility, risk-taking and decision-making in modern life^[6] have already been used in research on childhood immunisation (Williams and Calnan 1996; Hobson-West 2003; Poltorak et al. 2005), health risks management (Van Loon 2002) and health crises such as the BSE food hazard (Feindt and Kleinschmit 2011).

Following Beck, risk is a “structural condition of advanced industrialization” which reveals “hidden politics, ethics and morality issues” (Adam, Beck, and Van Loon 2000, 1–12). According to O’Malley (2009, 11), Beck makes no comment on risk’s diversity; “his theory deploys the vision of a thoroughgoing epochal rupture into the ‘risk society’”; and finally, he takes over a privileged observer’s standpoint.^[7] On the other hand, from a governmentality perspective, the concept of risk is an analytical tool of “specific ‘regimes of government’” (Cauchie and Chantraine 2005). Since the 16th and, especially, since the middle of the 18th century, populations became a main subject of governmental strategies in Western European societies. According to Foucault (1991, 100):

government has as its purpose not the act of government itself, but the welfare of the population, the improvement of its condition, the increase of its wealth, longevity, health, etc.; […] it is the population itself on which government will act either directly through large-scale campaigns, or indirectly through techniques that will make possible without the full awareness of the people, the stimulation of birth rates, the directing of the flow of population into certain regions or activities, etc.

To achieve “health and physical well-being”, medical policies became state management strategies of political control and the constraint of physical and social bodies, and thus part of “objectives of political power” (Foucault 1984, 277). Among the most important phenomena Foucault stresses since the 18th century are the medicalisation of the individual and the family (e.g. childhood vaccination), and the introduction of population hygiene programmes, transforming urban spaces into “medicalizable objects” (Foucault 1984, 280–2).

I find that risk society and governmentality approaches are more useful when being viewed as complementary rather than contradictory.

For example, from a risk society perspective, “new risk environments”, such as radioactivity, nuclear power, toxins and pollutants, genetic and environmental hazards, and the increasing number of new pathogens, are direct consequences of modernisations, industrial overproduction, and techno-economic progress, and, as such, represent global dangers (Beck 1992, 10–4, 21–4; Giddens 1994; Van Loon 2002, 23). Similarly, from a governmentality perspective, newly emerging diseases are also side effects of modernisation processes, including “ecological incursions, biotechnical manipulation, agricultural industrialization or increased global circulation” (Lakoff 2015, 40–1). Thus, individual lives became more global (nomadic or transnational); more socially reflexive, actively managed, and dependant on individual decisions; but at the same time more standardised and “institution-depended” (Giddens 1994, 83; Beck (1995) 2002, 22–7; Beck 2006, 338). Similarly, according to New Prudentialism, an approach coined by governmentalist scholars, the avoidance and minimisation of risks is among the multiple responsibilities of individuals and communities (Dean 1997).

In the Foucauldian tradition, risk has a more nuanced meaning—it is a tool to socially regulate individuals and groups. In other words, risk is “a ‘technology of government’”—“a governmental strategy of regulatory power by which populations and individuals are monitored and managed through the goals of neo-liberalism” (Lupton 1999, 89; O’Malley 2009, 5). By adapting Foucault’s theories on biopolitics (improving a population’s well-being through techno-political governing) and population security, Lakoff (2015) and Collier and Lakoff (2015) discuss pandemic health risks. Lakoff (2015) analyses the 2009 H1N1 pandemic vaccination controversy, naming risk management and vigilance as two types of global health security mechanisms. Collier and Lakoff (2015) study vital system security that emerged in the US as a new form of reflexive biopolitical governing caused by new types of risks. The authors mention the pandemic preparedness initiatives in the US “to address the threat of ‘emerging infectious diseases’ […] and to anticipate novel disease outbreak” as an example of vital system security (Collier and Lakoff 2015, 43–44). However, both of these studies are top-down.

In contrast, my study uses a bottom-up approach: my aim is to illustrate the possibilities of governmentality analysis for this type of empirical research. At the same time, I avoided hypothetical and generalised conclusions about personal responsibility of a rational self-reflexive individual in a totalised risk society, which are often critiqued by governmentality scholars (O’Malley 1999; Lupton 1999). In the following pages, I discuss the relationship between regular childhood vaccination practices and the new vaccination risks that emerged during the Covid-19 pandemic.

