By Rabbi Yair Hoffman
They are known as the “anti-vaxxers,” and leading medical experts in the United States claim they are putting the nation at risk. Who are these anti-vaccine advocates? From where did they originate and what do they want? And what does halachah have to say about the issue?
There is a biblical mitzvah of taking safety precautions, as the verse states, “V’nishmartem me’od l’nafshoseichem” (Devarim 4:15). Should the view of the anti-vaxxers set aside this Torah mitzvah? Are there other possible mitzvos involved here as well? And, finally, are vaccinations obligatory?
As of this writing, February 2015, there are over 120 cases of measles in the United States, stemming from an outbreak that began in Disneyland in Anaheim, California. There are approximately 20 million cases of measles each year. In 2013, close to 150,000 people worldwide died of measles. According to Time magazine, one in ten Americans believe that the vaccine for measles, mumps, and rubella (MMR) is not safe for healthy children. This is terribly sad, because measles was eliminated from the United States in the year 2000; the outbreaks come from abroad. The virus is highly contagious and can remain in the air many hours after an infected person has left the room.
It’s also not a harmless, risk-free disease. Aside from the risks of pneumonia and encephalitis and possible fatal consequences, measles can cause deafness and can be extremely painful, too. Pregnant women who contract the disease are more likely to miscarry, and cancer patients with weakened immune systems are placed at grave risk.
Many anti-vaxxers have not vaccinated their children, and some have actually fudged the documentation about it to allow their children into schools and camps that would otherwise not accept them. Senator John McCain has been among the anti-vaxxers, and it has even been reported that there is a leading gadol b’Yisrael among them.
Anti-vaxxers have not only entered Disneyland; they are in our yeshivos and day schools, too. Last year there were outbreaks in Brooklyn and in Monsey, two vibrant Orthodox Jewish communities. The fact that these outbreaks occurred in religious Jewish communities is also cause for chillul Hashem. The following is a historical overview, followed by a halachic analysis of the topic.
How It Started
The anti-vaxxers have two concerns that are often intertwined. The first is the MMR vaccine itself. They believe that there is some heretofore unidentified element in it that causes autism. The second is that some vaccines contained the preservative thimerosal, which contained ethyl mercury, a type of mercury that had been suspected of causing autism. Thimerosal has actually been removed from the MMR vaccine with no accompanying drop in the incidence of autism. No matter; this has not impacted the anti-vaxxer movement.
The MMR vaccine is given twice. The first dose is administered to infants between 12 and 15 months of age and the second vaccine is given between the ages of 4 and 6.
The impetus for the growth of the anti-vaxxer movement initially came from a 1998 study published in the February 28 edition of the Lancet by Andrew Wakefield, a gastroenterologist, and 11 colleagues. The Lancet is a highly prestigious medical journal published in England. The study supposedly linked autism in children to the MMR vaccine. The Lancet article also said that autism has origins in the gastrointestinal systems of children.
Wakefield then made a tour of the United States in the fall of 1998, and in that tour he gave an interview at a “Defeat Autism Now” conference. In the interview, he conflated his own patients with those mentioned in his study. Wakefield had treated patients with diarrhea who did not have autism. He had conflated them with autistic patients that he had never seen or treated. In November 2000, Wakefield even appeared on CBS’s 60 Minutes.
The combination of the article, the tour of U.S.-based autism groups, and Wakefield’s appearance on 60 Minutes caused a storm in both the medical and parenting worlds.
Doctors questioned how a serious study could have used such a small sample size (there were 12 subjects) to make such a revolutionary claim about vaccines that have been around for a half-century. They further questioned the uncontrolled nature and design of the study.
The main criticism expressed by many, however, was the fact that there was a serious logical fallacy at play. The Latin expression of this fallacy is “post hoc ergo propter hoc,” meaning that we infer that subsequent events are caused by prior events. But this is not necessarily so; just because event Y happens after event X, it doesn’t mean that Y is caused by X. An oft-cited example of this fallacy is that the rooster crows immediately before sunrise; therefore, the rooster causes the sun to rise. Autism is not detected at birth. It is generally not officially diagnosed until shortly after the time that one normally gives the second MMR vaccine, between 4 and 6 years of age.
