Viral complications

Outside a doctor’s office in an Orthodox Jewish neighborhood in Brooklyn stood a massive sign that read in Yiddish, “If you have a fever and a rash, or have been exposed to the measles, DO NOT ENTER.” On a train between terminals at New York’s John F. Kennedy International Airport, a city ad campaign showed a picture of a suitcase with the word “Measles” across it.

“Traveling overseas?” the ad read. “You might need a measles vaccine! Measles is spreading in many countries.”

Measles cases are up 300 percent globally in 2019, according to the World Health Organization, and now the United States is on track for the largest outbreak since it declared the disease eliminated in 2000. The measles cases cross 20 states, but New York is the outbreak’s epicenter, with about 600 cases. New York City health officials estimate that at least 11,000 people here have been exposed to the virus, one of the most contagious in the world.

Measles spreads through the air and lingers for two hours in the wake of a contagious person. It has a 90 percent infection rate for the unvaccinated in that wake, and brings a fever, rash, and cough. The illness is typically manageable but can cause serious complications and death in young children and the immune-compromised, and can cause miscarriage in pregnant women.

One in 20 children who contract measles gets pneumonia (a leading cause of death in young children), and 1 in 1,000 gets encephalitis, or inflammation of the brain. Thankfully no one to this point has died in the New York outbreak, although several children have gone into intensive care. The measles vaccine debuted in 1963; before that, measles epidemics killed on average 2.6 million people every year, according to the World Health Organization.

The New York outbreak, now in its seventh month and centered in the Hasidic community, has brought a collision between growing numbers of vaccine doubters and increasingly panicked government officials. The state’s small groups that have religious or medical exemptions to the measles-mumps-rubella (MMR) vaccine say the government is overreacting; the government says the unabated spread of the virus, even after months of attempted outreach to the vaccine-hesitant, calls for tougher measures.

A parent signing an affidavit as V.M. protesting some of these measures, acknowledged the threat of measles but expressed concern: “The amount of power, speech, and money directed toward the small number of us who have filed religious exemptions, or are questioning this practice, is concerning to us on so many levels.”

One reason the government has responded as it has is because of how difficult it is to contain measles and to achieve herd immunity. Herd immunity means a certain level of vaccination keeps even the unvaccinated (like newborns) protected because a virus can’t pass through the community.

Herd immunity for measles requires about a 94 percent vaccination rate, one of the highest. Other diseases, like polio, only require about an 80 percent vaccination rate to achieve herd immunity. Measles is so contagious it finds nearly every pocket of the unvaccinated.

Rockland County, a community with a large Orthodox Jewish population just north of the city where many of the cases have occurred, barred unvaccinated children from school starting several months ago. New York City did the same for certain zip codes in December and in April threatened fines for parents who do not vaccinate.

“If we had seen it start to level off, it would have been sufficient,” Mayor Bill de Blasio said as he announced the emergency measures in Williamsburg. Though there had been no measles-related deaths, he said, “We need to keep it that way.” (De Blasio said the city would do its best to avoid fining anyone.)

A handful of parents have sued over some of those measures, but religious leaders in the Hasidic communities have supported the government’s actions and have encouraged their communities to get vaccinated. Rabbis have done robocalls with the city, and Orthodox nurses have held living room meetings with mothers to answer questions about vaccines.

A poster in Hebrew went up in Rockland County: “Opinion of Great Rabbinic Legal Authorities on The Obligation to Vaccinate Against Measles” the poster read. The Orthodox rabbis, calling on fathers to vaccinate their children “immediately,” cited the Jewish obligation to save a life, called “pikuach nefesh,” the highest Jewish law. To prevent a doctor from healing patients, the poster read, “is bloodshed.”

Parents who won’t vaccinate their children “are not fighting with the doctors, with the evil government,” said Rabbi David Niederman, as he sat in his office at the United Jewish Organizations of Williamsburg and North Brooklyn, a Hasidic social services agency that he leads. “You’re fighting with your own friends who don’t want to get sick! ... You believe that you’re 100 percent right. You might unintentionally affect the life or welfare of someone else.”

In an afternoon that included a flurry of meetings, Niederman cranked on the air conditioning in his paper-strewn office. He quoted the Torah to me in Hebrew about the importance of seeking healing and protecting life.

Normally Niederman oversees work on housing, employment, Holocaust survivor services, and religious liberty issues with the city.

But over the last several months he has recorded robocalls on vaccines with the Department of Health, helped write culturally sensitive pamphlets in Yiddish to share with the community, and met with parents.

Acknowledging he is in a “press shy” community, he’s also worked as an ambassador to communicate to the outer world that vaccine hesitancy is not an Orthodox Jewish position.

He’s concerned that without such efforts, the anti-Semitism that Orthodox Jews have seen in the wake of the outbreak could grow. A Hasidic man in Brooklyn recently reported to Niederman that a city bus driver tried to avoid picking him up, but he ran and caught up at the next stop. As he boarded, he said the driver covered her face with a sweater and shouted, “Measles!” The city said it was investigating the incident.

