A headline published in The Toronto Star on Oct. 24, 1896 read: “Vaccination necessary and no one objects now.” The article went on to say that society had finally come to accept vaccines after nearly a century of protest, “monster demonstrations” and even the jailing of parents who refused to vaccinate. By 1896, the “agitation seems to have died out and very little is heard in these days against the efficacy of vaccination.” “Ultimately all these diseases which make such sad havoc in our homes will in time have to succumb to the scientists,” the report concluded. Today, smallpox has been eradicated and vaccines are considered to be one of medicine’s greatest achievements, preventing two to three million deaths every year, according to the World Health Organization. Yet, public health officials in many countries have been troubled by persistent resistance to vaccination from “anti-vaccination” movements.1

The first effective vaccine was developed by Edward Jenner, a British country doctor, who discovered that innoculating with cowpox, a mild disease related to smallpox, protected against smallpox, and had the opportunity to test his hypothesis in May 1796, when a milkmaid named Sarah Nelmes developed cowpox through contact with a cow.

The fall of smallpox (when syphilis became epidemic in the 15th century, the term smallpox was adapted, to distinguish it from the former “Great Pox”) began with the realization that survivors of the disease were immune for the rest of their lives. This led to the practice of variolation – a process of exposing a healthy person to infected material from a person with smallpox in the hopes of producing a mild disease that provided immunity from further infection. The French writer Voltaire wrote that in the early 1700’s, 60% of the population caught smallpox and 20% of the population died of it. Variolation saved many lives, but occasionally led to a full-blown case of smallpox. The first effective vaccine was developed by Edward Jenner, a British country doctor, who discovered that innoculating with cowpox, a mild disease related to smallpox, protected against smallpox, and had the opportunity to test his hypothesis in May 1796, when a milkmaid named Sarah Nelmes developed cowpox through contact with a cow. On 14 May, Jenner extracted fluid from a pustule on Nelmes’s hand and used it to inoculate a healthy 8-year-old boy named James Phipps through two half-inch incisions on the surface of the arm. Six weeks later, Jenner variolated (inoculated into the skin) smallpox material into the child’s arm and no skin rash or vesicles appeared, proving the child had become immune to smallpox from the initial compox inoculation. He performed the procedure again some months later with the same result. Jenner tested this on 23 more subjects, all of whom proved immune to smallpox from cowpox vaccination, and he eventually published his findings, with the result that smallpox vaccination became widespread throughout Europe and America in early 1800’s.

Anti-vaccination movements began to oppose vaccination after England passed laws from 1853-1867 requiring vaccination and imposing fines or imprisonment for refusal. Resistance to these laws began immediately after passage of the 1853 law, with violent riots in Ipswich, Henley, Mitford, and several other towns. The founding of the Anti-Vaccination League in London in the same year provided a nucleus for opponents of vaccination. A large number of anti-vaccination tracts, books, and journals appeared in the 1870s and 1880s. The journals included the Anti-Vaccinator (founded 1869), the National Anti-Compulsory Vaccination Reporter (1874), and the Vaccination Inquirer (1879). Similar movements flourished elsewhere in Europe. In Stockholm, the majority of the population began to refuse vaccination, so that by 1872 vaccination rates in Stockholm had fallen to just over 40%, whereas they approached 90% in the rest of Sweden. A major epidemic in 1874 shocked the city and led to widespread vaccination and an end to further epidemics.

In the 20th and 21st centuries anti-vaccination movements have continued, promoting ideas similar to those promoted in previous centuries. I explored this in an article published in the British Medical Journal in 2002 entitled “Antivaccinationists Past and Present.”2 Below is a sample of anti-vaccination ideas, past and present. The headings are based on another of my studies that examined anti-vaccination web sites.3

 

Table: Anti-vaccination claims, past and present

A number of studies have examined vaccinations to see if there is a link to autism, and to date no link has been found.8 The most persuasive study was done in Denmark. Records of 537,303 children born in Denmark between Jan. 1991 and Dec. 1998, representing almost 100% of children born in that period  were studied. 440,655 had been vaccinated with MMR and 96,648 were not vaccinated (18%). The incidence of autism appeared to be HIGHER in children who had NOT been vaccinated with MMR but statistically speaking, there was no difference in the rates. The adjusted RR (relative risk) of autistic disorder was 0.92 with MMR, 95% CI: [0.68 to 1.24]; this means that children who received MMR vaccine had 8% less autism than the average rate (average being 1.0), and the CI, or confidence interval, was 0.68 to 1.24, which means there was a 95% chance the actual rate for children immunized with MMR vaccine was between these two numbers; again, suggesting no difference between getting or not getting MMR.9

Suprisingly, many Orthodox Jews have attached themselves to this anti-vaccination idea.

