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A Nice Jewish Shot: Why Vaccinations are Kosher and Required
Let’s face it. Sometimes you can deny certain established scientific truths and it does not make much difference. You can, for instance, believe that the Earth was created about 6,000 years ago and life as we know it will still go on. OK, maybe Jon Stewart and certain professors and pundits will make fun of you, but as the little redhead Annie always reminds us, “the sun’ll come out tomorrow, bet your bottom dollar, that tomorrow there’ll be sun.”
If, however, you deny the safety and efficacy of approved medical vaccinations designed to prevent harmful, debilitating, even deadly diseases, such as polio, measles, hepatitis and tetanus, your belief may well make a great deal of difference to you, your family, your community and, indeed, all of humanity.
And yet, there are those who for a variety of reasons refuse to inoculate themselves or their children, or both, even when established governmental authorities require such action. While it is tempting to stereotype all such persons as undereducated or acting out of ignorance, some are not. Aside from the rare situations based on the medical condition of the child, some people object to a particular vaccine or procedure. Others have broader religious, philosophical and personal beliefs that militate against inoculations. (See, e.g., here and here.) Some even may be part of an otherwise socially conscious community.
Jewcology is a website that aims to be a resource for the “entire Jewish-environmental community.” One of the blogs that Jewcology hosts is written by Rafael Bratman, and one of Bratman’s posts is entitled “Water Fluoridation and Vaccinations are contrary to Torah principles.” Bratman’s diatribe is filled with so many erroneous statements that one is tempted to let this dog lie and hope that it gets lost in the tangle that is the World Wide Web. The problem, however, is that people visit the Jewcology site and several hundred of them have already indicated that they “like” the anti-vaccination post. While undoubtedly some people get their kicks from clicks, and will “like” anything, one cannot discount the possibility that some readers actually believe the nonsense contained in the piece.
Moreover, Jewish tradition teaches that we may not exploit our neighbors by placing a stumbling block in their path, neither may we stand idly by the blood of our neighbor. (See Lev. 19:14, 16.) To the contrary, we are obligated to remove the impediment, to protect the neighbor. So let’s remove this particular stumbling block, piece by piece. Let’s set the record straight.
Bratman’s post asserts three main arguments in opposition to vaccinations. The first is that they don’t work, that the benefits are “unclear and unproven.” The second and third relate to Jewish law. Bratman argues that vaccines are treif, that is, they contain ingredients forbidden to observant Jews, and also that their use violates the primary Jewish principle of pikuach nefesh, the preservation of life. None of the arguments is supported by any credible authority. The first is contrary to well established and documented medical science. The second and third thoroughly misstate Jewish tradition, as understood by a broad spectrum of scholars.
Vaccination Programs are Indisputably Safe and Effective
As explained by the U.S. Centers for Disease Control and Prevention (“CDC”), a vaccine is a chemical compound that contains a “killed or weakened infectious organism” that is then administered to a human being in order to prevent a disease. The diseases for which vaccines are administered include measles, mumps, pertussis (whooping cough), hepatitis, and smallpox, among more than a dozen. If you are not familiar with one or more of these diseases, thank a vaccination program.
According to the National Institute of Allergy and Infectious Diseases, a part of the U.S. National Institute of Health, vaccines work because they stimulate the human immune system to attack the invading microbes present in the vaccine. That is, they simulate a disease and trick the body into fighting it resulting in immunity to the real disease.
When introduced into a community, vaccination programs have been extraordinarily successful in preventing cases of disease and related consequences. The long view is instructive. In 1900, 53% of the causes of death in the United States were infectious diseases. By 2010, as a result of various vaccination programs, infectious diseases were responsible for only 3% of deaths in the United States.
The data is even more compelling when one looks at the results of introducing a vaccination program for a particular disease. For instance, prior to the wide spread use of measles vaccines in the United States in 1963, the annual number of reported measles cases exceeded 500,000. The drop-off after the introduction of the program was swift and dramatic. In 2009, there were only 71 reported cases, for a decline from base of 99.9%. Diphtheria, with a former base line of 175,000 annual cases, and smallpox with a base line of 48,000 cases, were non-existent in 2009, thanks to vaccination programs. Even where diseases have not been eliminated, e.g., mumps and pertussis, the reduction of cases has been dramatic. (See here.)
