Vaccinations and Judaism
Permitted? Optional? Forbidden?
-- Rabbi Goldie Milgram
Recently a friend sent me an eloquent anti-vaccination letter, asking me to help with its distribution. Usually a quick responder to tikkun olam (social justice) requests, upon reading this letter I froze having just had my annual flu shot. What to do? What would you do? What does Judaism have to offer by way of guidance? It happens this is a question I posed last year as a final exam question to the seminary course I give with Gary Cohen, Esq. in
Jewish bioethics for the ALEPH Ordination programs.
The case requires us to consider: Would Jewish values support the American ethos of the individual being allowed to do what s/he believes is best. Must the students' parents have to live in fear or their children be denied access to a Jewish day school education? Or, barring health problems that might lead a pediatrician to recommend against immunization in rare cases, is there a moral obligation to undergo vaccination? Does v'ahavta l'reyakhah kamokhah, to love one's neighbor as oneself, apply?
Here is the first part of the case that we set before the students:
“Dear Rabbi: We do not believe in vaccinating our children and so the Jewish Day School has refused them entry. Do they have a right to do this? There is no reason in Jewish ethics we would be obligated to vaccinate them, is there?”
In Jewish tradition a sh'eylah (question) or kasha (difficulty) can be placed before a rabbi or professional posek (explicator) to receive a t'shuvah (response or answer). The students were asked to work as a group and form a consensus-based t'shuvah after analyzing the inquiry and studying the sources. Additionally the students were asked to apply pastoral counseling skills in their response, a process known as Integral Halachah, or kavod lev halakhah, responding not only with the lev (heart) of the halachah (law), but also with the lev of the weighty and much honored kavod (parental role) in the situation.
The students appropriately sequenced texts from the tradition in developing their consensus. Pikuakh nefesh, acting to save someone's own or another's life, is a primary Jewish value reflected in the Bablyonian Talmud Tractate Yoma 82a: “for there is nothing that can stand before [the duty of] saving life, with the exception of idolatry, incest and murder [which are prohibited in all situations].” This is amplified in the Shulchan Aruch, Yoreh De'ah 263: “...one may not circumcise a baby if there is any possibility that he is ill. Danger to life overrides everything, for it is possible to circumcise later, but it is not possible to bring a single Jew back to life.”
The conflict here is concern about protecting their child from rare vaccine side effects on the part of the parents, and concern for maintaining what is known as “herd immunity” by society and the school. There is a decrease in the immunity of a community, our “herd,” when some of us are not immunized because the virus will have hosts who enable it to perpetuate itself in the community.
In Deuteronomy (Devarim) 4:15 we learn: V'nishmartem m'ode l'nafshoteikhem, “Greatly guard your souls.” This phrase has long been read in Jewish bioethics as a duty to protect ourselves from disease. In Kuntres Hanhagot Yesharot, Rabbi Nachman of Breslov teaches: “One must be very, very careful about the health of children...One must inoculate every baby against smallpox before one-fourth (3 months) of the year, because if not, it is like spilling blood (murder).”
Many readers have had relatives of our grandparents or parents who died before vaccines were created for polio, mumps, scarlet fever, etc. A few of us might also know of someone's child who had adverse vaccine reactions, such as the very few who develop a serious allergic reaction to the MMR – Measles Mumps Rubella vaccine (fewer than one out of every million children vaccinated). In Jewish bioethics the proportionate chance of survival versus damage is taken into account when making a determination.
Consider these statistics made available through
UNICEF Estimate of Deaths due to vaccine-preventable diseases 2008:
Total number of children who died from diseases preventable by vaccines currently recommended by the World Health Organization (WHO), plus diseases for which vaccines are expected soon: 2.5 million. These deaths were caused by:
- Hepatitis B: 600,000
- Hib: 363,000
- Pertussis: 254,000
- Tetanus: 163,000
- Other (polio, diphtheria, yellow fever): 36,000
Estimated number of deaths in children under five from diseases preventable by vaccines (excluding measles) currently recommended by WHO: 890 000.
- Hib: 363,000
- Pertussis: 254,000
- Neonatal tetanus: 128,000
- Tetanus (non-neonatal): 16,000
- Other (polio, diphtheria, yellow fever): 19,000.
Estimated number of deaths in children under five due to rotavirus and pneumococcus: 1.3 million.
- Pneumococcal disease: 735,000
- Rotavirus: 527,000
Having our children vaccinated was assumed to be part of good parenting until a lawyer fashioned an overly-publicized
campaign against vaccines which attributed autism spectrum disorders to vaccination via a hypothetical, unsubstantiated link to mercury, which netted him over a million dollars in “expert” testimony. Many were influenced by media reports on this one lawyer's claims and the support groups he spawned of angry, hopeful, caring parents. Enough people believed the media reports, which touted the lawyer's claims, that a there was a discernable rise in the number of unvaccinated children. As a result, measles rates, for example, reflect a serious increase in the most recent data (2008) over any time since 1966.[ S.P. Calandrillo, “Vanishing Vaccinations,” University of Michigan Journal of Law Reform, 37:2, Winter 2004.]