“[Vaccine hesitancy] is something that’s spread all over, and the ideology is all over,” said Niederman’s deputy director David Katz, sitting at Niederman’s desk responding to emails as we talked. As I left Niederman’s office, two Hasidic women serving as receptionists stopped to talk to me about reporting on measles in the Jewish community. “You’ll write nice things about us?” one asked nervously.

A REVIEW OF SCHOOL VACCINATION RATES in New York showed low vaccine rates in a potpourri of schools: some yeshivas, but also Waldorf schools, self-described “progressive” schools, a Seventh-day Adventist school, and Christian homeschool co-ops. Protestant and Catholic private schools generally had high vaccination rates.

In Rockland County, health officials tried not to single out Orthodox Jewish communities, instead issuing a blanket order against unvaccinated children in schools. That prompted a lawsuit from parents of unvaccinated children who were barred from their school, Green Meadow Waldorf School, which had a 37 percent total vaccination rate in 2018.

In affidavits attached to the lawsuit, parents explained their beliefs against vaccinating their children: Some based it on Christian faith, some on Shinto beliefs, and some on their own medical research.

One Christian parent, signing an affidavit as M.R., stated that the Bible had “entrusted us as parents [not the State of New York] with the care and welfare of the children (1 Timothy 5:8).” The parent said based on “research we conducted” the family had decided not to vaccinate, but then after the outbreak had their oldest child vaccinated.

Another Christian parent at Waldorf, signing an affidavit as L.V.G., argued that vaccines are derived from aborted fetuses, and that to take them would be complicity with murder. (Some vaccines were initially developed with aborted fetal cell lines, but no new lines have been created to continue production of vaccines. “Accepting these vaccines does not endorse or encourage abortions being done today,” said Dr. Gene Rudd in a Christian Medical & Dental Associations statement on the issue.)

Other parents cited Buddhist and Shinto beliefs that vaccines interfere with the natural course of illnesses, part of a child’s “destiny,” wrote parent K.K. in the affidavit. “Ultimately it is not our job to ‘play God,’ deciding which suffering our children will be excused from.”

A vegetarian couple cited the vaccines as having animal substances. Another parent, L.P., cited karma, reincarnation, and “anthroposophy,” where children are spiritual beings who choose their parents. Injecting “anything foreign” into her daughter’s bloodstream would be a violation.

For 15 years at his Illinois practice, Christian pediatrician Greg Garrison would listen and talk through vaccine doubts with Christian parents. He noticed the arguments shift over time. As more and more studies refuted any autism link to vaccines, parents began to associate vaccines with PANDAS (a strep complication), or they would ask for a delay in the schedule of vaccines. The conversations were time-consuming and often fruitless. The doctors at the practice decided five years ago that for all new patients, they would ask them to agree to the recommended schedule of vaccines.

“They just don’t want to let go, even with clear, objective information,” said Garrison. “I tell parents all the time, I practice in God’s grace, and there’s a lot we don’t know. But God has blessed people with knowledge and there are things that can be helpful, and they’re factual. But it doesn’t take anything away from God and His omnipotence and power. And I come back to, you wouldn’t … have a discussion with a surgeon about a need for an appendectomy.”

In the absence of convincing conversations, the government has stepped in. The number of people seeking state exemptions for vaccines has been climbing in the last decade. The New York Legislature now has a bill that would eliminate the religious exemption to vaccines, but that bill hasn’t yet found momentum despite the outbreak.

Edward Mechmann, a lawyer with the New York State Catholic Conference, said the Legislature seems content with leaving the issue to local health authorities. Other Christians working in Albany are quietly hoping for the preservation of the exemption even as they support vaccination.

Christian lobbyists I talked to distinguish between vaccines. For example, New York doesn’t mandate the HPV vaccine, but because of that particular vaccine, Christian lobbyists remain wary of efforts to mandate all vaccines.

California ended a “personal belief” exemption to vaccines in 2016 after a major measles outbreak. Both federal and state courts upheld the elimination of the exemption, after parents filed lawsuits saying it infringed on their religious rights. No Christian schools or religious liberty law firms challenged the California measure in court.

ONE THORN IN THE SIDE of Hasidic leaders in Brooklyn these past months has been a largely anonymous group, Parents Educating and Advocating for Children’s Health (PEACH). PEACH’s “vaccine safety” booklet, full of unfounded claims that vaccines contain aborted fetuses as well as pig and monkey cells, has made its way through Orthodox circles. PEACH also plays on historic Jewish fears, noting the arguments of Nazi doctors that their human experimentation was for the “greater good.”

Orthodox nurse Blima Marcus, part of the Orthodox Jewish Nurses Association, has been meeting with mothers concerned about vaccines to try to refute misinformation gently. They would often mention the PEACH handbook to her, so now Marcus’ group of Hasidic nurses is working on publishing its own handbook, titled “Parents Informed and Educated” (PIE). Niederman, too, has encountered these myths in meetings with parents that he described as “passionate.”

“On one hand, I like that. They care so much for their children, that they’re really concerned,” he said. “What I do is I ask one simple question. If, God forbid, your family doctor is telling you, ‘This child really needs surgery, something is wrong,’ who would you go to ask to do the surgery? … I tell them, you answer to yourself. Then you will understand if you should or should not vaccinate.”