Parents took action by refusing to vaccinate their children and creating a distrust of the medical community’s public policies on vaccination. Within a very short time, the United States experienced a 300% increase in people who were not vaccinating their children. All this with no proof.
In the March 6, 2004 edition of the Lancet, 10 of the 12 Wakefield co-authors published a retraction of their interpretation of the data. The Lancet editors also admitted that Wakefield had failed to disclose something crucial: Wakefield was being funded by lawyers who were representing parents in lawsuits against the companies that produce vaccines. (They eventually lost the lawsuit, but not for lack of trying.)
This information had been revealed by British journalist Brian Deer. Deer went on to win awards for his investigations, which also prompted an ethics-violation query by the British government. Apparently, since 1996, two years before he published the study, Wakefield had been receiving funding from Mr. Richard Barr of Alexander Harris Solicitors, one of the leading law firms in Luton, Bedfordshire. Barr had been funding Wakefield through the UK Legal Aid Fund, which paid bills submitted by a company owned by Wakefield’s wife. Wakefield had received the astounding sum of $750,000 (or rather its British pound equivalent) from Barr’s efforts. Another lawyer organization was funding Wakefield as well.
Almost six years later, in February 2010, the Lancet finally retracted the original 1998 article in its entirety. This time the editors stated that Wakefield was, in fact, guilty of scientific misrepresentation. Wakefield had stated in his initial article that the sampling was consecutive, when in fact it was selective. Wakefield was cherry-picking his results, seriously skewing any true analysis of the data.
The Great Damage Done
The damage done by the Wakefield article, the 60 Minutes segment, and the hoopla generated by it all has entrenched itself into our society so that people are dubious of vaccinations. This has led to the outbreak of measles at Disneyland and can further endanger the nation. The statistic of 1 in 10 Americans is no laughing matter.
In the 17 years since the publication of Wakefield’s article, dozens of legitimate studies have been conducted that show that there is no correlation between autism and vaccinations. Thimerosal has been eliminated in this country and there is still no lowering of the incidence of autism. What has happened is that we have expanded our definition of autism and autism-like symptoms.
Benefits Of Vaccines
Historically, public policies of widespread vaccination have saved countless lives. In the late 1790s, Edward Janner noticed something remarkable about milkmaids. For some reason, they were immune to smallpox. Janner realized that anyone who was exposed to cowpox developed immunity to smallpox. In 1798, he developed and promulgated a vaccine for smallpox that saved millions of lives. The author of the Tiferes Yisrael begged and pleaded that people take the vaccine, calling Janner one of the chassidei umos ha’olam, righteous gentiles of the world.
Smallpox has killed over 300 million people. It was eradicated completely because of vaccination programs, and the last smallpox-related death was in 1978. In the early 1800s, vaccines did not have preservatives and some of them were tainted. Now the vaccines are much safer.
It is this author’s contention that vaccinations involve the fulfillment of a number of Torah mitzvos, aside from the basic mitzvah of v’nishmartem mentioned at the beginning of this article. We must also make sure that we not allow the greedy actions of others to adversely affect our health, the health of our children, and the fulfillment of our Torah obligations. We should also make our best efforts not to allow misinformation and fraud to affect crucial decisions in our lives.
Hashavas Aveidah. The verse in Parashas Ki Seitzei (Devarim 22:2) discusses the mitzvah of hashavas aveidah, returning a lost object, with the words, “V’hasheivoso lo,” “and you shall return it to him.” The Gemara in Sanhedrin (73a), however, includes within its understanding of these words the obligation of returning “his own life to him as well.” For example, if thieves are threatening to pounce upon him, there is an obligation of “V’hasheivoso lo.” In other words, this verse is the source for the mitzvah of saving someone’s life. It is highly probable that it is to this general mitzvah that the Shulchan Aruch refers in Shulchan Aruch Orach Chaim 325. This is certainly the case with vaccinations, because vaccinations save lives.