Over and over, the demonstrated facts are that vaccines work. Moreover, if enough people in a particular community are vaccinated, a process known as community or herd immunity develops offering protection to the few who, due to special circumstance, cannot be vaccinated.
While Bratman acknowledges that the incidence of polio has declined over the years, he attributes that result to “improvements in sanitation and hygene [sic].” Of course, Bratman fails to cite to a single such improvement, much less one that occurred throughout the United States at exactly the time in 1955 when the newly approved Salk vaccine was first being administered and which would account for a rapid 93% decline in cases of paralytic polio. What hard data shows is that incidents of infectious diseases, including polio, did not decline slowly and steadily over time due to continuous environmental improvements, but dramatically and directly as a consequence of the administration of a vaccine program. Not surprisingly, and despite Bratman’s suggestion to the contrary, the savings in direct medical costs and in indirect social costs resulting from fewer cases of infectious disease is substantial. (See here and here.)
Conversely, where participation in a vaccination programs has declined or been refused, we have seen a resurgence of diseases like measles, mumps and whooping cough, that some thought were contained if not eradicated. These outbreaks typically occur in close communities whose members fail to act vigilantly to secure comprehensive compliance with vaccination programs. In 2013, for instance, measles outbreaks were reported in a faith healing megachurch in Texas and the Orthodox Jewish neighborhoods of Williamsburg and Borough Park in Brooklyn, New York. A few years earlier, there was a mumps outbreak in New York and New Jersey. An investigation found that 97% of the case patients were Orthodox Jews.
Even more recently, measles has spread to upper Manhattan and the Bronx and has been reported in other areas around Boston, San Francisco and Los Angeles. What the CDC has found is that more than 80% of the reported cases occurred in persons who were not vaccinated and about four of every five such individuals purposefully chose not to be vaccinated!
The cause and effect relationship between infectious diseases and inoculations against them could not be more clear. When vaccination programs are introduced, the incidence of disease falls sharply. When participation in such programs falters, purposefully or by negligence, disease returns and spreads and not just individuals but whole communities suffer. (See here.)
Accepting a non-oral administration of a vaccine with “treif ingredients” is not prohibited
Referring to certain ingredients found in vaccines, Bratman asserts that for anyone who takes kashrut seriously, “it would seem a no brainer to avoid vaccinations.” On analysis, however, this argument fares no better than his first claim.
Vaccines, like other medical preparations, contain a variety of ingredients for a variety of purposes. Some of these ingredients are the active components in the vaccine, necessary for it to perform its task. Others are used as stabilizers for live vaccines or as preservatives.
For vaccines available in the United States, the CDC provides a comprehensive list of ingredients contained in those vaccines, as well as ingredients used in the manufacturing process but removed or remaining only in trace amounts. There is no doubt that some formulations of certain vaccines contain products that, if consumed, would possibly or certainly be considered treif by most authorities. These include not only chick embryo cell cultures and bovine muscle tissue, but such items as Vero (monkey kidney) cells, Madin Darby Canine Kidney (MDCK) cell protein, hydrolyzed porcine gelatin, embryonic guinea pig cell cultures, and human diploid cells such as lung fibroblasts.
For many, whether those items are more or less appetizing than other ingredients like formaldehyde, thimerosal, hexadecyltrimethylammonium bromide and sodium taurodeoxycholate is a matter of, well, taste. But the question here is whether they are treif when received by way of inoculation or spray or some other non-oral application.
Israeli Orthodox Torah scholar Rabbi David Samson summarizes the legal situation as follows: “There is no prohibition in using medicines which contain forbidden ingredients if they are administered by injection, suppository, enema, medicated bandage, and the like, since they are not eaten.” Bratman seems to have missed that distinction.
The general principle announced by Rabbi Samson received specific application last year in the United Kingdom, when Fluenz, a new flu vaccine containing a hydrolyzed pork gelatin was introduced. Fluenz is administered as a nasal spray. When asked whether usage was permissible, British kashrut authority Rabbi Abraham Adler from the Kashrus and Medicines Information Service confirmed that there was “no problem” with pork or other animal derived ingredients “in non-oral products.” Concurring, Rabbi Yehuda Brodie, registrar of the Manchester Beth Din, noted that the vaccines were not taken orally, were taken for medicinal and not nutritional purposes, that the gelatin was a “denatured product” which was “very far from the original piece of pork it came from,” and that it was a “small part of a complex formula,” all of which made it “absolutely acceptable.” Said Rabbi Brodie, anyone saying otherwise is “acting in the extreme.”