How is it known that mercury in vaccines is not the culprit?
Mercury preservative (thimerosal) was removed from vaccines commonly given to infants and young children in the U.S. in 2001, but the rates of children being diagnosed with autism are still skyrocketing. A survey of autism rates in California in 2008 confirms that mercury is out and autism rates are still going up. If thimerosal was the cause of autism, and it was taken out SEVEN years ago, autism rates should be going down by now. That’s because autism spectrum disorders are usually diagnosed by three years of age. [Ari Brown, MD, FAAP, “Clear Answers and Smart Advice about Your Baby's Shots]
The Shulchan Aruch Choshen Mishpat 427: 8-10 teaches that “it is a positive commandment (mitzvah aseh) to remove anything that could endanger life, and to safeguard against any of these things, and to be very careful to guard yourself and guard your soul. Someone who does not remove that which is potentially dangerous will have set aside this positive mitzvah.
The text continues by asking, “What of one who indicates: “I am willing to endanger myself, why should this matter to anyone else?”...or whoever is careless about these issues is given lashes by the Beit Din (Jewish court) and whoever takes care to avoid them is considered praiseworthy.” While we no longer whip offenders, the emphasis on not endangering others is explicated clearly here. Leviticus 19:16 teaches: “Do not stand aside while your neighbor's blood is shed” and in the Shulchan Aruch Choshen Hamishpat 426 the commentator adds: “Do not abandon your neighbor when [s]he is in danger.”
The Rambam in Mishna Torah Hilchot Deot 4:1 teaches that God wishes us to remain healthy because it is impossible to integrate the teachings when we are ill, therefore one must remove anything that causes one harm and work to bring good health. This makes it a Jewish value to work on vaccinations and to promote those that prove safe for a high percentage of the population. It helps fulfill the mitzvah of pikuakh nefesh, saving a life.
Parental responsibilities are detailed in a number of our sacred texts. In Talmud Bavli, Tractate Kiddushin, 29:1 a father's duties are detailed as circumcision, pidyon ha-ben, teaching the child Torah, ensuring he is married, teaching him a trade, ensuring he is able to support his family and teaching him to swim, to protect him from drowning. The Ralbag on Proverbs in Chapter 23 offers an essay on parenting which emphasizes the parental role in teaching safe living practices in order to avoid addictions, diseases, and obesity.
Two contemporary teshuvot on our question exist, one written in 2004 by Rabbi Joseph Prouser for the Committee on Jewish Law and Standards of the Conservative Movement and, in 1999, the Reform Movement’s Central Conference of American Rabbis’ Responsa 5759.10. Integrating these into their recommendations, my students concluded:
- The Jewish day school has a right to refuse admission to children who are not vaccinated. Our ruling is based on numerous Jewish principles including pikuach nefesh (mandate to preserve life), refuah bedukah or vadait (a medical therapy, or proven effect) for which immunization qualifies, dina d'malchutah dina (the law of the land is the law) including state requirements for school vaccinations, and takkanat ha-kahal, the right of the school to set and enforce its own policies.
- Jewish ethics does support requiring school vaccinations. There is a wealth of Jewish halachah, ancient and contemporary, that justifies viewing the practice of medicine as a mitzvah. In addition, there is little peer-reviewed scientific evidence to demonstrate that the risks posed by school vaccinations outweigh the risks of children not being vaccinated.
Our students concluded as will I, with a section of Midrash Shmuel which reads: Yediat He-khakham V'b'keeat Ha-rofei in which the first letters of the words, yud-hey-vav-hey, correspond to the four letters of the name of God which transforms them into the notion that God aligns with “the knowledge of the wise and the expertise of the healer [physician].” This supports the notion that schools should be encouraged to hold educational forums for parents on immunization, and that parents should seek out and carefully evaluate studies and encourage such forums. The very parents who raise questions might become advocates for vaccination research and development so that more lives can be saved.
With honor and appreciation to the following ALEPH Ordination Program “School Vacination Teshuvah” authors: Aliza Erber of White Plains, NY, Cynthia Hoffman of Berkeley, CA, Jeff Schulman of Carmel, CA, Matia Angelou of Boston, MA, Miri Fleming of Tuscon, AZ, Miryam Levy of Alburquerque, NM, Orna Triguboff of Sydney, Australia, Patrice Spitz of Boulder, CO, Shayndel Kahn of Boston, MA and Stephanie Reith of Townsend, WA.
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