‘Not vaccinating is not a Torah value’

As of last week, there were 266 confirmed cases of measles in Rockland County.

According to the county’s health department, they’re “presently clustered in eastern Ramapo (New Square, Spring Valley, Monsey).”

Those are chasidic enclaves.

Although it is not only fair but also necessary to say that most right-wing Orthodox Jews — and even most chasidic and charedi Jews — vaccinate their children, just as most other Jews, from the centrist Orthodox to the farthest left Reform Jews do — and just like most other Americans do.

It is also not only fair but also necessary to say that parents who decide not to vaccinate their children love their children and work to provide them with what they think they need. Their decision not to vaccinate their children is not based on lack of care or love.

But it still can lead them to disaster. Because it’s been so long since the disease was almost eradicated, people forget how deadly it could be. Most people survive unharmed, but some are gravely affected, and some die.

And it’s back.

Dr. Alan Kadish of Teaneck, the president of Touro College, worries that although the number of cases sounds low, it continues to rise. “It seems to be contained, in that it is not yet reaching epidemic proportions,” he said. “We hope it won’t reach that level. The efforts that have been underway have managed to control it to some extent.

“That is good news. Nonetheless, there still remains a stubborn anti-vaccine movement that is continuing to try to discourage people from vaccination.”

An anti-vaxx rally in Monsey on May 13 drew a large crowd; another, in Brooklyn, on June 4, drew fewer people. Both rallies featured big names in the anti-vaccination movement; the one in Monsey included a Skyped interview with Andrew Wakefield, the British ex-doctor whose medical license was revoked in response to his paper, which purported to show that the measles-mumps-rubella vaccine given to young children caused autism but later was proven to be not only incorrect but also fraudulent. Del Bigtree, another famous anti-vaxxer who is a film and television producer by trade, spoke in Brooklyn.

Although there were some notable charedi and chasidic anti-vaxx speakers in Monsey, neither Wakefield nor Bigtree is Jewish.

“The rally in Brooklyn supposedly attracted few people, partly because there was an aggressive campaign to discredit the speakers,” Dr. Kadish said. “There also were ads taken out in some outlets read by the community saying that if you attend the rally, you will be photographed, and the pictures will be placed online.”

This is doxxing — putting someone’s private information online, thus allowing opponents to harass him or her not only virtually but offline as well. It is evidence of how the question of vaccination has roiled the charedi and chassidic communities, Dr. Kadish suggested. “This shows how strongly people feel that this anti-vaccination movement is dangerous, and could possibly lead both to severe illness and to a negative effect on the community, particularly in a city where the number of anti-Semitic episodes are increasing,” he said.

The rally was strong medicine for the anti-vaxx crowd, he said. “I was not at the rally, but I heard about it.

“What I heard was that there were a lot of crazy things discussed, including alleging that the measles outbreak is a Nazi plot by Bayer and Merck,” the drug companies. “And then there was Del Bigtree, who said crazy stuff, including the debunked idea that vaccines cause autism and diabetes, that they are harmful, and that doctors are untrustworthy and unreliable.”

Dr. Kadish pointed to a study released earlier this year, and online on the Annals of Internal Medicine, that looked at “657,461 children born in Denmark from 1999 through 31 December 2010, with follow-up from 1 year of age and through 31 August 2013.”

Its conclusion, like the conclusion of other, similar, but smaller studies, should be definitive, he said. This is how it reads: “The study strongly supports that MMR vaccination does not increase the risk for autism, does not trigger autism in susceptible children, and is not associated with clustering of autism cases after vaccination. It adds to previous studies through significant additional statistical power and by addressing hypotheses of susceptible subgroups and clustering of cases.”

“This unequivocally shows that this crazy idea” — that MMR vaccines cause autism — “clearly is not true,” Dr. Kadish said. “The analogy I use is that probably 250 million Americans were in a car yesterday, and today a few dozen people were diagnosed with brain cancer. That doesn’t mean that the car caused the cancer.” In fact, he added, as just about everyone who knows about the relationship between autism and vaccination does, autism usually manifests in young children coincidentally at the time when they are vaccinated. Correlation is no causation.

