Vaccinate your kid!

Rabbi Nachman of Bratslav was a great grandson of the Baal Shem Tov; he was a chasidic master whose mysticism, extremism, creativity, asceticism, willfulness, and wild emotional swings from despair to ecstasy and then always back to despair make him an almost Byronic figure – had Byron, his contemporary, been a Jew from eastern Europe.

Nachman was thought to be so irreplaceable to his chasidim that they never did replace him; his spiritual descendants go to his grave in Uman, an otherwise obscure Russian town, around Rosh Hashanah every year, wearing their Na-Nach-Nachman-Me-Uman kippot as they brawl noisily around the town.

So why, you might wonder, is Nachman at the start of a story about vaccines?

Get The Jewish Standard Newsletter by email and never miss our top stories Free Sign Up

Because, according to Joseph Prouser, rabbi of Temple Emanuel of North Jersey in Franklin Lakes, Nachman was firmly in favor of vaccines.

Rabbi Prouser wrote a teshuva, “Compulsory Immunization in Jewish Day Schools,” for the Conservative movement’s Committee on Jewish Law and Standards. Published in 2005, it finds that “”Unless medically contraindicated for specific children, in extraordinary and compelling cases, parents have an unambiguous religious obligation to have their children immunized against infectious disease…”

But back to Nachman.

This quote, from Kuntres Hanhagot Yesharot, paraphrases Nachman’s position, referring to him as “Our Rabbi, of blessed memory”: “We must be exceedingly careful about the health of children, especially while they are still small. One should in no way be lax in this matter… Our Rabbi, of blessed memory, said that one must vaccinate every baby against smallpox before the age of three months, for if he does not do so, he is like one who sheds blood. And even if one lives far from the city, one must travel there even if the season is very cold, etc.”

Nachman lived from 1772 to 1811; by that time, vaccinations against smallpox, possibly the greatest scourge among the many ghastly diseases that terrorized Europe, were not particularly new. Nor was the phenomenon of Jews urging the use of science to protect themselves against the threat.

Even before the Englishman Dr. Edward Jenner introduced the vaccine that protected against smallpox, there was a similar technique, called variolation, which also involved infecting people with what was hoped to be a far milder strain of the disease, giving immunity to those who survived it. (Not everyone did; the fatality rate, an estimated one in 1,000, was far higher than anything we’d find acceptable today.)

Rabbi Abraham Nanzig wrote a “brief but impassioned treatise,” Aleh Terufah, Rabbi Prouser tells us. A transplanted Frenchman living in England, Rabbi Nanzig had lost two children to smallpox by 1785, when he was asked whether it was permissible “for a Jew to use this treatment which, it appears, involves exposure to a minor risk in order to obviate a great risk yet to come.” Yes, he said. It is right to draw from both “the knowledge of the sage and the expertise of the physician.” As for the risk – “One who undergoes this treatment while still healthy, God will not consider it a sin. Rather, it is an act of eager religious devotion, and reflects the commandment to ‘be particularly careful of your wellbeing’ (Deuteronomy 4:15).”

In fact, Rabbi Prouser added in his teshuva, Rabbi Nanzig reached back one link on the chain of authentication to cite a colleague, Rabbi Shalom Buzagli, who was from Fez, Morocco.

A child who had survived smallpox and was recovering would be given a handful of raisins, Rabbi Buzagli said. After the child had clutched them long enough to warm them, the gooey mass would be retrieved from that child and given to another, someone who had not yet had smallpox. That child ate the raisins. The hope was that the virus would be etiolated enough at that point to provide immunity without disease. (The results were not reported.)

“I based that paper around the law of the parapet,” Rabbi Prouser said. That’s the requirement, from Deuteronomy 22:8, that a person building a roof had to build a railing around it to protect against the possibility of someone falling from it. “If there is a foreseeable danger to health or life, you have an affirmative obligation to put preventative measures in place to obviate that danger,” he said.

“Immunizations, with their proven track record and safety, are a pharmaceutical parapet. The explicit commandment in the Torah to prevent injuries or death resulting from foreseeable dangers is directly applicable to infectious disease and vaccines today.”

Rabbi Prouser addressed the once commonly held theory that vaccines caused autism. When he wrote his teshuva, “good science already said that it was bad science, but the link was later shown to be completely fraudulent,” he said

The link that Rabbi Prouser mentioned – the connection between autism and the vaccination for measles, mumps, and rubella – was made by a British physician, Dr. Andrew Wakefield, who claimed to have performed a 12-subject study proving it. The results of that 1998 study, which were published in the Lancet, a prestigious British medical journal, never could be duplicated, despite many scientists’ efforts. In 2004, most of the study’s co-authors removed their names from it, once they learned that Dr. Wakefield had financial conflicts of interest. In 2010 the Lancet retracted the study – if you google it today, you will find the word RETRACTED stamped all over it in big upper-case red letters.

The lack of connection is strongly endorsed by American groups, including the American Academy of Pediatrics and the Centers for Disease Control.