Overall Childhood Vaccination Status

My findings show that the majority of parents of Serbian origin regularly vaccinate their children. Only two mothers did not vaccinate their children at all. While one is married to a Serb and the other to a Slovak, they both have different worldviews from the rest of the participants. In both cases, the parents are vegan and their small children (aged between 2 and 9 years old) are vegetarians, and both families take a lot of care over the quality of ingredients. One of the families is also a follower of Maharishi Yogi and his transcendental meditation techniques. Moran et al. (2016) point out that negative vaccination decisions can emerge as a consequence of parental lifestyles and principles. Both mothers read about childhood vaccines and came to the conclusion that vaccines have more side effects than benefits for children.

On the other hand, the majority of Serbian parents (29) I talked to had fully vaccinated their children according to the NIP. However, some of them would think more carefully about the HPV vaccine when the appropriate time comes. In some cases, some parents had also vaccinated their children with vaccines not included in public vaccination programmes, such as against tuberculosis, Hepatitis C and/or B, and seasonal and swine flus, as advised by their physicians.

The rest of the interviewees had partially vaccinated their children. In the majority of these cases, the parents were against the MMR vaccine, meningococcal and/or the HPV vaccine as they found them unsafe. Regarding the HPV vaccine specifically, they were also suspicious of the HPV vaccine side effects as the vaccine is relatively new, according to them. In only four cases had the parents stopped further immunisation because they noticed adverse reactions. In these cases, two of the mothers are married to Dutch husbands and two have Serbian husbands. One mother, a paediatric nurse by vocation, suspected that her son, who was born and vaccinated in the Netherlands, developed diabetes after receiving the meningococcal vaccine and as a result did not have her younger daughter vaccinated against meningococcal. The three other mothers stopped further vaccinations completely after noticing various other side effects (asthma, continuous ear inflammations, swollen bladder). Two of them stopped with the vaccination programme in Serbia and one in the Netherlands (where the child was born).

The parents of non-vaccinated and partially vaccinated children did not plan to vaccinate themselves or their children against Covid-19, although at the time of our interviews, a prospective vaccine was still in the early phase of development and not a lot of information was available. At the same time, many parents who had fully vaccinated their children also raised concerns. They declared that since the beginning of the coronavirus outbreak, they had all started to think more carefully about any forthcoming (childhood) vaccines. This state of affairs prompted me to focus more closely on the narratives of parents who had fully vaccinated their children, the results of which can be seen in the following sections. First, I present the most general parental attitudes towards the Covid-19 vaccine and the reasons for the emerging hesitancy. Second, I interpret the new vaccination risks within the specific local context (the Netherlands) and temporal framework (the SARS-CoV-2 infection during the summer of 2020).

Main Reasons for the Developing Vaccine Risk Beliefs

Parents who had vaccinated their children according to the NIP generally trusted the Dutch health system. At the same time, they had increasingly started to have suspicions towards the state health system and political institutions, international health and political organisations, and consequently towards the then forthcoming Covid-19 vaccine. Even parents who believed that childhood immunisation should be compulsory or who would vaccinate themselves with the Covid-19 vaccine were concerned by the possible side effects.

One male participant (an economist), a second-generation Serbian migrant in the Netherlands and the father of a two-year-old child, planned to continue with childhood vaccinations. Although he was aware of potential risks, when the time comes, he would accept the Covid-19 vaccine:

They [the WHO] will eventually approve some of the many [Covid-19] vaccines. That vaccine will be far from perfect, because even these simple annual vaccines [against flu] are already complicated enough. So, there will certainly be some shit. […] That’s the process you can’t avoid, but as long as the majority does it, I’m convinced that it should be like that, because you don’t have any other choice.

Another example is a mother (unemployed, arrived in 2009) of two children (5 and 7 years old) born in the Netherlands, who fully supported childhood vaccination. As the wife of a Greek-Dutch husband, she was very familiar with the Serbian, Dutch and Greek health systems. Despite her doubts, she and her husband would accept the Covid-19 vaccine:

Like every good Srbenda [wholehearted Serb], I don’t trust anyone [laughs]. […] We have our own predisposition. […] The fact is that we’ll all have to be vaccinated [against Covid-19] because it will condition some things […] the husband won’t be able to work in school […] if you get sick [with Covid-19] your health insurance won’t cover anything. You probably won’t be able to travel. […] Like with some other things in life, it’s just the luck of the draw, [you hope] that the vaccine you receive is good and that your organism will react [accordingly] […] I have started to accept that these are the times we live in.