But he worries about the effect of so many people who are so visibly Jewish refusing vaccinations. “The Jewish community is being blamed for the measles outbreak,” he said. “This is clearly a dangerous time, and while I see the outbreak of measles being contained, I think that it will be harder to contain the outbreak of anti-Semitism.”

Ira Bedzow is an assistant professor of medicine at New York College, which is part of the Touro College and University System, and he’s the director of its medical ethics program. His academic credentials — a Ph.D. in religion from Emory, a master’s degree in Jewish studies from Touro and another master’s, this one in humanities, from the University of Chicago, all built on the B.A. in political science he earned at Princeton, as well as Orthodox ordination in Israel — leave him well if not uniquely situated to understand why the ultra-Orthodox communities include so many anti-vaxxers.

The chasidim and charedim who do not vaccinate their children do not do so because of a conflict of values, but because they do not believe that vaccinations will protect their children. “They suspect the evidence that vaccines are good,” Dr. Bedzow said. “It speaks to a larger issue in terms of their trust in the reliability of science and the scientific community. You see this not only with vaccination, but also with the increase in the use of alternative and complementary medicine in those communities.”

What? Really? There is?

“Yes,” Dr. Bedzow said. “There have been a number of books that came out recently both in support of and in criticism of complementary medicine. A book came out about two years ago called ‘Alternative Medicine and Halacha.’” (It’s by Rabbi Rephoel Szmerla of Lakewood, and it’s generally in favor of some alternative practices.)

There are always complicated questions “about the efficacy of medicine in general, and about the source of medical intervention.” In the Jewish world, the Talmud and rabbinic decisors offered ways to look at them. There are three basic principles, Dr. Bedzow said. You cannot go to a spiritual healer who is idolatrous; “that would rule out non-Jewish healers working in the name of their god or gods.” Next, if you do go to a healer who is not Jewish, but “says nothing about religion and is not doing anything in the name of his god, and if the healing works,” no problem. “You consider it as medicine.” And “if the procedure is natural, and there is cause and effect” — if it makes sense — “you don’t have to worry about what the healer says or does, because the healing will be attributed to general causes. So it doesn’t matter if an idolater is healing you, because the patient knows the healing is based on science, but if you don’t know why it works, and you can’t attribute it to science, then there is a concern that you can be drawn into improper beliefs through spiritual healing.”

So it’s complicated. You can trust the healer’s art — and results — as being natural and therefore acceptable, or you cannot. You can attribute something to science — or not. First you might have to define science. If you can’t, then the entire thing is off limits.

“So in today’s complicated medical environment, when people have to defer to experts in general, then okay, do we trust that expert in explaining facts and causation, or do we not?” Dr. Bedzow asked rhetorically. “That’s why the politics of vaccination has gone the way it has.”

Members of the charedi and chasidic community are against vaccinations, in other words, because they find the values of the scientists who provide them to be antithetical to Torah values. “Individuals and communities hold their own truths, where empirical data is understood given the value-lens through which people interpret it,” Dr. Bedzow wrote in an email. “Because it is perceived by certain charedi groups that the values held by those with a scientific worldview to be antithetical to a Torah outlook, even scientific findings, and not simply policies or treatments based on those findings, are seen by them to be contrary to a Torah outlook.

“It is, therefore, not the case that they are simply misinformed. Rather, it is a situation where the information cannot be trusted due to ad hominem concerns.”

So why does the community listen to people like Wakefield and Bigtree, who are absolute outsiders? “When they bring non-Jews who do not have the same core worldview, they are not trusting the positive part of what they are saying,” Dr. Bedzow said. “They are saying that we both agree not to trust the other guy.” The enemy of my enemy is my friend. “But once you say that, you realize that vaccinations now have become a litmus test.”

How do you fix this?

“It’s not useful to approach it by saying ‘I am right and you are wrong,’” Dr. Bedzow said; that’s an approach that’s rarely useful anywhere. “People become defensive. But if you can understand the source of the disagreement, then it’s easier to get to that source. If the disagreement is about trusting the source of the authorities providing the evidence, that has to be a part of the conversation.”

