Vaccination

'Vaccination in Halakhah and in Practice in the Orthodox Jewish Community' by Asher Bush in 2012 13 Ḥakirah, the Flatbush Journal of Jewish Law and Thought 185 comments

In 1998 a study was published in The Lancet linking the MMR vaccination with cases of autism. This study was widely circulated in both Great Britain and the United States. Despite the numerous other studies that confirmed the safety and value of these vaccinations, nevertheless, the publicity surrounding this article from The Lancet, particularly the follow-up broadcast on “Sixty Minutes,” led many parents to question the safety of childhood vaccinations. This study created a significant fear such that rates of childhood vaccinations decreased, in America to a relatively small extent and in Great Britain to a significantly greater extent. Correspondingly there was a marked increase in these diseases, particularly measles and mumps; this has included fatalities as well.

While most medical authorities doubted the accuracy and significance of this study, it was not until February 2010 that a retraction was printed in The Lancet. In May 2010 the General Medical Council of Great Britain found that the lead author of the study, Dr. Andrew Wakefield, had acted “dishonestly and irresponsibly,” and revoked his license to practice medicine in Great Britain. Prior to this, ten of the twelve coauthors associated with this paper had withdrawn their names. It is also worth noting that this now discredited study had focused on the link between Thimerosal (a mercury- based ingredient) and autism; that ingredient was removed from all vaccines other than influenza as of 2001 (the influenza vaccine is produced both with and without Thimerosal).

Nevertheless, as a result of the study and publicity that followed, many parents remain skeptical and either postpone or avoid vaccinating their children. Numerous organizations and websites still exist devoted to the “anti-vaccination cause,” casting doubts on both the efficacy and safety of the various childhood vaccines. The Orthodox Jewish community has not been immune from this trend, with strong support in some communities for parental autonomy not to vaccinate. In the early part of the nineteenth century, when vaccinations were still new and risks were higher and knowledge was less, Rav Yisrael Lifshitz1 ruled that even though slight risks do exist, the benefit of vaccination far outweighs the risk and they are permitted according to halakhah. Strikingly, in 1896 there was a case in London where an Orthodox Jew was imprisoned for his refusal to vaccinate his child, claiming his religion forbade him. The prosecutor in this case, who was also Jewish, turned to the Chief Rabbi of Great Britain, Rav Hermann Adler. The Chief Rabbi stated clearly that this man “was not justified in making the statements contained in the letter; that the most competent medical authorities were agreed as to vaccination being a prophylactic against small-pox, and added that its use was in perfect consonance with the letter and spirit of Judaism.”

This issue came to the fore in the Orthodox community again in three recent situations. The first one was in Lakewood, NJ, where in 2008-2009 a number of school medical officials had sought to exclude unvaccinated children from attending. A number of leading rabbinic authorities associated with that community issued varying statements and rulings, some of which have been clarified and even reversed since that time. The second event was the mumps outbreak in 2009-2010 that primarily affected children who had attended several Orthodox camps, and spread further following the summer when these boys returned to home and school. Even more recently, in October 2011 there was an outbreak of measles in portions of the Orthodox community in Brooklyn. As reported in the New York Times, “The latest outbreak took place within a closeknit Orthodox Jewish population in Brooklyn, officials said. There have been similar outbreaks among Orthodox Jews in the past. Some of the children had not been vaccinated, perhaps of a preference within the community to delay vaccination, health officials said.”

The purpose of this article is to address two fundamental questions: firstly, whether there is a halakhic obligation to vaccinate, and secondly, whether schools have the right and/or responsibility to prevent unvaccinated children from attending.