Rather than simply conclude that the issue is a “no-brainer” after all, let’s just say that some folks with very fine Jewish brains, who actually took the time to study the tradition and apply it to scientifically established facts, uniformly have agreed that the original source or nature of certain ingredients does not render non-oral applications of vaccines as treif.
Jewish Tradition Firmly Supports Compulsory Vaccination Programs
Bratman’s final argument is that vaccinations violate the Torah principle of pikuach nefesh. His contention could not be more wrong.
Obviously, there was nothing that we would recognize as resembling medical science in the days of the authors of the Torah or those of the Sages whose interpretations of Torah were collected in the Mishna and the Talmud. The rudimentary understandings of the great twelfth century physician scholar Moses Maimonides (aka Rambam) did not encompass vaccinations, either. Nevertheless, far from condemning vaccinations, the Jewish tradition contains principles that are both well established and almost universally understood to be applicable today and support vaccinations against infectious diseases.
The analysis begins, as it usually does, with the Torah. In addition to the two statements in Leviticus mentioned before, Deuteronomy contains a number of lessons that relate to a person’s obligation, his duty, to care for himself and his neighbor. In that last book of Torah, Moses is portrayed as summarizing the history of the Israelite experience from Mt. Sinai to the Jordan river and giving three farewell orations to the assembled people. In the first of these speeches, Moses urges the people to take the “utmost care,” to watch themselves scrupulously, to be “most careful.” (See Deut. 4:9, 4:15.) Later, in his second discourse, Moses reminds the people that indifference is prohibited, in favor of, for example, an obligation to make a parapet for a roof, so that the owner would not “bring bloodguilt” upon his house should anyone fall. (See Deut. 22:8.)
Subsequently, rabbis interpreted Moses statements as God’s commandments to protect one’s health, to guard against disease. The Talmudic concern with the well-being of a child was broad and deep. For instance, a parent was obligated to teach his child how to swim, lest the child be in danger if he was traveling by boat and the boat began to sink. (See BT Kiddushin 29a.) The overarching concern was the child’s needs.
The rabbinic discussion also considered whether the requirement to protect health was a negative or a positive mandate. The former would only require staying away from danger, but the latter would require affirmative conduct to protect one’s health. Rambam, in his summary of Jewish law, the Mishneh Torah, concluded that the duty was a positive one, and required proactive measures to mitigate a foreseeable harm. (See Mishneh Torah, Hilchot De’ot 4:1; Rotzei’ach 1:6, 14.) Similarly, the Shulchan Aruch, Joseph Caro’s mid-sixteenth century restatement of Jewish law, reaffirms that there is a religious obligation to take affirmative steps to prevent an anticipated danger to oneself or to others. (See Shulchan Aruch, Chosen Mishpat 427:8.)
The rabbis’ teachings were not merely academic, as became clear not long after Edward Jenner introduced the first effective vaccine against smallpox in England in 1796. In Eastern Europe, the Chassidic master Rabbi Nachman of Bratslov, wrote in his Kuntres Hanhagot Yesharot, that one “must be very careful about the health of children . . . (and) inoculate every baby against smallpox before the age of three months, for if he does not do so, he is like one who sheds blood.” (See here (14/31).) Sadly, in 1810, Rabbi Nachman died at age 38 of tuberculosis, a century and a half before the development of a TB vaccine.
More recently, the Reform and Conservative movements in the United States have issued formal commentaries on the issue of vaccination. The Reform analysis was published in 1999 by the Responsa Committee of the Central Conference of American Rabbis (“CCAR”), Rabbi Mark Washofsky, Committee Chair. (See generally, “Compulsory Immunization,” Reform Responsa for the Twenty-First Century (CCAR 2010 v. 1), at 107-120.)
The Reform responsum on vaccinations was written with respect to a challenge raised by some parents to a congregation’s policy that required immunizations as a pre-condition to a student’s attendance in the congregational school. Apparently, the parents thought the required vaccinations were “excessively risky” and elected not to immunize their children. (See Id.at 107.)