But the damage was done. Parents eager to find a reason for their children’s autism, which usually and coincidentally manifests itself clearly at around the same time the vaccine is given, found comfort and hope in that study.

Many of the roots of today’s vaccine wars can be found in that study.

“I was very sorry that I had written my paper shortly before the absolute proof that the link was fraudulent came out,” Rabbi Prouser said. “I felt that my argument was airtight without it – but it would have been even stronger with that information.

“It really is criminally negligent of parents to allow their children to be unvaccinated,” he concluded. “In addition to the danger it poses to other children, the danger is most directly to their own children.”

Shmuel Goldin, rabbi of Congregation Ahavath Torah in Englewood, is the immediate past president of the Rabbinical Council of America, representing Orthodox rabbis.

The RCA and the Orthodox Union released a joint statement on the issue, urging parents to vaccinate their children, based on both science and halacha. “The vaccination of children who can medically be vaccinated is absolutely the only responsible course of action,” it reads.

Rabbi Goldin strongly supports that position. “We rely on medical expertise when it comes to matters of health,” he said. “Given that the overwhelming majority of medical positions on vaccination hold that they should be administered and accepted for the benefit of the children involved, it’s our responsibility to do so.

“As parents and as members of the community, we are all affected by each other’s health, so it becomes not only a parental but a communal obligation.”

Rabbi Daniel Freelander of Ridgewood is the president of the World Union for Progressive Judaism and the former senior vice president at the Union for Reform Judaism.

He said that as he looks over his colleague’s responses to the issue of vaccination, “most see it as an issue of pikuach nefesh” – the overwhelming importance of protecting life. “It’s about protecting the lives of your own child and the others in the community.”

The question comes up when parents with unvaccinated children want to send them to the Reform movement’s camps or schools, he said. After some discussion, the decision was “that while we accept the right of an individual not to have his or her child vaccinated, we think it is unfair to put another child at risk because of someone else’s child.

“The needs of the community override the desire of the individual in this case.”

It is often hard to discuss the issue, Rabbi Freelander said, because “it is often not a rational conversation, but an emotional one.”

Rabbi Paul Resnick of Teaneck is the director of one of the Conservative movement’s Ramah camps. His camp, Ramah in the Berkshires, draws campers from northern New Jersey and the rest of metropolitan New York.

For at least 10 years, and in response to the decision of its medical committee, Ramah Berkshires has demanded that all campers and staffers be vaccinated. “It’s rarely a problem, but every few years there is a family who reads our literature, realizes the children have to be vaccinated, and then they speak to our medical chair,” Rabbi Resnick said. Usually the result of that conversation is that the children get vaccinations – most likely the parents already have started to realize that vaccination was inevitable, he said. “But it’s very rare – maybe once every four or five years.”

The decision is not only to protect campers, he said, “but staff members, possibly pregnant staff members – to protect the entire community.

“Parents realize that we are protecting not only that particularly camper but everyone. The entire community.”

Paul Reichenbach of Ridgewood is the director of URJ camps. “We came to the determination that it was absolutely in the interest of communal health and consistent with Jewish values that we would require every kid who comes to our camp and Israel programs to be vaccinated,” he said.

“We went through an entire process. We had conversations with our camp directors, with the medical advisers for each of our camps, and we also looked through the material Ramah had developed, a year or so ahead of us,” he said. “We developed and created a vaccination policy that speaks specifically to the critical importance to the health and welfare of our communities of having vaccinated kids.”

“Since we have gone to this policy, in the last seven or eight years maybe there have been three or four or five cases of legitimate medical refusals.”

Not vaccinating your children can have unanticipated results, he said. “They couldn’t have realized that it would eventually lead them to not being allowed in a Jewish camp. They thought that they would always be given a religious or philosophical pass.

“Sadly, we even have some parents who went to our camps who we have to tell that their kids are not vaccinated, so they are not eligible. They are very surprised. They say, ‘What kind of Jewish camp are you that you do not support people’s personal values?’

“The crisis now, though, has driven home the point that it is in people’s best interests to be vaccinated.”

Not surprisingly, he said, “historically, there were more unvaccinated kids who wanted to participate in our west coast camps than in other places.” Still, he said, it happens elsewhere as well. “We had a case last year with a kid from Mississippi. We have had kids from Florida, Connecticut – there are parents from all over the country who do not want to vaccinate their kids and still want to send them to camp.”

The recent measles outbreak does not make him feel “vindicated, but now the community finally is beginning to realize how extraordinarily important it is.

“We are dealing with the health of thousands of kids and adults every summer. Health and safety are our number one concern. We take it very seriously.”

Jeremy Fingerman of Englewood is the CEO of the Foundation for Jewish Camp. “We are a granting foundation, so we don’t operate camps and we can’t dictate what they do,” Mr. Fingerman began.

“But, with that caveat, we strongly recommend a vaccination policy.

“We think that it is in keeping with Jewish values of maintaining health and with the clear public health need to protect the community.

“We think that it is a very Jewish value, and we recommend it.”