• In March 2018, a group of Orthodox Jews in Lakewood, NJ, calling themselves “The Vaccine Choice Coalition” made a website (http://www.vaccinecoalition.org/) opposing mandatory vaccination. The APP website (part of USA Today) noted: “Some of Lakewood’s most influential Jewish institutions rebuffed the effort, calling it the work of a small, fringe group that ignores the advice of medical professionals who overwhelmingly support immunizations.”10

• In July 2018, the Israeli Ministry of Health was notified of cases of measles that were diagnosed in the northern city of Tzefas, primarily in the chareidi community.11

• In 2013 there were 175 reported cases of measles in the United States; 58 of those cases were among Hasidic Jews in the Brooklyn’s Boro Park and Williamsburg neighborhoods. In Boro Park, there were 28 cases, all members of three extended families who had refused to vaccinate their children. The primary reasons for lack of vaccination among the 30 infected in Williamsburg were refusal and delay to vaccinate.12

• In 2010, there was an outbreak of mumps among 1,500 Jewish boys and young men in Brooklyn. At that time, Dr. Eli Rosen published an open letter in a Crown Heights publication emphasizing that the illness is preventable, and urging the community to get vaccinated.13 On the website where his letter appeared, 46 comments were posted by readers, of which 21 argued against vaccines or for “natural” methods to prevent childhood infectious diseases.

When asked about vaccination, the Lubavitcher Rebbe was clearly in favor of vaccinating. In the spring of 1956 the Rebbe wrote (Igrot Kodesh, vol. 11, p. 137):

“. . In reply to your letter in which you ask my opinion about the injections that are commonly given to young children: It is with regard to matters such as these that the axiom ‘Do not set yourself apart from the community’ applies. You should act according to that which is done by [the parents of] the majority of children who are in your children’s classes . . .”
[quoted by Yehuda Sherpin in his article “What Does Jewish Law Say About Vaccination?” at Chabad.org.14]

The vast majority of halachic authorities support and encourage vaccination.14,15  However, there are some halachic authorities supporting anti-vaccinators, including Philadelphia-based Rabbi Shmuel Kaminetzky, and Rabbi Shlomo Miller, an halachic authority in Toronto, both of whom ruled that individuals have the right, according to Torah, not to vaccinate their children. (“The Vaccine Choice Coalition” mentioned above also cite the support of “HaRav Malkiel Kotler shlit’a, HaRav Elya Ber Wachtfogel shlit’a and HaRav Shmuel Meir Katz shlit’a”). In 2014, Rabbi Moshe Tendler, one of the heads of New York’s Yeshiva University and an expert in medical ethics strongly condemned the view of these rabbis. “This is an area in which medicine has made such tremendous progress for the benefit of humanity,” Tendler told The Forward. “I believe that there may very well be rabbis who agree with Kaminetzky, but they are not speaking under their authority as rabbis, they are speaking simply as uninformed laymen.”16

In general it is easier to alarm people about vaccines than to calm them down, especially in an era when we have modern medicine and antibiotics, and the memory of the scourge of childhood illness has receded into the past. The internet also plays a role in this, since it is easy to make a website, even of misinformation, look authoritative.

Mother, pale and silent, continued to walk the floor, wringing her hands and going to the window now and then to look down the road. I followed and looked up and down the road too, but saw nothing.

To help to understand what it was like to live in an era without vaccines, I particularly like this excerpt from a book “The Horse and Buggy Doctor” by Arthur E. Hertzler, MD (1870-1946),17 describing his childhood in Iowa in the pre-vaccination era:

“Protect us, 0 God, from diphtheria!” These ringing words uttered by my father at moming prayers were my first introduction to the tragedy of diseases. The atmosphere in our home that morning was tense. Father and mother ate no breakfast, and we children, not knowing why, left the large platter of fried mush, which usually quickly disappeared, practically untouched. Soon father left home dressed in his Sunday clothes. Mother, pale and silent, continued to walk the floor, wringing her hands and going to the window now and then to look down the road. I followed and looked up and down the road too, but saw nothing.

Some hours later a long line of teams came slowly down that road. Driving the lead team, a strange one, was my father, and beside him sat a man I did not know. In the bed of the farm wagon were three oblong boxes. Following were spring wagons, farm wagons, and a large number of men on horseback. Questions directed to my mother brought no answer. Father retumed home after many hours and cryptically announced as he came in the door: “Five more.” Mother sank into a chair and covered her face with her apron.