The CCAR began its analysis by noting the “fundamental fact” that Jewish tradition considers the practice of medicine to be a mitzvah, that is, a religious obligation. Moreover, it is an aspect of the dominant principle of pikuach nefesh (the preservation of human life), the precise principle Bratman thinks prohibits vaccinations. The Committee then reviewed the history of infectious diseases in the United States, including the reduction and even elimination of certain diseases due largely to vaccination programs. The result, it concluded, was “surely one of the great success stories of the twentieth century . . . .” (Id. at 109.)
Without discounting the reality that vaccines are not “completely safe,” based on credible scientific evidence, the Committee agreed that any risks posed were “‘very much outweighed by the public health benefit of’” vaccination programs. (Id. at 112.) Similarly, such programs generated enormous cost savings “in terms of direct medical costs alone.” (Id. at 110.)
Finally, the Committee recognized the benefit of community or herd immunity created when a sufficient percentage of a particular community are immunized. This immunity provided additional protection especially to those who were, for unique reasons, unable to be vaccinated. Conversely, it determined that refusal to vaccinate a child not only created a dangerous situation for the unimmunized child, but also for the community at large. (See Id. at 112-13.)
Concluding that “there are no valid Jewish religious grounds to support refusal to immunize as a general principle,” the Committee found the congregation entitled to require immunization of students in their congregational school as a prerequisite to attendance. (See Id. at 113-15.)
The Conservative Movement’s view was expressed six years later by the Rabbinical Assembly’s Committee on Jewish Law and Standards, also with respect to school immunizations. The Committee’s statement “Compulsory Immunization in Jewish Day Schools” (the “Statement”) was authored by Rabbi Joseph Prouser. It begins with a review of state immunization mandates and various objections to vaccinations. In its review of Jewish law, not surprisingly, it places a greater emphasis on a larger number and wider variety of traditional sources than did the CCAR. The results were, however, the same.
Prouser’s review of halachic literature begins with the telling observation that “(e)nthusiastic halachic support for immunization protocols emerged even before” Jenner’s development of a smallpox vaccine, at a time when the best practice, called variolation, consisted of deliberately infecting patients with smallpox or cowpox. While the risk of contracting the disease from that technique was about one in a thousand, at that time such a risk was considered negligible, especially given the potential benefit. (See Statement, at 12/31.)
The analysis also references three contemporary Orthodox authorities, each with a different, though consistent approach. One argues that society has a right to compel “life-sustaining treatment” even when a parent is opposed to it and even when that opposition is religiously motivated. Another supports vaccinations mandated by the state under the principle of Dina d’Malchuta Dina, that is, the law of the land is the law. A third finds that the laws of Shabbat may be set aside in order to avoid a “life-threatening situation.” (See Id. at 15/31.)
The conclusion, based on hundreds of years of experience with vaccinations, is clear to Prouser. There is a “well established preference for preventive medicine as a religious mandate.” (Id. at 15-16/29.) Consequently, “(u)nless medically contraindicated for specific children, in extraordinary and compelling cases, parents have an unambiguous religious obligation to have their children immunized against infectious disease.” By doing so, parents fulfill a “religious obligation to remove hazardous conditions which imperil the public’s health and safety.” Conversely, failure to do so is “a serious, compound violation of Jewish Law . . . .” (Id. at 29/31.)
And let’s not forget the Reconstructionists. Concerning a theoretical decision by parents to avoid vaccinating their children, Rabbi David Teutsch writes succinctly: “Since the duty to heal is communal, this choice is ethical only when parents believe that no one should be vaccinated or when the vaccine poses a grave health risk to a particular child.” (See A Guide to Jewish Practice (RRC Press 2011) at 505.)
Needless to say, Bratman does not discuss numerous pertinent passages in the Torah and Talmud, the various codes of Jewish Law, or contemporary commentary from Orthodox, Conservative, Reform and Reconstructionist perspectives, each of which leads to or reaches the same conclusions. Vaccinations are not contrary to Torah principles. Indeed, vaccinations are mandated because Jewish tradition places the highest value on preventing foreseeable damage to individuals and the community.
We must protect our community
There are not more than fourteen million Jews on this planet. And we cannot afford to lose a single one to a preventable disease. As Rabbi Prouser reminds us, in prior times, in places where Jewish law governed, those who endangered the health and well being of the community could be lashed or excommunicated. (See Statement, at 22-25/31.) In America today, lashing and excommunication are not likely, or even desirable, remedies to achieve compliance with Jewish norms. But we can still speak, and still insist: For the sake of the children and in the interest of the Jewish People, Mr. Bratman, take down that post!