Growing up, my introduction to communicable diseases was mainly limited to what I read in books, like More All-of-a-Kind Family in which an epidemic of “infantile paralysis” left Aunt Lena with a limp. Communicable diseases were in the murky past. I am of the generation who grew up free of the gripping fear that descended on communities during periods of epidemics.
The only personal experience I’d had with serious epidemics was “Joe,” a congregant in the synagogue I used to lead. In 1955, 6-year-old Joe was living in Chicago when the city’s children were getting the first Salk vaccines for polio. Before his side of the city received the vaccine, he got the polio virus. He lost the use of his legs. Thirty years later, Joe fell ill with post-polio syndrome, a condition that affects up to half of those who survive an acute case of polio. He was on a ventilator for the remainder of his life.
Most mothers and fathers don’t know a Joe, but plenty of them have heard rumors, traceable to fraudulent research by the English doctor Andrew Wakefield, that one vaccine—the one for measles, mumps, and rubella (MMR)—causes autism. And an alarming number—as we now know from the national outbreak of measles—have decided not to get their children immunized, with that or any other vaccine. Their alarmism can often be traced to ill-informed anti-vaxxer celebrities like Jenny McCarthy, who likes to claim that she doesn’t need science because her autistic son, Evan, whose condition she thinks was caused by vaccines, “is” her science.
Well, like Jenny McCarthy, I have an autistic son. Unlike Jenny McCarthy, I believe in vaccinations. I believe in them as a mother, as an educated citizen, and, above all, as a rabbi.
Let me explain.
Our son, Benjamin Adam, arrived in 2000 after a tiring, but uneventful, labor. His entry into the world, accompanied by the Psalms my father recited just beyond the laboring threshold, was celebrated by our extended family in the waiting room. Twenty-four of them. (He was the first great-grandchild on my side and the first grandchild on both sides.) Eight days later, his bris was a moment of profound joy.
As we had been instructed in our baby care class prior to Ben’s birth, we adhered strictly to the immunization schedule established by the American Association of Pediatrics. Not for a single moment did my husband, Warren, or I consider challenging the standard medical recommendation. From our perspective, if the medical community was advocating a particular protocol, on what grounds did we—two nonmedical professionals—challenge the very doctors to whom we would be entrusting our child’s well-being?
Plus, we had seen the way polio had ravaged Joe’s body, and we didn’t want that for our child.
From the very moment that Ben had emerged from my womb, I could not shake the sense that there was something wrong with my child. Ben cried. For an entire year. The only time that he wasn’t crying was when he was nursing. He barely slept. We barely slept. He startled easily. He needed to be swaddled long past the age most infants tolerate the restrictive binding. He often seemed to be looking just past us. I wondered if he was seeing long-gone relatives over my shoulder.
We tried going to a mommy-and-me play group. But he wasn’t like the other children. He didn’t seem to notice them. His differences were exaggerated alongside peers his age. Certain fabrics would send him into hysterics. His rigidity and insistence on routine simply couldn’t be written off as isolated oddities.
Finally, our doctors gave us an answer: autism spectrum disorder.
Our child, who had received all of his vaccinations, including the dreaded MMR shot, had autism.
To be clear, we never really suspected that the vaccine had caused his autism. Taking a look back, it was clear that Ben had autism prior to receiving his immunizations. What’s more, we are aware of the vast body of research that the vaccines are harmless and certainly don’t cause autism.
But what’s more, even if there were some risk of autism with vaccines—which there isn’t—that would be no reason not to vaccinate. This is autism. Not polio. Or pertussis or rubella. Or any potentially fatal infectious disease.
My generation has been lulled into a false sense of security; these diseases can be very dangerous. According to the CDC, the recent measles epidemic has put 28 percent of infected children into the hospital. It can cause pneumonia, deafness, and brain damage. And one to three children out of every thousand who fall ill from measles will die from the disease. People are contagious even before they show evidence of the rash. Most concerning is that, unlike other viruses, the measles virus remains live in a room for up to two hours after an infected person has exited.
These are the worst-case scenarios for those with normal immune systems. For those whose immune systems are compromised, such as those going through cancer treatment, as well as the elderly and those too young to be immunized, the result of contracting a transmissible disease such as the measles could be catastrophic. Immunosuppressed individuals are more likely to develop complications from the virus such as encephalitis, so they must rely on a herd immunity to protect them from measles and other transmissible diseases. For herd immunity to be effective, however, it requires a minimum level of compliance.
So, when the time came for our subsequent children to be immunized, we did not hesitate for a moment. Make no mistake: Autism makes life challenging for Ben and for our entire family. But autism doesn’t kill. Or maim. Or spread to others whose immune system is not capable of handling the myriad diseases that have—or should I say had—been eradicated in our country.