As days wore on I leamed that the wagon had borne the coffins containing the bodies of three of my playmates. Five more followed in quick succession. Eight of the nine children in that one family died of diphtheria in ten days. There remained only a baby of nine months. The mother took to carrying this child constantly even while she did the farm housework. Clutched to her mother’s breast, this child seemed inordinately wide-eyed as though affected by the silent grief which surrounded her. I used to steal away without knowing why and visit this home. There was something fascinatingly tragic about it. Watching that mother, I was learning then, though I did not know it, that it is not the dying but the living who suffer. Only slightly less terrible was the havoc wrought by diphtheria in other families. I know of several cemeteries which contain four or five graves made within a week or two. In fact, there were few families in those days which had not suffered from this devastating disease. In my early practice a family history usually revealed that some member had died of one of the infectious diseases of childhood, of which diphtheria was the chief.”

Insisting that vaccines cause more harm than good is a false notion, based on hearsay and poor thinking. The scientific methods that create and test vaccines are similar to the scientific methods that create computers, airplanes and iPhones. Strange that anti-vaccinators pick and choose which products of the scientific method they believe in and use. In Neve Chabad, we are committed to protecting our children and ourselves with the best medicines that modern healthcare can offer, of which vaccines are one of the greatest. Many parents like to think that they do not need to vaccinate their children, since most children are vaccinated, and this gives “herd immunity.” However, a study published in the year 2000 showed that vaccine refusers were 22.2 times more likely to acquire measles than persons who were immunized, and almost 6 times more likely to acquire pertussis (whooping cough) than persons who were vaccinated.18

We are firmly in favor of immunizing our children and decline to accept into our community persons believing in strange conspiracy theories that can put our children at risk of contracting serious infectious disease.

Dr. Reuven Wolfe made Aliyah from Chicago in November 2017. Born in the Bronx, he attended college and medical school at the University of Chicago. He is a board certified Family Practitioner and was associate clincal professor at the medical schools of Northwestern University and later at the University of Chicago. He’s been a consultant to Centers for Diease Control, has researched and lectured on immunization and immunization education. Not only is Reuven a publisher author in medicine he has also published on knot tying! He is an avid boomerang aficionado and cyclist. But more important to him than any of these accomplishments and accolades he proudly proclaims the most precious thing to him is Jewish wealth— children and grandchildren who love HaShem and do Torah and miztvot.

 

References:

1. Yang J. No longer a shot in the dark. The Toronto Star. http://www.thestar.com/news/world/2014/04/25/no_longer_a_shot_in_the_dark.html. Published April 25, 2014. Accessed May 2, 2014.

2. Wolfe RM, Sharp LK. Anti-vaccinationists past and present. BMJ. 2002;325(7361):430-432.

3. Wolfe RM, Sharp LK, Lipsky MS. Content and design attributes of antivaccination web sites. JAMA J Am Med Assoc. 2002;287(24):3245-3248.

4. Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351(9103):637-641.

5. Wakefield A, Murch S, Anthony A, et al. RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet. 1998;351(9103):637-641.

6. Measles in the EU/EEA: current outbreaks, latest data and trends – January 2018. Eur Cent Dis Prev Control. January 2018.

7. Milicic A, Vanderslott S, Loving S. What’s behind the sudden rise in measles deaths in Europe? The Conversation. July 2017.

8. Immunization Safety Review Committee. Immunization Safety Review: Vaccines and Autism. Washington, D.C.: The National Academies Press; 2004.

9. Madsen KM, Hviid A, Vestergaard M, et al. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. 2002;347(19):1477-1482.

10. Barchenger S. In Lakewood, vaccination choice group meets swift rebuttal in religious community. Asbury Park Press. March 2018.

11. Yekusiel. ANTI-VAAXERS: Israel Health Officials Concerned With Reported Cases Of Measles In Tzefas. Yeshiva World News. June 2018.

12. Ghert-Zand R. Measles vaccine developer warns Jewish anti-vaxxers. Times Isr. December 2013.

13. Rosen E. Mumps Virus Alert: Dr Rosen Addresses Outbreak. CrownHeightsinfo – Chabad News Crown Heights News Lubavitch News. February 2010.

14. Shurpin Y. What Does Jewish Law Say About Vaccination? Chabad.org. 2015.

15. Reichman E. Halachic Aspects of Vaccination. Jew Action. December 2008.

16. Sedley D. LA Orthodox Jewish community hit by measles outbreak. Times Isr. January 2017.

17. Hertzler AE (Arthur E. The Horse and Buggy Doctor, by Arthur E. Hertzler, M.D. New York, London, Harper & brothers; 1938.

18. Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE. Individual and Community Risks of Measles and Pertussis Associated With Personal Exemptions to Immunization. JAMA. 2000;284(24):3145-3150.