Furthermore, many of my interviewees felt let down by the health system and abandoned during the pandemic. Their narratives reveal that nobody is immune to the health fears that are integral to life in the globalised world and glocal risk society (in the Netherlands or Serbia).

Another male participant, also a second-generation Serbian migrant (economist) and the father of an eight-month-old child, explained his opposition to new vaccines:

Now you have a lot more questions about vaccines than 20 years ago. The content then was better checked. If you create a vaccine, you need at least 10 years to make it, to prove that it really works, that it doesn’t have a lot of side effects, approval from an expert team on an international level, only then can it be approved for production. Now in the 21st century, health care does not look at people but only material profit and then they rush the vaccine […]. Now everywhere in the world, people question vaccination in general and don’t believe in health care systems […].

Similar opinions were held by a female participant (a clerk) also born in the Netherlands. She had a 13-year-old child who had recently being diagnosed with ADD. She summarised the reasons for her emerging loss of trust in the Dutch health system and its government:

Look now how this vaccine [against Covid-19] is being bought and it hasn’t even been made yet. I don’t like that. The government says that they want to buy these vaccines now so they don’t have to wait later. They are afraid that other countries will get them and we won’t. Wait, the vaccine takes about five years to be tested, that won’t be tested now. So, we’re going to receive something now, but you don’t know whether it works at all. So now for every new vaccine I’ll think carefully about whether I will vaccinate or not, especially my son. […] Since corona, the worst thing is that I don’t trust anybody and that I must reassess everything myself and you have to use your common sense. In fact, you have no one to rely on, especially not the government. […] Until now, you always trusted the physician because they know more than you. Not any more.

Inconsistent state responses to the Covid-19 pandemic provoked suspicions among even the most responsible migrant parents.

For example, a female Serbian migrant (a clerk, arrived in 1995) became a refugee during the war in Bosnia and finally settled in the Netherlands. She did not have the usual BCG vaccine scar, although she had been vaccinated. Consequently, the Dutch health practitioners did not believe that she was vaccinated against tuberculosis. She had a second BCG vaccine, with severe consequences: she was hospitalised with a high fever and almost died. However, her negative experience did not change her opinions towards childhood vaccination. She fully trusted her family physician and the Dutch health system. Consequently, her 12-year-old child is fully immunised. He received a swine flu jab and will receive all remaining booster vaccines, including the HPV vaccine. On the other hand, the coronavirus pandemic has negatively influenced her relationship with the health system and vaccines:

Until corona started, we didn’t question vaccines, that’s how we learnt, took for granted […], felt good […] and didn’t think about it afterwards. […] Now, if this vaccine would appear, I wouldn’t have trust in it because it’s new […] not for a child. […] This is so new now, nobody knows anything, not even the health system in Serbia and in the Netherlands, we follow them both at the same time. Now, since corona began, we don’t trust anything [health and political system]. […] First, they told us that masks are unnecessary [when there were no masks], then after a month, masks can save lives [when they started to produce them]. They don’t have enough hospital beds in the Netherlands so patients are transferred to Germany, while in Serbia they make field hospitals. We’re confused, what now, whom to trust?

An additional example of the rising distrust is offered by the parents (a secretary, arrived in 2000; a factory operator, arrived as a newborn) of three teenagers. They started to intensively distrust the Dutch health system with the emergence of the Covid-19 virus:

Until corona, you didn’t think at all that something would happen to you, you pay [health] insurance, go where you need to go, you know whom you’ll ask, but now since corona you see that health policy is led by politicians not doctors. And then you hear that we should be locked down, how we should take care, wear masks, but nowhere you hear what healthy food we should be eating, what vitamins we should be taking, what we should be doing to boost our immune systems. […] Just stay in the house, wear masks, and nowhere had I heard that masks helped anything and that they were good for something. Then you have less and less trust in that health system.

Finally, even experts in health matters such as a polymer chemist working in the pharmaceutical industry (arrived in 2002), started to feel a hesitancy towards vaccines during the pandemic. She had vaccinated her seven-year-old child with all the recommended vaccines. However, she doubted that a vaccine against Covid-19 would pass all the necessary quality control tests:

Now, this is a vaccine that has to be produced overnight, but because this is a virus, it changes by itself and depends on its host. […] I will not vaccinate my child with that vaccine, neither myself nor my husband. It has nothing to do with [Orthodox Christian] religion; it has to do with common sense. […] If there is already a choice, then we’ll choose to increase the resistance of the immune system. […] I’m more afraid of the state than the vaccine [a laugh]. I’m afraid globally, because this vaccine is being so pushed that […] there are some other interests that even the Dutch government cannot reveal or doesn’t know. […] I believe in the health system [in the Netherlands], but all the institutions that are financed with foreign money, I don’t trust much [a laugh], because in the end, we are all just numbers. […] Bill Gates and his foundation finance Dutch health institutes here, they invest in other countries and their similar centres, invest in the WHO, give money, donate, are closely associated with the pharmaceutical industry […], now this elite that has a lot of money, they are […] above the law […], what does he ask for in return, if he gives so uncontrollably to everyone, right?