‘Thy Brother’s Blood.’ There is a negative mitzvah of not standing idly by your brother’s blood— “Lo sa’amod al dam rei’echa” (Vayikra 19:16). This is mentioned in Shulchan Aruch (C.M. 426:1) and in the Rambam. When people get sick and chance death because of our inaction, we are violating the commandment of “Lo sa’amod al dam rei’echa.”
‘Lo Suchal L’hisalem.’ There is yet another negative commandment associated with the positive commandment of hashavas aveidah, and that is the verse in Devarim (22:3), “You cannot shut your eyes to it.” This verse comes directly after the mitzvah of hashavas aveidah. The Netziv, Rabbi Naftali Tzvi Yehudah Berlin, in his HeEmek She’eilah, refers to this mitzvah as well.
‘V’chai Achicha Imach.’ The She’iltos (She’ilta #37), based upon the Gemara in Bava Metzia 62a, understands the words in Vayikra (25:36), “v’chai achicha imach,” “and your brother shall live with you,” to indicate an obligation to save others with you. The Netziv in his HeEmek She’eilah understands it as a full-fledged obligation according to all opinions. He writes that one must exert every effort to save his friend’s life, until it becomes a matter of pikuach nefesh for himself. The Netziv’s position would certainly advocate that vaccinations are obligatory, even if it involves a slight danger—which in modern times has been virtually eliminated.
‘V’ahavta L’rei’acha Kamocha.’ The Ramban, in Toras HaAdam Sha’ar HaSakanah (pp. 42–43), understands the verse of “And love thy neighbor as yourself” as a directive to save our peers from medical danger as well. We thus have a total of six Torah mitzvos involved in vaccinating our children.
Is It Obligatory?
It seems that in a situation where there is concern for an epidemic, poskim have ruled that vaccination is obligatory. (See Minchas Tzvi, siman 9, and Rabbi Eliezer Yehudah Waldenberg, zt’l, in Tzitz Eliezer, and Rav Yitzchok Zilberstein, shlita). How effective is the vaccine? With two shots, the efficacy rate for the MMR vaccine reaches 97%.
What about the issue that there will invariably be people with allergic and or other negative reactions to vaccinations? The language of the Shach (Y.D. 336:1) is informative. He writes that a doctor should not say, “What do I need this anguish for if I err and unintentionally kill a patient?” One could perhaps extrapolate from the words of the Shach that we should do whatever we can to ensure that the population is protected through proper vaccination.
In Teves of 5745 (winter 1984–1985), the Steipler Gaon was asked about a case where the measles vaccine was apparently problematic. He advised them to make sure that the next batch was problem-free and instructed them to take the vaccine (Orchos Rabbeinu, p. 350).
Should one violate Shabbos for a vaccination? Rav Shlomo Zalman Auerbach, zt’l (Shulchan Shlomo 329:1, 2) has a fascinating definition for what constitutes safek pikuach nefesh, possible risk to life. He writes that if from a sociological perspective people are not rushing to get the vaccination as soon as possible, then it is not considered enough of a danger to warrant Shabbos violation. He writes that this is the case even if there is an actual danger.
What about the rabbinic views that there may be substance to the anti-vaxxer view? Carefully researching the data behind a halachic question can be daunting at times. Occasionally, though rarely, the background information behind a question may not be sufficiently researched because the gadol or posek relied upon someone else, who did not properly weigh the issue or evidence. In recent years we have seen this when gedolei Torah reversed their rulings on the proper berachah for cashews; whether bran is considered animal food; and whether people can distinguish between pasteurized and unpasteurized wine.
Leading gedolim with whom this author has consulted in recent months—Rav Chaim Kanievsky, shlita, and a leading gadol in the United States—have said that when someone has done the research and is sure that the background information behind a p’sak is faulty, there is an obligation to respectfully publicize the correct information.
It is this author’s hope that the information in this article will help serve to protect us all from illness. Amen.
By Rabbi Yair Hoffman