 In discussing community wellbeing Bush comments

It is a given that all schools have an obligation to protect the health and well-being of their students. This duty is even more pressing in a yeshiva where both the physical and spiritual well-being of the students is a daily concern. Common health and safety regulations include: sick students are sent to the nurse or home, students are generally not permitted to possess medicines (which instead are administered by the nurse), and dangerous objects such as knives may not be possessed. More recently many schools have forbidden foods that cause severe allergic reactions in others, such as peanut butter. In a yeshiva the rules often go much farther, concerned with not just the physical well-being of the students but their spiritual and moral development as well. This often includes very specific dress codes, as well as regulation of cell phones, electronic devices and, depending on the school, reading material and forms of entertainment. Following this well-accepted pattern, it would seem that rules and regulations mandating vaccinations are just another example of a rule enacted for the health and well-being of the students and faculty alike. Accordingly, even if there were no Halachic obligation to vaccinate oneself or one’s child, the school would be well within its mandate to insist on vaccinations and to make this a requirement for attendance.

It has been suggested by some that a yeshiva has no right or business establishing and enforcing (mandatory) vaccination rules; this idea is more than difficult to accept. Even if a parent is particularly worried about the (supposed) ill effects of vaccinations, a medically unfounded concern for otherwise healthy children, this does not give them the right to ignore the rules established for the communal well-being. They are not forced to attend this school (or any other school for that matter, as home schooling is an option) if they choose not to conform to this or any other rules. The idea that parental autonomy should supersede school rules effectively means that there are no rules. Dress codes, which exist formally and informally in every yeshiva, are not left to parental discretion; so too those schools that regulate and restrict which forms of entertainment and media the students enjoy (on and off school premises) have specifically stated that they are not leaving it up to personal and family practice to decide these matters. The rules are imposed with the understanding that they have been deemed to be in the best interest of the students and represent the value system and world view of the Yeshiva; there is no reason to suggest that health and safety standards should be treated any differently.

 He goes on to discuss religious exemptions in US law -

In numerous states parents wishing not to vaccinate their children are permitted to sign a document stating that their religious convictions do not allow them to; based on this signature the child will then be permitted to attend school under the law. It is reported that small numbers of parents in Jewish schools have signed such documents. For a parent of a yeshiva student to sign such a statement in the name of Judaism is not just inappropriate, it is false. Whether a posek will rule that childhood immunizations are obligatory in halakhah or are discretionary (but highly advisable), there is no position in halakhah that says there is any prohibition or compelling reason to refrain from such vaccinations.

The New York State Department of Health allows exemptions for parents professing “genuine and sincere religious beliefs” that are contrary to immunization. As stated above, there is no validity to any suggestion that vaccinations are contrary to Jewish beliefs or practices. As such, to sign an affidavit in the name of Torah observance is simply false and should have no place in a yeshiva.

The State of New Jersey also provides for religious exemptions from mandatory immunization. N.J.S.A. 26:1A-9.1 states,

…When a parent or guardian submits their written religious exemption to immunization, which contains some religious reference, those persons charged with implementing administrative rules at N.J.A.C. 8:57-4.4, should not question whether the parent’s professed religious statement or stated belief is reasonable, acceptable, sincere and bone fide. In practice, if the written statement contains the word ‘religion’ or ‘religious’ or some reference thereto, then the statement should be accepted and the religious exemption of mandatory immunizations(s) granted

As is clear from the words of this code, the exemption is available for any and all professing a religious belief that vaccination is inappropriate, and such beliefs may not be questioned by any secular authorities. This language is most appropriate for the state, which neither has the interest nor the right to define religious doctrine; were it to do so it would likely soon find itself embroiled in legal action. However, this is not at all relevant to a yeshiva, which by definition sets the religious standards that are to be followed under its roof in all matters, both large and small. Even though the code itself does state that this exemption is to be given without questions being asked, there is no legitimate way that an Orthodox parent of an otherwise healthy child can claim that their religion prohibits or discourages vaccinations.

On the other hand, some states allow exemptions based on “personal beliefs” (not specifically religious beliefs). While there is nothing dishonest about a yeshiva parent having such a personal belief, it is a misguided one that should be corrected.