In the next section, I will explain why many migrant parents declared that they would think more carefully about vaccination “from now on”.

Individualisation and the Global Covid-19 Vaccination

While the SARS-CoV-2 virus posed a natural health risk within the global population, including to Serbian migrants in the Netherlands, the new vaccine was perceived as an emerging medical risk. Specifically, vaccines were interpreted as risk technologies under the auspices of the state and as augmenting, rather than minimising, the crisis. In other words, among the majority of the Serbian migrants I encountered, state and global health and social rules and the newly tested vaccine were not acknowledged as risk remedies. Instead, they create a new type of “risk environment”.

It is widely understood that vaccines are the most successful, easiest and most cost-effective tool against infectious diseases. They are meant to help humanity restore its general health balance. In this respect, for a high vaccination, uptake “trust in health authorities and their recommendations is essential” (European Commission 2018, 24). For migrant parents, such as Somali migrants in Stockholm, being able to trust their healthcare representatives played an important role in reaching a positive decision on childhood vaccination (Jama et al. 2018). However, during the Covid-19 pandemic, the behaviour of the government and healthcare officials had adverse effects on vaccine uptake, not only in the Netherlands but worldwide. Vaccine hesitancy among health workers, contradictory messages from health authorities, inconsistent government measures, the public questioning of scientific knowledge, doubts in the efficacy and safety of the then imminent vaccines, and widespread proliferation of misinformation, conspiracy theories and fake news had negative effects on the general trust of healthcare professionals, healthcare systems, science, and the sociopolitical context in general (Soares et al. 2021; Verger and Dubé 2020; Cairney and Wellstead 2021; Milošević Đorđević et al. 2021).

In this paper I analyse the narratives of Serbian migrants living in the Netherlands who vaccinated their children with all the recommended vaccines. Their trust in childhood vaccines initially confirmed my hypothesis that migrants’ trust stems from their confidence in the Dutch health institutions and the government. They had generally automatically accepted childhood immunisation as a standard public health measure. However, for the majority of them, the supposed risks from the then imminent Covid-19 vaccine changed their relationship towards Dutch society and its health system, as well as their general perspective towards vaccines. In other words, the increasing vaccine risk perceptions among Serbian parents influenced the development of ambivalent attitudes towards childhood vaccines. As migrants, the interviewees had the opportunity to follow media from different countries and make comparisons with Dutch policy and their personal experiences. This opportunity made them prone to be more suspicious towards different governments (Serbian, Dutch, Bosnian, Greek, Croatian, etc.) due to their incongruent policies and health measures during the pandemic. It was a similar experience for Lockyer et al.’s (2021) Slovak interviewee living in the United Kingdom. Changed parental worldviews in this respect was confirmed in their increasingly reflexive behaviour towards health and government authorities (Lock and Nichter 2002, 27).

The Serbian case has further specificities. Southeastern European societies like Serbia are usually defined as having low trust in institutions (Rot [Roth] 2012). People in these societies prefer to rely on individuals, such as family and friends, to obtain social capital or achieve some goals. They distrust authorities and institutions because “the public sphere is perceived as unreliable, unpredictable, even dangerous” (Rot [Roth] 2012, 295–6). On the other hand, Western European countries are “societies of high social trust” in government, the rule of law and other public institutions (Rot [Roth] 2012, 294). In other words, in contrast to people in Serbia, Serbian parents in the Netherlands had trust in the government until the pandemic. The pandemic, inconsistent government policies, and perceptions of the forthcoming Covid-19 vaccine as risky changed their views and consequently, they started to have low trust in the Dutch government. In Foucauldian terms, governmental strategies to obtain the welfare and sustain the health of the population were questioned as tools of social and health control. Consequently, parents’ individualisation of vaccine decision-making represents a form of resistance to the governmental biopolitics.

