Must Jewish Children Be Vaccinated?

Several years ago a British lawyer fashioned a campaign against vaccines that attributed autism spectrum disorders to vaccination via a hypothetical, never substantiated link to mercury. This fraud, for which he has been convicted, netted him over a million dollars in “expert” testimony. Children and adults have died for lack of immunity to devastating childhood diseases because many well-intentioned parents disseminated his position and that led some parents to refrain from having their children vaccinated. When their children contract one of these diseases, the lives and well-being of all who come in contact with them are placed in jeopardy.

Judaism, across the board, within every denomination, aspires to life for those born into this world. In Deuteronomy (Devarim) 4:15 we learn: V'nishmartem m'ode l'nafshoteikhem, “Greatly guard your souls,” which has long been read in Jewish bioethics as a duty to protect ourselves from disease. Reb Nachman of Breslov, who died in 1810 of tuberculosis long before treatment and a vaccine had been identified in the second half of the twentieth century, wrote: “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).” (Kuntres Hanhagot Yesharot)
 
History of Vaccinations
 
Small pox prevention was developed in India, some say, as far back as the year 1000. The best documentation for small pox prevention is a 15th Century Chinese document which records an ability to decrease mortality from 20-30% due to small pox, down to 0.5-2% through techniques directly related those that create the vast life-saving human "herd immunity" in place today. While many diseases remain to be conquered, the World Health Organization, established a world-wide vaccination that by 1980, eliminated small pox, a devastating disease that killed and maimed for generations.

Jewish Ethics of a School Refusing Admission to Students Who are Not Vaccinated
 
The question of whether a day school can refuse admission to a non-vaccinated student was posed to Jewish scholars and rabbinical students in regard to two essentially identical real-life situations of which I am aware. At least three comprehensive professional responses from an array of denominations exist. (Bibliography is listed at the end of this piece.) To summarize for those who wish a quick answer, all three groups, using Jewish scholarly research, found the school to absolutely have such a right and an obligation to a) the law of the land (state requirements), b) the principles of the mitzvah known as pikuach nefesh, saving lives, as many as possible.
 
Not only an answer, also a process is needed when it comes to addressing an answer to a bioethics question. By way of responding to the question, it would be appropriate for the school to respond to parent concern by validating that their feelings of concern and activism are appreciated by the administration. Even though their proposals regarding vaccines cannot be adopted under Jewish bioethics and under most legal systems, all people deserve to be listened to patiently when expressing ideas and concerns, we never know when a person is bringing something that is new information to our attention. It is also helpful to establish a series of educational programs about vaccines to help facilitate comfort with the requirement. It is helpful to subject articles from the popular or medical press provided by parents to the same rigorous scrutiny and discussion that we bring to Jewish sacred text, and to encourage the mitzvah of funding vaccine research.
 
Sources drawn upon in order to come to the position of the three panels regarding vaccinations and schools include the Shulchan Aruch, the code of Jewish law, which also weighs in heavily in favor of preventive medicine: “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." (Choshen Mishpat 427: 8-10)
 
What of the Parent Who Is Willing to Endanger Others?
 
The Shulchan Aruch citation 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. Further, we learn in the Bible, Leviticus 19:16: “Do not stand aside while your neighbor's blood is shed” and in the Shulchan Aruch Choshen Mishpat 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. Parental responsibilities are detailed in a number of our sacred texts. For example, 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.
 
Sadly, we have not yet achieved sufficient levels of immunization in our world to create the level of human world-wide immunity that might also wipe out a great many more major, life-threatening diseases. It is clearly vital to participate in immunization programs to bring us to that virtually messianic day. Here is some sobering data, if you are still not on-board with the decision of the majority of Jewish scholars:
 
Unicef Estimate of Deaths due to vaccine-preventable diseases 2008
 
Total number of children who died from diseases preventable by vaccines currently recommended by WHO, plus diseases for which vaccines are expected soon: 2.5 million.
 
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 (polioa, diphtheriaa, 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
 
May your life, and your children and grandchildren's lives, be healthy and blessed and your actions be a blessing for others.
 
 
Bibliography:
 
Teshuvah of 2004 by Rabbi Joseph Prouser for the Committee on Jewish Law and Standards of the Conservative Movement
 
Teshuvah of 1999, the Reform Movement’s Central Conference of American Rabbis’ Responsa 5759.10
 
Teshuva of Fall Semester 2009, by the Bioethics, Halachah and the Role of the Rabbi course taught by Rabbi Goldie Milgram for the ALEPH Ordination Program.