Simply put: It’s not for us to play with the lives of other people’s children, or our own. No good parent would do that. And as a rabbi, I am also mindful of our tradition’s teachings, which would also counsel against avoiding vaccines. Unlike Jehovah’s Witnesses, Jews don’t refuse blood transfusions. Unlike Christian Scientists, we have no problem with advanced medical care. We are grateful that God—or science, or the minds we are grateful to have—has given us life-saving cures and preventions. And we want our children, and everyone’s children, to have them.
Concern about transmissible diseases and preventative care extend far back into our tradition. Maimonides, whose experience as a 12th-century physician clearly influenced his bias toward healthy living, emphasizes in Mishneh Torah, Hilchot De’ot 4:1: “One must avoid those things that have a deleterious effect on the body, and accustom oneself to things that heal and fortify it.” Later, reflecting on the Rambam’s measures, Rabbi Moses Isserles, writing in the 16th century, pays specific attention to the danger posed by a city plagued by an infection outbreak:
One must flee a city in which there is a plague, and one must leave at the onset of the plague and not toward its end. All these cases are because of danger, and one who dutifully cares for his life will distance himself from them. It is forbidden to rely on a miracle, thereby endangering oneself in such cases.
From the Rambam in the 12th century to the Rema and his contemporary Rabbi Isaiah Horowitz in the 16th century, and continuing to 17th century Rabbi Abraham Gombiner and, in the 18th century, Rabbi Yehuda Ashkenazi, the halakhic response to infectious outbreaks was a mandatory evacuation simply because there was no other reliable prevention. One who did not evacuate one’s children would be, according to Jewish law, responsible for their deaths.
Toward the end of the 18th century, however, medical advances would push halakha to consider other alternatives. Having buried two of his children due to the smallpox outbreak in London, Rabbi Abraham Nanzig published in 1785 a pamphlet on inoculation, Aleh Terufah, in which he asked, “Is it or is it not 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?” Nanzig ultimately concluded: “One who undergoes this treatment while still healthy, God will not consider a sin. Rather, it is an act of eager religious devotion, and reflects the Commandment to ‘be particularly careful of your well-being’ (Deut. 4:15).” He went on to acknowledge that even .001 percent likelihood of contracting smallpox from the inoculation was insufficient to reject the more likely positive outcome. A year later, a prophylactic measure against smallpox was introduced and endorsed by other rabbinic giants such as Rabbi Israel Lipschuetz and Rabbi Nachman of Bratzlav.
But the obligation to vaccinate one’s child goes beyond the individual. The final two chapters of the Shulchan Aruch focus entirely on the religious obligation to preserve the life of those in danger, and they offer a variety of situations requiring the intervention of an individual to save his fellow human’s life (Choshen Mishpat 426 and 427). Rather than list every possible calamity, the Rambam sums it up thus: “Anyone who is able to save a life but fails to do so, violates ‘You shall not stand idly by the blood of your neighbor’ ” (Mishneh Torah, Hilchot Rotzeach U’Shemirat Nefesh, 1:14).
Furthermore, our tradition demands that we anticipate dangers and proactively avoid them in order to safeguard the well-being of others. The most explicit statement of this communal duty is the requirement to erect a parapet: “When you build a new house, you shall make a parapet for your roof, so that you do not bring blood upon your house if anyone should fall from it” (Deuteronomy 22:8). So important is this notion that both the Rambam and Choshen Mishpat assign not one but two separate commandments to this “building code”: “One who leaves his roof with no parapet has neglected a positive commandment and violated a negative commandment, to wit: ‘Do not bring blood upon your house’” (Maimonides, Mishneh Torah, Hilchot Rotzeach U’Shemirat Nefesh, 11:3; Shulchan Aruch, Choshen Mishpat, 427:6).
It seems clear that choosing to withhold immunizations from one’s child is akin to neglecting to build the parapet on one’s roof. Both are designed to protect the individual from bodily and possibly lethal harm.
The medical community has been trying, with limited success, to convince people that there is no scientific basis to avoid immunizations. Perhaps it is time to change the discourse. Jewish law holds that the imperative to vaccinate depends not on one’s personal feelings but on the moral and religious obligation to protect one’s child as well as the entire community. In other words, what you believe might not matter as much as you think. For Jews, there is no such thing as a personal-belief exemption.
When Ben had his vaccinations, we didn’t know that he had autism; nor did we have his diagnosis when it was time for Lilly to receive hers. But when it came time for Jacob, we knew that Ben was on the spectrum. Yet I whispered in my baby’s ear the same prayer I had whispered in his siblings’ ears. The same prayer I composed to soothe my child. To soothe my own nerves, I suspect. And to acknowledge, Jewishly, how fortunate I was to have access to medical knowledge that can prevent my baby from falling ill to devastating illness: “Thank You, God, for allowing us to live in a time and place where we have access to preventative medicine so that I can do everything I can to protect you, my dear child, from those dangers I can predict.”
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