The SARS-CoV-2 virus triggered a new type of individualisation—that is, individual responses among parents to vaccination management. The supposed global risks from this virus became both the cause and the explanation of life in a world risk society. The Covid-19 vaccine health risks correspond to Beck’s main features of global risks: de-localisation, the incalculableness consequences, and non-compensability (Beck 2006). The Covid-19 vaccine risks became part of everyday parental concerns: for example, in loss of trust in Dutch health care and government. They were unpredictable in their scope (for example, a vaccine would have unknown side effects); and out of the control of parents (for example, the lack of time for thorough vaccine trials and parents’ rising fears of what was in the vaccine). According to these parents, the Covid-19 vaccine was a politicised measure to govern and regulate its citizens (as vaccination opened up possibilities such as work, travel, and health insurance) rather than a preventive health measure to protect and safeguard them. In other words, the major fears that arose from the Covid-19 pandemic were not the possibility of sickness or death, but rather the thorough separation of the individual and the state. For the majority of my interviewees, this has resulted in a feeling of leading individualised lives surrounded by distrustful institutions, even in a high-income European Union (EU) country such as the Netherlands. In the case of Serbian migrant parents, their increased individualisation of understanding of the risks from the SARS-CoV-2 virus or the then impending vaccine came as a consequence of the failure of the health and political systems on either a local or global scale to present themselves as “ethical” and “scientific.” This can be seen in doubts about the philanthropic intentions of the Bill and Melinda Gates Foundation; an understanding of vaccines as more profit-oriented and less health-oriented tools; and criticisms of the lack of basic public health information on how to improve one’s immune system.^[8] This triggered further distrust among Serbian parents, not only of the Dutch government but also of other states, such as Serbia or Greece, and their vaccine policies. Instead of building upon feelings of shared solidarity, common interest and omnipresent trust, the increased feeling of personal responsibility during the Covid-19 pandemic compelled some of the parents I talked with to establish personalised responses and individual decision making on immunisation matters, an area that was previously informed by public health practitioners. Parallel to this, rather than developing feelings of security and confidence in a system or relief that a vaccine will soon emerge, Serbian migrant parents reflected more about living in a corrupt, manipulative and profit-oriented world.

Both risk society and governmentality perspectives fail to acknowledge the perspective of the individual. In my study, parental narratives on emerging Covid-19 vaccination risks and their rising vaccine hesitancy became a form of resistance to the state social and health control established during the Covid-19 pandemic and to global health control through vaccines. The state discourse on the forthcoming Covid-19 vaccine resulted in parents starting to doubt their previous, and successful, childhood vaccination decisions and consequently becoming suspicious of vaccines in general. Further research is needed to investigate whether these new sentiments could lead to childhood vaccination refusal.

According to Hobson-West (2003), religious communities often resist vaccination due to differing perceptions of health, disease and illness. In the Netherlands, members of the Orthodox Protestant Denominations usually refuse the MMR vaccine. On the other hand, Harmsen et al.’s study (2015) showed that their Turkish and Moroccan study participants see vaccination as a part of their duties as Muslim to protect their health. Among Somali migrants in Sweden, an ethnic community with a low MMR vaccination rate, those who accepted vaccination also accepted any possible outcome as God’s will (Jama et al. 2018). None of my interviewees with fully vaccinated children who are also regular churchgoers gave a religious explanation for opting for childhood vaccination.^[9] Officially, the Serbian Orthodox Church did not provide its members with clear guidelines regarding vaccination. During the 2019 regular meeting of the Holy Assembly of Bishops of the Serbian Orthodox Church, the bishops discussed mandatory childhood vaccination. In their statement, they approved both the vaccination acceptance and the anti-vaccination stance—“[T]he reasons for scientific medicine should be respected as well as the parents’ fear.”^[10] There were many disputes among bishops in the case of Covid-19 vaccines. However, the Serbian Church left the final decision on, and the responsibility for, vaccination to be assessed on a case-by-case base. According to the episcopate, the Church “does not possess relevant scientific knowledge in order to publicly recommend massive vaccination” (Cvetković 2022, 64, 70). Therefore, the connection between Orthodox Christianity and vaccine hesitancy needs a more detailed study to reach any conclusions. My research indicates that the emerging opposition towards the Covid-19 vaccine has more sociocultural than religious explanations.

Finally, this paper demonstrates that subjective risk awareness has the potential to alter vaccination decisions and to raise unexpected doubts towards the health system and the state itself. Subjective parental perceptions of potential vaccine risks can disrupt the relationship between an individual and the state in highly industrialised countries with high childhood vaccination rates.