Rabbi Larry Rothwachs talked about vaccination in his Shavuot sermon at his shul, Congregation Beth Aaron in Teaneck. “I started with the conclusion and worked my way back to it,” he said. “And the conclusion is that the concept of a religious exception from vaccination for someone who is claiming to represent a Torah perspective is an oxymoron.

“There is no halachic argument that can be made that an otherwise healthy child somehow should not be vaccinated. That was where we started.”

Of course, the argument is complicated. “When it comes to any Torah discussion, there are a range of views, and matters are complex,” Rabbi Rothwachs said. “We focused on different angles — the importance of maintaining your health, from a Torah perspective, and what to do in a situation with potential conflicts. If someone has to to undergo a treatment where there are risks, Torah law addresses how we are to determine what those risks are, and how a person is required to act.

“In this case, though, the conversation is more theoretical, because the overwhelming consensus is that the risk of vaccinating a child is relatively minor — sometimes some swelling, rashes, maybe a fever — and the benefits both to the child and to the whole community are extraordinary.”

Doctors are experts in this field, Rabbi Rothwachs said, and their counsel is to be followed. “The Torah says we are to take care of ourselves. How do we define that? It’s what the doctors tell us to do.

“My understanding is that over 99 percent of Western doctors vaccinate. There are people who claim to be scientists who say that the earth is flat, or that the moon landing was a hoax. There are people with a history in the defense department who say that 9/11 was an internal job. There always are people who despite their experience and knowledge may be prone to conspiracy theories, but you would be hard pressed to find more than a handful of doctors who are against vaccination, even if you were to spend many days driving from one community to the next. We have moved beyond that as a community.”

Anti-vaxxers are not a problem in Beth Aaron, Rabbi Rothwachs said. “If there are any members of my community who have made the decision not to vaccinate their children, I am entirely unaware of it, and it would surprise me.

“But I spoke about it on Shavuot because I wanted to make it absolutely clear, despite what you hear, that there is no basis in Torah law to say that vaccination is anything other than a good thing. And it’s not just a good thing, it is one of the most consequential medical developments in modern times. So I want to reassure anybody who needs reassurance that despite the fact that there are some Jews who are carrying the banner of Torah law, tradition, and halacha to say that vaccination is wrong, and we don’t do it, there are no reputable poseks who maintains this position. None.

“A rabbi can have a long beard and payes and he can say whatever he wants, but his long beard and his payes do not make him a posek.”

Like Dr. Kadish and Dr. Bedzow, Rabbi Rothwachs emphasized that anti-vaxxers love their children very much, and he sympathizes with the Jews who feel that they are being targeted with vaccines because they’re Jewish. “They are not bad people; my guess is that they have been raised in very insular settings,” he said. “They probably don’t know much about scientific research and the scientific methods, and what it takes for drugs to get FDA approval.

“It is no secret that there was a time in our history when their fears were not baseless, but they seem to be stuck in time. They leave the rest of us scratching our heads saying, ‘I don’t know how to respond to this.’”

The only way to respond, he continued, “is to take their hands. It will be a slow process. You can’t yell at them. They very much care about their children, and they think that people want to poison them. They think that there is a big conspiracy to kill their children.”

He is encouraged by a “glossy pamphlet that had been included in Mishpacha magazine.” That’s a Hebrew- and English-language publication put out by and for various ultra-observant Orthodox groups and distributed around the world. “It had copies of handwritten letters from gedolai Israel from all the different camps, mainly right-wing chasidic. All of them, without mincing words, came to the same conclusion — that vaccination is a requirement, a mitzvah. One of the letters went further and said that people who are not vaccinated should not be included in schools or shuls or camps. It was really very shtark” — very strong — “words in Yiddish. I have to imagine that something like that will have an effect.

“My guess is that they are concerned about the health of their communities, and also about trying to preserve their reputations,” Rabbi Rothwachs said. “Sometimes these individuals take positions that are not popular, like about service in the Israeli army, that many people don’t appreciate.” (They’re fiercely opposed to the young men in their community serving in the IDF.) “It is critical for them to dissociate themselves with this mishegoss” about not vaccinating children. “This is a community with its own norms, but they clearly are putting a lot of effort and resources and energy into propagating a very clear and unambiguous message.

“The message is that not vaccinating is not a Torah value.”